Benign Prostatic Hyperplasia

Waking up multiple times a night to use the restroom or struggling to start a urinary stream, you are not alone<img src="/-/media/ech-media/images/widgets/medicalimages/bph.jpg?h=65&iar=0&w=100&sc_lang=en&hash=E4FE4448275A04A12E3382AE1F93DB1A" alt="BPH" width="100" height="65" DisableNVelocity="true" />Benign Prostatic Hyperplasia1/15/2026 6:00 AM<img src="/-/media/ech-media/images/widgets/medicalimages/bph.jpg?h=205&iar=0&w=315&sc_lang=en&hash=FF06BF955FCDDE75B66C738D4192CF01" alt="BPH" width="315" height="205" DisableNVelocity="true" />Waking Up at Night? It Might be your prostate, not your bladder. If you find yourself waking up multiple times a night to use the restroom or struggling to start a urinary stream, you are not alone. These are classic signs of Benign Prostatic Hyperplasia (BPH). What is BPH? Benign prostatic hyperplasia is a non-cancerous condition that commonly occurs in aging men when the prostate enlarges. It can cause lower urinary tract symptoms because the prostate grows and compresses the urethra, making it harder to pass urine. What causes it? BPH is mainly related to hormonal changes that occurs naturally with aging, especially shifts in testosterone and dihydrotestosterone (DHT) as well as estrogen-to-androgen balance. Who gets BPH? BPH affects approximately 25% of men age 40-49 years of age and 80% of men 70-79 years of age. Risk factors include age >50, family history, obesity, and diabetes or metabolic syndrome. What are the symptoms?  The symptoms can range from mild to severe and includes hesitancy (difficulty starting urination), weak stream, straining, incomplete emptying, urinary frequency, nocturia (waking up at night to urinate), and urinary urgency. How do you diagnose it? <ul> <li> Symptom scoring at the doctor’s office</li> <li>Physical exam including a digital rectal exam</li> <li>Urinalysis - PSA (to rule out prostate cancer, not to diagnose BPH)Post-void residual (bladder ultrasound) to evaluate for incomplete bladder emptying</li> </ul> What is the treatment and management? Many men successfully manage BPH for years. The American Academy of Family Physicians recommends self-management strategies including <ul> <li>limiting evening fluid intake</li> <li>reducing caffeine and alcohol consumption </li> <li>Practice double voiding (urinating, waiting a moment, and trying again) </li> </ul> More than one half of affected men have at least moderate symptoms, and approximately one-third receive medical treatment. Primary medical treatment can include medications for urinary symptom relief and slowing prostate growth. There are surgical intervention options for severe symptoms and signs of BPH-related complications. How can you can prevent it? While you can’t entirely prevent BPH, addressing modifiable lifestyle factors such as maintaining physical activity, managing hypertension, and controlling diabetes may help reduce the risk of bothersome symptoms. Bottom line: BPH is common and manageable. It is not cancer and does not increase prostate cancer risk, though both can coexist. If you are noticing changes in your urinary habits, talk to your doctor. <a href="/providers/anne-nguyen-do">Anne Nguyen, DO</a>, is a Family Medicine Physician and current Geriatric Medicine Fellow at Mayo Clinic in Rochester. She completed her medical degree at the University of the Incarnate Word School of Osteopathic Medicine. Dr. Nguyen completed a Family Medicine residency at Baylor Scott & White Health in Texas. Her interests include preventive care, post acute and long term care, and home based care settings.Anne Nguyen, DOPrimary Care in Rochester and KassonBenign Prostatic HyperplasiaPrimary Care in Rochester and KassonLearn about your baby's first week at home.<img src="/-/media/ech-media/images/widgets/kids/newbornbaby.jpg?h=65&iar=0&w=97&sc_lang=en&hash=18CF945D033110371A124B8B67DADAF8" alt="newbornbaby" width="97" height="65" DisableNVelocity="true" />Newborn care1/29/2026 1:00 PM<img src="/-/media/ech-media/images/widgets/kids/newbornbaby.jpg?h=166&iar=0&w=250&sc_lang=en&hash=C666BDBF319D72C17114A1A7E1EA08B7" alt="newbornbaby" width="250" height="166" DisableNVelocity="true" />Congratulations on your newborn. Each experience with a newborn is a unique adventure. Here are some things you can expect within the first week of life. The first Clinician Visit Your baby's first clinician visit usually happens within the first 24- 72 hours after hospital discharge. This visit is an opportunity to check in on how you are settling in at home, to monitor your baby's feeding and weight since discharge, and to follow up on jaundice, a yellowish discoloration of the skin seen commonly in newborns. Use this time at the visit to ask all the questions you may have. Your care team is there to support you and your baby during this special period of adjustment. If your baby is eligible for and did not receive the respiratory syncytial virus (RSV) vaccine before discharge, it will be recommended at this visit. If you have any questions regarding this or other vaccinations for your infant, your care team will be there to address them. <a rel="noopener" href="https://www.cdc.gov/rsv/infants-young-children/index.html" target="_blank" title="Link opens in a new window">RSV in Infants and Young Children</a> Feeding and diaper changes Full term babies will typically need to eat about every two to three hours, though sometimes they may want to feed even more often until breastfeeding is fully established. This breastfeeding pattern, called cluster feeding, will also help to establish milk supply in breastfeeding moms. Whether you are breastfeeding or formula feeding, pay attention to your baby's hunger cues, like sucking motions, facial movements like rooting, or fussiness. As your baby feeds larger amounts of milk, the stool will transition from dark and sticky (meconium) to yellowish and seedy. Expect a daily increase in the number of wet diapers, reaching an average of six to eight per day by the end of the first week. Sleep routine Newborns can sleep up to 18 hours a day, though the duration and pattern are highly variable. It's unlikely that your baby's sleep routine will be consistent in the first week, and that's completely normal. It is essential to place your baby to sleep on their back on a firm sleep surface, with no loose blankets, crib bumpers, pillows or toys. This is the best way to decrease the rate of Sudden Infant Death Syndrome (SIDS). Babies are also safest in their own sleep space close to you. If you feel sleepy while holding your baby, place them safely in their designated sleep space and continue your cuddles once you're awake and alert. Caring for yourself and your baby The first week of your baby's life is full of new beginnings. It can be exciting and, at times, may feel overwhelming. Never shake your baby, no matter how frustrated or tired you may feel. Take time for yourself and ask for help when you need it. Be mindful of your own mood and seek mental health support if you notice sadness, anxiety or difficulty coping. You and your baby are learning together. Be kind to yourself and to each other. Remember, that you are never alone and that you can contact your baby’s primary care provider or your own primary care provider, if you have concerns or need help. <a href="/providers/emmanuella-salia-mbchbmph">Emmanuella Lebasaana Salia, M.B., Ch..B, M.P.H.</a>, is a third year resident in the Department of Pediatric and Adolescent Medicine at Mayo Clinic. She is interested in neonatal-perinatal medicine career.Emmanuella Lebasaana SalinaPrimary Care in Rochester and KassonNewborn CarePrimary Care in Rochester and KassonOutdoor winter activities for the whole family<img src="/-/media/ech-media/images/widgets/activities/aftonalpssnowshoeing.jpg?h=65&iar=0&w=100&sc_lang=en&hash=6ED584342B9E2B871D22F9C3C926BB9F" alt="AftonAlpsSnowshoeing" width="100" height="65" DisableNVelocity="true" />Winter outdoor activities1/5/2026 3:00 PM<img src="/-/media/ech-media/images/widgets/activities/aftonalpssnowshoeing.jpg?h=205&iar=0&w=315&sc_lang=en&hash=0A814E67F5B871C350F709BF2EA48D22" alt="AftonAlpsSnowshoeing" width="315" height="205" DisableNVelocity="true" />Step Into Winter: Small Steps Outside, Big Benefits for Your Health Winter in Minnesota can feel long and heavy, but it also brings quiet beauty - the kind that slows you down in a good way. And stepping outside, even briefly, can make a surprising difference. Fresh air clears your mind. Natural light boosts your mood. Gentle movement warms up the body and helps you shake off stress. You don’t need to ski for miles or spend hours outdoors. Start small: a five-minute walk, a moment in the sunlight, or a quick breath of cold air on your porch. These tiny outdoor moments add up. Rochester and Olmsted County have plenty of simple, welcoming ways to enjoy winter - no experience needed. Rochester Parks & Recreation: Easy Ways to Get Moving Gamehaven Park Gamehaven offers groomed cross-country ski trails and a fun sledding hill. With snowmaking equipment running again this year, trails stay in good condition all season. Skiing is great for warming up your muscles, getting your heart moving, and lifting your spirits on darker days. Outdoor Ice Rinks Rochester has nine outdoor ice rinks, typically open from late December through early March. If you don’t own skates, Soldiers Field Park offers free skate checkout on Saturdays and Sundays from 12–4 PM starting in January. Ice skating is a simple way to build balance, enjoy fresh air, and get a little burst of winter joy. Weather updates are posted on the Parks & Recreation Facebook page. More Skiing & Sledding Spots You can find additional ski trails at Eastwood Golf Course, Quarry Hill Park, and Essex Park. Judd Park also has a great sledding hill - and yes, adults are allowed to have fun too. Indoor Skating at the Rec Center If the weather feels too cold some days, the Rochester Recreation Center has open indoor skating and skate rentals. It’s an easy way to stay active without stepping into the wind. Quarry Hill Nature Center: A Calm Winter Escape Quarry Hill is perfect for slow winter walks, peaceful ski loops, or simply taking in the beauty of the woods. You can rent snowshoes or skis right at the nature center. Spending time in quiet natural spaces like Quarry Hill helps lower stress, supports better sleep, and gives your brain a chance to reset - something many of us need during the winter months. Olmsted County Parks: Affordable, Family-Friendly Options Oxbow Park and Chester Woods Park rent snowshoes, kick sleds, and cross-country skis for just $5 per set every day from 10 AM–3 PM. Snowshoeing is easy to learn and a great way to stay active, even if you’re new to winter recreation. Kick sleds make winter walks more fun for kids and adults while helping you enjoy the cold in a lighthearted way. Project Get Outdoors: Winter Ideas for Kids If you’re looking for simple, creative things to do with children, the Project GO Activity Calendar offers daily nature activities that work all year long. These ideas help kids burn energy, use their imaginations, and spend a little more time in the fresh air. Find free resources here: <a rel="noopener" href="https://www.mnprojectgo.org/resources-to-get-outdoors" target="_blank" title="Link opens in a new window">https://www.mnprojectgo.org/resources-to-get-outdoors</a> Simple Winter Activities You Can Try Anytime <ul> <li>Take a 10-minute walk and notice how the air feels on your face.</li> <li>Look for animal tracks in the snow and guess who made them.</li> <li>Build something small with snow - a tower, a shape, anything.</li> <li>Bring hot chocolate to a local park for a quick “winter picnic.</li> <li>Step outside for a few minutes at sunrise - morning light boosts mood and energy. </li> </ul> Try One Small Step This Week Winter doesn’t have to keep us indoors. Pick one activity, one park, or one short outdoor moment this week. It doesn’t need to be long or perfect - just a few minutes outside can help you feel calmer, clearer, and more refreshed. Bundle up, step outside, and let winter surprise you in a good way. Muse Abdi, M.B.B.S., B.BiomedSc, M.P.H., has a background in medicine and leads nature-based health initiatives, including Park Rx/Exercise is Medicine, Healing Forest, and the cultural liaison program in the parks under the Statewide Health Improvement Partnership (SHIP) grant. He facilitates the SE MN Park Rx Coalition, a key component of the Park Initiative, and also leads health equity and community engagement efforts through SHIP. Expertise: Nature-Based Health Promotion, Healthcare Integration, Health Equity & Equity-Focused Programs, Cross-Cultural Communication & Community Engagement, Program Development& Evaluation, Organizational Health Literacy, Cultural Competency, Policy, Systems and Environmental Change. <a href="/providers/brian-lynch-md">Brian A. Lynch, M.D</a>., is a primary care pediatrician at Mayo Family Clinic Northwest in Rochester. He co-chairs the Primary Care Work Group of the Mayo Clinic Obesity Council and chairs the Primary Care Obesity Task Force. Dr. Lynch works closely with the Southeast Minnesota Park Rx Team to promote the physical and mental health benefits of spending time in nature with his patients and colleagues.Muse Abid, M.B.B.S, B.BiomedSc, M.P.H. and Brian Lynch, M. D.Primary Care in Rochester and KassonWinter activities in MinnesotaPrimary Care in Rochester and KassonLearn more about this common health condition in children.<img src="/-/media/ech-media/images/widgets/kids/irondeficiencyanemia.jpg?h=65&iar=0&w=100&sc_lang=en&hash=EA672C15BA1BF4F328ACE42678BD59F8" alt="irondeficiencyanemia" width="100" height="65" DisableNVelocity="true" />Iron-Deficiency Anemia2/12/2026 3:30 PM<img src="/-/media/ech-media/images/widgets/kids/irondeficiencyanemia.jpg?h=205&iar=0&w=315&sc_lang=en&hash=3BE7C9D80322D38C7BFFE6787509F948" alt="irondeficiencyanemia" width="315" height="205" DisableNVelocity="true" />What is iron-deficiency anemia? Iron-deficiency anemia (IDA) is a common health condition in children. It happens when the body does not have enough iron to make healthy red blood cells. Red blood cells carry oxygen throughout the body. Without enough iron, children may feel tired and weak. Iron deficiency can also affect brain development, behavior, growth and the immune system. Finding and treating IDA early is very important.   How can I prevent iron-deficiency anemia in my child? The American Academy of Pediatrics (AAP) recommends starting prevention early in life. Babies who are born full-term and only breastfed should receive iron supplements starting at four months of age until they begin eating foods that contain iron. Babies who drink iron-fortified formula usually get enough iron and do not need extra supplements. Babies born early (preterm infants) have a higher risk of iron deficiency and often need iron supplements earlier, usually in the form of a multivitamin with iron.   For older children who eat solid foods, the AAP recommends offering foods that contain iron. These include iron-fortified cereals, spinach, meats and beans. Toddlers under two years old should not drink too much cow’s milk. Drinking more than 24 ounces a day can prevent the body from absorbing iron properly.   When should my child be tested for IDA? The AAP recommends that all children be tested for iron-deficiency anemia at around 12 months of age. This is usually done with a simple blood test. Doctors also look at risk factors such as being born early, having limited access to healthy foods or eating a diet low in iron.   How is iron-deficiency anemia treated? If a child is diagnosed with iron-deficiency anemia, treatment usually includes iron supplements taken by mouth. Families also receive advice on improving the child’s diet. Follow-up blood tests are done to make sure the treatment is working.   If you have any questions or concerns about iron-deficiency anemia, talk with your child’s pediatrician or healthcare provider.   <a href="/providers/cody-hall-mdms">Cody Hall, MD</a> is currently  a 3rd year pediatric resident at Mayo Clinic, planning to start Pediatric Hematology/Oncology Fellowship at the end of his residency.Cody Hall, M.D.Primary Care in Rochester and KassonAnemiaPrimary Care in Rochester and KassonNot all breakfast cereals are created equal, but there are nutritious options available.<img src="/-/media/ech-media/images/widgets/food/breakfastcereal.jpg?h=65&iar=0&w=100&sc_lang=en&hash=193924740FB76D91881DAC368434461E" alt="breakfastcereal" width="100" height="65" DisableNVelocity="true" />Pulling the curtain on breakfast cereals: What's really in your bowl?2/26/2026 8:00 AM<img src="/-/media/ech-media/images/widgets/food/breakfastcereal.jpg?h=205&iar=0&w=315&sc_lang=en&hash=E291895E3272857874BA8EF47BB4FC0D" alt="breakfastcereal" width="315" height="205" DisableNVelocity="true" />Breakfast cereals offer a quick, easy meal or snack option, but are they a healthy choice? Despite being fortified with important vitamins (B vitamins, vitamin D, etc.) and minerals (e.g., iron), many cold cereals are also packed with sugar, artificial dyes and flavorings, and contain limited nutrients, such as fiber. However, not all breakfast cereals are created equally. When deciding which breakfast cereal to buy, make sure to read the nutrition label. A good rule of thumb to ensure you’re choosing a more nutritious option is to look for the following: • Made with whole grains. • Limited or no added sugars (aim for no more than six grams per serving). • At least 3—5 grams of fiber per serving. • Choose options with at least three grams of protein per serving. • Limited preservatives or ingredients, such as food dyes and artificial flavors. There are also steps you can take at home to turn your favorite breakfast cereal into a healthier meal or snack option. • Add berries to your cereal to increase fiber, antioxidant and vitamin content. • Create a healthy snack by mixing your favorite cereal with nuts and dried fruit. • Pair your cereal with a high protein option, like Greek yogurt or hard-boiled eggs to create a well-balanced meal. • Add a tablespoon of peanut butter to increase healthy fats and protein. • Use dairy milk with your cereal to add a boost of protein as well as calcium. • Use a protein shake instead of milk to create a high protein meal. Breakfast cereals have been highly criticized throughout the past several years. While they may have gotten a bad reputation, it’s important to understand that there are no bad foods. Any food can be made part of a healthy diet, including breakfast cereal. Kelli Kirkley is a dietetic intern at Mayo Clinic in Rochester, MN. She earned her Bachelor of Science in Food and Nutrition and Master of Science in Human Nutrition through The University of Alabama.Kelli KirkleyPrimary Care in Rochester and KassonBreakfast CerealPrimary Care in Rochester and KassonFevers in children<img src="/-/media/ech-media/images/widgets/kids/feverchild.jpg?h=65&iar=0&w=100&sc_lang=en&hash=93E9D9C36642F3B2ACB1D4838D5BB6E4" alt="feverchild" width="100" height="65" DisableNVelocity="true" />Fevers in children - when to call the doctor2/5/2026 3:00 PM<img src="/-/media/ech-media/images/widgets/kids/feverchild.jpg?h=205&iar=0&w=315&sc_lang=en&hash=D69BD66537C5C96647DDDDFF902B079B" alt="feverchild" width="315" height="205" DisableNVelocity="true" />Fever in children: When to call the doctor A fever is a body temperature of 100.4°F (38°C) or higher. Fevers are a normal way the body fights infection. The most accurate way to check a temperature is with a rectal thermometer (for young children) or under the tongue (for older children). Underarm and forehead thermometers are less accurate and may miss fevers. Common fever myths Clearing up common myths can help parents feel more confident. Myth: “Fevers are dangerous and can cause brain damage.” Truth: Most childhood fevers do not harm the brain. Fever is the body’s natural response to infection. Myth: “The higher the fever, the sicker the child.” Truth: How your child looks and acts matters more than the number. Pay attention to drinking, breathing, and behavior. Myth: “If my child feels warm, they definitely have a fever.” Truth: Warm skin can happen for many reasons. Always check with a thermometer. Normal fever patterns Fevers often rise in the evening and fall in the morning. Most fevers in children over two months old who are up‑to‑date on vaccines are caused by viral illnesses and get better with home care. Some fever patterns are not typical: <ul style="list-style-type: disc;"> <li>Fever every day for five days or more</li> <li>Fever with drenching night sweats or unexplained weight loss</li> <li>Fever that improves, then returns after a few days (“second worsening”), which may suggest a new infection </li> <li>Fevers within 24 hours after vaccines can be normal.</li> </ul> Tips for monitoring your child’s fever <ul style="list-style-type: disc;"> <li>Check less often. <ul style="list-style-type: circle;"> <li>You don’t need to check unless your child seems uncomfortable or worse.</li> </ul> </li> <li>Use the same thermometer method each time.</li> <li>Watch your child, not just the number. <ul style="list-style-type: circle;"> <li>Behavior and hydration matter most.</li> </ul> </li> <li>Keep a simple log of temperatures and medicines if the fever lasts.</li> <li>Don’t chase the number. <ul style="list-style-type: circle;"> <li>Fever medicine is for comfort, not to make the temperature normal.</li> </ul> </li> </ul> Home care Help your child feel better by: <ul style="list-style-type: disc;"> <li>Offering plenty of fluids</li> <li>Encouraging rest</li> <li>Using acetaminophen (Tylenol) or ibuprofen with weight‑based dosing</li> </ul> Avoid cold baths, alcohol rubs, and aspirin. Red flags — time to call your doctor Call your doctor or seek urgent care if your child has a fever and: <ul style="list-style-type: disc;"> <li>Breathing problems (fast breathing, working hard to breathe, wheezing)</li> <li>Signs of dehydration (very little urine, dry mouth, no tears)</li> <li>Extreme sleepiness or constant irritability</li> <li>Severe or worsening pain</li> <li>Repeated vomiting or can’t keep fluids down</li> <li>A fast‑spreading or unusual rash, especially with neck stiffness</li> <li>You’re worried or something doesn’t feel right</li> </ul> Key Message Most fevers in children over two months old are caused by viral illnesses and can be safely treated at home with supportive care. <a href="/providers/haley-sherburne-md">Haley Sherburne, M.D.</a> is a resident physician in Pediatric and Adolescent Medicine in Rochester, Minnesota. Following residency, she will start fellowship in pediatric hospital medicine at the Mayo Clinic.Haley Sherburne, M.D.Primary Care in Rochester and KassonFever in childrenPrimary Care in Rochester and KassonLearn how healthy eating can support both your mind and your heart.<img src="/-/media/ech-media/images/widgets/people/mindheartconnection.jpg?h=65&iar=0&w=100&sc_lang=en&hash=6520FC64ABF62A7AA3AFBE7863752893" alt="mindheartconnection" width="100" height="65" DisableNVelocity="true" />The mind-heart connection: How nutrition can help3/2/2026 6:30 AM<img src="/-/media/ech-media/images/widgets/people/mindheartconnection.jpg?h=205&iar=0&w=315&sc_lang=en&hash=2739DE1CB5279F1996731B65239B7E67" alt="mindheartconnection" width="315" height="205" DisableNVelocity="true" />The mind-heart connection: How nutrition can help Have you ever noticed how differently your body responds when you’re under a lot of stress compared to when you feel happy or content? On stressful days, your heart may race, or your muscles may become tense. This response is a simple example of how closely the mind and heart are connected. Mental health conditions, such as chronic stress, anxiety and depression can influence cardiovascular health in several ways. Ongoing stress can: • Raise stress hormone levels. • Increase heart rate and blood pressure. • Promote inflammation. • Affect blood vessel function over time. Mental health challenges may also make it harder to maintain healthy routines, which may include eating well, staying active or getting enough sleep. Together, these factors can create a cycle that impacts both mental well-being and heart health. The good news is that nutrition is one practical tool that can help support both. Eating patterns that support heart health are also associated with better mental health. Diets rich in fruits, vegetables, whole grains, lean proteins and healthy fats, like the Mediterranean-style eating pattern, have been linked to lower rates of depression and reduced cardiovascular risk. These foods provide fiber, antioxidants, vitamins, minerals and healthy fats that support brain function, reduce inflammation and help regulate the body’s stress response. Additionally, limiting ultra-processed foods, when possible, may also support both mental health and heart health. Small, realistic changes that can make a difference: • Fill half your plate with fruits and vegetables when possible. • Choose whole grains over refined grains. • Choose lean and plant-based protein sources, such as fish, poultry, beans and nuts. • It includes healthy fats from nuts, nut butters, seeds, olive oil, fatty fish and avocados. • Limit highly processed foods when you can. Nutrition works best alongside other healthy habits. Getting adequate sleep, staying physically active and keeping up with preventative healthcare, can help buffer stress, support mental well-being and promote heart health over time. Overall, focusing on creating simple, sustainable habits, rather than following a specific diet, can help support both mental and heart health. Lea Carlson received her Bachelor’s degree in Dietetics from Iowa State University and is currently pursuing her Master’s degree in Clinical Nutrition from the University of Wisconsin – Madison while completing her dietetic internship at Mayo Clinic in Rochester, MN. She is interested in providing both outpatient and inpatient services in clinical nutrition upon graduation. References:  <a rel="noopener" href="https://newsnetwork.mayoclinic.org/discussion/the-brain-heart-connection-mayo-clinic-expert-explains-powerful-tie-that-works-both-ways/" target="_blank" title="open link in new window">https://newsnetwork.mayoclinic.org/discussion/the-brain-heart-connection-mayo-clinic-expert-explains-powerful-tie-that-works-both-ways/</a> <a rel="noopener" href="https://www.todaysdietitian.com/mental-healths-link-to-cvd-risk/" target="_blank" title="link opens in a new window">https://www.todaysdietitian.com/mental-healths-link-to-cvd-risk/</a>Lea CarlsonPrimary Care in Rochester and KassonMind heartPrimary Care in Rochester and KassonLearn a few ways to reduce the daily use of plastic.<img src="/-/media/ech-media/images/widgets/randomimages/reusableshoppingbag.jpg?h=65&iar=0&w=100&sc_lang=en&hash=871359BB8AE5C492D0BE30D5D57EFAE9" alt="reusableshoppingbag" width="100" height="65" DisableNVelocity="true" />Pushing back on plastic packaging!2/19/2026 8:00 AM<img src="/-/media/ech-media/images/widgets/randomimages/reusableshoppingbag.jpg?h=205&iar=0&w=315&sc_lang=en&hash=547E7B410F62FC1FBF37F2003EB85C2D" alt="reusableshoppingbag" width="315" height="205" DisableNVelocity="true" />Plastic packaging waste is a global issue. In the U.S. alone, there was 40 million tons of plastic waste generated in 2021—and only 5% was recycled properly. Improved plastic recycling methods are not the solution to this problem. Plastics that are put in the recycling bin often end up incinerated or in landfills. Additionally, plastic recycling facilities in the U.S. are incredibly water-intensive and can’t keep up. This instead highlights a great need to reduce the single-use plastic items we encounter each day. Here are a few ways to reduce plastic use in our everyday lives: <ul style="list-style-type: disc;"> <li>Carry reusable bags to avoid plastic shopping bags.</li> <li>Pack your own utensils for lunch and skip the plastic ones offered in the cafeteria.</li> <li>Purchase reusable fruit and vegetable bags for grocery shopping.</li> <li>Bring your own food storage container from home for leftovers.</li> <li>Select grocery stores that have refillable spice stations. <ul style="list-style-type: circle;"> <li>Tip: Look for zero-waste grocery stores in your area! </li> </ul> </li> <li>Opt for refillable products of toiletries, cleaning supplies and even cosmetics.</li> <li>Use reusable water bottles instead of plastic ones.</li> <li>Use cloth napkins instead of paper napkins.</li> <li>Replace plastic wrap with cloth or silicone food wraps. <ul style="list-style-type: circle;"> <li>Tip: These can be washed and reused again and again.</li> </ul> </li> <li>Some coffee shops allow you to bring your own mug or carafe to use instead of disposable cups.</li> </ul> Small changes make a big difference! Each time single-use plastic is avoided, it keeps one more item out of the landfill. <a href="http://">Margo Meekin</a> is a dietetic intern at the Mayo Clinic in Rochester, MN. She received her Bachelor of Science from the University of Wisconsin- Madison in dietetics and is currently completing her Masters of Science in Clinical Nutrition from there too. She has an interest in clinical nutrition, specifically pediatrics and metabolic disorders.  References used: <a href="https://www.epa.gov/facts-and-figures-about-materials-waste-and-recycling/plastics-material-specific-data">Plastics: Material-Specific Data | US EPA</a> <a href="https://www.smithsonianmag.com/smart-news/the-us-recycled-just-5-percent-of-its-plastic-in-2021-180980052/">At Least 85 Percent of U.S. Plastic Waste Went to Landfills in 2021</a> <a href="https://howtodispose.com/16-tips-for-reducing-plastic-use-in-everyday-life/">16 Tips for Reducing Plastic Use in Everyday Life - How to Dispose</a>Margo MeekinPrimary Care in Rochester and KassonReducing wastePrimary Care in Rochester and KassonRisks of Undereating for Weight Loss<img src="/-/media/ech-media/images/widgets/food/eatingless.jpg?h=65&iar=0&w=100&sc_lang=en&hash=55896D4A473F94B0C7044213D59573DB" alt="eatingless" width="100" height="65" DisableNVelocity="true" />Fuel Your Body, Don't Fool Your Body2/9/2026 2:30 PM<img src="/-/media/ech-media/images/widgets/food/eatingless.jpg?h=205&iar=0&w=315&sc_lang=en&hash=7FBB9ABE80639F705BB5057B56397749" alt="eatingless" width="315" height="205" DisableNVelocity="true" />Interested in weight loss? There are an infinite number of methods available to you to help with your weight loss journey such as diets, exercises, lifestyle modifications, and supplements. But keep in mind that weight loss will happen through a combination of methods (i.e. diet and exercise). When focusing on your calorie intake to promote weight loss, you are changing your eating habits and other lifestyle choices, so it is important that you are not heavily restricting yourself of key nutrients found in food. Food is fuel and fuel gives us energy. Yes, we can restrict ourselves of certain foods to help us lose weight, but what does too much restriction do to your body? The food you put into your body is converted to energy that supports your body’s normal functions. Thus, our body requires calories to function properly. When we are consuming fewer calories than what our body needs for a long period of time, we are putting our system in a state of starvation which can increase your risk for serious medical issues down the road such as osteoporosis/fractures, arthritis, heart disease, and anemia. Undereating can provoke: <ul> <li>Metabolic disturbances that can make it harder to meet your weight loss goal and create a weight loss plateau (i.e. nutritional deficiencies, gastrointestinal issues, decreased metabolism). </li> <li>Poor nutrient distribution when we are only eating at certain times throughout the day (i.e. intermittent fasting, eating one meal a day) which makes it harder for your body to absorb and digest all of the nutrients at once. </li> <li>Disordered eating patterns that create a poor relationship with food (i.e. eating disorders, cognitive issues). </li> </ul> Because you don’t want to excessively limit the amount of food you are consuming when trying to lose weight, it is crucial to make sure you are making changes in your diet in a healthy manner. <ol> <li>Control your food intake by creating a meal schedule that works for you and includes healthy choices (whole grains, lean proteins, healthy fats, vegetables, fruit). Try to plan 3 meals a day with a few snacks in between if needed. </li> <li>Aim for a relatively balanced diet consisting of protein, fruits, vegetables, starch, and dairy with each meal (or have each meal contain at least 2-3 of the food groups). Planning your meals may be a great first step in your weight loss journey. </li> <li>Take 30 minutes to eat each meal. Leave the television off and don’t be on your phone. Thoroughly take the time to eat and listen to your body’s hunger and fullness cues to prevent under or over-eating. </li> <li>Consider creating a food log/dairy of the meals and snacks you eat throughout the day to monitor the amount of food you are eating. This tool can allow you to reflect on what works for you and what doesn’t. This method is to be used short-term as a starting point, to provide some insight into your dietary habits; it is not meant to be strictly indicative of what you can and cannot eat. </li> </ol> It is important that even though you are aiming for weight loss, that you must do so in a manner that will not restrict your calories too much that can create even bigger issues in the future. Looking for a good place to start? The Academy of Nutrition and Dietetics provides a great refresher on the <a rel="noopener" href="https://www.eatright.org/health/wellness/weight-and-body-positivity/back-to-basics-for-healthy-weight-loss" target="_blank" title="Link opens in a new window">basics of healthy eating for weight loss</a>. Resources: <a rel="noopener" href="https://www.ncbi.nlm.nih.gov/books/NBK572145/" target="_blank" title="Link opens in a new window">Metabolic Consequences of Weight Reduction - StatPearls - NCBI Bookshelf</a> <a rel="noopener" href="https://equip.health/articles/food-and-fitness/how-to-stop-undereating" target="_blank" title="Link opens in a new window">How to Stop Undereating: Actionable Guidance from Experts</a> <a rel="noopener" href="https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/healthy-meals/art-20546806?cjdata=MXxOfDB8WXww&cjevent=28b60777f6d011f0809f00720a82b836&cm_mmc=CJ-_-100357191-_-5250933-_-Evergreen+Link+for+Mayo+Clinic+Diet&utm_source=cj&utm_content=100357191&utm_capaign=3-months" target="_blank" title="Link opens in a new window">Healthy meals start with planning - Mayo Clinic</a> <a rel="noopener" href="https://www.todaysdietitian.com/the-risks-of-undereating-for-weight-loss/" target="_blank" title="Link opens in a new window">The Risks of Undereating for Weight Loss - Today's Dietitian Magazine</a> <a rel="noopener" href="https://www.eatright.org/health/wellness/weight-and-body-positivity/back-to-basics-for-healthy-weight-loss" target="_blank" title="Link opens in a new window">Back to Basics for Healthy Weight Loss</a> Morgan Machemehl has graduated from Iowa State University with a bachelor's degree in Dietetics. Currently, she is completing her master’s degree in clinical nutrition at the University of Wisconsin Madison and undergoing a dietetic internship through Mayo Clinic in Rochester, MN.Morgan MachemehlPrimary Care in Rochester and KassonUndereating weight lossPrimary Care in Rochester and KassonLearn how upcycling foods can be a good fit for you.<img src="/-/media/ech-media/images/widgets/food/upcycledfoods.jpg?h=65&iar=0&w=107&sc_lang=en&hash=4AB0D9ADB9C21220D8E36DE478660814" alt="UpcycledFoods" width="107" height="65" DisableNVelocity="true" />Upcycled Foods: Healthy for you and the planet2/26/2026 8:00 AM<img src="/-/media/ech-media/images/widgets/food/upcyclefoods.jpg?h=205&iar=0&w=315&sc_lang=en&hash=FCC6641BF7755AA1E760B761B7D0DD4B" alt="UpcycleFoods" width="315" height="205" DisableNVelocity="true" />If your New Year’s goals include eating healthier or adopting a more environmentally friendly lifestyle, upcycling food may be a good fit for you. From using more of the ingredients already in your kitchen to recognizing upcycled products in stores, this small change is an easy way to support both your health and the planet. Upcycling is a way to use ingredients that often go unused, such as fruit pulp or peels, vegetable stems, or byproducts from food processing, and turn them into something nutritious. According to the United States Department of Agriculture, about one-third of the food produced in the US is lost or wasted. Upcycling helps reduce this waste, while also lowering greenhouse gas emissions, easing pressure on landfills, and saving consumers money. Many companies across the food industry are finding creative ways to reduce waste by transforming these unused ingredients into new, nutritious products. Examples include snacks made with fruit fibers and high-protein, high-fiber flours made from byproducts of vegetables or grains. These upcycled items are starting to emerge in stores and are safe to consume. If you're interested in trying any of these types of products, look for the Upcycled Certified™ label on items currently in stores. This stamp highlights foods made with verified upcycled ingredients. However, buying these products isn’t the only way to make an impact. You can also make simple changes at home that reduce waste and stretch your groceries further. Many of which you may already be doing! <ul> <li>Use overripe bananas to make banana bread</li> <li>Add overripe fruits to smoothies</li> <li>Use stale bread to make breadcrumbs or French toast</li> <li>Use “ugly” tomatoes for spaghetti sauce or pizza sauce</li> <li>Add wilting herbs to soups or sauces</li> <li>Use leftover vegetable cuttings to make vegetable stock and freeze it for later</li> <li>Grate broccoli stems for fritters</li> <li>Make a pesto with carrot tops</li> </ul> Small upcycling habits can help you stretch your groceries further, reduce waste, and support a healthier, more sustainable New Year. Lea Carlson received her Bachelor’s degree in Dietetics from Iowa State University and is currently pursuing her Master’s degree in Clinical Nutrition from the University of Wisconsin – Madison while completing her dietetic internship at Mayo Clinic in Rochester, MN. She is interested in providing both outpatient and inpatient services in clinical nutrition upon graduation. References <a rel="noopener" href="https://www.todaysdietitian.com/upcycling-innovations/" target="_blank" title="Link Opens in new window">https://www.todaysdietitian.com/upcycling-innovations/</a> <a rel="noopener" href="https://www.upcycledfood.org/" target="_blank" title="Link opens in a new window">https://www.upcycledfood.org/</a> <a rel="noopener" href="https://www.usda.gov/about-food/food-safety/food-loss-and-waste" target="_blank" title="Link opens in a new window">https://www.usda.gov/about-food/food-safety/food-loss-and-waste</a> <a rel="noopener" href="https://www.foodnetwork.com/fn-dish/recipes/what-to-make-with-food-scraps-max-lamanna" target="_blank" title="Link opens in a new window">https://www.foodnetwork.com/fn-dish/recipes/what-to-make-with-food-scraps-max-lamanna</a> Lea CarlsonPrimary Care in Rochester and KassonUpcycled FoodsPrimary Care in Rochester and KassonWhile colorectal cancer is the third most common cause of cancer, it's preventable.<img src="/-/media/ech-media/images/widgets/medicalimages/colorectalcancer.jpg?h=65&iar=0&w=100&sc_lang=en&hash=D7D9AD4CB96FC135285D31B58EA981B2" alt="ColorectalCancer" width="100" height="65" DisableNVelocity="true" />Colorectal cancer screening saves lives3/5/2026 7:00 AM<img src="/-/media/ech-media/images/widgets/medicalimages/colorectalcancer.jpg?h=205&iar=0&w=315&sc_lang=en&hash=DEB31E803CF042852B53E74AAA087B8B" alt="ColorectalCancer" width="315" height="205" DisableNVelocity="true" />Colorectal cancer is the third most common cause of cancer, and it's preventable. Screening can detect pre-cancerous colon polyps (abnormal tissue growth) and safely remove them before they develop into cancer. Who should be screened for colorectal cancer? <ul> <li>Adults age 45 - 75 years with an average risk of colorectal cancer. Previously, screening started at 50. This recommendation was adjusted because the incidence of colorectal cancer at a younger age has increased.</li> <li>After 75 years, the decision to continue screening should be personalized. </li> </ul> If you have any of the following, you would not be considered average risk: <ul> <li>A personal/family history of colorectal cancer or high risk for polyps.</li> <li>A genetic disorder causing a high risk of colorectal cancer or inflammatory bowel disease. </li> </ul> What are the options for colorectal cancer screening? <ul> <li>Colonoscopy: This is considered the gold standard. This test requires prior use of bowel cleansing preparation and a scope to look for and remove polyps in your entire colon and rectum. Colonoscopies should be repeated every 10 years or more frequently, depending on the type and number of polyps found.</li> <li>2-step screening tests: Any positive test requires a follow-up colonoscopy. <ul> <li>FIT (Fecal Immunochemical Test): This stool-based test detects hidden blood in the stool. Completed annually.</li> <li>Multitarget stool DNA test (Cologuard): A non-invasive stool-based DNA test looking for abnormal DNA associated with colon cancer or precancerous polyps. This is completed every three years if normal.</li> <li>Computed tomography (CT) colonography: An imaging modality that requires colon cleansing preparation and oral contrast agents. It may be reasonable in select circumstances. </li> </ul> </li> </ul> What are the symptoms of colorectal cancer? <ul> <li>Most commonly, early cancers do not cause symptoms, which is why it is important that you get screened.</li> <li>If you have symptoms, they may include: <ul> <li>Bright red or black blood in the stool.</li> <li>Change in bowel habits (constipation).</li> <li>Change in stool shape and size. </li> <li>Abdominal or rectal pain. </li> <li>Fatigue from low blood counts (anemia).</li> <li>Unexplained weight loss. </li> </ul> </li> </ul> March is Colorectal Cancer Awareness Month. Speak with your healthcare clinician about getting colorectal cancer screening today. Sara Shu, D.O., is a board-certified family medicine physician and geriatrician-in-training in Community Internal Medicine, Geriatrics and Palliative Care at Mayo Clinic in Rochester.Sara Shu, D.O.Primary Care in Rochester and KassonColorectal CancerPrimary Care in Rochester and KassonMaking time to sit down and share a meal can make a meaningful difference in everyday life.<img src="/-/media/ech-media/images/widgets/food/familymeals.jpg?h=65&iar=0&w=100&sc_lang=en&hash=88DBE302E189B67BDC6A4F7D98A45425" alt="familymeals" width="100" height="65" DisableNVelocity="true" />Family Meals - More than just eating together3/19/2026 8:30 AM<img src="/-/media/ech-media/images/widgets/food/familymeals.jpg?h=205&iar=0&w=315&sc_lang=en&hash=1DB881DC7D76E5AA4B5DF16991301980" alt="familymeals" width="315" height="205" DisableNVelocity="true" />In today’s busy world, finding time to sit down together can be tough, but sharing meals with family and friends offers benefits that go far beyond food. Family meals create a regular space for connection, conversation and healthy habits. Even a few shared dinners each week can make a meaningful difference. Connection: Family meals provide structure. Having a predictable time to come together can be calming and grounding, especially during stressful weeks. It sends a simple but powerful message: no matter how busy life gets, time together matters. Conversation: Sitting at the table encourages family members to talk about their day, share ideas and listen to one another. Over time, these small conversations build trust and help everyone feel heard and supported. Healthy habits: Meals eaten together are often more balanced and nutritious, and they encourage mindful eating rather than rushing or eating alone. For kids and teens especially, this routine can support better attitudes toward food and overall well-being. For both adults and children, benefits such as lower rates of obesity, lower rates of disordered eating, higher self-esteem, higher academic achievement and overall psychological well-being are among the many positives of prioritizing family meals. In the end, family meals aren’t about perfection or fancy recipes, they’re about presence. Natalie Niebler received a Bachelor of Science in nutrition and dietetics from the University of Wisconsin-Madison. She is currently completing her master’s in clinical nutrition at UW Madison in addition to a dietetic internship at Mayo Clinic in Rochester, MN. Resources Used: <a rel="noopener" href="https://www.todaysdietitian.com/fresh-look-at-family-meals/" target="_blank" title="link opens in new window">Fresh Look at Family Meals - Today's Dietitian Magazine</a> <a rel="noopener" href="https://www.mdpi.com/1660-4601/18/4/1577" target="_blank" title="link opens in new window">Diet and Health Benefits Associated with In-Home Eating and Sharing Meals at Home: A Systematic Review | MDPI</a>Natalie NieblerPrimary Care in Rochester and KassonFamily MealsPrimary Care in Rochester and KassonWhat is infant dyschezia? How is it different from constipation?<img src="/-/media/ech-media/images/widgets/people/infantcrying.jpg?h=65&iar=0&w=100&sc_lang=en&hash=46C5B09E321205725B5F44C52C2CE9BA" alt="infantcrying" width="100" height="65" DisableNVelocity="true" />Tiny tummies, Big Effort3/9/2026 7:00 AM<img src="/-/media/ech-media/images/widgets/people/infantcrying.jpg?h=205&iar=0&w=315&sc_lang=en&hash=12951ADA806BF929880E024064FE4069" alt="infantcrying" width="315" height="205" DisableNVelocity="true" />Tiny tummies, Big Effort Dyschezia is a medical term that means difficulty pooping. Infant dyschezia happens when babies have not yet learned how to coordinate the different muscles needed to poop. This can make it look like they are struggling to poop, but when they do poop, it is soft. Constipation is different. In babies, constipation is generally defined by poops that are hard. What does infant dyschezia look like? • Straining. • Grunting, crying, screaming. • Turning red or purple in the face with effort. • Kicking their feet or squirming. • Symptoms last for at least 10 minutes. • Can result in a normal, soft stool — or sometimes no stool. How long does it last? Infant dyschezia usually goes away on its own in the first 3—6 months of life. As babies grow, they learn how to coordinate the muscles needed to create enough pressure to push poop out and the muscles needed to relax the anus, so that poop can pass through. Is there anything that can be done to help? There is no treatment needed for infant dyschezia — it will get better on its own. Try to keep the environment calm and comfort your baby if they become upset or frustrated. What should I avoid? Using suppositories or rectal stimulation is not recommended. These are unnecessary and can interfere with your baby learning how to poop on their own. When should I contact my child’s doctor? You should call your clinic or have your child seen if: • Poops are hard, rock-like, pellet-shaped. • There is blood in the poop. • Your infant has other symptoms such as vomiting or new belly distension. What else do I need to know? Remember: normal pooping patterns vary widely in babies. Some babies poop several times a day, while others may only poop once per week. Going several days between poops does not always mean that your baby is constipated. <a href="/providers/summer-bernard-md">Summer Bernard, M.D.</a> is currently a 3rd year pediatric resident at Mayo Clinic, planning to go into pediatric primary care at the end of her residency.Summer Bernard, M.D.Primary Care in Rochester and Kassoninfant dyscheziaPrimary Care in Rochester and KassonLearn about the six pillars of lifestyle medicine that can be practiced dailyLifestyle medicine3/16/2026 12:00 PM<img src="/-/media/ech-media/images/widgets/activities/ech_biking_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=2BED82EA38CF18D69DB6535CB6062742" alt="ECH_Biking_Widget" width="300" height="195" DisableNVelocity="true" />While lifestyle medicine has made recent headlines in today’s world, its main principles date back to over 2,500 years ago. Lifestyle medicine is defined by the American College of Lifestyle Medicine (ACLM) as “a medical specialty that uses therapeutic lifestyle interventions as a primary modality to treat chronic conditions, including but not limited to cardiovascular disease, type 2 diabetes and obesity.” Lifestyle medicine has overlapped with preventative medicine and integrative medicine, but lifestyle medicine is a unique, evidence-based practice to reduce the severity of a disease, improve disease markers and help quality of life. These are the six pillars of lifestyle medicine used to improve health outcomes— and they can be practiced each day: 1. Nutrition: The ACLM recommends following a diet of minimally processed fruits, vegetables, whole grains, legumes, nuts and seeds. A plant-based diet low in added sugar, sodium and processed ingredients has been shown to support disease prevention, treatment and reduce risk. 2. Physical activity: Exercise and movement pack a powerful punch! Physical activity positively impacts seven of the 10 most common chronic diseases. The recommendations are 150 minutes per week of moderate-intensity activity and two or more strength training sessions per week to build and support muscle. 3. Restorative sleep: It’s much harder to focus on the other pillars if we’re getting poor sleep. While it varies slightly from person-to-person, eight hours a night is the recommendation for most adults. Practice good sleep hygiene by limiting afternoon caffeine, reducing screen time, and setting up a bedroom environment supportive of rest and relaxation. 4. Stress management: While not all stress is bad, high levels of chronic stress negatively affect our health. Some stress-reducing techniques to try are spending time in nature, practicing meditation and mindfulness, decreasing screen time, and improving exercise, sleep and nutrition. All the pillars are connected, so improving one pillar helps the others. 5. Social connection: Positive social connections have been associated with better health outcomes. Conversely, isolation and loneliness are associated with a higher incidence of premature mortality. Call a friend, join a book club or talk to a stranger! 6. Avoidance of risky substance: The last pillar of lifestyle medicine looks at the use of alcohol, tobacco and recreational drugs. While these directly affect our health, they also affect our nutrition, stress management and sleep. Talk to your healthcare provider if you are looking for resources on stopping or using these substances in a more balanced way. <a rel="noopener" href="https://www.todaysdietitian.com/lifestyle-medicines-six-pillars/" target="_blank" title="open link in new window">Lifestyle Medicine’s Six Pillars - Today's Dietitian Magazine</a> Margo Meekin is a dietetic intern at the Mayo Clinic in Rochester, MN. She received her Bachelor of Science from the University of Wisconsin- Madison in dietetics and is currently completing her Master of Science in Clinical Nutrition from there too. She has an interest in clinical nutrition, specifically pediatrics and metabolic disorders.Margo MeekinPrimary Care in Rochester and KassonLifestyle medicinePrimary Care in Rochester and KassonSmall changes, Big Impact: Reduce Single - Use Plastics<img src="/-/media/ech-media/images/widgets/randomimages/reducingplasticwaste.jpg?h=65&iar=0&w=100&sc_lang=en&hash=81CED7EE70F57D3AD042FE0178C2707E" alt="reducingplasticwaste" width="100" height="65" DisableNVelocity="true" />Pushing back on plastic packaging!3/26/2026 11:30 AM<img src="/-/media/ech-media/images/widgets/randomimages/reducingplasticwaste.jpg?h=205&iar=0&w=315&sc_lang=en&hash=3DE7082D922C60D4231655EE6D880A3F" alt="reducingplasticwaste" width="315" height="205" DisableNVelocity="true" />Plastic packaging waste is a global issue. In the US alone, there was 40 million tons of plastic waste generated in 2021—and only 5% was recycled properly. Improved plastic recycling methods are not the solution to this problem. Plastics that are put in the recycling bin often end up incinerated or in landfills. Additionally, plastic recycling facilities in the US are incredibly water-intensive and can’t keep up. This instead highlights a great need to reduce the single-use plastic items we encounter each day. Here are a few ways to reduce plastic use in our everyday lives: <ul> <li>Carry reusable bags to avoid plastic shopping bags </li> <li>Pack your own utensils for lunch and skip the plastic ones offered in the cafeteria </li> <li>Purchase reusable fruit and vegetable bags for grocery shopping</li> <li>Anticipate leftovers? Bring your own food storage container from home </li> <li>Select grocery stores have refillable spice stations <ul> <li>Tip: Look for zero-waste grocery stores in your area!</li> </ul> </li> </ul> <ul> <li>Opt for refillable products of toiletries, cleaning supplies, and even cosmetics</li> <li>Use reusable water bottles instead of plastic ones </li> <li>Use cloth napkins instead of paper napkins </li> <li>Replace plastic wrap with cloth or silicone food wraps <ul> <li>These can be washed and reused again and again</li> </ul> </li> <li>Some coffee shops allow you to bring your own mug or carafe to use instead of disposable cups</li> </ul> Small changes make a big difference! Each time single-use plastic is avoided, it keeps one more item out of the landfill. Resources: <a rel="noopener" href="https://www.epa.gov/facts-and-figures-about-materials-waste-and-recycling/plastics-material-specific-data" target="_blank" title="Link opens in new window">Plastics: Material-Specific Data | US EPA</a> <a rel="noopener" href="https://www.smithsonianmag.com/smart-news/the-us-recycled-just-5-percent-of-its-plastic-in-2021-180980052/" target="_blank" title="link opens in new window">At Least 85 Percent of U.S. Plastic Waste Went to Landfills in 2021</a> <a rel="noopener" href="https://howtodispose.com/16-tips-for-reducing-plastic-use-in-everyday-life/" target="_blank" title="link opens in a new window">16 Tips for Reducing Plastic Use in Everyday Life - How to Dispose</a> Margo Meekin is a dietetic intern at the Mayo Clinic in Rochester, MN. She received her Bachelor of Science from the University of Wisconsin- Madison in dietetics and is currently completing her Masters of Science in Clinical Nutrition from there too. She has an interest in clinical nutrition, specifically pediatrics and metabolic disorders.   Margo MeekinPrimary Care in Rochester and KassonPlastic wastePrimary Care in Rochester and KassonShake off winter and step into spring!<img src="/-/media/ech-media/images/widgets/activities/spring.jpg?h=65&iar=0&w=100&sc_lang=en&hash=9F5A8D5667D0665748DD74956E6D0D17" alt="spring" width="100" height="65" DisableNVelocity="true" />Spring Is Here, Let's Step Outside3/12/2026 8:00 AM<img src="/-/media/ech-media/images/widgets/activities/spring.jpg?h=205&iar=0&w=315&sc_lang=en&hash=354DFEA17A61D24D2DC2C39CA52FBE54" alt="spring" width="315" height="205" DisableNVelocity="true" />After a long Minnesota winter, the shift into spring is hard to miss. The light lingers a little longer in the evening, birds return and trails begin to soften as the snow disappears. For many people, it also brings a quiet reminder that it might be time to spend more time outside again. Time outdoors is not just enjoyable, It can also benefit our health. Research suggests that spending time in natural environments can help reduce stress, improve mood and encourage regular physical activity. Exposure to daylight supports healthy sleep patterns and even gentle movement outdoors can support heart health and overall well-being. The good news is that it doesn’t take hours to notice a difference. A short walk, a bit of gardening, or simply sitting outside for a few minutes can help reset the mind after a long winter indoors. Across Southeast Minnesota, local parks and community organizations offer many opportunities this spring to step outside, learn something new, and reconnect with nature. Chester Woods Park programs March—May 2026 • Chester Woods County Park offers a variety of seasonal programs that make it easy for families and individuals to enjoy the outdoors. Sunday, March 15 at 1:00 p.m. — Egg carton gardens • Celebrate the longer days by getting an early start on gardening. Kids can plant seeds in egg cartons and take them home to watch them grow before transplanting them into a garden or pot later in the season. Gardening is a hands-on way for children to develop patience, fine motor skills and a sense of accomplishment as they watch something they planted begin to grow. Space is limited. Call 507-328-7350 by March 10 to reserve a spot. Sunday, April 12 at 1:00 p.m. – Early signs of spring hike • Join the park naturalist for a relaxed hike along one of Chester Woods’ trails, as we look for early wildflowers, budding plants and other small signs of spring. Walking at a comfortable pace outdoors provides gentle physical activity, while offering a chance to slow down and notice the seasonal changes around us. Tuesday, April 14 from 7:30—9:00 p.m. — ZVAS Woodcock hike • Each spring, American Woodcocks perform one of the most unusual mating displays in the bird world. Beginning at dusk, participants will gather at the horse corral parking lot to try to observe this unique behavior. Evening nature walks can also be a peaceful way to unwind and transition from the busy pace of the day. Saturday, April 25 from 9:00 a.m.—12:00 p.m. — Friends of Chester Woods Spring Clean-Up Day • Volunteers are invited to help prepare the park for the busy spring and summer season. Meet at the park office for coffee and doughnuts before heading out to help with cleanup projects. Community volunteer activities combine light physical movement with social connection important for long-term health. Sunday, April 26 from 9:00 a.m.—12:00 p.m. — ZVAS Bird Walk at Root River Park • Located just south of Rochester near Simpson, Root River Park features a two-mile loop trail with diverse habitat for many bird species. Participants may see early spring migrants such as Golden-crowned Kinglets and Yellow-rumped Warblers, while also watching for early blooming wildflowers. Bird walks combine gentle walking with focused observation, which many people find both relaxing and mentally refreshing. Saturday, May 9 from 8:00 a.m.—12:00 p.m. — ZVAS Big Birding Day • Held during the peak of spring migration, this annual event often brings the opportunity to see a wide variety of bird species. Participants will meet at the boat landing parking lot. After the morning walk, there will be a pause for lunch. Participants should bring their own food and beverages. Sunday, May 10 at 10:00 a.m. — Spring kids craft • A fun seasonal craft activity for younger visitors. Creative activities help children build fine motor skills while encouraging curiosity about nature. Friday, May 22 at 10:00 a.m. — Beach and watercraft rentals open • The beach and watercraft rentals open for the season, offering opportunities for swimming, paddling and other water recreation. Water-based activities provide enjoyable outdoor exercise that is easy on the joints. Learning and exploration at Oxbow Park • Oxbow Park programs offer hands-on opportunities to learn about wildlife, water systems and the natural environment. Outdoor learning experiences help build curiosity, while giving participants time outside in natural settings, which is something many people miss during the winter months. • Spring programs include maple syrup demonstrations, reptile and amphibian presentations and guest educators from organizations such as the Wildlife Rehabilitation Center of Minnesota and the National Eagle Center. These programs give visitors a chance to learn about wildlife up close while spending time outdoors with family and community members. Highlights include: • February 28: Kick-off weekend – WOW Mobile Metal Lab (1—4 p.m.) • March 1: Karst public program • March 7: Master Gardeners – Rainwater Barrels & Rochester Stormwater program • March 8: Water Cycle class • March 14: Maple Syrup program (11 a.m.) and Rochester Public Library Water Science Discovery (1:30 p.m.) • March 15: Wildlife Rehabilitation Center of Minnesota presentation • March 21: Quarry Hill – Blanding’s Turtle program • March 22: Maple Syrup program • March 29: Reptile and Amphibian program • April 4: “Shaped by Water” presentation • April 11: Soil and Water Conservation program • April 12: DNR Invasive Species program • April 18: Meet the Otters – Photo and presentation event • April 19: National Eagle Center presentations Rochester Parks & Recreation summer programs As the weather continues to warm, Rochester Parks & Recreation offers a wide range of summer programs designed to keep residents active and connected. Tennis, hockey and youth recreation programs encourage regular physical activity, while helping participants build skills and confidence. <a rel="noopener" href="https://www.rochestermn.gov/departments/parks-and-recreation/leagues-classes-accessable-recreation/accessable-recreation" target="_blank" title="link opens in a new window">The Accessible Recreation Program</a> provides inclusive activities for children and adults with diverse cognitive needs, creating welcoming opportunities for everyone to participate. Regular movement, whether through organized sports, recreation programs or simple outdoor play, supports cardiovascular health, strengthens muscles and bones and contributes to overall well-being. Learn more about these summer programs on the <a rel="noopener" href="https://www.rochestermn.gov/departments/parks-and-recreation/leagues-classes-accessable-recreation/youth-activities-classes/summer-activities" target="_blank" title="link opens in a new window">Rochester Parks & Recreation website</a>. A simple invitation For many people, the hardest part of spending time outdoors after winter is simply getting started again. This spring offers plenty of opportunities to take that first step, whether it is joining a guided hike, attending a nature program, volunteering in a park or simply walking a local trail. Sometimes the most meaningful way to support our health is also one of the simplest: spending a little more time outside. Muse Abdi, M.B.B.S., B.BiomedSc., M.P.H., is a population health specialist at Olmsted County Public Health. Trained in medicine and public health, his work focuses on connecting healthcare, communities, and nature to support physical and mental wellbeing. Through the Statewide Health Improvement Partnership (SHIP), he leads initiatives such as Park Rx and Exercise is Medicine. He also facilitates the Southeast Minnesota Park Rx Coalition, bringing together healthcare providers, parks, and community partners to expand access to nature and promote the health benefits of spending time outdoors. <a href="/providers/brian-lynch-md">Brian A. Lynch, M.D.</a>, is a primary care pediatrician at Mayo Family Clinic Northwest in Rochester. He co-chairs the Primary Care Work Group of the Mayo Clinic Obesity Council and chairs the Primary Care Obesity Task Force. Dr. Lynch works closely with the Southeast Minnesota Park Rx Team to promote the physical and mental health benefits of spending time in nature with his patients and colleagues.Muse Abid, M.B.B.S, B.BiomedSc, M.P.H. and Brian Lynch, M. D.Primary Care in Rochester and KassonSpring ParksPrimary Care in Rochester and KassonLearn how to turn fresh summer produce into satisfying salads.<img src="/-/media/ech-media/images/widgets/food/summersalad.jpg?h=65&iar=0&w=100&sc_lang=en&hash=D5A6B445A693310932D0CE283AB4BF69" alt="summersalad" width="100" height="65" DisableNVelocity="true" />Summer Salads3/23/2026 2:30 PM<img src="/-/media/ech-media/images/widgets/food/summersalad.jpg?h=205&iar=0&w=315&sc_lang=en&hash=25A26AA7B195F5A920E030473E1FFF84" alt="summersalad" width="315" height="205" DisableNVelocity="true" />Summer salads are a great way to take advantage of seasonal produce in their peak flavor. With endless ways to customize, putting together the perfect summer salad creates a healthy and satisfying meal. Shopping for a variety of fruits and vegetables at your local supermarket or farmers market helps to capture peak freshness and packs in fiber and nutrients for a refreshing meal. Building a tasty and filling salad: <ul> <li>Start with a bed of leafy veggies: summer favorites might include spinach, arugula, red and green leaf lettuce, and more.</li> <li>Add a variety of seasonal fruits and vegetables: sweet corn, roasted zucchini, or berries.</li> <li>Make it filling: adding an extra grain like quinoa, rice or farro; a protein source like grilled chicken, tofu, or shrimp; a variety of nuts or seeds like pistachios, pumpkin seeds, or almonds will help make the salad more satisfying.</li> <li>Choose a dressing: making your own dressing with ingredients like olive or avocado oil for healthy fats, and vinegar, lemon juice, or fresh herbs for flavor can be a money saving and healthier option to store bought dressings. </li> </ul> Incorporating multiple ingredients from different food groups builds a nourishing and satisfying meal without compromising flavor. Other recipe ideas can be found on the Mayo Clinic Healthy Recipes website. Use them for inspiration or build your own! Resources: <a rel="noopener" href="https://www.todaysdietitian.com/supercharge-your-summer-salads/" target="_blank" title="link opens in new window">Supercharge Your Summer Salads - Today's Dietitian Magazine</a> <a rel="noopener" href="https://minnesotagrown.com/whats-in-season/" target="_blank" title="link opens in new window">What's in Season - Minnesota Grown</a>  <a rel="noopener" href="https://www.mayoclinic.org/healthy-lifestyle/recipes/salad-recipes/rcs-20077224" target="_blank" title="link opens in new window">Salad recipes - Mayo Clinic</a> Natalie Niebler received a Bachelor of Science in nutrition and dietetics from the University of Wisconsin-Madison. She is currently completing her master’s in clinical nutrition at UW Madison in addition to a dietetic internship at Mayo Clinic in Rochester, MNNatalie NieblerPrimary Care in Rochester and KassonSummer SaladsPrimary Care in Rochester and KassonLearn how to refuel your body after a workout<img src="/-/media/ech-media/images/widgets/womandrinkingwater.jpg?h=65&iar=0&w=100&sc_lang=en&hash=91C52376FFCFDB59E81D87C046C33580" alt="womandrinkingwater" width="100" height="65" DisableNVelocity="true" />Nutrition recovery4/15/2026 1:00 PM<img src="/-/media/ech-media/images/widgets/womandrinkingwater.jpg?h=205&iar=0&w=315&sc_lang=en&hash=6441628DBD003A9EF817414B2398D6F2" alt="womandrinkingwater" width="315" height="205" DisableNVelocity="true" />You just finished your workout, now it’s time to focus on recovery! Often recovery can be overlooked after a hard workout with busy schedules and competing priorities. What you consume 1—2 hours post-exercise is what repairs the muscles and replenishes glycogen stores lost. Post-exercise nutrition includes carbohydrates, protein and fluids! These fuel the body for the next workout and optimize future performance. The 3 R’s of recovery The three R’s of recovery include refuel, repair and rehydrate. Refuel the body with adequate carbohydrates (whole grains, fruits, low fat dairy): <ul> <li>Preferred source of energy for muscles. </li> <li>Replenishes glycogen stores. </li> <li>Normalizes blood sugar. </li> <li>Protects protein from being used as an energy source. </li> <li>Timing is important: Refuel within 1—2 hours of exercise. </li> </ul> Repair with adequate protein (around 0.25 to 0.4 g/kg) within two hours of exercise. <ul> <li>For an adult weighing 180—200 pounds, consider consuming 20—35 grams of protein after exercise. </li> </ul> Rehydrate the body with fluids and sodium. <ul> <li>Depending on the intensity and length of exercise: <ul> <li>Consider replenishing the body with plenty of fluids: around 16—32 ounces of fluid is a good start. </li> <li>Consider replenishing sodium with around 200—300 mg. See the nutrition label for sodium content information. </li> </ul> </li> </ul> Recovery Beverages <ul> <li>Liquid allows for quick absorption of nutrients. <ul> <li>Consider looking for the NSF Certified Sport or Informed Sport Certification as an indication that the beverage does not contain any banned substances. </li> </ul> </li> <li>Remember not all recovery beverages are created the same. Some only focus on protein, but carbohydrates and sodium are just as important. </li> <li>Consider a glass of milk as “nature’s recovery beverage”. Milk contains fluids, protein, carbohydrates and sodium — a cost effective and all-inclusive option! </li> </ul> Recovery meal and snack ideas <ul> <li>Snacks:</li> </ul> <ul> <li style="margin-left: 40px;">Greek yogurt or cottage cheese with berries </li> <li style="margin-left: 40px;">Low-fat chocolate milk </li> <li style="margin-left: 40px;">Smoothie with fruit, yogurt and milk </li> <li style="margin-left: 40px;">Peanut butter and banana sandwich.</li> </ul> <ul> <li>Meals:</li> </ul> <ul style="margin-left: 40px;"> <li> Avocado toast or a bagel with eggs. </li> <li>Oatmeal cooked in milk, with fruit and peanut butter. </li> <li>Pasta with tomato sauce, lean ground beef and cheese. </li> <li>Turkey and cheese sandwich on hearty bread with a banana. </li> <li>Taco bowl. </li> </ul> In Summary: Whether you choose a recovery beverage or balanced snack, post-exercise nutrition is critical for optimal recovery in athletes and active adults. By refueling with carbohydrates, protein, fluids and sodium, your body has all the tools to recover so you are ready for your next workout! References: <a rel="noopener" href="https://www.todaysdietitian.com/postexercise-recovery/" target="_blank" title="link opens in new window">Postexercise Recovery - Today's Dietitian Magazine</a> <a rel="noopener" href="https://www.eatright.org/fitness/physical-activity/exercise-nutrition/timing-your-pre-and-post-workout-nutrition" target="_blank" title="Link opens in new window">Timing-your-pre-and-post-workout-nutrition</a> <a rel="noopener" href="https://www.medicalnewstoday.com/articles/nutrition-for-athletes#macronutrients" target="_blank" title="Link opens in new window">Nutrition and athletic performance: What to consider</a> <a rel="noopener" href="https://nancyclarkrd.com/2018/04/29/recovery-after-a-gym-workout/" target="_blank" title="lnk opens in new window">Recovery after a gym workout – Nancy Clark RD</a> Ella Gigstead is a dietetic intern at Mayo Clinic in Rochester, MN, and is currently getting her MS through the University of Wisconsin-Madison. She received her Bachelor of Science in Dietetics through the University of Wisconsin-Stout. During her free time, she loves to play pickle ball with friends.Ella GigsteadPrimary Care in Rochester and KassonNutrition recoveryPrimary Care in Rochester and KassonAre weight loss medications an option for kids and teens?<img src="/-/media/ech-media/images/widgets/kids/teenweightloss.jpg?h=65&iar=0&w=100&sc_lang=en&hash=AB9BA5DC98FFF2882E85AAE6AB884C3D" alt="teenweightloss" width="100" height="65" DisableNVelocity="true" />Weight Loss Medications: Are they right for kids and teens?4/7/2026 11:00 AM<img src="/-/media/ech-media/images/widgets/kids/teenweightloss.jpg?h=205&iar=0&w=315&sc_lang=en&hash=C3F51196414B36DADED827D517D1E68C" alt="teenweightloss" width="315" height="205" DisableNVelocity="true" />Supporting a child or adolescent with obesity can be challenging. It is important to recognize that treatment is not about body shape, but about improving overall health, energy, emotional well-being, and long-term outcomes. Pediatric obesity is associated with multiple health conditions, including type 2 diabetes, high blood pressure, liver disease, sleep apnea, and joint problems, all of which can begin early in life and persist into adulthood if not addressed. Healthy lifestyle changes remain the cornerstone of treatment. These include balanced nutrition, regular physical activity, adequate sleep, and strong emotional and family support. Intensive, family-based behavioral interventions are often the most effective first step. However, for some adolescents, lifestyle changes alone may not lead to sufficient improvement. In these cases, prescription medications may be considered as part of a comprehensive, medically supervised treatment plan. When Are Medications Considered? Medications are typically considered for adolescents aged 12 years and older who have obesity, particularly when: Lifestyle interventions alone have not resulted in meaningful improvement There are obesity-related health conditions (such as type 2 diabetes or hypertension) There is a need to reduce long-term cardiometabolic risk Medication use should always be individualized and closely monitored by a healthcare professional with experience in pediatric weight management. Medication Classes Used in Adolescents Several medication classes are approved for use in adolescents and are used in combination with lifestyle and behavioral interventions. Glucagon-like peptide-1 (GLP-1) receptor agonists These medications have emerged as a cornerstone of pharmacologic treatment for adolescent obesity. They work by enhancing satiety, reducing appetite, and slowing gastric emptying, which helps decrease overall caloric intake. They are administered as injections, either daily or weekly depending on the formulation. Among currently available options, this class has demonstrated the most substantial and consistent weight reduction in adolescents. In addition to weight loss, they may improve metabolic parameters such as blood glucose, insulin resistance, and lipid profiles. Common side effects include nausea, vomiting, and abdominal discomfort, particularly during dose escalation. These effects are usually mild to moderate and tend to improve over time. Careful dose titration and counseling can help improve tolerability. As with all medications, ongoing monitoring is important. Phentermine/ Topiramate combination therapy: These oral medications act on central nervous system pathways involved in appetite regulation and reward. By reducing hunger and cravings, they can support meaningful weight reduction in some adolescents. However, these medications require careful monitoring due to potential side effects, including increased heart rate, mood changes, sleep disturbances, and effects on attention or cognition. They are typically used in selected patients after weighing risks and benefits. Gastrointestinal fat absorption inhibitors These medications reduce the absorption of dietary fat in the intestine, leading to a decrease in caloric intake. The expected weight loss is generally modest compared to other options. Their use may be limited by gastrointestinal side effects. Important Considerations Weight-loss medications are not a cure for obesity and should not be used in isolation. Their effectiveness depends on integration with healthy lifestyle habits and ongoing behavioral support. Regular follow-up is essential for monitoring. Not every child or adolescent is a candidate for medication, and decisions should be individualized based on medical history, risk factors, and family preferences. The Bottom Line For some adolescents, weight-loss medications can be a valuable addition to lifestyle interventions, helping to improve health, reduce complications, and support overall well-being. When used thoughtfully, under medical supervision, and as part of a comprehensive care plan, these therapies can play an important role in managing pediatric obesity and improving long-term outcomes. <a href="/providers/mostafa-salama-mbbch">Mostafa A. Salama, M.B., B.Ch</a>. is a 3 rd. year pediatric resident at Mayo Clinic in Rochester, Minnesota. Special interests in Pediatric and Adolescent Medicine, Endocrinology, Genetics and Obesity. He loves spending time with family, enjoys cooking and spending time outdoors with friends at barbeques. He also enjoys jogging around Rochester's beautiful lakes.Mostafa A. Salama, M.B., B.Ch.Primary Care in Rochester and KassonTeen Weight lossPrimary Care in Rochester and KassonThe new Blood Donor Dashboard makes being a donor even easier.<img src="/-/media/ech-media/images/widgets/people/mancellphoneholdingdog.jpg?h=65&iar=0&w=100&sc_lang=en&hash=CB6B2E36F17AF0880ADF415789732AF7" alt="ManCellPhoneHoldingDog" width="100" height="65" DisableNVelocity="true" />Schedule donation appointments online through the Mayo Clinic Blood Donor Dashboard1/13/2025 12:00 AM<img src="/-/media/ech-media/images/widgets/people/mancellphoneholdingdog.jpg?h=205&iar=0&w=315&sc_lang=en&hash=02F079091B80B3B6961C3B84CBA3A9ED" alt="ManCellPhoneHoldingDog" width="315" height="205" DisableNVelocity="true" />The Mayo Clinic Blood Donor Program is excited to announce the launch of a new,  highly-requested online scheduling system, the Mayo Clinic Blood Donor Dashboard. The dashboard makes being a donor and supporting our local patients even easier. Easily schedule your blood donation, view past donations and manage your appointments online, all in one place. Giving the gift of life has never been more convenient. How do I use the dashboard? Step 1: Go to www.blood-donor-program-mn.mayoclinic.org to open the Mayo Clinic Blood Donor Dashboard. Step 2: Filter your blood donation appointment options using date, miles and ZIP code to choose where and when you want to donate. Then select your preferred Donor Center or Mobile Drive. Next, choose the appointment type and time that works best for you. Finally, tap Continue to proceed to step 3. Step 3: <ul> <li>Existing donors: Tap Sign In / Create an Account. <ul> <li>If it is your first time signing into the Dashboard, you'll need your Donor ID (not Mayo ID) and email address that the Blood Donor Program has on file. Unsure of this information? No problem! Call us at 507-284-4475 or email us at donateblood@mayo.edu; we’d be happy to help.</li> </ul> </li> <li>New donors: Tap Request Appointment and input the requested details. Click Continue.</li> </ul> Have questions or prefer to chat with us directly? Our phone line is still an option. Call us at <a rel="noopener" href="tel:5072844475" target="_blank" title="Link opens in a new window">507-284-4475</a>, and we’d be happy to assist you! Added bonus! The first 100 people to sign up for the Mayo Clinic Blood Donor Dashboard will receive a limited-edition tumbler. If you are one of the first 100 to sign up, you will receive an email from <a title="Link opens in a new window">MCBloodDonorPMRTm@mayo.edu</a> with a notification regarding when and where you can pick up your tumbler. Feeling inspired to give back? You can help save up to three lives with each blood donation. Mayo Clinic offers several convenient locations where you can donate: <ul> <li>Downtown Rochester: Hilton Building, open Monday through Friday, 6 a.m. to 4:30 p.m.</li> <li>Northwest Rochester: Medical Complex NW Building A, open Monday through Friday, 6 a.m. to 4:30 p.m. </li> </ul> Mayo Clinic makes it easy for employees to donate during work hours, so be sure to check <a rel="noopener" href="https://mcsm.service-now.com/employeeconnect?id=kb_article&sys_id=970a65ee937fc6107167b57c5cba10f0&spa=1" target="_blank" title="Mayo Clinic employees only">the policy</a> for more details. To self-schedule your next donation, head to <a rel="noopener" href="https://www.blood-donor-program-mn.mayoclinic.org" target="_blank" title="Link opens in a new window">www.blood-donor-program-mn.mayoclinic.org</a>. For more information, visit the <a rel="noopener" href="http://www.mayoclinic.org/donateblood" target="_blank" title="Link opens in a new window">Mayo Clinic Blood Donor Program website</a> and follow us on <a rel="noopener" href="https://www.instagram.com/mayoclinicbdp/" target="_blank" title="Link opens in a new window">Instagram</a> and <a rel="noopener" href="https://www.facebook.com/blooddonorcentermc?ref=br_tf" target="_blank" title="Link opens in a new window">Facebook</a>.Primary Care in Rochester and KassonBlood Donor DashboardPrimary Care in Rochester and KassonEach year, this odorless gas sickens thousands and kills hundreds.<img src="/-/media/ech-media/images/widgets/randomimages/carbonmonoxide.jpg?h=65&iar=0&w=100&sc_lang=en&hash=8C2B2F91DB0BE8066CA11F3EF99CD1AF" alt="CarbonMonoxide" width="100" height="65" DisableNVelocity="true" />Do you know the signs of carbon monoxide poisoning?2/17/2025 4:30 AM<img src="/-/media/ech-media/images/widgets/randomimages/carbonmonoxide.jpg?h=205&iar=0&w=315&sc_lang=en&hash=D4CF1408F1F7DF39760DF241CC924997" alt="CarbonMonoxide" width="315" height="205" DisableNVelocity="true" />Each year, more than 20,000 people visit emergency departments and over 400 die from accidental carbon monoxide poisoning. Everyone is at risk for carbon monoxide poisoning, especially infants, the elderly population, and people with heart or lung disease.  What do you know about the signs and effects of carbon monoxide poisoning? Read on for some answers to common questions about carbon monoxide.  What is carbon monoxide, and where does it come from?  Carbon monoxide is a colorless, odorless gas found in the fumes from stoves, lanterns, gas ranges and other appliances, portable generators, grills, and burning wood or charcoal. The risk of exposure increases in winter or during power outages because people use alternative heat sources indoors, including portable gas camp stoves, generators, ranges or charcoal grills.  How can you recognize carbon monoxide poisoning?  While symptoms of carbon monoxide poisoning are not specific, they can include headache, dizziness, weakness, nausea, confusion and even chest pain. High levels of carbon monoxide can lead to unconsciousness and death. Carbon monoxide is also harmful to your pets.  What should you do if carbon monoxide levels are high?  If you suspect carbon monoxide poisoning, get fresh air. Open the windows, go outside and go to another location. If you feel ill or think you may have carbon monoxide poisoning, seek medical attention. Once you're feeling better, have your local gas utility company check any gas appliances, such as ranges, furnaces, dryers or water heaters, to be sure they're working correctly.  How can you protect your family? <ul style="margin-top: 0in; list-style-type: disc;"> <li>Ensure you have working carbon monoxide detectors. Installing them in your home and regularly changing the batteries is the first step. </li> <li>Have your wood-burning stove or fireplace inspected regularly. </li> <li>Never leave a car or gasoline-powered engine in an enclosed area. </li> </ul> The Centers for Disease Control and Prevention (CDC) offers tips for <a rel="noopener" href="https://www.cdc.gov/natural-disasters/psa-toolkit/prevent-carbon-monoxide-poisoning.html" target="_blank" title="Opens in new browser window">preventing carbon monoxide poisoning</a> and fact sheets about <a rel="noopener" href="https://www.cdc.gov/carbon-monoxide/factsheets/co-poisoning-fact-sheet.html" target="_blank" title="Opens in new browser window">carbon monoxide poisoning in other languages</a>. For more information, check out the carbon monoxide resources from the <a rel="noopener" href="https://www.cdc.gov/carbon-monoxide/about/index.html" target="_blank" title="Opens in new browser window">CDC</a> and the <a rel="noopener" href="https://data.web.health.state.mn.us/co" target="_blank" title="Opens in new browser window">Minnesota Department of Health</a>.  <a href="/providers/denise-dupras-md">Denise Dupras, M.D., Ph.D.</a>, is a physician in Primary Care in Rochester and Kasson's Division of Community Internal Medicine, Geriatrics and Palliative Care. She completed her medical and doctoral degrees at Mayo Clinic Alix School of Medicine and her residency in internal medicine at Mayo Clinic in Rochester. Her interests include medical education and evidence-based medicine. Denise Dupras, M.D., Ph.D.Primary Care in Rochester and KassonCarbon MonoxidePrimary Care in Rochester and KassonFinding the proper diabetes medication can be complex; let your healthcare team guide you.<img src="/-/media/ech-media/images/widgets/diabetes/diabetesoptions.jpg?h=65&iar=0&w=100&sc_lang=en&hash=6EBAF190381938E4838D46BD76BA1130" alt="DiabetesOptions" width="100" height="65" DisableNVelocity="true" />Diabetes medications: Finding the right option for you2/13/2025 5:00 AM<img src="/-/media/ech-media/images/widgets/diabetes/diabetesoptions.jpg?h=205&iar=0&w=315&sc_lang=en&hash=F09C77C8D55C2FAED7BF5F0D0EAAEE74" alt="DiabetesOptions" width="315" height="205" DisableNVelocity="true" />If you are among the 38 million Americans living with diabetes, you're likely taking at least one medication to control your blood sugar. There are many medications approved for treating type 1 or type 2 diabetes, so choosing the right one can be challenging. Your choice will depend on many things, including:  <ul style="list-style-type: disc;"> <li style="color: #131313;">Type of diabetes you have.</li> <li style="color: #131313;">How much your blood sugar needs to be lowered.</li> <li style="color: #131313;">Other health conditions.</li> <li style="color: #131313;">Your risk for hypoglycemia (low blood sugar). </li> <li style="color: #131313;">Cost and insurance coverage.</li> </ul> Options for type 1 diabetes If you have type 1 diabetes, you require insulin to control your blood sugar. There are different kinds of insulin and other ways to take it: <ol> <li>Types of insulin: <ul style="list-style-type: disc;"> <li>Analog insulins: This type includes long-acting insulin and rapid-acting mealtime insulin. They work well but can be expensive.</li> <li>Human insulins: This includes NPH (neutral protamine hagedorn) and regular insulin, which can also manage diabetes safely. </li> </ul> </li> <li>Ways to take insulin: <ul style="list-style-type: disc;"> <li>Insulin injections: Most people inject insulin through pens or syringes under the skin.</li> <li>Insulin pump: This device gives a steady flow of insulin through a small tube under the skin. It often uses rapid-acting insulin and can help keep blood sugar levels stable. Some insulin pumps can work with a continuous glucose monitor (CGM), pause insulin during low blood sugar or adjust insulin delivery rates automatically. </li> </ul> </li> </ol> Options for type 2 diabetes Some people with type 2 diabetes can manage their blood sugar by eating healthy and exercising. However, most will eventually need medication to keep their blood sugar levels within the goal range. There are many different medications used to treat type 2 diabetes. You can discuss options with your clinician to decide the best medication for you. You can start by reviewing your options <a rel="noopener" href="https://diabetes.org/health-wellness/medication/oral-other-injectable-diabetes-medications" target="_blank" title="Opens in new browser window">here</a>.   Diabetes is progressive, and sometimes medicines stop working as well as they used to. When this happens, your clinician might change your medicine or add new ones. This approach could include adding insulin to your treatment plan and does not mean you are doing anything wrong. Sometimes, you may require a temporary adjustment to your medication, like adding insulin, even if your current diabetic medications keep your blood sugar within goal. This adjustment could occur due to an infection or surgery. Options for diabetes in pregnancy and gestational diabetes Type 1 diabetes: If you have type 1 diabetes, you will continue to require insulin, including during pregnancy. Your insulin requirements will change throughout pregnancy. Type 2 diabetes: If you have type 2 diabetes before pregnancy, you will likely need insulin during pregnancy. Gestational diabetes: If you are diagnosed with diabetes during pregnancy, this is called gestational diabetes. Many women with gestational diabetes can control their blood sugar with diet and exercise alone. If that is not enough, medications are prescribed. In the U.S., insulin is still the first-line treatment for gestational diabetes.  How do you choose the right medication? <ol> <li>Understand your options.</li> <li>Personalize your treatment. </li> <li>Consult your healthcare clinician. </li> <li>Monitor and adjust medications per your clinician’s orders.</li> </ol> The key thing to remember is that there are many ways to treat diabetes, and each person is unique. Talk with your healthcare clinician to learn which options may be best for you.  Elizabeth Miles, APRN, CNP, is a family nurse practitioner in the Department of Endocrinology, Diabetes, Metabolism, and Nutrition. She specializes in managing type 1 and type 2 diabetes and has over 15 years of experience in endocrinology. Elizabeth is an Instructor in Medicine and Associate Program Director for the Mayo Clinic School of Health Sciences Nurse Practitioner Program. Elizabeth Miles, APRN, C.N.P.Primary Care in Rochester and KassonDiabetes MedicationsPrimary Care in Rochester and KassonShould you see your care team, head to the ER or treat at home?<img src="/-/media/ech-media/images/widgets/kids/ech_ear_pain_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=AE30363FF1F64274DE10998547B68F01" alt="ECH_ear_pain_widget" width="100" height="65" DisableNVelocity="true" />Ow! My child has an earache!2/27/2025 4:30 AM<img src="/-/media/ech-media/images/widgets/kids/ech_ear_pain_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=3AEA309A7FD79725A128C3F3F2645E00" alt="ECH_ear_pain_widget" width="300" height="195" DisableNVelocity="true" />As a parent, how you respond to your child’s ear pain depends a lot on their age and ability to tell you what hurts. Your 9-year-old can say, “My left ear hurts,” while your 2-month-old may just be fussy or unable to sleep. It’s uncommon for infants younger than two months old to develop ear infections. After three or four months of age, infections become more common. Why? There are two key factors: <ul style="margin-top: 0in; list-style-type: disc;"> <li>Infections usually affect the middle ear space, which is smaller at this age. The Eustachian tube, which helps drain the area, is flatter and not as effective in draining away fluids.</li> <li>Children 3 and younger tend to get a lot of colds. Fluid builds up, which can cause pressure and pain, and sometimes becomes infected.</li> </ul> Infants and toddlers may show symptoms of ear pain that include fussiness, pulling on their ears, running a fever, or not sleeping or eating well. The only way to tell if they’re suffering from an infection is to have their ears examined at a clinic. If your child is less than a year old, you should bring them in to be checked. If your child is diagnosed with an ear infection, there are several things your healthcare clinician should consider when determining if an antibiotic is necessary. If your child is six months or younger, an infection likely will be treated with an antibiotic, typically amoxicillin. After six months, getting an antibiotic will depend on how the ear looks, whether both ears are infected, and how high your child’s fever is and how long it has lasted. If your child is 2 or older and only one ear is infected, there’s a 75-80% chance the infection will go away on its own. Just watch them and treat the pain. If two or three days go by and they are getting worse or not showing signs of improvement, an antibiotic may be helpful. Home remedies for ear pain include: <ul style="margin-top: 0in; list-style-type: disc;"> <li>Using acetaminophen (Tylenol) or Ibuprofen (Motrin/Advil) according to instructions on the box.</li> <li>Propping your child up for better sleeping since lying down can increase the pressure and pain in the ear.</li> <li>Applying a warm, moist compress, such as a washcloth, to the ear hasn’t been proven to help but likely won’t cause harm.</li> </ul> These infections are more common in the first three years of life (up to 3 years old isn't unusual). But after age 3, they become less common. However, if your child has recurring ear infections — up to three in a single season or four in a year — talk with your clinician about whether ear tubes, which drain fluid from the middle ear, would be an option for your child. Ways to reduce the chance of your child getting an ear infection include: <ul style="margin-top: 0in; list-style-type: disc;"> <li>Breastfeed.</li> <li>Keep them away from second-hand smoke.</li> <li>Make sure their routine immunizations are up to date.</li> </ul> An infection in the middle ear isn’t the only cause of earaches. The pain may be the result of a jaw or tooth issue, teething, infected lymph node, sore throat, wax build-up or swimmer’s ear. Swimmer’s ear is an infection of the outer ear canal often caused by water remaining in the ear after swimming or bathing. The ear canal becomes inflamed and red; gently pulling on the earlobe is painful. Swimmer’s ear is usually treated with prescription ear drops. No matter your child's age, ear pain is rarely an emergency. So rather than bundling them up and heading to the ER in the middle of the night, make them comfortable with home remedies and wait until morning. <a href="/providers/jason-homme-md">Jason (Jay) Homme, M.D.</a>, is a Community Pediatric and Adolescent Medicine physician. His main areas of practice and interest are pediatric and adolescent medicine, inpatient medicine, office-based procedures and medical education. He’s the father of six children.Jason (Jay) Homme, M.D.Primary Care in Rochester and KassonEar Pain KidsPrimary Care in Rochester and KassonWith a little planning, turn your meals into masterpieces without breaking the bank.<img src="/-/media/ech-media/images/widgets/food/foodcalculator.jpg?h=65&iar=0&w=100&sc_lang=en&hash=2DD60BE396C118203C61E9A38328E3C6" alt="FoodCalculator" width="100" height="65" DisableNVelocity="true" />Eating economically2/6/2025 3:26 PM<img src="/-/media/ech-media/images/widgets/food/foodcalculator.jpg?h=205&iar=0&w=315&sc_lang=en&hash=5405B2E81D63CABDDDAAA298564718D5" alt="FoodCalculator" width="315" height="205" DisableNVelocity="true" />If you've ever found yourself staring into the fridge wondering what magical meal you can create with what you have left on hand, you're not alone. With some planning, you can turn your meals into masterpieces without breaking the bank or skimping on flavor and nutrition. Let's explore five simple, wallet-friendly hacks that'll leave your belly and your bank account feeling full. Plan like a pro What's the No. 1 secret to eating on a budget? You guessed it, planning ahead. Taking a small amount of time to plan can save you from an outrageous grocery receipt. Before heading to the grocery store, take inventory of what you already have on hand. Build your meal plan around these items and only buy what is missing. Please remember to stick to your list. Staying focused on your list will keep you from any surprise purchases. Don't let leftovers go to waste It's time to talk about the dreaded leftovers. Eating the same meal for the third time can feel repetitive, but rest assured, leftovers do not have to be boring. Repurposing last night's dinner into something fresh and fun is like giving it a makeover. Got some leftover veggies? Maybe some tortillas in the fridge? Turn those leftovers into a yummy veggie quesadilla. After all, leftovers are your budget's best friend, so don't let them go to waste. Shop seasonally Ever notice how some fruits and vegetables cost more at certain times of the year? That's because they're not in season. When you choose produce that's in season, you get the freshest items and save cash. You can freeze seasonal produce when it's cheap and use it later. Having frozen veggies and berries on hand is a lifesaver for future meals. Meal prep Planning ahead is a great time saver. Pick a day and prep big batches of food. Think soups, casseroles, egg bites or even simply preparing your sandwiches for the week. Portion them out and store them in the fridge or freezer for quick, easy meals all weeklong. Knowing you have a homemade meal ready to go will help prevent you from ordering takeout or ending up in the drive-thru after a busy day. Go generic Last but certainly not least, don't be afraid to shop generically. The name-brand products always look so fancy. But did you know that store-brand items are often just as good and usually for a fraction of the price? ALDI grocery stores are one example of a great place to buy store-brand items. With a bit of creativity and planning, you can whip up tasty, delicious, and budget-friendly meals. It's all about making smart food choices, embracing those leftovers and knowing when to splurge (and when not to). Audrey McKinney graduated from Purdue University with a bachelor's degree in nutrition and dietetics. She is completing her master's in clinical nutrition from UW-Madison alongside her dietetic internship at Mayo Clinic in Rochester.Audrey McKinneyPrimary Care in Rochester and KassonEating EconomicallyPrimary Care in Rochester and KassonThese tips can help your family prevent and prepare for hazards from fire. <img src="/-/media/ech-media/images/widgets/randomimages/firedrill_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=55D8377E43045A96636172B1CF72BBFA" alt="FireDrill_widget" width="100" height="65" DisableNVelocity="true" />Keep your family safe from fire2/20/2025 4:30 AM<img src="/-/media/ech-media/images/widgets/randomimages/firedrill_widget.jpg?h=205&iar=0&w=315&sc_lang=en&hash=5817F2064C88E159435024188FC1870F" alt="FireDrill_widget" width="315" height="205" DisableNVelocity="true" />Keeping your family safe is important, and there are a few things that you can do to protect those you love from the harms of fire. Make sure you have working smoke alarms. Smoke alarms reduce the risk of dying from fire in a home by half. Smoke alarms should be installed in sleeping areas, outside each separate sleeping area and on every level of the home. Smoke alarms should be tested at least monthly. Batteries should be replaced at least yearly. The smoke alarm should be replaced every 10 years. As we age, our hearing declines, so it is essential to ensure that the alarm can be heard by everybody in the home. Make sure everyone understands the fire escape plan. Smoke alarms only work as well as the plan that allows people to escape when there is a fire. Every family should have a home escape plan, which should be practiced. Teach children how to escape on their own if you cannot help. Specifically, make sure that they can open windows, remove screens and unlock doors. Safe fire practices should travel with you. When checking into a hotel, ask what the fire alarm sounds like. Also, ask if the room is equipped with a smoke alarm and accessories that will wake people who are hard of hearing if needed. Count the number of doors between your room and the nearest fire exits. Prepare those who are planning to live in college or university housing. Choose a dorm or off-campus housing with fire sprinklers, as they provide the best level of protection. Do not burn candles in your room. Practice fire safety in the kitchen. The leading cause of fires in the kitchen is unattended cooking. Do not cook if you have consumed alcohol or if you are taking a medication that makes you drowsy. Always turn off burners if you leave the kitchen for any reason. Keep a pot lid nearby when cooking so it can be used to extinguish any fire. A turkey fryer that uses cooking oil is not suitable for safe use in the home — they should only be used outside by a well-informed and careful consumer. Don't smoke or allow smoking in your home. If you smoke cigarettes, smoke outside ― and require all guests to do the same. Limit the use of extension cords. Major appliances, such as refrigerators, stoves, washers, dryers and microwave ovens, should be plugged directly into a wall outlet. Never use an extension cord with a major appliance; it can overheat and start a fire. Candles are beautiful, but they require special considerations. Never leave a burning candle unattended. Never burn a candle on or near anything that might catch fire. Keep all candles out of the reach of children and pets. Consider using battery-operated flameless candles for greater safety. Home oxygen therapy saves lives, but it is also dangerous. Where medical oxygen is in use, never use a sparking toy; an open flame, such as a match or lighter, a fireplace or stove; or any other device fueled by gas, kerosene, wood or coal. Always post appropriate signage to alert others that oxygen is used on the premises. For additional safety tips, visit the <a rel="noopener" href="https://www.nfpa.org/Education-and-Research/Home-Fire-Safety" target="_blank" title="Opens in new browser window">National Fire Protection Association's website</a>. <a href="/providers/jon-ebbert-md">John Ebbert, M.D.</a>, is a physician in Community Internal Medicine, Geriatrics and Palliative Care. He is chair of Community Internal Medicine's Telehealth Division and offers virtual visit care across Southeast Minnesota.John Ebbert, M.D.Primary Care in Rochester and KassonFire SafetyPrimary Care in Rochester and KassonLife's Essential 8 gives you a starting point for improving your heart and overall health. <img src="/-/media/ech-media/images/widgets/randomimages/healthyheart.jpg?h=65&iar=0&w=100&sc_lang=en&hash=FBA7343BD654FF92B5D3026D579CB5EF" alt="HealthyHeart" width="100" height="65" DisableNVelocity="true" />For a healthy life, start with your heart2/3/2025 4:30 AM<img src="/-/media/ech-media/images/widgets/randomimages/healthyheart.jpg?h=205&iar=0&w=315&sc_lang=en&hash=20E8C5F98DDFBDD5E1E3D86163025D6C" alt="HealthyHeart" width="315" height="205" DisableNVelocity="true" />This time of year, a common question that comes up is, "What can I do to improve my health?" It can seem daunting to figure out where to start. Fortunately, the American Heart Association (AHA) created a simple <a rel="noopener" href="https://www.heart.org/en/healthy-living/healthy-lifestyle/lifes-essential-8" target="_blank" title="Opens in new browser window">Life's Essential 8</a> map to guide us on a healthy lifestyle. The eight components we can tackle are included below: 1) Eat Better Eating healthy is an important part of improving our health and staying healthy. The AHA recommends making smart choices to build an overall healthy dietary pattern. There's a right number of calories for you, based on your age, activity level, and whether you're trying to lose, gain or maintain your weight. You can improve your health by reading nutrition labels, watching your calorie intake, cooking at home, aiming for vegetables and whole grains, and avoiding processed foods.  2) Be More Active Get moving! Adults should get about 2.5 hours of moderate-intensity activity per week. Moderate-level physical activity means breaking a sweat and having difficulty maintaining an entire conversation during activity. Kids should have about 1 hour of activity every day (including play and structured activities).  3) Quit Tobacco If you smoke, the single best thing you can do for your health is to quit. Smoking can lead to numerous health risks, including heart disease, stroke and cancer. The benefits are significant and can be felt as soon as one day after you stop! There are many resources to help you quit, and we recommend talking to your healthcare clinician to explore your options.  4) Get Healthy Sleep The newest recommendation is to get adequate sleep. Most adults need 7-9 hours of sleep per night. Sleep is essential to improve your health, promote healing and reduce your risk of chronic diseases. 5) Manage Weight Staying within a healthy weight range for your body type is essential to keeping your heart, brain and skeleton happy. Understanding your calorie intake and activity level is important to help you identify the changes you want to make. It is essential to understand your body mass index (BMI), which is a numerical value of your weight relative to your height, and it can help you know if you're at a healthy weight or need to lose weight. Optimal BMI is less than 25, but less than 18.5 is considered underweight. 6) Control Cholesterol Cholesterol is a fat substance that comes from two sources — our body and our diet. There are two types of cholesterol: low-density lipoprotein, or LDL ("bad" cholesterol), and high-density protein, or HDL ("good" cholesterol). While the HDL ("good") cholesterol protects our artery walls, the LDL ("bad") cholesterol sticks to them, contributing to plaque build-up, which can clog our arteries. It is important to control our cholesterol levels to prevent plaque build-up, which leads to heart disease and stroke. 7) Manage Blood Sugar The carbohydrates and sugars we eat turn into glucose (sugar) in the stomach and digestive system. This glucose then enters the bloodstream. Insulin is a hormone secreted by our pancreas that lowers blood glucose by helping cells take it in. With diabetes, glucose builds up in the bloodstream because cells no longer take it in as effectively. This can be due to genetics, increased weight and our diets. These high blood sugar levels can damage the heart, kidneys, eyes and nerves over time. That's why keeping our blood sugar at a normal level is important. 8) Manage Blood Pressure Our blood pressure is made up of two numbers: the systolic (higher) number measures the pressure in the arteries during the heartbeat, and the diastolic (lower) number measures the pressure in the arteries when the heart is resting between beats. Normal is <120/<80. High blood pressure levels strain and pressure the heart, arteries and kidneys over time. Everyone's levels fluctuate during the day, but it's important to know your range and maintain control of your blood pressure. People with great adherence to the ideal Life's Essential 8 metrics had an over 60% reduced risk for heart-related death compared to people without perfect metrics. The benefits of these Life's Essential 8 metrics go beyond the heart — they can also help you reduce your risk of other chronic diseases. If you can achieve each of these metrics, patients were found to have: <ul> <li>20% lower risk for cancer.</li> <li>62% lower risk for chronic kidney disease.</li> <li>43% lower risk for pneumonia.</li> <li>49% lower risk for chronic obstructive pulmonary disease (COPD). </li> </ul> The amazing thing about these metrics is that anyone can make these changes. The steps aren't expensive, and even minor improvements can make a huge difference. Start with one metric and see how small steps can cascade into a healthy lifestyle. If you'd like to learn more and discover how to improve your health, visit the <a rel="noopener" href="https://www.heart.org/en/healthy-living/healthy-lifestyle/lifes-essential-8" target="_blank" title="Link opens in a new window">Life's Essential 8 | American Heart Association webpage</a>. Talk to your healthcare clinician about how you can optimize your health today! <a href="/providers/allison-ducharme-smith-md">Allison Ducharme-Smith, M.D.</a>, is a physician in Primary Care in Rochester and Kasson's Division of Community Internal Medicine, Geriatrics and Palliative Care and practices at Mayo Family Clinic Northeast in Rochester. Her interests include preventive medicine, women's health, chronic disease management and medical education.Allison Ducharme-Smith, M.D.Primary Care in Rochester and KassonHealthy HeartPrimary Care in Rochester and KassonThese screenings check for rare but treatable health conditions.<img src="/-/media/ech-media/images/widgets/kids/newbornbabyhospital.jpg?h=65&iar=0&w=100&sc_lang=en&hash=5697E691274EE4E9F3A385FBCD782E8D" alt="NewbornBabyHospital" width="100" height="65" DisableNVelocity="true" />Why newborn screenings are important2/10/2025 5:00 AM<img src="/-/media/ech-media/images/widgets/kids/newbornbabyhospital.jpg?h=205&iar=0&w=315&sc_lang=en&hash=F46036DD4A7F640C38FDE46E5EE0843E" alt="NewbornBabyHospital" width="315" height="205" DisableNVelocity="true" />If you are expecting a baby, you're probably already thinking about how to keep them healthy. An essential part of their health is newborn screenings, which include simple tests that check for rare but treatable health conditions. These appointments include blood, hearing and heart screenings. Why should my baby be tested? Your baby can be born with a health condition but may not initially show any signs of the problem. If a health condition is found early with newborn screening, it often can be treated. Early treatment is vital because it can help prevent more serious health problems for your baby. The newborn screenings make sure that your baby stays safe and healthy. When will my baby be tested? Newborn screenings are usually done when your baby is one or two days old. If your baby is born in a hospital, the screenings are done before you go home. If you plan to deliver at home or in a birthing center, your baby’s clinician can help you schedule the screenings. What are the three newborn screening tests? Blood spot screening: This test can detect genetic, metabolic or hormone-related health conditions. For this test, a quick prick of your baby’s heel is used to sample blood. The blood drops are collected on a special paper and sent for testing. Results are usually back by the time your baby is about seven days old. Hearing screening: For the hearing screening, the medical team will use tiny earphones and special software to check how your baby responds to sound. Your baby needs a hearing test because hearing loss can affect speech and overall development. Heart screening: Heart screening, also known as the Critical Congenital Heart Disease (CCHD) screening, ensures that your baby has a healthy heart. For this screen, sensors called pulse oximeters are placed like stickers on your baby’s hand and foot, and they measure the amount of oxygen in the blood. This test helps detect any babies who may have heart problems. What if the newborn screening results are not normal? Most newborn screening test results are normal. However, if your baby’s screening results are abnormal, they need more testing. Your baby’s clinician will recommend another kind of test, called a diagnostic test, to see if there is a health condition. If the diagnostic test results are normal, no more testing is needed. If the diagnostic test results are not normal, then your baby’s clinician will guide you on the next steps for your baby, which may include interventions, medications or diet modifications. Klara Milojkovic, M.D., is a Pediatric and Adolescent Medicine resident in Rochester, Minnesota. She is currently applying for a fellowship in Neonatal-Perinatal Medicine.Klara Milojkovic, M.D.Primary Care in Rochester and KassonNewborn ScreeningsPrimary Care in Rochester and KassonThere are several health benefits to following the whole food, plant-based diet. <img src="/-/media/ech-media/images/widgets/food/plantbasedfood.jpg?h=65&iar=0&w=100&sc_lang=en&hash=2105375651A8DB4368BFAA3C6EB7C527" alt="PlantBasedFood" width="100" height="65" DisableNVelocity="true" />Plant power: Your ability to thrive on whole foods2/24/2025 4:30 AM<img src="/-/media/ech-media/images/widgets/food/plantbasedfood.jpg?h=205&iar=0&w=315&sc_lang=en&hash=BEAFC4F3EAC8DD73BEC585B23D17D86D" alt="PlantBasedFood" width="315" height="205" DisableNVelocity="true" />The whole food, plant-based (WFPB) diet is not necessarily a diet, but more of a lifestyle change. There are several major benefits when following the WFPB diet, which include but aren’t limited to the following: <ul style="list-style-type: disc;"> <li>Reducing cholesterol, blood pressure and blood sugar.</li> <li>Decreasing the risk of developing heart disease, diabetes and cognitive decline.</li> <li>Preventing and improving fatty liver disease.</li> <li>Preventing and slowing the progression of different cancers.</li> </ul> The focus of the WFPB diet emphasizes consuming a diet rich in whole, plant-based foods — which include fruits, vegetables, legumes, whole grains, nuts and seeds. It excludes animal products such as meat, chicken, turkey, fish, dairy products and eggs. This approach is like the vegan diet; however, the WFPB diet limits the amount of processed ingredients commonly found in vegan alternatives. Processed foods can be thought of as refined ingredients, artificial flavors and colors, sugar, sweets, and foods high in oils. Examples include Twizzlers, Tofurky, vegan mac and cheese and more.   Because the diet is mostly plant-based, it is naturally rich in fiber, phytochemicals and antioxidants, while being lower in saturated fats, sodium and added sugars. Below is a brief overview of the five major food groups to incorporate on the WFPB diet:   Fruits: apples, bananas, kiwi, strawberries, citrus fruits, melons, etc. Vegetables: dark leafy greens, peppers, corn, zucchini, broccoli, cauliflower, etc. Tubers (Starchy Root Vegetables): potatoes, sweet potatoes, yams, etc. Whole Grains: quinoa, brown rice, whole wheat oats, cereals. Legumes: beans, lentils.   What about protein?   Sources of protein encouraged on the WFPB diet include legumes, quinoa, nuts and seeds. For example, one-half cup of cooked lentils contains 12 grams of protein and 1 cup of quinoa contains 8 grams of protein. Products such as meat, poultry and fish are avoided because of the cholesterol and saturated fat content, which have been linked to poor cardiovascular health. Additionally, processed meats such as cured meats, bacon and sausage, are higher in sodium. If you choose to incorporate animal-based products on the WFPB diet, choose lean meats such as skinless poultry, seafood and fish. Aim to focus on the quality of the product and think of them as complementary to the plant-based meal.   Do I have to make a full commitment to the WFPB diet?   Some individuals choose to completely follow the WFPB diet; however, this can be a dramatic lifestyle change. Luckily, the WFPB diet is flexible and can be tailored to meet people's individual needs and goals. When adopting aspects of the WFPB diet, focus on meals being centered around whole, plant-based food choices. Below are small changes to help incorporate more plant-based foods into your lifestyle:   Replace processed food with more wholesome varieties: Swap sugary cereal with oatmeal topped with fruit and honey. Consider homemade trail mix instead of packaged granola bars.   Reflect upon commonly made meals: Try making one or two plant-based meals a week. For example, consider chili without meat or scrambled tofu.   Choose ingredients the whole family will enjoy: Try different kinds of nut butters or hummus.   Regardless of the WFPB dietary approaches you choose, this way of eating will work to improve your health. It is a major lifestyle change but take your time and consider incorporating more whole-food, plant-based options into your lifestyle.   Alison Brantner is a dietetic intern for the Mayo Clinic in Rochester, Minnesota. She was awarded her bachelor’s and master’s degree through the University of Wisconsin Stout. Her passion in the dietetic field is to become a diabetes educator. Alison BrantnerPrimary Care in Rochester and KassonPlant Based DietPrimary Care in Rochester and KassonThis event is for kids age 6–12 who have a sibling living with a chronic health, mental health or developmental need. <img src="/-/media/ech-media/images/widgets/kids/ech_sibshops_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=C8D01B6D9C8D1E2BC90B6FA8B695B5B2" alt="ECH_sibshops_widget" width="100" height="65" DisableNVelocity="true" />Sibshops: Chip Shots, pizza and a movie1/14/2025 12:00 AM<img src="/-/media/ech-media/images/widgets/kids/ech_sibshops_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=788D39D74CBCCCFC7417A4D8C388F844" alt="ECH_sibshops_widget" width="300" height="195" DisableNVelocity="true" />Sibshops is a program for children and teens who have a sibling living with chronic health, mental health or developmental needs. Sibshops events offer therapeutic opportunities for children and teens to connect with peers experiencing similar circumstances. The events are held multiple times throughout the year and are divided into age groups: <ul> <li>6–12 years (school-age).</li> <li>13–18 years (teen edition).</li> <li>Family Event.</li> </ul> Children and teens who participate in Sibshops have the opportunity to: <ul> <li>Explore their experience of having a sibling living with chronic health, mental health or developmental needs.</li> <li>Express how they view their family and their role within it.</li> <li>Relate to and have fun with kids facing similar circumstances.</li> <li>Enhance their awareness of how important they are.</li> <li>Have fun by playing games, doing crafts and engaging in physical activities. </li> </ul> Join us for "Chip Shots, Pizza and a Movie!" on Monday, Feb. 17 The day will begin with drop-off at Chip Shots (3708 North Broadway Avenue, Suite 140, Rochester, Minnesota). It will end with pick-up (time to be determined) following a matinee showing at CMX Chateau Theater (3450 East Circle Drive NE, Rochester, Minnesota.) Registration is required by Saturday, Feb. 1 ($10 per child — scholarships are available). Space is limited, so register soon. For more information about Sibshops or the upcoming event, email <a href="mailto:mailto:mayosibshop@mayo.edu" title="Opens in new window">mayosibshop@mayo.edu</a>.Primary Care in Rochester and KassonSibshops February 2025Primary Care in Rochester and KassonFrom infants to seniors, brain injuries can happen throughout our lives. <img src="/-/media/ech-media/images/widgets/kids/ech_braininjuryagelimit_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=7AAED48FD061BBBE51C375589C362332" alt="ECH_concussionAgeLimit_widget" width="100" height="65" DisableNVelocity="true" />There's no age limit for brain injuries3/13/2025 4:30 AM<img src="/-/media/ech-media/images/widgets/kids/ech_braininjuryagelimit_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=7926C763FFCA4643FFFE294C04BC47AD" alt="ECH_concussionAgeLimit_widget" width="300" height="195" DisableNVelocity="true" />The skull is a sturdy shell protecting the delicate brain inside from harm. But almost from the time we're born, we put that protective shell through its paces. We fall while learning to walk, tumble from trees and off bicycles, collide with each other during games and sports, bonk our heads on low doorways, get in vehicle accidents, slip in the tub, and trip on rugs. Brain injuries range in severity from mild concussion to death and fall under the umbrella of traumatic brain injury (TBI). The Centers for Disease Control and Prevention's data showed that in 2019, TBI resulted in over 60,000 deaths nationwide. The leading causes of TBI were: <ul> <li>Falls, primarily among children (age 0-14) and adults (age 65 and older).</li> <li>Being struck by or against an object.</li> <li>Motor vehicle accidents.</li> <li>Self-harm. </li> </ul> While the skull protects the brain, it also floats in fluid, which helps absorb shocks. But any form of blow can rattle the brain inside the skull, causing bruising and even tears that lead to bleeding and swelling. Sometimes, the TBI is so severe that the person loses consciousness and may die. Any part of the brain can be injured, and where that injury occurs can affect cognition, personality, motor control, coordination, ability to plan movements, sensation, critical thinking, decision-making and inhibitions. Injuries toward the front of the brain can affect critical thinking, and vision may be impaired through injuries toward the back. TBIs should be taken seriously, especially if symptoms progress from mild to moderate to severe. If you or a loved one is having trouble with memory or orientation with dates and locations, seek urgent care. There can also be delayed complications, so be sure you're not alone after an injury or that someone checks on you regularly. Brain injury can happen throughout our lives, but so does prevention: <ul> <li>Use car seats for infants and children; adults should fasten seat belts.</li> <li>Install "baby gates" at the top of stairs and guards on windows.</li> <li>Wear well-fitting helmets for sports — from skateboarding to horseback riding.</li> <li>Drink alcohol responsibly and abstain when driving motorized vehicles, including boats, ATVs and snowmobiles.</li> <li>Remove clutter and loose rugs, install handrails on both sides of staircases and improve lighting.</li> <li>Remain physically active.</li> <li>Improve lower body strength and balance. </li> </ul> No matter our age, all it takes is one TBI to affect our thinking and functioning. So, if you suspect you've experienced a head injury, go to the Emergency Department, urgent care or see your care team. <a rel="noopener" href="https://www.mayoclinic.org/biographies/stitt-derek-w-m-d/bio-20452943" target="_blank" title="Link opens in a new window">Derek Stitt, M.D.</a>, is a physician specializing in neurology. He is a member of the Division of Education in the Department of Neurology and a general neurologist with primary interests in clinical neurology education and the overlap between neurology and systemic disease.Derek Stitt, M.D.Primary Care in Rochester and KassonBrain InjuryPrimary Care in Rochester and KassonIdentifying delays early can lead to better outcomes. <img src="/-/media/ech-media/images/widgets/kids/ech_childdevelopment_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=350BC8E40A377F55F74E46D8B5F126EB" alt="ECH_ChildDevelopment_widget" width="100" height="65" DisableNVelocity="true" />Pay attention to your child's development3/20/2025 4:30 AM<img src="/-/media/ech-media/images/widgets/kids/ech_childdevelopment_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=BEBE368DB0B402A56E95B3D7712AD667" alt="ECH_ChildDevelopment_widget" width="300" height="195" DisableNVelocity="true" />No one knows your child as well as you do. Your child's clinician and care team rely on your observations of your child, those from your family and anyone who cares for your child. While every child develops at their own rate — some leap ahead, some make slow-but-sure progress — there are general milestones your child should reach around certain ages. The Centers for Disease Prevention and Control (CDC) offers <a rel="noopener" href="https://www.cdc.gov/ncbddd/actearly/milestones/" target="_blank" title="Link opens in a new window">checklists</a> for following your child's developmental milestones from 2 months to 5 years old, including 15- and 30-month milestones. This site has tips and resources for how you can help your child learn and grow. Some developmental issues to watch for include: <ul> <li>Speech delay. Children usually say their first word between 12 and 15 months. By 18 months, they should be saying a few words. Your child will rapidly progress in their speech for the next six months.</li> <li>Gross- or fine-motor delays. Walking usually gets underway by 15 to 16 months of age. Your child should also start putting on their clothes and picking up small items.</li> <li>Non-typical behaviors. These can range from throwing long tantrums several times a day and not calming down afterward to being more aggressive or overactive to making unusual body movements like hand flapping or head banging. Typically, these behaviors are daily struggles for parents, not just once in a while.</li> <li>Sensory sensitivities. The issues include being sensitive to sounds (covering their ears when the toilet flushes or the blender runs), clothes/shoes (don't like tags or the feel of certain fabrics) and foods (texture, temperature, etc.). </li> </ul> One of the best things you can do for your child's health and development is to keep your eyes open, be sure to go to all the recommended well-child visits and speak up if you sense something isn't quite right with your child. If there is a problem, the earlier your child's care team is notified, the better the outcomes. They may decide to watch it for a while and document it to see if it persists. Ideally, a diagnosis is made when your child is between 2 and 3 years old. Primary Care in Rochester and Kasson has an Integrated Community Specialties (ICS) clinic especially devoted to helping parents and young children (ages 9 months to 4 years 11 months) address developmental delays. The ICS Development clinic connects you with the appropriate resources and therapies, whether it's speech, physical or occupational therapy, or behavioral training for parents. Depending on the concern, your primary care clinician may refer you to this clinic, where the team will complete an initial assessment to determine if more in-depth examinations are needed. <a href="/providers/jessica-davis-md">Jessica Davis, M.D.</a>, is a general pediatrician in Community Pediatric and Adolescent Medicine. She completed her medical degree at the University of Texas — San Antonio and her residency at the military program in San Antonio. She has a strong interest in caring for children with Autism Spectrum Disorder and developmental delays.Jessica Davis, M.D.Primary Care in Rochester and KassonChild DevelopmentPrimary Care in Rochester and KassonThis simple fluoride coating can be applied at your child's next well-child visit. <img src="/-/media/ech-media/images/widgets/kids/ech_babytooth_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=18F925CF516A7015F7C96331302EAED3" alt="ECH_babytooth_widget" width="100" height="65" DisableNVelocity="true" />Tooth varnish paints a future of healthy smiles3/31/2025 4:30 AM<img src="/-/media/ech-media/images/widgets/kids/ech_babytooth_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=333B6AC8C963222BC4B8F17EA98EA887" alt="ECH_babytooth_widget" width="300" height="195" DisableNVelocity="true" />The next time you bring your child in for a regular well-child visit, your nurse or clinician may ask if you would like your child to receive fluoride treatment. What’s up with that? While fluoride treatment is offered at your child's dental appointments, receiving this treatment during a medical appointment is just one more way to ensure quick and timely cavity prevention. This simple treatment for children 6 months to 5 years old is an easy way to prevent cavities and slow the progress of early cavity formation. Fluoride varnish is applied to teeth every three to six months. The American Dental Association, the American Academy of Pediatric Dentists, the American Academy of Pediatrics, the American Academy of Family Physicians and the U.S. Preventive Services Task Force back it. Here’s what to expect at your well-child visit: <ul> <li>Your child’s electronic health record will alert the clinician that fluoride varnish is due. (Be sure to let us know if you have recently had this done at your dental office.)</li> <li>If you have an infant or toddler, you and the clinician will sit knee-to-knee with your child on your lap between you. You’ll gently hold your child’s arms.</li> <li>The nurse or clinician will dry the child’s teeth with a piece of gauze, then using a little brush, they’ll paint the varnish on all tooth surfaces. That’s it! </li> </ul> Children can eat or drink anything immediately but should hold off on sticky foods for four hours and wait to brush their teeth until the next day. The varnish has a delicious bubblegum flavor and is typically very well tolerated. It is safe for your child. Fluoride varnish is just one step in creating a lifetime of healthy smiles for your child. Here are other important strategies to use: <ul> <li>Brushing. Brush teeth twice a day after the first tooth. For children age 3 and younger, use a toothbrush with a smear of fluoride toothpaste about the size of a grain of rice. After age three, increase the amount of toothpaste to pea-size. Up until about age six, parents will need to help their children with brushing.</li> <li>Healthy eating habits. Encourage eating lots of fruits and veggies, little or no sugary foods or drinks, and less processed food. These same habits will also help prevent obesity.</li> <li>Plenty of water. Water is good for every part of our body, and our teeth are no exception. Fluoridated water is the best because fluoridation helps strengthen teeth. Well water must be tested for fluoride to know if it is good for your teeth. Keep in mind that bottled water is only fluoridated if it's spelled out on the label.</li> <li>Regular dental checkups and care. Take your child to the dentist after the first tooth emerges or by their first birthday. </li> </ul> <a href="/providers/gabriela-kovacikova-md">Ika Kovacikova, M.D.</a>, is a Community Pediatric and Adolescent Medicine physician in Rochester, Minn. She practices primary pediatric care at Mayo Family Clinic Northeast.Ika Kovacikova, M.D.Primary Care in Rochester and KassonFluoride VarnishPrimary Care in Rochester and KassonGetting enough sleep goes beyond helping you feel rested. <img src="/-/media/ech-media/images/widgets/people/ech_sleeping_therapy_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=0251DE10052573B205813B8269CCE3D2" alt="ECH_sleeping_therapy_widget" width="100" height="65" DisableNVelocity="true" />Getting a good night's sleep is good for your health3/10/2025 4:30 AM<img src="/-/media/ech-media/images/widgets/people/ech_sleeping_therapy_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=0E4FA279E891076BADDB4A0E684DFD7A" alt="ECH_sleeping_therapy_widget" width="300" height="195" DisableNVelocity="true" />You toss and turn. Your partner snores. The dog takes up too much of the bed. Events of the day plague your dreams. You wake up groggy and dull, hoping a cup of coffee will jump-start your system. A poor night's sleep may make your day sluggish, but a poor sleep pattern can affect your health. Why is sleep so important? People spend one-third of their lives sleeping, restoring their bodies and mind to function well during the day. The amount of sleep people get is just as significant as the quality. While the quantity of sleep needed to feel rested and function well during the day varies from person to person, the <a rel="noopener" href="https://aasm.org/" target="_blank" title="Link opens in a new window">American Academy of Sleep Medicine</a> recommends a minimum of seven hours for adults. Less than five hours of sleep per night has been associated with higher mortality, cancer risks and adverse effects on heart health. What does a typical night's sleep look like from a scientific standpoint? Sleep comprises alternating rapid eye movement (REM) and non-REM sleep cycles. Each cycle lasts about 90 minutes. As the night progresses, the amount of REM increases. This is when people experience vivid dreaming, accounting for about 20%–25% of total sleep. Experts don't know precisely why REM sleep is essential, but they theorize that during REM sleep, people learn or unlearn information gathered during the day. Think of it as the brain creating new work files and deleting unnecessary ones. So, how do people improve the quality of their sleep? They start by prioritizing sleep and creating an environment and schedule conducive to sleep. Try these techniques if you have difficulties sleeping: <ul> <li>Try to keep the same schedule every day, particularly waking up at the same time, even on weekends and on vacation. If you have trouble falling asleep, delay bedtime until you feel drowsy.</li> <li>Try not to spend more than eight hours per day in bed.</li> <li>Make sure where you sleep is dark, quiet, and not too hot or too cold. Wear comfortable clothing.</li> <li>Work regular physical activity into your day but refrain from exercising four to six hours before bedtime.</li> <li>Limit caffeine to two servings daily and drink those before noon.</li> <li>Avoid electronics, screens or anything mentally stimulating, like an exciting movie or book, before bedtime.</li> <li>Save your bed and bedroom for sleeping and sexual activity</li> <li> Limit napping to 30 minutes a day, ideally before early afternoon. </li> </ul> On those nights when you have difficulty falling or staying asleep, don't watch the clock. If you're not feeling sleepy or can't get back to sleep, after about 15 to 20 minutes, get up and do something boring, like reading a dull book. If you've fallen into a pattern of poor sleep, one of these conditions may be the culprit: <ul> <li>Insomnia, where you cannot fall asleep or stay asleep.</li> <li>Restless legs syndrome, where your legs feel fidgety or twitchy.</li> <li>Sleep apnea is when you stop breathing and wake up gasping and choking. </li> </ul> These conditions — or just feeling like you're not getting sufficient sleep — may indicate the need for a sleep consultation and treatment. As researchers learn more about sleep disorders, new therapies are being developed, such as insomnia medications, implantable devices for sleep apnea and different medications for restless legs syndrome. People function better and lead healthier lives when they're well-rested. If you're concerned about the quality of your sleep, contact your care team. <a rel="noopener" href="https://www.mayoclinic.org/biographies/mansukhani-meghna-p-m-d/bio-20199994" target="_blank" title="Link opens in a new window">Meghna Mansukhani, M.D.</a>, is a Pulmonary Medicine and Family Medicine physician. She is the former co-director of the Center for Sleep Medicine, director of the Sleep Medicine Fellowship Program at Mayo Clinic in Rochester and regional chair of research and innovation for Mayo Clinic Health System in Southwest Minnesota. She is the director of Academic Advancement and Promotions for Midwest Family Medicine at Mayo Clinic. Dr. Mansukhani has also recently was president of the Minnesota Sleep Society and chair of the American Academy of Sleep Medicine's Education Committee.Meghna Mansukhani, M.D.Primary Care in Rochester and KassonGood SleepPrimary Care in Rochester and KassonQuestions and answers to increase knowledge and awareness of multiple sclerosis. <img src="/-/media/ech-media/images/widgets/randomimages/ech_ms_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=C2645E41CB8B9E35DF56001F71173779" alt="ECH_MS_widget" width="100" height="65" DisableNVelocity="true" />What you need to know about multiple sclerosis3/3/2025 4:30 AM<img src="/-/media/ech-media/images/widgets/randomimages/ech_ms_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=07B7CE6DA9471DC74FD3FD3FDAE9CEFE" alt="ECH_MS_widget" width="300" height="195" DisableNVelocity="true" />You may have been asked to sponsor someone in an MS bike or walk event, or maybe a colleague has multiple sclerosis (MS). But how much do you know about this chronic disease? Check out these FAQs. What is MS? MS is an unpredictable, often disabling disease of the central nervous system that disrupts the flow of information within the brain and between the brain and body. This chronic autoimmune disorder is most often marked by periods of relapse and remission or symptom-free periods. Rarely, it could be a steady progression of disability. People with MS may have difficulty with walking, vision and concentration problems. Who gets MS? It's more common in females than males; 2 to 3 times the number of females than males get the disease. The average age of diagnosis ranges from 28-31, but the disease can appear at almost any age. MS is most common in northern parts of the world. About 400,000 people in the U.S. live with MS, and 10,000 new cases are diagnosed each year. What causes MS? While it's not entirely understood why MS happens, current research indicates that many factors may cause it. People who have MS seem to have a dysfunction in their immune system and may have been exposed to certain environmental factors in common. A great deal of research is looking at genetic factors and viral factors related to MS. When should I see a healthcare professional? If you have any of these symptoms or other concerns, make an appointment with your primary care clinician: <ul> <li>Blurred or double vision, pain with eye movements, inability to see color when you could previously.</li> <li>Numbness, tingling or inability to move part of your body.</li> <li>Difficulty walking or a change in the way you walk.</li> <li>Bladder dysfunction, not being able to control your bladder.</li> <li>Electrical sensation when flexing your neck (moving your chin to your chest). </li> </ul> What will my healthcare professional do? Your clinician will want to discuss your symptoms, including when they occur, how long they've been happening and what makes them worse or better. You'll probably undergo simple tests in the office to look at your nerve function. If your clinician has concerns about your nerve function, you may be asked to have an MRI, see a neurologist or both. If your clinician has concerns about your vision, you may be referred to an eye doctor for a complete exam. Amanda Lee, APRN, C.N.P., D.N.P., is a nurse practitioner in Primary Care in Rochester and Kasson at Mayo Family Clinic Northwest. She enjoys caring for patients of all ages, focusing on preventive care and chronic disease management.Amanda Lee, APRN, C.N.P., D.N.P.Primary Care in Rochester and KassonMultiple SclerosisPrimary Care in Rochester and KassonOats are more than just a breakfast staple. Find out how they can boost your health.<img src="/-/media/ech-media/images/widgets/food/oatmeal.jpg?h=65&iar=0&w=100&sc_lang=en&hash=D28AA0420786168CC5C3D9F8B6E475D6" alt="Oatmeal" width="100" height="65" DisableNVelocity="true" />Power up your day with oats3/6/2025 4:30 AM<img src="/-/media/ech-media/images/widgets/food/oatmeal.jpg?h=205&iar=0&w=315&sc_lang=en&hash=9094FCE4E11619C92C3C97ECBD1BD1AC" alt="Oatmeal" width="315" height="205" DisableNVelocity="true" />Have you ever wondered how such a simple grain can boost your health? Oats are more than just a breakfast staple — they are also filling and a nutritional powerhouse. In 1997, oats became the first food to earn an approved health claim from the Federal Drug Administration, highlighting their role in lowering cholesterol and supporting heart health. Why you need oats in your life Oats are rich in beta-glucan, a soluble fiber that forms a thick, satisfying texture when cooked. This fiber is a game-changer for your health: <ul> <li>Feel fuller longer. Oats keep you satisfied, reducing your appetite and aiding in weight management.</li> <li>Heart health hero. Oats lower both total and bad cholesterol levels for heart health.</li> <li>Gut-friendly goodness. Oats feed beneficial gut bacteria for a healthy microbiome.</li> <li>Blood sugar balance. Oats slow sugar spikes after meals for steady energy. </li> </ul> And there's more — oats are packed with vitamins and minerals (including vitamin E, thiamin, zinc and manganese) and antioxidant and anti-inflammatory phytonutrients. What is the nutritional value of one-half cup of dry rolled oats? <ul> <li>Calories: 150.</li> <li>Fat: 3 grams.</li> <li>Carbohydrates: 27 grams.</li> <li>Fiber: 4 grams.</li> <li>Protein: 5 grams. </li> </ul> Low in calories and a good source of fiber, they are the perfect way to fuel your body at any time. But not all oats are created equal. The less processed they are, the longer they take to digest, leading to a slower rise in blood sugar, which helps maintain a better blood sugar balance. There are many types of oats. Which is better for you? <ul> <li>Steel-cut oats: minimally processed and loaded with fiber.</li> <li>Rolled oats: steamed and flattened for a balance of nutrition and convenience.</li> <li>Quick-cooking oats: thinner for faster prep but slightly less fiber.</li> <li>Instant oats: more processed but still a good fiber source. Check for brands without added sugar or additives that influence sodium content. </li> </ul> Simple and tasty ways to enjoy oats Oats are quick, versatile and perfect for any time of day. Here are a few ideas to get you started: <ul> <li>Breakfast oat bowl. Add a pop of flavor by topping oatmeal with fresh berries, creamy yogurt and almond butter.</li> <li>Oat pancakes. Blend one-quarter cup of oats with eggs and a banana for a fluffy, protein-packed pancake.</li> <li>Oat smoothies. Combine one-half cup of oats with mango, banana and pineapple for a creamy, nutrient-rich drink.</li> <li>Berry-oatmeal bake. Layer oats with almonds, a fruit cobbler and yogurt for a cozy, delicious treat. </li> </ul> Overall, oats offer many health benefits and endless culinary possibilities. You can try this <a rel="noopener" href="https://www.mayoclinic.org/healthy-lifestyle/recipes/overnight-refrigerator-oatmeal/rcp-20197730" target="_blank" title="Opens in new browser window">Overnight refrigerator oatmeal</a> recipe from Mayo Clinic for adding oats in a delicious way. Aya Elmir is a dietetic intern at Mayo Clinic in Rochester, Minnesota. She earned her master’s degree at the University of Wisconsin—Stout and her bachelor’s degree overseas at Beirut Arab University. She is dedicated to clinical nutrition and nutrition support.Aya ElmirPrimary Care in Rochester and KassonOatmeal BenefitsPrimary Care in Rochester and KassonThis new two-way texting is just the beginning of how Mayo Clinic will use two-way texting to connect with patients. <img src="/-/media/ech-media/images/widgets/people/mancellphoneholdingdog.jpg?h=65&iar=0&w=100&sc_lang=en&hash=CB6B2E36F17AF0880ADF415789732AF7" alt="ManCellPhoneHoldingDog" width="100" height="65" DisableNVelocity="true" />Quickly accept appointments using two-way text2/4/2025 10:00 AM<img src="/-/media/ech-media/images/widgets/people/mancellphoneholdingdog.jpg?h=205&iar=0&w=315&sc_lang=en&hash=02F079091B80B3B6961C3B84CBA3A9ED" alt="ManCellPhoneHoldingDog" width="315" height="205" DisableNVelocity="true" />Have you ever received an email or text from Mayo Clinic letting you know that an appointment is available to schedule? You might have received this message if you’ve been added to a department's appointment waitlist and an appointment is now available. When you receive this notification, you click a link to log in to the Patient Portal to find out the time and date of the appointment and you can then determine if you want to schedule that appointment. A better way: Two-way texts If you currently receive texts from the Patient Portal, you'll receive a new kind of text for appointment offers: two-way texts. These texts, coming from a new number, 62016, will share a new appointment date and time option. You can then reply directly to the text to accept or decline the offer. The texts will look like these texts, depending on the type of appointment offer: <img alt="TwoWayText" style="height:503px; width:622px; align:center;" src="/-/media/ech-media/images/twowaytext.png?h=503&w=622&sc_lang=en&hash=A5E78A838616E50F96FF287116DFC563"> If you reply with "1," and you’re the first patient to do so, you'll be scheduled for the new time and receive a text confirming the appointment. If the appointment time is no longer available when you reply, you'll receive a text sharing that information. In some cases, you can also choose to be removed from the wait list if you don't want to receive other texts about earlier appointment offers for that specific, scheduled appointment. Two-way texting is easy. You don't have to log in to the Patient Portal to schedule or reschedule. You only need to respond to the text. Currently, these texts are sent in either English or Spanish, depending on your preferred language. More languages are being considered for the future. Updating communication preferences If you haven't opted in for text messages, desk and registration staff can help you update your preference. You can also choose to opt-in by going to the Communication Preferences in the Patient Portal on the web or in the Mayo Clinic app: <ul> <li>Log in to the Patient Portal.</li> <li>Select the down arrow button next to the word "Account" in the upper right corner. </li> <li>Select "Account Settings."</li> <li>Select "Notification Settings" to open the Communication Preferences page. </li> </ul> You can select your preferred messaging types (text, email, phone, mail) for different notifications. If you have access to other Patient Portal accounts, such as your child's account, you'll need to update communication preferences for those patients by switching to that account. It's also important to know that texting STOP will prevent you from receiving all texts from Mayo, not just these appointment offers. The future of patient texting This new two-way texting is just the beginning of how Mayo Clinic will use two-way texting to connect with patients. Watch for more information.Primary Care in Rochester and KassonPatient Portal TwoWay TextPrimary Care in Rochester and KassonEveryday items can be poisonous to kids. Follow these tips to keep them safe. <img src="/-/media/ech-media/images/widgets/kids/ech_poisonprevention_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=0728E062386AC71F1B7813BEE3B560F7" alt="ECH_PoisonPrevention_widget" width="100" height="65" DisableNVelocity="true" />Pills, plants, pods: Know the potential poisons in your home3/24/2025 4:30 AM<img src="/-/media/ech-media/images/widgets/kids/ech_poisonprevention_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=DFE9F63DF114451946BD0BFA84F1129B" alt="ECH_PoisonPrevention_widget" width="300" height="195" DisableNVelocity="true" />Every day, more than 300 children, from infants to teens, are treated in U.S. emergency departments for accidental poisoning; of those, two will die. Curious kids will often investigate — and sometimes try to eat or drink — anything they can get into. It's not just chemicals marked with clear warning labels that are dangerous. Everyday items in your home, such as household cleaners and medicines, can be poisonous. Others that pose a danger include: <ul> <li>E-cigarettes.</li> <li>Liquid nicotine.</li> <li>Hand sanitizer (alcohol poisoning).</li> <li>Laundry detergent packets (pods).</li> <li>CBD products, including gummy bears and other edibles.</li> <li>Chewable gummy vitamin.</li> <li>Indoor and outdoor plants.</li> <li>Mouthwash.</li> <li>Cosmetics.</li> <li>Skin lighteners.</li> <li>Hair treatments, perms and dyes.</li> <li>Alcoholic "pods" (whisky in a clear, seaweed pod).</li> <li>Alcoholic beverages, including hard ciders, sodas and seltzers.</li> <li>Batteries, particularly the button type. </li> </ul> But it's not hard to poison-proof your home. <ul> <li>Lock poisonous items up and away. Keep medicines and products such as cleaning solutions and detergent pods in their original packaging. Store them where kids can't reach or see them. Use child-proof locks on cupboards and medicine cabinets.</li> <li>Read labels carefully. Follow directions and read all the warnings when giving medications to children to avoid giving them too much or the wrong medication.</li> <li>Don't keep it if you don't need it. Take household chemicals to the local hazardous waste disposal points and drop off unused medications at drop boxes maintained by local law enforcement or at the National Drug Take-Back event. You can also dispose of medicines by mixing them with coffee grounds or kitty litter and tossing them in the garbage.</li> <li>Know the number: <a rel="noopener" href="tel:8002221222" target="_blank" title="Opens in new browser window">1-800-222-1222</a>. Keep the National Poison Control Center's number by phones throughout your house or programmed into your cellphone and other devices. The center is open 24/7. Call them if you suspect your child has been poisoned and they're awake and alert. If your child has collapsed or isn't breathing, call 911. For more information, visit the <a rel="noopener" href="https://www.poison.org/" target="_blank" title="Opens in new browser window">Poison Control Center's website</a>. </li> </ul> <a href="/providers/nusheen-ameenuddin-md">Nusheen Ameenuddin, M.D.</a>, is a pediatrician in Community Pediatric and Adolescent Medicine. She has a strong interest in child advocacy and the effects of media on children. She previously was chair of the American Academy of Pediatrics Council on Communications and Media and the board of the Minnesota chapter of the AAP. She holds a master's in public health and a master's in public administration.Nusheen Ameenuddin, M.D.Primary Care in Rochester and KassonPoison PreventionPrimary Care in Rochester and KassonThe link between rheumatoid arthritis and heart disease is complex, but you can help reduce the risk. <img src="/-/media/ech-media/images/widgets/arthritis/ech_arthritis_01_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=89C46154796C016557E5A29B77E2FD95" alt="ECH_Arthritis_01_widget" width="100" height="65" DisableNVelocity="true" />4 things to know about RA and heart disease3/27/2025 4:30 AM<img src="/-/media/ech-media/images/widgets/arthritis/ech_arthritis_01_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=66F1FDDFC15F9888ADCE0F63FB0273E9" alt="ECH_Arthritis_01_widget" width="300" height="195" DisableNVelocity="true" />Most people know that rheumatoid arthritis (RA) affects the joints, causing swelling and pain. However, it also affects multiple organ systems. Before new medications were introduced in the 1980s and '90s, RA often progressed rapidly and resulted in early deaths for many who had the disease. Modern drugs have greatly improved both the quality of life and survival for people with RA, but it continues to be a significant threat to their health. Research has found that one of the most important areas of added risk is cardiovascular disease. Here are four things those with RA should know about this complex link between the condition and heart disease: <ol> <li>Inflammation. RA increases the risk of coronary artery disease, which can cause heart attacks. This probably is due to the overall higher level of inflammation caused by RA. Inflammation increases the chance of developing plaques in the arteries supplying blood to the heart. </li> <li>Less exercise. Most with RA exercise less due to joint pain. Regular exercise is essential for preventing coronary artery disease and heart attacks. Less exercise can contribute to a higher risk for these health issues. </li> <li>Steroid use. To control their disease, many with RA require frequent or long-term use of glucocorticoids (steroids). While steroids usually are not associated with more risk for heart disease, chronic use by those with RA does seem to increase the risk. The reason is not understood and is still being researched. </li> <li>Other pain relievers. Many with RA also tend to use NSAIDS and (cox)-2 inhibitors, such as Motrin and Celebrex, to control their pain. These medications have been shown to increase the risk of heart attack for all patients when used frequently or in high doses. The risk is somewhat higher for people with RA because they are more likely to use these drugs. </li> </ol> People with RA should work with their clinicians to reduce their risk of cardiovascular disease as much as possible. These strategies have been shown to help: <ul> <li>Stop smoking! There are many ways available to help people stop smoking, including nicotine replacement, counseling and inpatient treatment.</li> <li>Eat healthy foods. Those with RA should eat a healthy diet low in fat and rich in fruits and vegetables. If their cholesterol is above normal, they should discuss medications to control it with their clinician.</li> <li>Set treatment goals. While it may be possible for many to eliminate the use of NSAIDs and steroids, they should work with their clinician to set goals for minimizing their use yet still controlling pain and improving mobility.</li> <li>Exercise more. Many studies show that regular activity, whether walking, swimming or just working around the house, reduces the overall fatigue and pain caused by RA. As little as 30 minutes per day of light to moderate activity (walking, housework) has the added benefit of reducing the risk of heart disease and death from all causes. </li> </ul> <a href="/providers/elliot-bruhl-md">Elliot Bruhl, M.D.</a>, is a family medicine physician who provides primary care to patients at the Baldwin building.Elliot Bruhl, M.D.Primary Care in Rochester and KassonRA Heart DiseasePrimary Care in Rochester and KassonLearn about the benefits of choline.<img src="/-/media/ech-media/images/widgets/food/avocadodeviledeggs.jpg?h=65&iar=0&w=100&sc_lang=en&hash=6BFF61E8FE225BD48AE4E03133C88F01" alt="AvocadoDeviledEggs" width="100" height="65" DisableNVelocity="true" />'Can-Do' Choline4/7/2025 4:00 AM<img src="/-/media/ech-media/images/widgets/food/avocadodeviledeggs.jpg?h=205&iar=0&w=315&sc_lang=en&hash=21DC8B307D641E2F189171F0AFE5D626" alt="AvocadoDeviledEggs" width="315" height="205" DisableNVelocity="true" />What is choline? On social media, people commonly associate choline as being beneficial during pregnancy and for people with ADHD due to its cognitive health benefits. Research shows that this nutrient plays a role in memory, mood, and how our muscles and nervous system work by producing certain neurotransmitters. Choline is essential for forming and repairing cell membranes, fat metabolism and early brain development. This nutrient does all this by turning genes into proteins to allow for cell regeneration and growth. The overall recommended adequate intake for choline varies by age and gender: <ul> <li>Birth-1 year: 125-150 mg/day.</li> <li>1-8 years old: 200-250 mg/day.</li> <li>9-18 years old: 375-550 mg/day.</li> <li>Adults: 425-550 mg/day.</li> </ul> The primary sources of choline are animal-based products such as meat, poultry, fish, dairy and eggs. Cruciferous vegetables, or those characterized by the four-petaled flowers, such as broccoli and cauliflower, and some beans, such as soybeans, kidney and lima beans, are also a rich source. Other sources include nuts, seeds and whole grains. These foods are reliable sources of choline: <ul> <li>Hard-boiled egg (1 large): 147 mg/day or 27% of daily value. Eat by themselves or add to a wrap or salad.</li> <li>Braised beef top round (3 oz): 117 mg/day or 21% of daily value. This food could serve as a main course.</li> <li>Shiitake mushrooms (1 cup cooked): 116 mg or 21% of daily value. These make a great side dish or an easy vegetable addition to any dish.</li> <li>Chicken breast (3 oz): 72 mg/day or 13% of daily value. Baked or grilled, it’s a classic.</li> <li>Cauliflower (1 cup cooked): 72 mg or 13% of daily value. This vegetable is tasty when served raw or roasted in the oven. </li> </ul> Most people do not get the recommended amount of choline every day. The average intake tends to be about 256 mg for children and teens and 278-402 mg for adults. To reach your daily intake, include choline-rich sources like those mentioned above. Here are a few recipes from Mayo Clinic that include choline-rich foods: <ul> <li><a rel="noopener" href="https://www.mayoclinic.org/healthy-lifestyle/recipes/chicken-salad-with-thai-flavors/rcp-20049869" target="_blank" title="Link opens in a new window">Chicken salad with Thai flavors</a>.</li> <li><a rel="noopener" href="https://www.mayoclinic.org/healthy-lifestyle/recipes/6-grain-hot-cereal/rcp-20197750" target="_blank" title="Link opens in a new window">6-grain hot cereal</a>.</li> <li><a rel="noopener" href="https://www.mayoclinic.org/healthy-lifestyle/recipes/avocado-deviled-eggs/rcp-20125131" target="_blank" title="Link opens in a new window">Avocado deviled eggs</a>. </li> </ul> Melissa Gess is a dietetic intern at Mayo Clinic in Rochester. She received her Bachelor of Science in Dietetics and Master of Science in Nutrition and Dietetics from the University of Wisconsin-Stout. She is exploring clinical nutrition and is interested in pediatrics, WIC and diabetes education.Melissa GessPrimary Care in Rochester and KassonCholine BenefitsPrimary Care in Rochester and KassonFind activities and events in Southeast Minnesota Parks.<img src="/-/media/ech-media/images/widgets/activities/morelwhitewater.jpg?h=65&iar=0&w=100&sc_lang=en&hash=1D2A5BE0572CF7CE5D5C180DDB7D3C41" alt="MorelWhitewater" width="100" height="65" DisableNVelocity="true" />Exploring the outdoors4/3/2025 4:00 AM<img src="/-/media/ech-media/images/widgets/activities/morelwhitewater.jpg?h=205&iar=0&w=315&sc_lang=en&hash=4170503DAAA26FB0CB5ACE36F8771B49" alt="MorelWhitewater" width="315" height="205" DisableNVelocity="true" />As the days grow longer and nature awakens from its winter slumber, spring is the perfect time to embrace the outdoors. Olmsted County Parks, the City of Rochester and Project Get Outdoors offer a diverse lineup of activities to connect people with nature, promote wellness and encourage community engagement. From birdwatching to hands-on environmental education, there's something for everyone to enjoy this season. These activities provide opportunities for relaxation, learning and community building. We hope those who attend can foster a deeper appreciation for nature and well-being. Exciting programs at Oxbow Park & Zollman Zoo Located in Byron, Minnesota, Oxbow Park & Zollman Zoo offers interactive and educational programs that bring visitors closer to wildlife and the natural world. <ul> <li>Animal Feeding Time (April 6, 10:30 a.m.): Watch the zoo's residents enjoy their meals during National Zoo Lovers Day celebrations.</li> <li>Nature Art & Craft Show (April 12, 10 a.m. to 4 p.m.): Support local artists by browsing nature-inspired artwork and crafts, perfect for finding one-of-a-kind gifts or personal treasures.</li> <li>Turkey Calling Adventure (April 26, 11 a.m.): Experience the iconic spring turkey gobble during a guided walk through the forest and learn about turkey behavior.</li> <li>Homeschool classes (Thursday, June 5, and Wednesday, August 6, at 10 a.m. — Feed the Bear; Thursday, July 17. at 11 a.m. — Life cycles): Oxbow Park offers Naturalist Programs reserved for homeschool families. The fee is $5 per student, 3 years and older (parents and children 2 and under are free). Call <a rel="noopener" href="tel:5073287340" target="_blank" title="Link opens in a new window">507-328-7340</a> to sign up.</li> </ul> Discover Chester Woods Park Chester Woods Park offers a variety of exciting programs during April and May that will engage families and outdoor enthusiasts alike. <ul> <li>ZVAS Woodcock Hike (April 10, 7 p.m.): Experience the fascinating courtship display of the Woodcock at Chester Woods County Park, one of nature's most captivating springtime rituals.</li> <li>RAVA Volunteer Fair (April 16, 9:30 a.m. to 1:30 p.m.): Explore volunteer opportunities with the Rochester Area Volunteer Alliance at 125 Live. Whether you're interested in environmental stewardship or community outreach, there's a role for everyone.</li> <li>Spring Cleanup Day (April 26, 9 a.m. to noon): Join Friends of Chester Woods to prepare the park for the season. This event is a wonderful way to give back to the community and help maintain the park's beauty.</li> <li>ZVAS Bird Walk at Root River Park (April 27, 9 a.m.): Join an expert naturalist on a walk through Root River Park to explore local wildlife and early spring wildflowers. It is a fantastic opportunity for beginner birdwatchers.</li> <li>ZVAS Big Birding Day (May 10, 8 a.m.): Experience peak spring migration at Chester Woods Park, one of the best times of year for birdwatching in Southeast Minnesota.</li> <li>Beach & Watercraft Rentals Open (May 23, 10 a.m.): Celebrate the official start of summer with a relaxing day by the water. Rentals for kayaks, canoes and paddleboards will be available so you can enjoy the park's beautiful lake. </li> </ul> Rochester Recreation Programs: Stay Active The City of Rochester invites you to stay active by offering various recreational programs designed to keep you active and engaged — including tennis, hockey and the AccessABLE Recreation program, which supports people with intellectual disabilities. For more details, visit <a rel="noopener" href="https://www.rochestermn.gov/departments/parks-and-recreation/leagues-classes-accessable-recreation/youth-activities-classes/summer-activities" target="_blank" title="Link opens in a new window">Rochester Summer Activities</a>. Project Get Outdoors Project Get Outdoors provides enriching outdoor experiences for families and children, connecting them to nature through storytelling, hands-on activities and exploration. <ul> <li>Nature in the Neighborhood (Wabasha Public Library) <ul> <li>May 2 — Morel Mushroom Field Trip, 10 a.m. to noon.</li> </ul> </li> <li>Nature Explorers (Lake City Public Library & Frontenac State Park) <ul> <li>May 6: Dragonflies, 10 to 11 a.m.</li> <li>May 28: Baby Animals, 10 to 11 a.m.</li> </ul> </li> <li>Childcare Provider Training & Wellbeing Development <ul> <li>May 8: La Crescent Training Event, 6 to 8 p.m. </li> </ul> </li> </ul> Making parks accessible to all Olmsted County Parks is committed to making outdoor experiences accessible for everyone. To support this effort, the parks offer: <ul> <li>Action Trackchairs for enhanced mobility assistance.</li> <li>Sensory-friendly kits for people with sensitivities.</li> <li>ASL interpretation and audio support for select programs. </li> </ul> For accessibility requests, please get in touch with <a rel="noopener" target="_blank" title="Link opens in a new window">oxbow@olmstedcounty.gov</a> or call <a rel="noopener" href="tel:5073287340" target="_blank" title="Link opens in a new window">507-328-7340</a> at least two days in advance (two weeks for ASL interpretation). Additional activities in Southeast Minnesota parks If you're looking for even more ways to connect with nature, check out these exciting events in Southeast Minnesota parks this spring: <ul> <li><a rel="noopener" href="https://www.dnr.state.mn.us/state_parks/event.html?id=80842" target="_blank" title="Link opens in a new window">BARK Ranger Walk at Forestville/Mystery Cave State Park</a> (May 24, 10 to 11 a.m.): Bring your leashed canine companion for a ranger-guided walk through the park.</li> <li><a rel="noopener" href="https://www.minnesotaflyfishing.com/" target="_blank" title="Link opens in a new window">Free Fly Fishing 101 Beginner Classes:</a> These classes begin April 5 and are every other Saturday during the season.</li> <li><a rel="noopener" href="https://www.dnr.state.mn.us/fishing/trout/index.html" target="_blank" title="Link opens in a new window">Minnesota Trout Streams Opener</a>: (April 15): Celebrate the opening of the trout fishing season in Minnesota's beautiful, scenic streams.</li> <li><a rel="noopener" href="https://www.sembabluegrass.com/" target="_blank" title="Link opens in a new window">Southeast Minnesota Bluegrass Association May Festival</a> (May 16-18, Houston, Minnesota): Enjoy a weekend full of bluegrass music at this annual festival held at a scenic campsite connected to the Root River State Trail. The event features live performances from regional and national bluegrass artists, hands-on workshops, and open jam sessions where musicians of all skill levels can join in. Whether you're an avid bluegrass fan or just looking for a fun outdoor experience, this festival is a wonderful way to enjoy music and nature in a beautiful setting. </li> </ul> Step outside and get involved! With so many ways to explore, learn and be involved with nature, this spring promises a season of memorable outdoor experiences for all ages. Whether you're planting a garden, spotting birds or attending an educational workshop, now is the perfect time to embrace the beauty of Olmsted County's parks. Muse Abdi, M.B.B.S., B.BiomedSc, M.P.H., has a background in medicine and leads nature-based health initiatives, including Park Rx/Exercise is Medicine, Healing Forest, and the cultural liaison program in the parks under the Statewide Health Improvement Partnership (SHIP) grant. He facilitates the SE Minnesota Park Rx Coalition, a key component of the Park Initiative. He also leads health equity and community engagement efforts through SHIP, including the MOVE (Mobilizing Olmsted Voices for Equity) project. Expertise: Nature-Based Health Promotion, Healthcare Integration, Health Equity & Equity-Focused Programs, Cross-Cultural Communication & Community Engagement, Program Development& Evaluation, Organizational Health Literacy, Cultural Competency, Policy, Systems and Environmental Change. <a href="/providers/brian-lynch-md">Brian A. Lynch, M.D.</a>, is a primary care pediatrician at Mayo Family Clinic Northwest in Rochester. He co-chairs the Primary Care Work Group of the Mayo Clinic Obesity Council and chairs the Primary Care Obesity Task Force. Dr. Lynch works closely with the Southeast Minnesota Park Rx Team to promote the physical and mental health benefits of spending time in nature with his patients and colleagues.Muse Abdi, M.B.B.S., B.BiomedSc, M.P.H., and Brian A. Lynch, M.D.Primary Care in Rochester and KassonParkRx Summer 2025Primary Care in Rochester and KassonAdults seeking care for an attention problem should visit their primary care clinician.<img src="/-/media/ech-media/images/widgets/people/adultadhd.jpg?h=65&iar=0&w=100&sc_lang=en&hash=CB4A2C9E0D6C1AF2DF8886457867497F" alt="AdultADHD" width="100" height="65" DisableNVelocity="true" />Do I have ADHD?4/21/2025 4:30 AM<img src="/-/media/ech-media/images/widgets/people/adultadhd.jpg?h=205&iar=0&w=315&sc_lang=en&hash=FFFCFFEB226039744D27BD8301F7EBC5" alt="AdultADHD" width="315" height="205" DisableNVelocity="true" />In recent years, TikTok and other social media sites have made it seem like an epidemic of inattention has crashed upon us. Changes in how we work — often meeting online rather than face-to-face — can make concentrating hard. At the same time, a historical pattern of attention-deficit/hyperactivity disorder, or ADHD, going unnoticed in females is being rectified. Both trends have increased identification rates in the last few years. Diagnosing ADHD in an adult involves more than feeling like you're experiencing those symptoms described online since there's a big difference between being sometimes frustrated by symptoms of distraction or forgetfulness on the one hand and being "impaired" on the other. When you have more trouble deciding on and accomplishing a course of action than the average person in your situation might, and that trouble is present in every aspect of your life, that's when you might be identified as having an impairment. By comparison, a student who, for the first time, has trouble concentrating on an advanced chemistry project — a subject that would be difficult for the average person — but who has successfully managed their friendships and work life probably isn't impaired. In that example, it'd just be that their chemistry project is complex. ADHD is defined as a problem that a person is born with. While your ADHD might not have been labeled in childhood, there should have been some signs of it then for it to be diagnosed now. For that reason, diagnosing ADHD among adults often includes interviewing your parents or other adults who knew you before you were 12 years old. It's also true that it's hard to have ‘only' ADHD — instead, ADHD tends to run with other problems. Learning disorders, eating disorders, sleep disorders, intra-family trauma, poverty or tics are often present when a person has ADHD. A good evaluation for inattention seeks to find and address as many of these issues as possible so that all the things that contribute to inattention might be better. Finally, you might be saddled with any number of other conditions that can decrease your focus and could explain your inattention trouble. So, a good ADHD evaluation starts with a medical checkup. You should work with your primary care clinician to discuss depression and anxiety and rule out sleep apnea, iron deficiency, the hormone variation of menopause or other common causes of cognitive change. Your clinician may eliminate medications that make you sluggish. You should also reduce or eliminate your use of alcohol or cannabis, as little as two servings of either of these substances per week can worsen concentration. Making sleep habits predictable is very important; using melatonin to put yourself to sleep or a lightbox to wake up is enough to reduce symptoms of ADHD by 30%. Exercise is an excellent treatment for ADHD, too. After physical activity, you might notice that for 6 to 8 hours, you find it significantly easier to settle yourself for a task that needs concentration. Initiating the above steps may correct many of the issues causing you to be concerned about ADHD. If your symptoms are not improving, schedule a visit with your primary care clinician to discuss the possibility of ADHD. <a href="/providers/robert-wilfahrt-md">Robert Wilfahrt, M.D.</a>, is a physician in the Department of Family Medicine and practices in the Baldwin building in Rochester. His interests include ADHD, psychiatry in primary care, and medical student education.Robert Wilfahrt, M.D.Primary Care in Rochester and KassonADHD AdultPrimary Care in Rochester and KassonAir fryers are replacing oil fryers across the nation. Find out why. <img src="/-/media/ech-media/images/widgets/food/airfyer.jpg?h=65&iar=0&w=100&sc_lang=en&hash=831270B3E6AFF9291BE72ADE760771AF" alt="AirFyer" width="100" height="65" DisableNVelocity="true" />Is hot air the new hot oil?5/5/2025 4:30 AM<img src="/-/media/ech-media/images/widgets/food/airfyer.jpg?h=205&iar=0&w=315&sc_lang=en&hash=14820DD2A6CB79C713EFC4E7187B6D5B" alt="AirFyer" width="315" height="205" DisableNVelocity="true" />Air fryers have become a staple on kitchen counters across America, reducing the amount of cooking oil needed to create that crisp, golden coating on the outside of your foods, while keeping the inside of the food moist. In 2010, the Philips Air Fryer hit the shelves and revolutionized the way we "fry" foods. This cooking appliance relies on a process called Rapid Air Technology that utilizes a heating element and a fan that moves hot air very quickly around the food. You might recognize this method as convection cooking. It requires little to no oil, which greatly reduces fat and calories when compared to traditional deep-frying methods. You might be asking, what's so bad about using oil? We all need healthy fats in our diet, but the calories in even the healthiest of oils, such as olive oil and avocado oil, add up quickly. A little spritz or drizzle goes a long way when cooking in an air fryer. In addition, traditional deep-fried-in-oil foods can be high in trans fats, which can raise LDL cholesterol, increasing your risk of heart disease. With air frying at home, you have the option to choose your oil and how much you use. Ready to dive in? Here are some suggestions to get you started on this hot new way of cooking, as well as a recipe courtesy of the American Heart Association! Foods that lend themselves to air fryer cooking: <ul> <li>Homemade French fries, tater tots or potato wedges.</li> <li>Vegetables, including Brussels sprouts, cauliflower, carrot or kale chips.</li> <li>Coconut shrimp, chicken parmesan, salmon bits and tofu steaks. </li> </ul> Check out this recipe for "<a rel="noopener" href="https://recipes.heart.org/en/recipes/air-fryer-crispy-unfried-chicken" target="_blank" title="Link opens in a new window">Air Fryer Crispy (Un) Fried Chicken</a>" from the American Heart Association. Tamara Soerensen completed her bachelor's degree in biology at the University of California, Santa Barbara and her master's degree in nutrition at Bastyr University. She is a dietetic intern at Mayo Clinic in Rochester, Minnesota. Special interests include digestive health and the utilization of diet for disease prevention.Primary Care in Rochester and KassonAir Fryer CookingPrimary Care in Rochester and KassonThe sports clinic will be open to patients ages 12–18 with a primary care clinician at Mayo Clinic in Rochester or Mayo Family Clinic Kasson. <img src="/-/media/ech-media/images/widgets/activities/sports-collage1.jpg?h=65&iar=0&w=100&sc_lang=en&hash=792F529D182EC20B5DDF38E1A765D3F4" alt="Sports Collage1" width="100" height="65" DisableNVelocity="true" />Primary Care to offer sports checkups for students5/19/2025 4:30 AM<img src="/-/media/ech-media/images/widgets/activities/sports-collage1.jpg?h=205&iar=0&w=315&sc_lang=en&hash=D472586FBB263D4BAC70A38143D26CA1" alt="Sports Collage1" width="315" height="205" DisableNVelocity="true" />Community Pediatric and Adolescent Medicine has scheduled clinics for student-athletes ages 12–18 and entering grades 7–12 who need a physical to participate in school sports. Patients who have had a well-visit examination within the past year may not require another exam. Contact your primary care clinician with questions. The clinics will be held on the afternoon of July 24 and the morning of August 4. The location for both clinics will be the third floor of the Baldwin Building, 221 Fourth Avenue SW, in Rochester, Minnesota. These clinics will be available to adolescent patients who receive their primary care at Mayo Clinic in Rochester or Mayo Family Clinic Kasson. No college sports physicals or camp exams will be conducted. During the visit, the patient will move through a series of stations to complete vision/hearing screenings, immunizations and a physical examination, which meets all requirements of a well-visit examination. Appointments required Appointments are required for these clinics and may be scheduled starting May 12. <ul> <li>Direct schedule through the <a rel="noopener" href="https://onlineservices.mayoclinic.org/content/staticpatient/showpage/patientonline" target="_blank" title="Link opens in a new window">Patient Portal</a>. Parent(s) or guardian(s) can schedule using the proxy setup.</li> <li>Contact the patient's <a href="/contact-us">primary care clinician's appointment office</a> to schedule via phone. </li> </ul> Other requirements <ul> <li>One parent or guardian will be required to accompany the patient. Note that parent(s) or guardian(s) will be separated from patients during parts of the visit.</li> <li>Arrive no more than five minutes before the patient's check-in time.</li> <li>Wear athletic apparel that allows for an examination.</li> <li>Bring prescription eyewear with you to the appointment.</li> <li>Complete page 2, the top of page 3 and page 4 (if applicable) of the <a rel="noopener" href="https://www.mshsl.org/sites/default/files/2025-04/2025-2026-ppe-4-4-25-english.pdf" target="_blank" title="Link opens in a new window">2025-2026 Minnesota State High School League Sports Qualifying Physical Examination Medical Eligibility form</a> and bring these pages with you to the appointment. </li> </ul> Construction news Construction on our downtown campus may affect your arrival and departure. Visit the <a rel="noopener" href="https://www.mayoclinic.org/rochester-construction" target="_blank" title="Link opens in a new window">Rochester construction updates webpage</a> before your appointment to ensure you have adequate time for arrival and parking.Primary Care in Rochester and KassonBaldwin Sports ClinicPrimary Care in Rochester and KassonDefining child abuse is tricky, and the answer is not always clear. <img src="/-/media/ech-media/images/widgets/people/ech_coachingforparents_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=C531041B2C9C077CAAB0B8F5A1443F13" alt="ECH_CoachingForParents_widget" width="100" height="65" DisableNVelocity="true" />What is considered child abuse?4/10/2025 4:30 AM<img src="/-/media/ech-media/images/widgets/people/ech_coachingforparents_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=7992C2736D2A7FE8E6393DD8B439AE77" alt="ECH_CoachingForParents_widget" width="300" height="195" DisableNVelocity="true" />While walking through the grocery aisles, you hear a mother whisper to her child, "You are so annoying; I wish you were never born." Is this abuse? A family from another country moves in next door, and you overhear that the father bathes with his 4-year-old daughter. Is this abuse? Your friend at work describes giving his 18-month-old a "swat on the butt" to stop his tantrums. Is this abuse? Defining child abuse is tricky. Finding the line where suboptimal parenting ends and child abuse begins is not clear-cut. The answer is often "it depends." It depends on how severe and persistent the mother's spurning is, whether the father has any sexual intent, whether any bruises are left on the toddler, and even where the family lives (search the <a rel="noopener" href="https://www.childwelfare.gov/resources/states-territories-tribes/" target="_blank" title="Link opens in a new window">Child Welfare Information Gateway</a> to find child abuse laws in every state). Does this mean the examples above are model parenting as long as they do not break the law? Of course not. It just means that charging and convicting may not be the answer. Mandatory supporting is another way to help families. This method means connecting families with needed resources to support their basic needs as well as their mental and physical health. Look for local community education classes, parenting coaches, parent-child interaction therapy and classes that teach children healthy boundaries and body safety. Attend, recommend and vote to fund these resources every chance you get. If you have a concern that a child you know is being abused or neglected, reach out to your primary care team or county child protection team to discuss the next steps. <a rel="noopener" href="https://www.mayoclinic.org/biographies/johnson-katie-l-m-d/bio-20535878" target="_blank" title="Link opens in a new window">Katie M. Johnson, M.D.</a>, is a child abuse pediatrician at the Mayo Clinic Center for Safe and Healthy Children and Adolescents in Rochester, Minnesota. She has expertise in medical education, serving as an associate program director for the Mayo Clinic Pediatric Residency and hosting a child abuse curriculum that over 70 programs worldwide have requested.Katie M. Johnson, M.D.Primary Care in Rochester and KassonChild AbusePrimary Care in Rochester and KassonLifestyle changes and treatment from your clinician can help with flares. <img src="/-/media/ech-media/images/widgets/medicalimages/ech_gout_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=2847CFBBE54EB6316FAD447D2CCCCA19" alt="ECH_Gout_widget" width="100" height="65" DisableNVelocity="true" />Understanding gout: A guide for patients5/19/2025 4:30 AM<img src="/-/media/ech-media/images/widgets/medicalimages/ech_gout_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=ABA19058C7E4561BE4100CBCA3B74453" alt="ECH_Gout_widget" width="300" height="195" DisableNVelocity="true" />Gout is a type of inflammatory arthritis that causes sudden, severe attacks of pain, swelling and redness in the joints. Most often, it affects the joint at the base of the big toe, but it can also affect other joints. While it can be extremely painful, gout is also manageable with proper treatment and lifestyle changes. What is gout? Gout is caused by a buildup of uric acid in the blood. When uric acid levels become too high, it can form sharp, needle-like crystals in the joints, leading to inflammation and pain. Uric acid is a waste product usually removed by the kidneys through urine. It forms when your body breaks down substances called purines, which are found naturally in your body and certain foods. Who gets gout? Gout can affect anyone, but here are common risk factors: <ul> <li>Increasing age is a risk factor for developing gout. The age of onset varies by sex; for males, the most significant increase in gout incidence occurs during the fourth or fifth decades of life, while in females, it occurs later in the sixth or seventh decades.</li> <li>People with a family history of gout.</li> <li>Individuals who are overweight or have certain health conditions, like high blood pressure, diabetes and kidney disease. </li> </ul> Common triggers and risk factors Some common factors that can raise your risk of developing gout include: <ul> <li>Diet: Eating a lot of red meat, seafood, or foods high in purines.</li> <li>Alcohol: Especially beer and spirits.</li> <li>Sugary drinks: Beverages sweetened with fructose.</li> <li>Certain medications: Diuretics (water pills), aspirin and some immune-suppressing drugs.</li> <li>Dehydration: Not drinking enough water can increase uric acid levels. </li> </ul> Symptoms of gout A gout attack often happens suddenly, sometimes overnight. Symptoms include: <ul> <li>Intense joint pain, most often in the big toe, but also ankles, knees, elbows, wrists and fingers.</li> <li>Swelling and redness.</li> <li>Warmth in the affected joint.</li> <li>Limited movement in the joint. </li> </ul> Attacks usually peak within 24 hours and can last a few days to a week. Diagnosing gout To diagnose gout, your clinician may: <ul> <li>Review your medical history and symptoms.</li> <li>Examine the affected joint.</li> <li>Test your blood for uric acid levels.</li> <li>Take a sample of joint fluid to look for uric acid crystals. </li> </ul> Treatment options Gout treatment focuses on relieving symptoms and preventing future attacks. During an attack <ul> <li>Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen.</li> <li>Colchicine, a medication that reduces gout inflammation.</li> <li>Corticosteroids, either pills or injections.</li> </ul> Long-term management <ul> <li>Urate-lowering medications such as allopurinol or febuxostat.</li> <li>Regular check-ups to monitor uric acid levels.</li> <li>Lifestyle changes to reduce triggers. </li> </ul> Living with gout: Lifestyle tips Managing your diet and lifestyle can make a big difference. Here are some tips: <ul> <li>Stay hydrated and drink plenty of water.</li> <li>Limit purine-rich foods, such as red meat, organ meats and shellfish.</li> <li>Reduce alcohol and sugary drink intake.</li> <li>Eat more low-fat dairy, fruits and vegetables.</li> <li>Maintain a healthy weight.</li> <li>Exercise regularly but avoid stressing painful joints during a flare. </li> </ul> Takeaway While gout can be very painful, it's manageable with the right approach. Understanding your triggers, following your treatment plan and making healthy lifestyle choices can help reduce flares and improve your quality of life. Always work closely with your healthcare clinician to tailor a plan that's right for you. <a href="/providers/jaclyn-houghton-pac">Jaclyn (Jackie) Houghton, P.A.-C.</a>, is a Community Internal Medicine, Geriatrics and Palliative Care physician assistant. She is interested in chronic disease management, and preventive and acute care.Jaclyn (Jackie) Houghton, P.A.-C.Primary Care in Rochester and KassonGoutPrimary Care in Rochester and KassonLearn more about heel pain and when to see your healthcare clinician. <img src="/-/media/ech-media/images/widgets/feet/plantarfasciitis.jpg?h=65&iar=0&w=100&sc_lang=en&hash=EBB3DCEBD08D746B7EB78A5382D49740" alt="PlantarFasciitis" width="100" height="65" DisableNVelocity="true" />Ouch! My heel hurts4/14/2025 4:30 AM<img src="/-/media/ech-media/images/widgets/feet/plantarfasciitis.jpg?h=205&iar=0&w=315&sc_lang=en&hash=9D29F1BC77B11C01F341A4EBE069FF6B" alt="PlantarFasciitis" width="315" height="205" DisableNVelocity="true" />Heel pain is a frequent problem. Often, the diagnosis is made based on the patient's history and physical examination alone. The most common cause of heel pain is plantar fasciitis. This condition affects about 1 in 10 adults. Risk factors include: <ul> <li>Age: most common between 40 and 60 years of age.</li> <li>Gender: more common in women than men.</li> <li>Obesity.</li> <li>Foot mechanics: flat foot or high arch.</li> <li>Occupation: increased time on your feet — especially on hard surfaces. </li> </ul> Symptoms typically include sharp stabbing pain in the bottom of the foot near the heel. It's often the worst with the first few steps after getting out of bed in the morning or after a rest period and may get better after walking around. You often can't see anything when you look at the foot or heel, and plantar fasciitis is typically not associated with an injury. The plantar fascia connects the heel bone to the base of your toes and supports the arch of the foot. It's thought that tension and stress can result in small tears, irritation or inflammation that cause the pain at the fascia insertion into the heel bone. The diagnosis can be made without the need for X-rays or MRI testing. Your healthcare clinician can usually find a tender spot on your heel and make the diagnosis. The primary treatment involves: <ul> <li>Using ice to decrease inflammation multiple times a day.</li> <li>Taking an anti-inflammatory medication such as ibuprofen (be sure to ask your healthcare clinician if it is safe to use these medications).</li> <li>Stretching the plantar fascia.</li> <li>Avoiding activities that increase pain.</li> <li>Sometimes, getting night splints to keep your foot bent to 90 degrees while you sleep. </li> </ul> Be patient; it can take a while for this condition to improve. Rarely, additional treatments need to be considered, including injections, shock wave therapy, ultrasound tissue repair or surgery. <a href="/providers/denise-dupras-md">Denise Dupras, M.D., Ph.D.</a>, is a physician in Primary Care in Rochester and Kasson's Division of Community Internal Medicine, Geriatrics and Palliative Care. She completed her medical and doctoral degrees at Mayo Clinic Alix School of Medicine and her residency in internal medicine at Mayo Clinic in Rochester. Her interests include medical education and evidence-based medicine.Denise Dupras, M.D., Ph.D.Primary Care in Rochester and KassonHeel PainPrimary Care in Rochester and KassonIn recognition of National Infant Immunization Week, make sure your baby's vaccinations are up to date. <img src="/-/media/ech-media/images/widgets/kids/ech_infantimmune_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=3EA26B87E2F260A6A17D4FF18C323A8E" alt="ECH_InfantImmune_widget" width="100" height="65" DisableNVelocity="true" />Protect your infants with up-to-date vaccinations4/22/2025 11:30 AM<img src="/-/media/ech-media/images/widgets/kids/ech_infantimmune_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=C44A6CD0F55569CAC7167DCCDEF4670D" alt="ECH_InfantImmune_widget" width="300" height="195" DisableNVelocity="true" />National Infant Immunization Week is from April 21 to April 28. This week provides a timely opportunity to discuss the importance of vaccines, which help keep our children, families and communities healthy. Giving babies the vaccines they need in their first two years provides effective protection against 15 serious diseases. These diseases include measles, whooping cough, and Hib (which can cause meningitis). Many of these diseases used to be common in the United States but are now rare because of vaccines. Even though we have vaccines, these diseases still exist. Outbreaks can happen in the United States and around the world, and they especially happen in places where people do not get their recommended vaccines or don’t have access to them. Getting vaccines on time stops the spread of diseases and prevents future outbreaks. Some parents worry they can't afford vaccines, but Mayo Clinic partners with the Vaccines for Children program. This program provides free vaccines to eligible children who are 18 years old or younger. Please join us to recognize National Infant Immunization Week. Work with your healthcare team to make sure your baby or child gets their vaccines on time. This simple but important step will keep them safe from diseases that vaccines can prevent. They are counting on you to protect them!Primary Care in Rochester and KassonInfant ImmunizationsPrimary Care in Rochester and KassonThese clinics are available to Dodge County students entering grades 7–12 in the Kasson-Mantorville, Hayfield and Triton school districts. <img src="/-/media/ech-media/images/widgets/activities/ech_sports_clinic2018_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=BA4BF257D3C4FEC0870814BC202C6492" alt="ECH_sports_clinic2018_widget" width="100" height="65" DisableNVelocity="true" />Kasson Clinic offers free sports physicals for students5/5/2025 4:30 AM<img src="/-/media/ech-media/images/widgets/activities/ech_sports_clinic2018_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=14B3D89D68B5FACB73B5420DC215D154" alt="ECH_sports_clinic2018_widget" width="300" height="195" DisableNVelocity="true" />Mayo Family Clinic Kasson will be offering an opportunity for Dodge County students who need a physical to participate in sports to schedule an appointment. This free clinic is available to Dodge County students entering grades 7–12 in the Kasson-Mantorville, Hayfield and Triton school districts. Only sports screening exams will be conducted (no college sports physicals or camp exams will be conducted). No immunizations or treatments will be provided. If a medical concern is discovered, the student will be given instructions for follow-up care. When: Wednesday, June 18, 4:30 to 6 p.m. Where: Mayo Family Clinic Kasson, 411 West Main, Kasson, Minnesota Who: Dodge County students in the Kasson-Mantorville, Hayfield and Triton school districts entering grades 7–12. Sports Clinic requirements: <ul> <li>Appointments are required for these clinics. Please schedule through your patient portal account or call <a rel="noopener" href="tel:5072843967" target="_blank" title="Link opens in a new window">507-284-3967</a>.</li> <li>Please arrive five minutes before your scheduled appointment time.</li> <li>Dress comfortably with shorts and a T-shirt (weather permitting).</li> <li>Bring your Mayo Clinic identification number if you are a current patient.</li> <li>Bring the <a rel="noopener" href="https://www.mshsl.org/sites/default/files/2025-04/2025-2026-ppe-4-4-25-english.pdf" target="_blank" title="Link opens in a new window">2025–2026 Minnesota State High School League Sports Qualifying Physical Examination Medical Eligibility form</a>. Complete page 2 and the top of page 3, as well as page 4 if applicable, before arriving at the clinic.</li> </ul>Primary Care in Rochester and KassonKasson Sports Clinic 2025Primary Care in Rochester and KassonLook for warning signs to know when to be seen by a clinician.<img src="/-/media/ech-media/images/widgets/skin/skincancercheck.jpg?h=65&iar=0&w=100&sc_lang=en&hash=62F05ADB90ABD5950AF5655ACC34DA6C" alt="SkinCancerCheck" width="100" height="65" DisableNVelocity="true" />Understanding melanoma: When to worry about a dark mole5/29/2025 4:30 AM<img src="/-/media/ech-media/images/widgets/skin/skincancercheck.jpg?h=205&iar=0&w=315&sc_lang=en&hash=B9DD1C57BA2AE87BB7BC85F855797584" alt="SkinCancerCheck" width="315" height="205" DisableNVelocity="true" />Melanoma is a serious form of skin cancer that originates in melanocytes, the pigment-producing skin cells. While it accounts for only 1% of skin cancer cases, melanoma is responsible for most skin cancer-related deaths. In 2024, an estimated 100,640 new invasive melanoma cases were diagnosed in the United States. Early detection is crucial. One of the most important warning signs is the "ugly duckling" sign, a mole that looks significantly different from others on your skin. If a spot stands out, a healthcare clinician should evaluate it. Also, the ABCDE rule can help identify concerning moles: <ul> <li>Asymmetry: One half of the mole does not match the other.</li> <li>Border: Irregular, blurred or jagged edges.</li> <li>Color: Multiple shades of brown, black, red, white or blue.</li> <li>Diameter: Larger than 6 mm (about the size of a pencil eraser).</li> <li>Evolving: Any size, shape, color or texture change over time. </li> </ul> Certain risk factors, such as fair skin, family history, male gender and age over 50, increase melanoma risk. If you notice a suspicious mole, seek medical evaluation promptly. What does melanoma care involve? At Mayo Clinic, dermatologists and specialists focus on diagnosing and treating melanoma. If melanoma is detected, surgical removal is often the first step. In addition to surgery, we can analyze tumor cells using molecular tests to better understand the cancer's behavior. This approach helps us personalize treatment for each patient, improving care and outcomes. Does sunscreen help prevent melanoma? Sunscreen is widely recommended to reduce the risk of skin cancer, including melanoma, by protecting the skin from harmful UV rays. However, some studies suggest that while sunscreen can help prevent sunburn, it may not always lower melanoma rates. One theory is that people who wear sunscreen may feel a false sense of security, leading them to spend more time in the sun. For the best protection, use sunscreen along with other sun safety measures: Seek shade, wear protective clothing and avoid peak sun hours when possible. <a rel="noopener" href="https://www.mayoclinic.org/biographies/meves-alexander-m-d-m-b-a/bio-20055397" target="_blank" title="Link opens in a new window">Alexander Meves, M.D., MBA</a>, is a physician in the Department of Dermatology at Mayo Clinic in Rochester and a specialist in skin cancer. He combines research with patient care, focusing on advancing melanoma diagnostics and treatment. His work bridges scientific discoveries with real-world clinical applications to improve patient outcomes.Alexander Meves, M.D., MBAPrimary Care in Rochester and KassonMelanomaPrimary Care in Rochester and KassonWith warm weather approaching, it's important for drivers of all kinds to be aware of their surroundings. <img src="/-/media/ech-media/images/widgets/randomimages/bicyclesafety.jpg?h=65&iar=0&w=100&sc_lang=en&hash=252810FAB5AEFFAB82E177A1F0865799" alt="BicycleSafety" width="100" height="65" DisableNVelocity="true" />Motorcycle and bicycle awareness: Creating safer roads5/8/2025 4:30 AM<img src="/-/media/ech-media/images/widgets/randomimages/bicyclesafety.jpg?h=205&iar=0&w=315&sc_lang=en&hash=F44A8F32002B581AE5074E3B8BA124CA" alt="BicycleSafety" width="315" height="205" DisableNVelocity="true" />Every year, a significant number of injuries and deaths result from vehicle collisions with bicycles and motorcycles. In the state of Minnesota in 2022, for example, there were six deaths and 499 reported injuries after a bicycle versus motor vehicle accident. That same year, there were 26 fatalities from motorcycle crashes involving another motor vehicle. Almost half of all motorcycle crashes involve a collision with a car or truck. As primary care clinicians, we want to share some tips on how both drivers and riders can take steps to create safer roads for everyone. For drivers <ul> <li>Stay alert: Always be on the lookout for motorcycles and bicycles, especially at intersections and during lane changes. Keep in mind that motorcycles and bicycles are vulnerable on the road due to their smaller size and lower visibility compared to cars and trucks.</li> <li>Give space: Maintain a safe distance when passing cyclists and motorcyclists. A minimum of three feet is recommended.</li> <li>Avoid distractions: Keep your focus on the road and avoid using mobile devices while driving.</li> <li>Right-hand turns: Be particularly cautious when making right-hand turns at intersections. Check for cyclists who may be approaching from behind or riding alongside your vehicle. Keep in mind that a bicyclist in a bike lane next to you may intend to go straight. There are conventions and laws for cyclists and drivers depending on the type of intersection, but be alert since not all are aware of the rules. </li> </ul> For bicyclists and motorcyclists <ul> <li>Wear protective gear: Helmets, reflective clothing and other protective gear can significantly reduce the risk of injury.</li> <li>Follow traffic rules: Obey traffic signals and signs, and ride in designated bike lanes whenever possible. When riding in vehicle lanes, always ride in the direction of traffic. Riding on sidewalks is considered dangerous and is sometimes illegal — use extra caution when crossing driveways and intersections as drivers may not be expecting you, especially if you are moving quickly.</li> <li>Be visible: Use lights and reflectors, especially during low-light conditions. Bright and reflective clothing can also help. Avoid riding in the dark.</li> <li>Avoid high-traffic areas: Plan routes that minimize exposure to heavy traffic. Use bike paths and quieter streets when possible.</li> <li>Use hand signals: Indicate turns and stops using hand signals to inform drivers of your actions.</li> <li>Use technology: Invest in devices that detect cars approaching from behind, such as rearview radar systems. </li> </ul> For everyone By fostering a culture of awareness and mutual respect on the roads, we can do our part to reduce injuries and fatalities among cyclists and motorcyclists. Let's work together to ensure that our roads are safe for all users, whether they are on two wheels or four. <a href="/providers/david-brennan-md">David Brennan, M.D.</a>, is a primary care physician in the Division of Community Internal Medicine, Geriatrics and Palliative Care in Rochester, Minnesota. He focuses on prevention and treatment of a wide variety of common diseases.David Brennan, M.D.Primary Care in Rochester and KassonMotorcycle Bicycle AwarenessPrimary Care in Rochester and KassonCertain factors put people at greater risk of developing this disease.<img src="/-/media/ech-media/images/widgets/randomimages/ech_osteoporosis_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=C1D242C1971DFD4A4CE587DF27DAFD8D" alt="ECH_osteoporosis_widget" width="100" height="65" DisableNVelocity="true" />Are you at risk for osteoporosis?5/12/2025 4:30 AM<img src="/-/media/ech-media/images/widgets/randomimages/ech_osteoporosis_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=E5B01A695F82B17E4A8EDADC71DE82D3" alt="ECH_osteoporosis_widget" width="300" height="195" DisableNVelocity="true" />Chances are that you or someone you know has or will develop osteoporosis. Osteoporosis can significantly impact your quality of life and ability to remain independent as you age. Certain factors put both women and men at greater risk for developing this disease and experiencing a fracture as a result. What is osteoporosis? Osteoporosis is the most common bone disease. Bones become brittle (thin) and more likely to break (fracture). They can be so weak that a minor fall or stress, such as bending over or coughing, can cause them to break. The weaker and more brittle the bones are, the higher the fracture risk. The most common fractures from osteoporosis are of the hip (femur), wrist (radius) and spine (vertebrae). Osteoporosis develops slowly, so it is important to detect bone loss early and prevent it from progressing. Osteopenia is a related condition. With osteopenia, the bone density is lower than usual but not low enough to be called osteoporosis. People with osteopenia also are at risk for fractures, but the risk is lower than with osteoporosis. Everyone is at risk for developing osteoporosis, although postmenopausal older women are at highest risk. Some factors are out of your control, including: <ul> <li>Men and women. Women after menopause are at the highest risk.</li> <li>Race and ethnicity. White and Asian people are at higher risk than those of Hispanic/Latino, African American, African and Native-American origin.</li> <li>Age. Older age is the strongest risk factor.</li> <li>Genetics. A family history of osteoporosis or hip fracture increases your chances of having the disease. </li> </ul> Protecting your bones Our bodies use calcium and phosphorus minerals to make new bone that replaces older, less healthy bone. These are factors that affect bone health that you can control: <ul> <li>Vitamin D. This vitamin helps maintain a normal calcium balance. Our bodies make vitamin D but need sunlight to activate it. People who live in northern climates or spend a lot of time indoors are at high risk for vitamin D deficiency. Vitamin D is not usually found in food except for small amounts of fatty fish, along with many dairy products that are fortified with it. You can take an over-the-counter vitamin D2 or D3 supplement of 800-1,000 IU daily to reach adequate levels.</li> <li>Calcium. This mineral is found in many foods: dairy products, dark-green vegetables, beans, fish and nuts. Most adults need 1,000 mg daily; women older than 50 and men older than 70 generally need 1,200 mg daily. If you do not get enough calcium from your food, take a supplement, such as calcium carbonate or calcium citrate. Certain medications affect calcium absorption, so you may need a higher dose.</li> <li>Smoking. Tobacco use contributes to weak bones.</li> <li>Consuming alcohol. Regular consumption of more than two alcoholic drinks a day increases the risk of osteoporosis.</li> <li>Being active. Gravity keeps bones healthy, so at least 30 minutes of weight-bearing activity, such as walking daily, helps reduce the risk of osteoporosis.</li> <li>Falls. This factor is the most significant risk for fractures. Help prevent falls by being careful, paying attention, and following these guidelines: <ul> <li>Wearing safe shoes, keeping laces tied.</li> <li>Reducing clutter, loose rugs and cords that could be tripped on.</li> <li>Taking care when walking on ice, snow and other slippery surfaces.</li> <li>Using a cane or walker to help with stability. </li> </ul> </li> </ul> Why diagnosis is important These statistics underscore the importance of maintaining bone health and detecting bone loss early: <ul> <li>10.2 million Americans have osteoporosis, and 43.4 million have low bone mass and are at risk for osteoporosis.</li> <li>There are more than 2 million fractures caused by osteoporosis annually.</li> <li>Osteoporosis affects both men and women; however, women are more than twice as likely to experience an osteoporosis-related fracture (approximately 70% occur in women). </li> </ul> Additional risk factors If you are a woman younger than 65 or a man younger than 70 and have any of these major risk factors, you should talk with your care team about early osteoporosis testing: <ul> <li>Prior low-impact fractures.</li> <li>Premature menopause due to removal of the uterus and both ovaries or loss of estrogen production at a young age.</li> <li>Medical conditions such as rheumatoid arthritis, Cushing's disease, osteogenesis imperfecta, hyperparathyroidism, hyperthyroidism (untreated), multiple myeloma or celiac disease.</li> <li>History of anorexia, malnutrition or rapid weight loss, even if current weight is normal.</li> <li>Steroid use for a long time, such as prednisone, dexamethasone or hydrocortisone. Even high doses of topical or inhaled steroids, if used for a long time, may worsen bone density.</li> <li>Weight-loss surgery.</li> <li>Anti-estrogen medications for breast cancer (tamoxifen, Arimidex, Aromasin, Femara) or anti-androgen medicines for prostate cancer (Lupron).</li> <li>Immobility, such as from paralysis, multiple sclerosis or stroke.</li> <li>History of organ transplant.</li> <li>Loss of height ≥ 4 cm (1.5 inches). </li> </ul> There are other risk factors for osteoporosis, although they may not call for early testing <ul> <li> Long-time use of Coumadin/warfarin.</li> <li>Use of some anti-seizure medications.</li> <li>Long-time use of heartburn medications/antacids.</li> <li>Taking some oral diabetes medications for type 2 diabetes or having type 1 diabetes. </li> </ul> Visit the <a rel="noopener" href="http://www.mayoclinic.org/diseases-conditions/osteoporosis/home/ovc-20207808" target="_blank" title="Link opens in a new window">Mayo Clinic website</a> to learn more about osteoporosis and osteopenia. <a href="/providers/sara-medinabielski-md">Sara Medina-Bielski, M.D.</a>, is an internist and geriatrician in Community Internal Medicine, Geriatrics and Palliative Care. She provides primary care to older adults at Mayo Family Clinic Northwest and in skilled nursing facilities in Rochester.Sara Medina-Bielski, M.D.Primary Care in Rochester and KassonOsteoporosis RiskPrimary Care in Rochester and KassonTremors are the most well-known symptom of this progressive disease. <img src="/-/media/ech-media/images/widgets/elderly/shakinghandglasswater.jpg?h=65&iar=0&w=100&sc_lang=en&hash=D8D461FD2F43E5587ACDB062ABFBFE36" alt="ShakingHandGlassWater" width="100" height="65" DisableNVelocity="true" />Demystifying Parkinson's disease4/17/2025 4:30 AM<img src="/-/media/ech-media/images/widgets/elderly/shakinghandglasswater.jpg?h=205&iar=0&w=315&sc_lang=en&hash=18185AD7E57FD7953EB9F23B2567A687" alt="ShakingHandGlassWater" width="315" height="205" DisableNVelocity="true" />What do you know about Parkinson’s disease? Most people know that this condition causes tremors and that Michael J. Fox, Neil Diamond and Katherine Hepburn were diagnosed with it. While not uncommon — about 1 million Americans have Parkinson's — this disease is not well-known. What is Parkinson's disease? Parkinson's disease is a neurological disorder marked by tremors, such as shaking of the hands or head, particularly on one side of the body. These tremors are seen at rest, not just when moving. Parkinson's disease progresses to stiffness and slowness of movement. Patients' mobility is affected, and they may be unable to move spontaneously. The disease worsens over time, and there is no cure. However, just because people have tremors doesn't mean they have Parkinson's disease. Tremors also can be caused by medications that stimulate the body, such as asthma or chronic obstructive pulmonary disease inhalers, or other conditions like essential tremors. Are there other symptoms of Parkinson's disease? Other major symptoms of the disease include poor sleep, bowel problems, mood disorders and depression, and these side effects may be as challenging as movement issues. People may not make many spontaneous movements, will have limited facial expressions and have trouble standing up. When walking, they may be more stooped, shuffle, take smaller steps and have difficulty turning. Who tends to get Parkinson's disease? Parkinson's disease is more common in men than women and in white people rather than people of other ethnicities. Typically, people are diagnosed with Parkinson's disease in their 60s and 70s, although a small percentage may develop it younger. How is Parkinson's disease diagnosed? To diagnose Parkinson's disease, your primary care clinician can usually perform clinical bedside tests. No blood test or imaging will reveal Parkinson's disease. As the disease progresses, you may want to see a neurologist. How is Parkinson's disease treated? Patients usually seek a diagnosis and treatment when symptoms begin to affect their lives. While there's no cure, medications can effectively treat the symptoms. The most common and well-tolerated medication is carbidopa/levodopa. This generic drug promotes the production of dopamine, a neurotransmitter in the brain that regulates movement, attention, learning and emotional responses. As the disease progresses, your clinician typically will increase the frequency and dose of your medication. What happens as Parkinson's disease progresses? Parkinson's is a slow-progressing disease, so patients lose more function as time goes on. Disability becomes challenging, fall risk increases, and maintaining independence becomes more difficult. Cognitive issues may start appearing, including memory concerns and behavioral changes. Parkinson's disease patients may require support as the disease progresses. What's being done to cure Parkinson's disease or improve treatment? Researchers continue to explore the mechanism of degeneration and what's causing it, down to the molecular level. Drugs that can slow, treat or even reverse Parkinson's disease are in trials. Devices, such as stimulators, are being used to reduce tremors or other symptoms, and pumps are being used to help with medication administration. What should a patient do after being diagnosed with Parkinson's disease? If you or a loved one has been diagnosed with Parkinson's disease, you can optimize your situation by maintaining your level of activity, focusing on strength training to minimize weakness, and eating a healthy, balanced diet. Also, follow your medication regimen and know how it works. Is it wearing off? Is it causing side effects? Since Parkinson's disease is progressive, now is the time to plan ahead and consider in-home and long-term care options. If you or a loved one experience symptoms or have concerns, reach out to your care team for help. <a href="/providers/paul-takahashi-md">Paul Takahashi, M.D.</a>, is an internal medicine physician in Primary Care in Rochester and Kasson's Division of Community Internal Medicine, Geriatrics and Palliative Care. He practices in the Baldwin Building in Rochester. His interests include geriatric medicine, long-term nursing home care, and public health.Paul Takahashi, M.D.Primary Care in Rochester and KassonParkinsons DiseasePrimary Care in Rochester and KassonThis new service offers flexible and convenient care, 24/7/365, for urgent symptoms and conditions, including video visits with a physician. <img src="/-/media/ech-media/images/widgets/people/mandoctorvideovisit.jpg?h=65&iar=0&w=100&sc_lang=en&hash=83DABE059CCD86F002761203E8B95542" alt="ManDoctorVideoVisit" width="100" height="65" DisableNVelocity="true" />Introducing Primary Care On Demand5/1/2025 4:30 AM<img src="/-/media/ech-media/images/widgets/people/mandoctorvideovisit.jpg?h=205&iar=0&w=315&sc_lang=en&hash=F6FF2C6CE361477168B73A7AAD320B6C" alt="ManDoctorVideoVisit" width="315" height="205" DisableNVelocity="true" />Mayo Clinic Primary Care is excited to introduce our new mobile app and virtual care service, <a rel="noopener" href="https://www.primarycareondemand.mayoclinic.org/home" target="_blank" title="Link opens in a new window">Primary Care On Demand</a>. Available 24/7/365, this option offers flexible and convenient care for urgent symptoms and conditions, including video visits with a physician. As a complement to in-person care, Primary Care On Demand syncs with your electronic health record and the patient portal, so care and treatment notes remain all in one place. This means you can easily switch between in-person care with your primary care team and on-demand virtual care. Below you’ll find answers to a few commonly asked questions about this new service. What conditions can be treated using Primary Care On Demand? Use Primary Care On Demand for sudden illnesses and common conditions like sore throat, rash, cough, pink eye, upper respiratory infection, sinus infection, urinary tract infection and many more. When should I use Primary Care On Demand? Primary Care On Demand is available any time, day or night. This option is especially helpful when clinics are closed (evenings, weekends and holidays), when same-day appointments fill up and without disrupting school or work schedules. It may also be a good alternative for urgent issues that don’t need a trip to the emergency department. You can use this new app-based service from home, work or anywhere in Minnesota, Wisconsin or Iowa. Primary Care On Demand is also an ideal option when you’re away from home or don’t have easy access to the clinic. Who can use Primary Care On Demand? This service is available for all primary care patients ages 3 and older. Children and teens ages 3 to 17 can use this service with the help of a parent or guardian. Your out-of-town college student and young adult children can also use this service if they need quick care for urgent symptoms. How do you use Primary Care On Demand? To access Primary Care on Demand, you’ll need to download the new mobile app through PrimaryCareOnDemand.MayoClinic.org or by scanning the QR code below. You can also find the app on your phone’s app store. Here’s how it works: <ul> <li><img alt="PCOD_QRcode" style="width: 90px; height: 90px; float: right; margin-left: 20px;" src="/-/media/ech-media/images/pcod_qrcode.jpg?h=90&w=90&sc_lang=en&hash=F9250EE41B248F0B35FBDDA3A1518F5E" />Log into the Primary Care On Demand app using your Mayo Clinic patient portal username and password. If you don’t have a Mayo Clinic patient portal account, you can create one by visiting <a rel="noopener" href="https://onlineservices.mayoclinic.org/content/staticpatient/showpage/patientonline" target="_blank" title="Link opens in a new window">OnlineServices.MayoClinic.org/PatientPortal</a>.</li> <li>Using the chat feature, answer questions about your symptoms and receive information about your condition. </li> <li>If you’d like, choose to move on to a video visit with a physician. You can request to be seen as soon as possible or register for a visit at a future time.</li> <li>If necessary, your physician can send a prescription to your preferred pharmacy or order required lab tests. </li> </ul> After you register for a visit, you’ll typically connect with a physician in under 30 minutes. Most patients wait less than 10 minutes for a video visit. If you complete a video visit with a Primary Care On Demand physician, Mayo Clinic will bill your insurance like a primary care video visit.  If I have questions while using Primary Care On Demand, what can I do? If you have questions while using Primary Care On Demand, a dedicated support team is available to help 24/7/365. You can reach them through the app or by phone at <a rel="noopener" href="tel:5076075858" target="_blank" title="Link opens in a new window">507-607-5858</a>. Mayo Clinic is excited to offer this convenient virtual care option to our primary care patients. Download the app today so you’re ready whenever illness strikes.Primary Care in Rochester and KassonPrimary Care On DemandPrimary Care in Rochester and KassonThis chronic condition is not preventable and lasts a lifetime. <img src="/-/media/ech-media/images/widgets/arthritis/ech_arthritis_01_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=89C46154796C016557E5A29B77E2FD95" alt="ECH_Arthritis_01_widget" width="100" height="65" DisableNVelocity="true" />What is psoriatic arthritis?5/15/2025 4:30 AM<img src="/-/media/ech-media/images/widgets/arthritis/ech_arthritis_01_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=66F1FDDFC15F9888ADCE0F63FB0273E9" alt="ECH_Arthritis_01_widget" width="300" height="195" DisableNVelocity="true" />Psoriatic arthritis is when someone with a personal or family history of psoriasis develops inflammatory arthritis. This chronic condition is something they will have for life, and it’s more common in adults but can also be present in children. Psoriatic arthritis is not preventable, but there are risk factors (tobacco use and obesity) that people can work on to reduce the risk of developing this disease. Once diagnosed, some medications can help control the symptoms. What is psoriasis? Psoriasis is a skin condition that results from an overactive immune system. Psoriatic skin rashes can affect many areas of the body. Rashes typically involve skin redness in the affected area and scales or plaques of skin overlying the impacted skin. Fingernails and toenails can be impacted as well. Changes to the nails include pitting or indentation of the affected nails. What is inflammatory arthritis? Inflammatory arthritis refers to arthritis joint pain that is caused by an inflammatory process driven by an overactive immune system. This results in pain, swelling and stiffness of the joints and surrounding tissues. In psoriatic arthritis, unique patterns of joint disease can help a rheumatologist distinguish this diagnosis from other causes of joint pain. Common joints involved include small joints of the hands and feet, larger joints (knees, elbows and shoulders), and even spine joints. Tendons that connect muscles to bones can also become inflamed, which can be perceived as joint or muscle pain. Psoriatic arthritis affects up to 30% of patients who have psoriasis. Can other organs be involved in psoriatic arthritis? Other organs involved in this disease include ocular inflammation, like uveitis, and gastrointestinal inflammation, like Crohn's disease or ulcerative colitis. What else can cause joint pain in someone who has psoriasis? Osteoarthritis, or degenerative arthritis, is a common form of arthritis associated with aging and can lead to joint pain, which can sometimes be mistaken for psoriatic arthritis. Gout is another diagnosis that can cause joint pain and swelling and can be mistaken for psoriatic arthritis. How is psoriatic arthritis diagnosed? Psoriatic arthritis is diagnosed based on the presence or history of psoriasis and evidence of inflammatory arthritis with features and patterns consistent with the diagnosis of psoriatic arthritis. Blood testing, X-ray imaging, ultrasound and other more advanced imaging tests can and may be used to achieve the diagnosis. How is psoriatic arthritis treated? There is no cure for psoriatic arthritis. Permanent joint damage can result without treatment. Current treatment options provide many patients with success in easing symptoms and achieving remission. These therapies are targeted at reducing inflammation. Many of these options are also very effective in managing psoriasis skin lesions. Therapy options may include: <ul> <li>NSAIDs (Nonsteroidal anti-inflammatory drugs): These medications help to reduce inflammation and therefore help with pain. Examples include ibuprofen and naproxen. There are also prescription-strength options.</li> <li>Biologics agents: These are a newer class of disease-modifying agents. A few oral options are available, but more common options are available as a self-injection or infusion. They are generally tolerated well, target suppression of the overactive immune system and are associated with a high infection risk. Some do require laboratory monitoring.</li> <li>Conventional DMARDs (Disease-modifying antirheumatic drugs): These therapies are used less commonly but do have a role for use in some patients.</li> <li>Non-pharmacological options: Maintaining a healthy weight can reduce overall inflammatory burden and help control both joint and skin symptoms of psoriatic arthritis long term. Physical and occupational therapy may help manage isolated symptoms or lessen risk. Also, ice and heat could be helpful in isolated scenarios. </li> </ul> Takeaway If you suspect you may have psoriatic arthritis, it's important to discuss this concern with your healthcare clinician. You may require a dermatologist and a rheumatologist to help manage this condition. A growing number of therapies available to treat this condition allow many patients to have low or no disease symptoms. Psoriatic arthritis is a chronic disease, and medications prescribed to help manage this condition should be taken as prescribed. Andrea Pauly, APRN, C.N.P., is a nurse practitioner in the Department of Rheumatology at Mayo Clinic in Rochester, Minnesota, supporting the community and established patients. She has special interests in systemic autoimmune rheumatic disease and nurse practitioner medical education and training. She serves as a volunteer with the American College of Rheumatology. Kara Delger, APRN, C.N.P., is a nurse practitioner in the Department of Rheumatology at Mayo Clinic in Rochester, Minnesota. She has a special interest and experience with inflammatory arthritides. She also supports patient education and medical education of nurse practitioners in rheumatology.Andrea Pauly, APRN, C.N.P., and Kara Delger, APRN, C.N.P.Primary Care in Rochester and KassonPsoriatic ArthritisPrimary Care in Rochester and KassonSimple strategies to stay ahead of seasonal sniffles. <img src="/-/media/ech-media/images/widgets/people/sneezingflowers.jpg?h=65&iar=0&w=100&sc_lang=en&hash=2F9FC03F9167BAD8D512B1ABCBD67EC8" alt="SneezingFlowers" width="100" height="65" DisableNVelocity="true" />When seasons change: Managing allergies with ease4/24/2025 4:30 AM<img src="/-/media/ech-media/images/widgets/people/sneezingflowers.jpg?h=205&iar=0&w=315&sc_lang=en&hash=1731121B05D06BC43BF6CDFB061920AB" alt="SneezingFlowers" width="315" height="205" DisableNVelocity="true" />With warmer weather, nature blooming and increased time outdoors, many people experience symptoms of allergies. Seasonal allergies, also known as hay fever or allergic rhinitis, can cause a variety of symptoms including: <ul> <li>Sneezing.</li> <li>Runny or stuffy nose.</li> <li>Itchy or watery eyes.</li> <li>Itchy throat or ears.</li> <li>Postnasal drip.</li> <li>Coughing.</li> <li>Sinus pressure.</li> <li>Headaches.</li> <li>Fatigue. </li> </ul> Why do you experience symptoms when others do not? Symptoms typically occur during specific seasons when pollen levels are high, such as spring with tree pollen, summer with grass pollen, or fall with ragweed pollen. Other common allergens include indoor and outdoor fungal spores, dust mites, pet dander and cockroaches. These allergens can cause symptoms all year for some people. Allergy symptoms are caused by the body's immune response. Your body releases histamines. The best way to decrease symptoms is to avoid the allergens and disrupt your body's response to them with antihistamine medications. Avoiding allergens <ul> <li>Monitor local pollen counts and avoid outdoor activities on high pollen count days. Windy weather spreads pollen farther. Pollen levels are usually highest in the morning and early evening.</li> <li>If you are outdoors, shower and change clothes when you go back inside. Avoid hanging laundry outdoors.</li> <li>Keep the windows closed and the air conditioning on. Consider a bedroom air purifier with a HEPA filter.</li> <li>Air humidity in your home should be between 30% and 50%. </li> </ul> Decreasing symptoms Several medications called antihistamines are available over the counter to help. Ideally, you should start taking these before you're exposed to your allergens. Drowsiness is the most common side effect, but most 24-hour antihistamines cause much less drowsiness. These medications include loratadine (Claritin), cetirizine r (Zyrtec), and fexofenadine (Allegra). If your healthcare clinician has cleared you to take an antihistamine, follow the package dosing instructions. More medication will not give you better results and may be dangerous. Other medications and remedies Saline nasal rinses with a rinse bottle or neti pot plus saline packets made for this purpose used with distilled water. Rinsing twice daily helps clear nasal passages and flushes out allergens. Intranasal steroids such as fluticasone or Flonase, triamcinolone acetonide or Nasacort, and budesonide or Rhinocort. Topical eye antihistamines like ketotifen fumarate (Zaditor or Alaway) for eye symptoms. Often, treating the nose will improve eye symptoms. If you have other symptoms not listed above or your symptoms are severe, consider visiting your healthcare clinician for further evaluation. Prescriptions are also available. Severe symptoms may require a more detailed workup or referral to an allergist. <a href="/providers/tessa-hessedal-aprncnp">Tessa Hessedal, APRN, C.N.P.</a>, is a nurse practitioner in the Department of Family Medicine. She practices at Mayo Clinic Express Care in Rochester, Minnesota. Her interests include acute care, managing upper respiratory symptoms and antimicrobial overuse. She enjoys outdoor activities, teaching students and spending time with her family.Tessa Hessedal, APRN, C.N.P.Primary Care in Rochester and KassonSpring AllergiesPrimary Care in Rochester and KassonFind out how to protect your skin from the summer sun. <img src="/-/media/ech-media/images/widgets/skin/ech_sunprotection_01_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=08D327C871F95E421D7D32B916C82032" alt="ECH_SunProtection_01_widget" width="100" height="65" DisableNVelocity="true" />Sunscreens and their use5/1/2025 4:30 AM<img src="/-/media/ech-media/images/widgets/skin/ech_sunprotection_01_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=3B242FC3E0C956CC081F9D5B34107E84" alt="ECH_SunProtection_01_widget" width="300" height="195" DisableNVelocity="true" />Suddenly, it's spring, and the sun is out! You're looking forward to spending time outside, but don't care for the painful sunburn or other negative effects of sun exposure. Here are some tips to protect your skin from the sun. What's the problem with sun exposure? The sun can certainly cause havoc with your skin. In the short term, you can get sunburn. In the long term, your skin will get wrinkled and look old, not to mention the markedly increased risk of skin cancers, which are reaching epidemic proportions in people who spend a lot of time in the sun. Skin cancer resulting from sun exposure is the most common type of cancer. Is there any benefit of sun exposure? Being outside in nature can raise your mood. It will also increase your vitamin D. But you only need about 10-30 minutes of sun exposure a few times a week to get adequate vitamin D. How can I get the benefits of being outside and still avoid the problems with sun exposure? Cover up! <ul> <li>Wear long-sleeved clothing. Look for clothing with a UPF rating, or ultraviolet protection factor, and a broad-brimmed hat so your face is in the shade.</li> <li>Use ultraviolet light-blocking sunglasses to protect your eyes.</li> </ul> Apply sunscreen daily. <ul> <li>Make sure the sunscreen is labeled "broad spectrum," which means you are protected against UVA and UVB.</li> <li>Make sure the sunscreen is labeled SPF 30 or higher.</li> <li>Apply sunscreen before you go out. Use a mirror when applying it to make sure you cover the skin adequately.</li> <li>A sunscreen cream directly applied to the skin gives more reliable coverage than a spray.</li> <li>Apply sunscreen to all exposed areas, particularly ears, neck, hands, feet and lips (use a lip balm on the lips).</li> <li>Reapply every 2 hours and after swimming or sweating.</li> <li>A good habit to get into is to apply sunscreen or makeup containing sunscreen to your skin daily, no matter what the weather or time of the year.</li> </ul> It's best to stay in the shade if possible, but beware! <ul> <li>You can still burn even on cloudy days or in the shade.</li> </ul> Recognize that reflective surfaces can reflect ultraviolet rays even if you are not directly exposed to the sun. <ul> <li>Snow, sand, water and concrete can reflect ultraviolet rays onto your skin. </li> </ul> Enjoy your time outdoors and catch a few sun rays safely this summer. <a rel="noopener" href="https://www.mayoclinic.org/biographies/davis-mark-denis-p-m-d/bio-20053324" target="_blank" title="Link opens in a new window">Mark Davis, M.D.</a>, is a physician and chair of the Department of Dermatology at Mayo Clinic in Rochester, Minnesota. He completed his medical degrees at the Royal College of Surgeons of Ireland. He completed his internal medicine and dermatology residencies at Mayo Clinic in Rochester, Minnesota. He has special interests in general dermatology, complex rashes and hospital dermatology.Mark Davis, M.D.Primary Care in Rochester and KassonSunscreenPrimary Care in Rochester and KassonHow your toenail looks can be affected by injury or an underlying illness. <img src="/-/media/ech-media/images/widgets/feet/onychomycosis.jpg?h=65&iar=0&w=100&sc_lang=en&hash=85A44731E42D0319A599646292ACA597" alt="Onychomycosis" width="100" height="65" DisableNVelocity="true" />Think you have ugly toenails? What should you do?4/28/2025 4:30 AM<img src="/-/media/ech-media/images/widgets/feet/onychomycosis.jpg?h=205&iar=0&w=315&sc_lang=en&hash=881006A1EB22D80084E852CAC7C8E398" alt="Onychomycosis" width="315" height="205" DisableNVelocity="true" />Toenails may have an altered appearance for many reasons — including injury to the nail, underlying illnesses like psoriasis, or, more commonly, a fungal infection called onychomycosis, which can occur in up to 10% of the population. Generally, there are no symptoms. Nail appearance <ul> <li>Discolored — usually yellow, white or brown.</li> <li>Thickened.</li> <li> Brittle.</li> <li>Ragged.</li> <li>Pulled away from the underlying skin. </li> </ul> Risk factors for onychomycosis <ul> <li>Fungal infection of the skin of the foot, more commonly known as Athlete's foot.</li> <li>Increased age.</li> <li>Extended exposure to moisture, sweating of the feet or being barefoot in moist environments such as swimming pools, shower rooms and gyms.</li> <li>Underlying illnesses, including psoriasis, diabetes or impaired circulation. </li> </ul> Onychomycosis is contagious, so to prevent the spread, thoroughly clean shared shower stalls or wear shower shoes. Treatment is not usually required, but it is essential to consult your healthcare clinician if you experience bleeding, pain, infection or spread of color changes at the base of your nail. Prescription medications can include topical remedies that can be applied to the skin and nails, but those are much less effective than oral medications. Since nails grow slowly, oral medications must be used for 12 weeks, and laboratory tests must be monitored. These medications can also interact with other medicines. Topical medications, in some cases, require use for much longer, up to 48 weeks, but are unlikely to interact with other drugs. <a href="/featured-stories/toenails">Denise Dupras, M.D., Ph.D.</a>, is a physician in Primary Care in Rochester and Kasson's Division of Community Internal Medicine, Geriatrics and Palliative Care. She completed her medical and doctoral degrees at Mayo Clinic Alix School of Medicine and her residency in internal medicine at Mayo Clinic in Rochester. Her interests include medical education and evidence-based medicine.Denise Dupras, M.D., Ph.D.Primary Care in Rochester and KassonToenailsPrimary Care in Rochester and KassonTrampolines provide sky-high fun but also the risk of injury. <img src="/-/media/ech-media/images/widgets/kids/ech_trampoline_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=FC651B3C4D9AB5C433CCD08A04C926B6" alt="ECH_trampoline_widget" width="100" height="65" DisableNVelocity="true" />Balancing the fun and dangers of trampolines5/22/2025 4:30 AM<img src="/-/media/ech-media/images/widgets/kids/ech_trampoline_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=6C51BB3DBD6EA4C4C3BA639330FC5B45" alt="ECH_trampoline_widget" width="300" height="195" DisableNVelocity="true" />Balancing a child’s fun and safety presents a key parenting challenge. Trampolines are a perfect example of this dilemma. When it comes to trampoline use for kids, are we overreacting, or is there a significant risk of injury? Since 1977, the American Academy of Pediatrics (AAP) has been making safety recommendations for trampolines. Given the relatively high risk of injury, the AAP currently recommends keeping kids away from trampolines, except in settings where they have close monitoring with professional coaches or on specialized equipment. Despite this recommendation, trampoline popularity is increasing, so parents will likely have to contend with deciding whether to let their child jump or not. The dangers Trampoline injuries can range from minor (such as sprains or bruises) to more severe (including broken bones, concussions, and even permanent injuries from head, neck, or spinal trauma). One nationwide surveillance system counted over 800,000 pediatric injuries in the 2009–2018 time frame, with a majority of injuries (54%) occurring on a trampoline at a child’s own home. So, what are the dangers and types of injuries from playing on trampolines? <ul> <li>The most common injuries are typically fractures, sprains/strains, and bruises or scrapes.</li> <li>Multiple people jumping simultaneously accounts for approximately 75% of injuries.</li> <li>Children ages 2-12 years seem to have the highest risk of getting hurt. Compared to adolescents, younger children are more likely to sustain internal injuries or dangerous internal bleeding as a result of trampoline accidents.</li> <li>Falls account for about one-third of injuries. Arms are most commonly injured after a fall, and about 60% are fractures.</li> <li>Head and neck injuries account for up to 17% of injuries. The most severe are caused by doing a somersault or the child falling from the trampoline and landing on their head or neck.</li> </ul> Manufacturers have been trying to improve trampoline construction and safety, including netting and padding around trampolines. Surprisingly, current evidence doesn't show that these additions have led to a significant decrease in injuries. Unfortunately, the trampoline mat is still the culprit for various injuries. The balance Jumping on a trampoline is still a lot of fun, so it's up to every parent to decide what amount of risk they can tolerate when balancing fun and safety. The good news is that the risk of injury can be reduced by following a few trampoline safety rules: <ul> <li>Only one jumper at a time on the trampoline.</li> <li>No somersaults allowed.</li> <li>An adult should supervise at all times.</li> <li>Children younger than six aren't allowed to jump on the trampoline.</li> <li>Adequate protective padding and a netted enclosure should be required.</li> </ul> Set up on level ground away from trees, patios, yard furniture, play equipment, etc. Also, check your homeowner's policy to see if additional coverage is required for trampoline-related injuries if you have one on your property. For more information, check out "<a rel="noopener" href="https://www.healthychildren.org/English/safety-prevention/at-play/Pages/Trampolines-What-You-Need-to-Know.aspx" target="_blank" title="Link opens in a new window">Are Trampolines Safe for Kids?</a>" published at <a rel="noopener" href="https://www.healthychildren.org/English/safety-prevention/at-play/Pages/Trampolines-What-You-Need-to-Know.aspx" target="_blank" title="Link opens in a new window">www.healthychildren.org</a>. <a href="/featured-stories/trampoline-danger">Paige Partain, M.D.</a>, is a general pediatrician in Community Pediatric and Adolescent Medicine (CPAM) and practices at Mayo Family Clinic Northeast. She completed her medical degree at the University of Alabama and pediatric residency at the Mayo Clinic in Rochester, Minnesota.Paige Partain, M.D.Primary Care in Rochester and KassonTrampoline DangerPrimary Care in Rochester and KassonThere's more to this disease than just memory loss.<img src="/-/media/ech-media/images/widgets/randomimages/alzheimer_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=79CFBE4D4C294B2490D3AD2B4DD13AD3" alt="Alzheimer_widget" width="100" height="65" DisableNVelocity="true" />Struggling with questions about Alzheimer's disease?6/19/2025 4:30 AM<img src="/-/media/ech-media/images/widgets/randomimages/alzheimer_widget.jpg?h=205&iar=0&w=315&sc_lang=en&hash=3C9573D0B63B8AE6B2E505BBD614C5C1" alt="Alzheimer_widget" width="315" height="205" DisableNVelocity="true" />Dementia is a general term for disorders that affect memory and other brain functions, causing changes in a person's ability to perform day-to-day activities. Dementia is progressive, meaning that it worsens over time, usually years. Alzheimer's disease is the most common type of dementia. Usually, the first symptom of Alzheimer's disease is a change in memory, with difficulty learning new things or remembering recent events. Other changes can occur as time progresses, such as changes to personality, behavior, speech, swallowing and walking. Some people may have a family history, but aging is the most significant risk factor. When to get help If you notice changes in your memory or that of a family member, you should discuss this with your primary care clinician. Some people may not see the changes themselves. Often, a family member or a close friend will first notice a difference. Evaluation and treatment The first step is to be evaluated to assess the changes. Many issues can cause changes to memory with age, and not all of them indicate Alzheimer's disease or another type of dementia. The evaluation typically involves visiting your primary care clinician to discuss the changes, a cognitive test, blood tests and brain imaging. Other testing may be necessary. If you are diagnosed with Alzheimer's disease, your clinician will discuss options that can help you and your care partner. Lifestyle options and modifications are essential, such as regular exercise, maintaining social interactions and cognitively stimulating activities, addressing cardiovascular health (blood pressure control) and maintaining a healthy diet. While there is no cure, medications may have some benefits in slowing progression. Your clinician will review these options with you. Since Alzheimer’s disease is a progressive condition, it is essential to plan. People may need help managing medications, finances, transportation or assistance with other day-to-day activities at home. Preparing an advanced directive allows a person's wishes for medical care to be known. It also allows a trusted person to be nominated to help with decision-making when needed. A big part of caring for people with Alzheimer's disease is helping the person and their care partner live as well as they can. Support groups, educational resources and community resources are available. Your healthcare clinician can help connect you with resources in your area. <a href="/providers/mairead-bartley-mbbchbaomd">Mairead Bartley, M.B., B.Ch., B.A.O., M.D.</a>, is a Community Internal Medicine, Geriatrics, and Palliative Care physician at Mayo Clinic in Rochester. Her interests include dementia care and care of medically complex older adults in skilled nursing facilities and homebound settings. <a href="/providers/maria-mendoza-delagarza-md">Maria Mendoza De la Garza, M.D.</a>, is a Community Internal Medicine, Geriatrics, and Palliative Care physician at Mayo Clinic in Rochester. She is a geriatrician with vast experience caring for high-risk, frail, medically complex older adults. Her clinical practice is focused on the care spectrum of skilled nursing facilities, home-based and outpatient care.Mairead Bartley, M.B., B.Ch., B.A.O., M.D., and Maria Mendoza De la Garza M.D.Primary Care in Rochester and KassonAlzheimers DiseasePrimary Care in Rochester and KassonThese tips can keep your brain sharp and healthy.<img src="/-/media/ech-media/images/widgets/food/brainfood.jpg?h=65&iar=0&w=100&sc_lang=en&hash=8EFDB12ACFC1CEE15BED18205BAF28A2" alt="BrainFood" width="100" height="65" DisableNVelocity="true" />Food for thought: Easy ways to nourish your brain6/25/2025 4:30 AM<img src="/-/media/ech-media/images/widgets/food/brainfood.jpg?h=205&iar=0&w=315&sc_lang=en&hash=1BE8E572BD4B6DFCA79F0F761D430703" alt="BrainFood" width="315" height="205" DisableNVelocity="true" />When it comes to eating for health, nutrition tips are mainly geared toward things like heart health, muscle function and bone health. However, the foods you eat can also affect your brain's functions. Cognitive health, which impacts your ability to think, learn and focus, can be enhanced by key nutrients often missed or forgotten in the everyday diet. Here are some tips on foods to incorporate into your meals to keep your brain sharp and healthy. Go fish! Salmon, tuna and sardines are high in omega-3 fatty acids. These fats are commonly referred to as “essential” fats, which means your body cannot produce them and must get them from foods in your diet. Omega-3 fatty acids are essential for brain development, function, and aging. Not a fan of fish? No worries! You can also get omega-3s from flaxseeds, chia seeds, hemp seeds, walnuts and almonds. Add them to salads or pack them as a quick midday snack! Eat the rainbow You might have heard that fruits and vegetables contain many good nutrients for your immune system. Vitamins (like C and E) and minerals are also great for your brain. They protect brain cells from harmful things like inflammation and stress. Foods like oranges, bell peppers and broccoli are rich sources of vitamin C. Spinach, avocado and kiwi are great examples of things with vitamin E. Adding more colorful fruits and vegetables to your meals, like a fruit salad or stir-fry, is a simple way to boost your brain power. Protein power Protein isn’t just for muscles; it’s also vital for brain health! The amino acids found in protein foods act as building blocks for chemicals in your brain, which are essential for mental and physical health. These chemicals allow your brain to communicate with your body, helping you to think, remember, sleep and digest. Excellent protein sources include lean meats (like chicken, turkey or fish), eggs, beans, lentils and tofu. A grain bowl for lunch or an egg/tofu scramble for breakfast are easy, brain-healthy options. Fill your cup This may surprise you, but your brain (and body) is 75% water. Staying hydrated gives your brain energy to concentrate and remain clear. If your mind feels foggy or unfocused, add more liquid fuel to your day. Foods like cucumbers, watermelon and celery have a lot of water, and every bit counts. Another trick is to keep a water bottle in your car to sip on during your commute to work. If you don’t like the taste of water, fruit or mint can add a little flavor boost. Sparkling water is also a great option. Like your heart and muscles, your brain needs nutrients to fire on all cylinders. A well-balanced diet with healthy fats, fruits and vegetables, protein, and water can improve memory, learning and attention. It may seem daunting to make all these changes, but small switches over time can have a powerful effect on your brain health. Ultimately, it’s all about what you can add to your diet, not what you should takeaway! Samantha Toy is a dietetic intern at Mayo Clinic in Rochester, Minnesota. She graduated from Bradley University with a bachelor’s in nutrition and dietetics and is pursuing a master’s in clinical nutrition at the University of Wisconsin-Madison. Her special interests include nutrition support, pediatrics and neurology.Samantha ToyPrimary Care in Rochester and KassonBrain FoodPrimary Care in Rochester and KassonThe liver is one of the largest organs in our body. Find out how to keep it healthy.<img src="/-/media/ech-media/images/widgets/people/liverdisease.jpg?h=65&iar=0&w=100&sc_lang=en&hash=DA630A16FF51CDF07D462D951172B539" alt="LiverDisease" width="100" height="65" DisableNVelocity="true" />The liver: An essential player in our health and wellness6/9/2025 4:30 AM<img src="/-/media/ech-media/images/widgets/people/liverdisease.jpg?h=205&iar=0&w=315&sc_lang=en&hash=09863280A93A4D68E9D1F052D42E360A" alt="LiverDisease" width="315" height="205" DisableNVelocity="true" />The liver is a complex organ with many functions that are extremely important to our health and well-being, and we can’t survive without it. Some of these essential functions include assisting digestion through the production of bile that is released into the small intestine, filtration of toxins and other substances from the blood, metabolizing some medications, storing energy in the body for later use, and producing specific proteins for the body. Liver disease A broad range of diseases can occur in the liver, some with sudden onset of severe symptoms and others with little to no early symptoms, but symptoms can become severe later. Injury to liver cells can lead to abnormal blood test findings in liver enzymes. However, given the interactions with many other organs, these lab elevations can sometimes be due to issues stemming from other organs not functioning properly. When liver disease is severe, symptoms can include: <ul> <li>Yellowing of the skin (jaundice) due to decreased liver processing of bilirubin.</li> <li>Fluid retention due to increased pressure in the liver and lowered blood flow through it.</li> <li>Confusion or changes in cognitive ability due to decreased processing of toxins.</li> <li>Bleeding related to decreased production of clotting proteins.</li> <li>Increased pressure in veins from the backflow of blood and reduced platelets in the blood, also due to the poor blood flow through the liver. </li> </ul> Some contributors to liver disease cause slow damage to the liver over time that may not be noticeable until the disease has significantly progressed. These contributors include alcohol intake, some medications, chronic viral infections and the effects of metabolic syndrome (the combination of high cholesterol, obesity and/or diabetes) on the liver. If your laboratory exams suggest liver disease or you have symptoms that are suggestive of it, imaging tests (such as ultrasound, CT scan or MRI) and other specific blood testing can be used to assess you for the causes and severity of liver disease. Occasionally, obtaining a biopsy sample of the liver tissue is necessary to help diagnose the cause of liver disease. Common causes of liver disease While there are many causes of liver disease, several are common: <ul> <li>Fat in the liver (fatty liver or hepatic steatosis), related to metabolic syndrome, leads to liver inflammation and eventual scarring.</li> <li>Excess alcohol intake, leading to toxic injury of liver cells.</li> <li>Viral infection, such as hepatitis A, B and C. Hepatitis B and C can lead to chronic infections that develop into low-grade liver injury and eventual scarring of the liver.</li> <li>Adverse drug reactions.</li> <li>Inflammatory and inherited disorders such as autoimmune diseases, alterations of some types of proteins in the body and changes in handling of minerals in the body (notably iron and copper). </li> </ul> Treating liver disease Determining the underlying cause to treat liver disease is crucial so that specific treatments can be used if appropriate. If alcohol is determined to be a contributing factor, then complete avoidance is often necessary. When the issue is related to metabolic syndrome, which has become the most common cause of liver disease, weight loss is an extremely important part of treatment. For people found to have viral infections playing a role, there are now effective treatment options for both hepatitis B and C to help clear the infection. When liver disease progresses to severe disease, there is a risk that liver transplantation may be necessary. How to keep your liver healthy Things that are considered healthy lifestyle choices in general tend to help promote liver health as well. Maintaining a healthy body weight with a diet focused on plants, whole grains and lean meats and avoiding processed foods, as well as consistent exercise, helps to keep a well-functioning liver. These healthy choices can help prevent diagnoses like high cholesterol and diabetes, which are known to contribute to chronic liver disease. Coffee has also been shown to have beneficial and protective effects on the liver. Alcohol is a known toxin to the liver, especially with high intake levels, but lower intake levels can also have an adverse effect. Generally, it’s best to drink no more than one alcoholic beverage daily. <a rel="noopener" href="https://www.mayoclinic.org/biographies/schupack-dan-a-m-d/bio-20534553" target="_blank" title="Link opens in a new window">Dan Schupack, M.D.</a>, is a physician in the Division of Gastroenterology and Hepatology at Mayo Clinic in Rochester, Minnesota. He treats a wide range of GI/Hepatology-related conditions with a focus on preventing GI cancers and long-term management in patients at high risk for developing them.Dan Schupack, M.D.Primary Care in Rochester and KassonHealthy LiverPrimary Care in Rochester and KassonOpen and honest communication with your clinician is vital for your health. <img src="/-/media/ech-media/images/widgets/lgbtqi/lgbtqiaholdinghands.jpg?h=65&iar=0&w=100&sc_lang=en&hash=CAF269114D6E11166D709E1A01C40A97" alt="LGBTQIAholdinghands" width="100" height="65" DisableNVelocity="true" />Your voice, your health: Partnering with your clinician for LGBTQIA+ care6/5/2025 4:30 AM<img src="/-/media/ech-media/images/widgets/lgbtqi/lgbtqiaholdinghands.jpg?h=205&iar=0&w=315&sc_lang=en&hash=7FDBF48D9511BF1DCC0010B48742E662" alt="LGBTQIAholdinghands" width="315" height="205" DisableNVelocity="true" />Mayo Clinic is committed to providing an inclusive and welcoming healthcare environment for all patients, including LGBTQIA+ patients and their families. To provide the most comprehensive and personalized care, your healthcare clinician needs to understand your unique identity. While biological sex is assigned at birth, gender identity – one's internal sense of self – is a deeply personal experience that may or may not align with societal expectations. Similarly, sexuality encompasses the spectrum of attraction, encompassing attraction to men, women, both or neither. Open and honest communication about your gender identity, sexual orientation and sexual activity is crucial for assessing your individual health risks and tailoring your care plan. To facilitate this important conversation, we offer these guidelines: <ul> <li>Embrace this safe space. Your privacy is paramount. All discussions with your clinician are confidential and protected by law, ensuring a safe environment for sharing sensitive information.</li> <li>Proactively share your pronouns and identity. Help us understand how you wish to be addressed. Clearly communicate your preferred name and pronouns, as well as those of any accompanying partner or support person.</li> <li>Be transparent about your health history. A complete and honest health history, including past and present illnesses, partners and sexual practices, empowers your clinician to provide the most effective and individualized care.</li> <li>Offer constructive feedback. Your insights are invaluable. By providing feedback, you contribute to the ongoing improvement of our practices and enhance the care we provide for all patients. Don't hesitate to correct your clinician, your voice matters. </li> </ul> Providing this information lets your care team personalize recommendations for the most appropriate care to ensure your health and well-being. The Fenway Institute provides a free resource, “<a rel="noopener" href="https://www.lgbtqiahealtheducation.org/publication/dadt/" target="_blank" title="Link opens in a new window">Do Ask, Do Tell</a>,” which may be helpful when talking to your care team. <a href="/providers/matthew-heinrich-mdmba">Matthew Heinrich, M.D., M.B.A.</a>, is an internal medicine physician in Community Internal Medicine, Geriatrics and Palliative Care at Mayo Clinic in Rochester. He earned his medical degree at Texas Tech University Health Sciences Center School of Medicine and completed residency in internal medicine at Mayo Clinic in Rochester. His interests include education, evidence-based medicine and care of LGBTQIA+ patients.Matthew Heinrich, M.D., M.B.A.Primary Care in Rochester and Kassonlgbtqia carePrimary Care in Rochester and KassonTalk with your care team about osteoporosis screening. <img src="/-/media/ech-media/images/widgets/randomimages/ech_osteoporosis_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=C1D242C1971DFD4A4CE587DF27DAFD8D" alt="ECH_osteoporosis_widget" width="100" height="65" DisableNVelocity="true" />FAQ for detecting and treating osteoporosis6/16/2025 4:30 AM<img src="/-/media/ech-media/images/widgets/randomimages/ech_osteoporosis_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=E5B01A695F82B17E4A8EDADC71DE82D3" alt="ECH_osteoporosis_widget" width="300" height="195" DisableNVelocity="true" />Osteoporosis is the most common bone disease. Bones become brittle (thin) and more likely to break (fracture). Everyone is at risk for developing this disease, although older, postmenopausal women are at the highest risk. Some diseases, medications, smoking, and personal and family history of fractures also increase your risk. In this article, you can read more about these risk factors and how to prevent osteoporosis. Over a lifetime, half of all women will suffer a fracture of the spine, hip or wrist due to osteoporosis, while up to one-quarter of men over age 50 will fracture their hip or spine. Given these statistics, it’s essential to maintain bone health and detect and treat bone loss early. Here are answers to questions patients frequently ask about screening and treatment of osteoporosis. Q: When should I be screened? A: In our practice, we recommend that women who are postmenopausal and age 65 or older should be tested. We also screen men aged 70 and older. Younger women and men also may need to be screened if they have risk factors for osteoporosis or fractures. Q: What does testing for osteoporosis entail? A: A bone-density test is the most common way to diagnose bone loss. The test is an X-ray of the spine and hip, taken at a certified radiology center. If you have an artificial hip or arthritis in your hip or spine, another option is to use the wrist. Measuring bone density at other sites, like the heel or finger, is possible, but these tests and ultrasounds are much less helpful and reliable. Q: What results will I get from the test? A: A bone-density test will provide your actual bone density at each measured location and calculate a T-score and a Z-score. T-score tells how your bone density compares to that of an average healthy young adult of your sex. A normal T-score falls between -1 and +1. Anything outside of that range is abnormal, and fracture risk increases as the T-score decreases: <ul> <li>-1.1 to -2.4 indicates osteopenia (at risk for osteoporosis)</li> <li>-2.5 and lower indicates osteoporosis.</li> <li>Z-score compares your bone density with what is normal for someone of your age, sex, weight and race/ethnicity. </li> </ul> Q: How is osteoporosis treated? A: Treating osteoporosis, as well as osteopenia, involves lifestyle, diet and medications. Healthcare clinicians recommend lifestyle and dietary modifications to everyone with or at risk of osteoporosis. These include: <ul> <li>Get enough Vitamin D. Have your Vitamin D level tested. It should be between 30-50 ng/mL. If low, you can eat more D-fortified foods such as dairy products and take over-the-counter supplements of 800-1000 international units/day of Vitamin D2 or D3.</li> <li>Get enough calcium. Calcium is the building block for bone. If you have been diagnosed with osteoporosis, you should be getting about 1,200 mg/day through diet and/or a supplement.</li> <li>Get at least 30 minutes of weight-bearing exercise/day. This can be as simple as walking and does not need to be vigorous. Activities that do not work against gravity, such as biking or swimming, are not weight-bearing.</li> <li>Stop smoking.</li> <li>Limit alcohol.</li> <li>Be cautious and avoid falls. </li> </ul> The decision to start a medication is more difficult because even though medicines for treating osteoporosis generally are very safe, effective and affordable, they still have some risks. They may be started if their benefits (much lower risk of fractures) outweigh these risks. You should discuss all options with your healthcare clinician. Q: What drugs are used for treating osteoporosis? A: Several prescription medications treat osteoporosis and reduce the risk of fractures. There are advantages and disadvantages to each one. You’ll need to discuss these options with your clinician to determine what will work best for you. <ul> <li>Bisphosphonate medications have the best scientific evidence for effectively reducing vertebral (spine), nonvertebral (wrist, etc.), and hip fractures in both men and women. These include alendronate (Fosamax), a tablet taken one time/week; risedronate (Actonel), a tablet usually taken weekly or monthly; and zoledronic acid (Reclast), a quick intravenous infusion that is given once a year.</li> <li>Denosumab (Prolia) is an injection given once every six months and can be used safely by patients with more advanced chronic kidney disease.</li> <li>Teriparatide (Forteo) and Abaloparatide (Tymlos) are injections that help build bone. It is a self-administered injection given once daily for up to two years. It must be followed by either a bisphosphonate or denosumab to solidify the newly built bone.</li> <li>Romosozumab (Evenity) is a monthly injection done for one year that helps build bone and stops breakdown. It can be given to patients with chronic kidney disease. It can be given for up to one year and must be followed by either a bisphosphonate or denosumab to solidify the newly built bone.</li> <li>Raloxifene (Evista) is a non-hormonal, estrogen-like medication that can reduce the risk of vertebral fractures in women. However, it does not lower the risk of non-vertebral or hip fractures.</li> <li>Estrogen therapy for postmenopausal women and testosterone therapy for men are controversial and not recommended for the treatment of osteoporosis because of the potential harm to older women and men. This recommendation is different for young women who experienced early menopause and men who experienced hypogonadism; in these cases, hormone therapy may be beneficial for reasons other than bone health. </li> </ul> Q: Do I need to take osteoporosis medications for the rest of my life? A: Just like the decision to start an osteoporosis medication, the decision of when to stop it should be discussed in depth with your clinician. Most medications will have a recommended stop time, also known as a "drug holiday." We generally advise that lifestyle and dietary approaches continue indefinitely. To learn more about risk factors, prevention, diagnosis and treatment of osteoporosis and osteopenia, visit the <a rel="noopener" href="http://www.mayoclinic.org/diseases-conditions/osteoporosis/home/ovc-20207808" target="_blank" title="Link opens in a new window">Mayo Clinic website</a>. <a href="/providers/sara-medinabielski-md">Sara Medina-Bielski, M.D.</a>, is an internist and geriatrician in Community Internal Medicine, Geriatrics and Palliative Care. She provides primary care to older adults at Mayo Family Clinic Northwest and in skilled nursing facilities in Rochester.Sara Medina-Bielski, M.D.Primary Care in Rochester and KassonOsteoporosis TreatmentPrimary Care in Rochester and KassonFind out more about psoriasis and your treatment options. <img src="/-/media/ech-media/images/widgets/skin/psoriasisitch.jpg?h=65&iar=0&w=100&sc_lang=en&hash=D80AC11611F7670087AD0D5FF0294562" alt="PsoriasisItch" width="100" height="65" DisableNVelocity="true" />What is this red, scaly patch on my skin?6/2/2025 4:30 AM<img src="/-/media/ech-media/images/widgets/skin/psoriasisitch.jpg?h=205&iar=0&w=315&sc_lang=en&hash=C4D5B09479788004F24FBA1A6093E32A" alt="PsoriasisItch" width="315" height="205" DisableNVelocity="true" />Psoriasis is a relatively common chronic inflammatory skin condition. It causes people to develop red, raised plaques on their skin that have an overlying silvery scale. The knees and elbows are most commonly affected, but other body areas like the scalp, nails and groin/buttocks may also be affected. The plaques may itch, and they may bleed when scratched. Psoriasis is most common in adults but can also be present in children. The immune system is overactive in psoriasis, causing your skin to proliferate (grow) too much. This effect leads to the development of red, scaly plaques. We do not know the exact cause of psoriasis, but most experts agree that it has a genetic basis. This means you may be more likely to be affected if you have a family member who has psoriasis. Smoking, alcohol use or abuse and obesity are also risk factors. In addition, infections can act as a trigger for psoriasis or can worsen existing psoriasis, especially a strep throat infection. Stress or certain medications can make psoriasis worse as well. Unfortunately, there is no cure for psoriasis. People with psoriasis can expect to have flare-ups of the disease from time to time. However, with treatment, most people can keep their flare-ups to a minimum. When to be seen If you think you might have psoriasis, you should see your primary care clinician. They can examine your skin and determine if psoriasis is the most likely cause of your rash, or if there might be another cause. Your primary care clinician can also help determine if you have any conditions that are sometimes associated with psoriasis of the skin, such as arthritis or abnormalities in your cholesterol or blood sugar. You should see your primary care clinician as soon as possible if the rash is widespread, affects sensitive areas like the groin, or if there are associated joint symptoms such as joint pain, stiffness, redness or swelling. Treatment options If the rash is mild and limited to only a few areas of your body, it can be treated by your primary care clinician. In these cases, prescription-strength topical creams, ointments or shampoos (depending on the location affected) can often be used to keep the rash at bay. For very mild disease, moisturizing cream and over-the-counter hydrocortisone cream can sometimes be enough to keep symptoms under control. When to see a specialist If your psoriasis is widespread, is not responding to topical treatments, or you have joint symptoms, your primary care clinician may recommend seeing a dermatologist or rheumatologist. These clinicians specialize in skin diseases (dermatologists) and joints (rheumatologists). Other treatment options Many treatments are now available for psoriasis if topical creams are not controlling your disease or if your condition is widespread. These treatments include: <ul> <li>Light therapy.</li> <li>Medications taken by mouth.</li> <li>Biologics target the overactive immune system pathways involved in psoriasis and are given as an injection a few times a month or sometimes just a few times a year. </li> </ul> If needed, your primary care clinician can refer you to a specialist to discuss these treatment options. Psoriasis can be a very frustrating disease and can cause distress due to the appearance of the rash on your skin. You are not alone in feeling this way. Reach out to your primary care clinician if you are struggling and psoriasis is affecting your mood. Support and treatments are available to help. <a rel="noopener" href="https://www.mayoclinic.org/biographies/link-jenny-l-m-d/bio-20553450" target="_blank" title="Link opens in a new window">Jenny Link, M.D.</a>, is a physician in the Department of Dermatology at Mayo Clinic in Rochester, Minnesota. She completed her medical degree at the University of Arkansas in her hometown of Little Rock. She then completed her dermatology residency at Medical College of Georgia in Augusta, serving as chief resident in her final year. Following residency, she joined the staff at Mayo Clinic, where she has a special interest in complex medical dermatology, including psoriasis, dermatitis, cutaneous lymphoma and autoimmune diseases affecting the skin.Jenny Link, M.D.Primary Care in Rochester and KassonPsoriasisPrimary Care in Rochester and KassonPost-traumatic stress disorder, or PTSD, can happen following a traumatic incident. <img src="/-/media/ech-media/images/widgets/teens/sadteensittingonbed_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=6D036777C5CC444E155AD53ED66324A8" alt="SadTeenSittingOnBed_widget" width="100" height="65" DisableNVelocity="true" />PTSD: Symptoms, resilience and evidence-based treatments6/23/2025 4:30 AM<img src="/-/media/ech-media/images/widgets/teens/sadteensittingonbed_widget.jpg?h=205&iar=0&w=315&sc_lang=en&hash=22871C28E90917A332E9811E5AB3B375" alt="SadTeenSittingOnBed_widget" width="315" height="205" DisableNVelocity="true" />Many people experience some kind of traumatic event at least once throughout their lives. Most people have a brief reaction to the stressor and recover naturally. However, some will continue to experience negative outcomes following the traumatic incident, which can lead to a condition called post-traumatic stress disorder, or PTSD. What is PTSD? Several main features define PTSD. <ul> <li>Exposure to actual or threatened death, serious injury or sexual violence.</li> <li>Intrusion symptoms, such as flashbacks (feeling as though you are re-experiencing the trauma in the present moment) and nightmares.</li> <li>Avoidance of things that remind you of the trauma, such as people, places or sensations.</li> <li>Negative thoughts, including thoughts about yourself, others and the world, and a depressed mood.</li> <li>Reactivity and hyperarousal ("jumpy" or "on edge").</li> <li>Dissociation or derealization (extreme feelings of detachment).</li> <li>Symptoms cause significant impairment in your life and/or significant distress.</li> <li>Symptoms present for at least one month. </li> </ul> About 6% to 9% of adults in North America will develop PTSD at some point in their lives. Types of traumatic events may include physical assault or injury, intimate partner violence, sexual trauma, accidents, combat/war, race-based trauma, gender- and sexual orientation-based trauma, natural disasters, refugee trauma and medical trauma, among others. Minoritized people and groups are more likely to develop PTSD due to higher rates of traumatic exposure coupled with greater barriers to accessing care. PTSD affects the central nervous system, causing the body to be in a chronic state of stress. The brain and body are on high alert to help you look for potential danger. Usually, this ability to identify and respond to dangers in our environment is helpful and adaptive, but among people who have PTSD, this system becomes overactive. This chronic stress response is difficult for the body to maintain and has been linked to increased risk of several other health concerns, including: <ul> <li>Sleep disturbances.</li> <li>Substance use disorders.</li> <li>Mood disorders (e.g., depression).</li> <li>Anxiety disorders (e.g., panic disorder, generalized anxiety disorder).</li> <li>Irritable bowel syndrome.</li> <li>Hypertension.</li> <li>Type II diabetes.</li> <li>Cardiovascular disease.</li> <li>Autoimmune diseases. </li> </ul> Fortunately, many people recover and no longer meet the criteria for PTSD. Recovery can occur through resilience-promoting factors and/or receiving evidence-based treatment. Resilience can be characterized as "bouncing back" or adapting to maintain functioning following a stressful or traumatic experience. Importantly, resilience is not a characteristic that some people possess and others do not — resilience can be fostered in various ways. Examples of things we can do to help promote resilience may include: <ul> <li>Connecting and spending time with supportive and safe others, such as friends, family or community-based groups.</li> <li>Taking care of your health by prioritizing sleep, moving your body, eating well, hydrating and attending regularly scheduled primary care visits.</li> <li>Engaging in activities that you find enjoyable and meaningful, even when they may feel challenging.</li> <li>Allowing yourself to feel what you feel and have compassion for yourself and your experience. </li> </ul> It's also important to consider resilience as a process that doesn’t just fall on people. Societal and policy-level changes are critical in fostering the resilience of our communities. Finally, seeking professional psychological treatment can be very effective in promoting recovery from PTSD. When seeking this type of support, it's important to be aware of the evidence-based psychotherapies (i.e., supported by research) to be the best consumer of your care. Many of the symptoms of PTSD are maintained by avoidance of people, places, emotions, thoughts or memories associated with a traumatic event. Therefore, evidence-based treatments for PTSD typically focus on approaching these experiences in ways that are safe and structured with support from a clinician. Through approaching, instead of avoiding, we learn new ways of relating to difficult thoughts, memories and emotions, and they tend to become less distressing over time. Two common research-supported therapies are prolonged exposure (PE) and cognitive processing therapy (CPT). PE focuses on helping a person specifically approach trauma-related memories as well as situations in the person's life they may be avoiding due to trauma and associated emotions. CPT focuses on helping people understand how trauma may have led to thoughts and beliefs that are unhelpful for recovery. In CPT, patients work with their therapist to examine these thoughts and to build skills to think more flexibly about their trauma. Finally, trauma-focused cognitive behavioral therapy (TF-CBT) is a treatment approach for children and adolescents and their parents/guardians. TF-CBT focuses on identifying the associations between thoughts, emotions and behaviors in the context of trauma and helping children and adolescents build effective coping skills. If you believe that you or a loved one is struggling with trauma symptoms, consider reaching out to your primary care clinician and talking about your concerns. Ask your clinician about mental health resources and support that may be available to you. Kyle Schofield, Ph.D. is a clinical health psychology fellow in Primary Care in Rochester and Kasson's Division of Integrated Behavioral Health at Mayo Clinic. <a rel="noopener" href="https://www.mayoclinic.org/biographies/roche-anne-i-ph-d-l-p/bio-20569110" target="_blank" title="Link opens in a new window">Anne Roche, Ph.D., L.P.</a>, is a clinical psychologist in Primary Care in Rochester and Kasson’s Division of Integrated Behavioral Health. She is a Population Health Scholar at Mayo Clinic. <a href="/providers/craig-sawchuk-phdlp">Craig Sawchuk, Ph.D., L.P.</a>, is a clinical psychologist in Primary Care in Rochester and Kasson's Division of Integrated Behavioral Health. He is the co-chair of the Division of Integrated Behavioral Health and co-chair of Clinical Practice with the Department of Psychiatry and Psychology at Mayo Clinic.Kyle Schofield, Ph.D., Anne Roche, Ph.D., L.P., and Craig Sawchuk, Ph.D., L.P.Primary Care in Rochester and KassonPTSDPrimary Care in Rochester and KassonLearn more about scoliosis and treatment options.<img src="/-/media/ech-media/images/widgets/kids/scoliosis.jpg?h=65&iar=0&w=100&sc_lang=en&hash=B5D26BB50B72FFE05408BADF8FF5C109" alt="Scoliosis" width="100" height="65" DisableNVelocity="true" />How serious is scoliosis?6/30/2025 4:30 AM<img src="/-/media/ech-media/images/widgets/kids/scoliosis.jpg?h=205&iar=0&w=315&sc_lang=en&hash=10F6C7484DFAD4253A55E17F50DD7CAB" alt="Scoliosis" width="315" height="205" DisableNVelocity="true" />Scoliosis is a sideways curve of the spine with rotation. It most often develops during the growth spurt just before puberty. If the spinal curve is small — less than approximately 15 degrees — then having it checked periodically at follow-up appointments may be the only treatment needed. Most of the time, these small curves don't get worse over time. However, when the curve is in the 20- to 40-degree range and a child has at least two years of growth remaining, a brace is typically the best treatment choice. Wearing a brace doesn't cure scoliosis or reverse the curve, but it usually prevents the curve from worsening. The most common type of brace is made of plastic and is contoured to a child's body. It fits under the arms and around the rib cage, lower back and hips. The brace must be worn day and night to be most effective. Children who wear braces for scoliosis can usually participate in most activities and have few restrictions. If necessary, kids can take off the brace to participate in sports or other physical activities. A child stops wearing the brace once their bones stop growing. A brace won't help older teens and young adults diagnosed with scoliosis after they have stopped growing. In general, surgery is also the first step in treatment for large curves, usually greater than 50 degrees. The standard surgery for scoliosis is spinal fusion. This procedure corrects the spine curve by connecting two or more spinal vertebrae. Metal screws and rods are used to hold the vertebrae together so that they can heal into one solid unit. A newer surgical option is anterior vertebral body tethering. It involves inserting screws into the vertebrae affected by scoliosis. The surgeon attaches a cord to each of the screws and then pulls and secures the cord, so the vertebrae are cinched together on one side and splayed open on the other, correcting the curve. This technique aligns the spine and gives the vertebrae space to grow properly. This surgery is used mainly in cases of significant scoliosis in a child with growth remaining. Mayo Clinic is one of only a handful of centers where this surgery is performed. If moderate to severe scoliosis is not treated, it usually progresses at an average of 2 to 3 degrees a year. By the time a person reaches middle age, that could result in a curve of 100 to 115 degrees. Such a significant spinal deformity leads to noticeable changes in appearance, such as shoulders that are not level, ribs on one side of the body that stick out farther than on the other side, uneven hips, and a shift of the waist and trunk to the side. It can also cause increased back pain, and the rib cage may press against the lungs and heart, making it more difficult to breathe and harder for the heart to pump. If you notice that your child's spine seems to be curved, or if you spot other signs and symptoms of scoliosis — such as uneven shoulders or an uneven waist, one hip higher than the other, or one shoulder blade that seems more prominent than the other — make an appointment to have it evaluated as soon as possible. <a rel="noopener" href="https://www.mayoclinic.org/biographies/milbrandt-todd-a-m-d/bio-20113873" target="_blank" title="Link opens in a new window">Todd Milbrandt, M.D.</a>, is a physician in the Division of Pediatric Orthopedic Surgery at Mayo Clinic in Rochester. He specializes in the care of children with spine disorders, including scoliosis.Todd Milbrandt, M.D.Primary Care in Rochester and KassonScoliosisPrimary Care in Rochester and KassonLiving with migraines is difficult, but prevention and treatment help make them bearable<img src="/-/media/ech-media/images/widgets/people/headache.jpg?h=65&iar=0&w=100&sc_lang=en&hash=8F90D3F4C846C5AC7032F61772E02DA9" alt="Headache" width="100" height="65" DisableNVelocity="true" />Understanding migraines6/12/2025 4:30 AM<img src="/-/media/ech-media/images/widgets/people/headache.jpg?h=205&iar=0&w=315&sc_lang=en&hash=AC5BECF76DFB518F61B9CA8D503AA736" alt="Headache" width="315" height="205" DisableNVelocity="true" />Migraines are severe headaches that often come with nausea, sensitivity to light or sound, and sometimes even vision problems. They can last for hours or even days. Migraine prevention vs. treatment There are two main ways to manage migraines: prevention and treatment. <ul> <li>Prevention means taking steps to stop migraines before they start. This approach could involve medications, lifestyle changes or identifying things that bring on a migraine.</li> <li>Treatment is what you do when a migraine starts. These medications work to reduce the pain and other symptoms while migraines are happening. </li> </ul> Both prevention and treatment are essential parts of managing migraines, and your clinician can help you determine which options are best for you. Common medication options <ul> <li>Prevention medications <ul> <li>Beta-blockers: metoprolol or propranolol.</li> <li>Antidepressants: venlafaxine ER (Effexor XR) or amitriptyline.</li> <li>Anti-seizure medications: valproate or topiramate.</li> <li>CGRP inhibitors: fremanezumab (Ajovy), galcanezumab (Emgality) and erenumab (Aimovig).</li> <li>In some cases, Botox injections are used to prevent chronic migraines.</li> </ul> </li> <li>Treatment medications <ul> <li>Pain relievers: Over-the-counter options like ibuprofen or acetaminophen.</li> <li>Triptans: These are prescription medications that are highly effective at stopping a migraine once it starts. Examples include rizatriptan (Maxalt) or sumatriptan (Imitrex).</li> <li>Anti-nausea medications: If nausea is a problem, your clinician might suggest medications to help, such as metoclopramide (Reglan).</li> <li>CGRP inhibitors: Examples include ubrogepant (Ubrelvy), rimegepant (Nurtec) and zavegepant (Zavzpret). </li> </ul> </li> </ul> Side effects and when to talk to your clinician It's important to talk to your clinician or pharmacist if you experience any side effects from the medication, especially if they last or become bothersome. You should also contact them if you: <ul> <li>Notice your migraine medications are no longer working as well as they used to.</li> <li>Have any unusual or severe reactions to your medication.</li> <li>Are pregnant, planning to become pregnant or breastfeeding, as some migraine medications can affect pregnancy.</li> <li>Have other health conditions like high blood pressure or heart disease, as some medications may not be safe for you. </li> </ul> Jasmine King, Pharm.D., is a pharmacy resident in ambulatory care at Mayo Clinic in Rochester. She will train at several Primary Care in Rochester and Kasson outpatient sites.Jasmine King, Pharm.D.Primary Care in Rochester and KassonUnderstanding MigrainesPrimary Care in Rochester and KassonThat added spice in your chili is not just for taste. <img src="/-/media/ech-media/images/widgets/food/hotpeppers.jpg?h=65&iar=0&w=100&sc_lang=en&hash=8967D0D39BECEC3FEF0E1B5AFCD9840E" alt="HotPeppers" width="100" height="65" DisableNVelocity="true" />The many benefits of spicy foods7/7/2025 4:30 AM<img src="/-/media/ech-media/images/widgets/food/hotpeppers.jpg?h=205&iar=0&w=315&sc_lang=en&hash=AB02C79522B09A17379903413C2B2EC6" alt="HotPeppers" width="315" height="205" DisableNVelocity="true" />Have the changing temps left you with a summer cold? Turn up the heat by elevating your spice game! That's right, spicy foods are back, and we will break down why and how you should incorporate them into your diet. Boost your metabolism Did you know the spicy kick you get from a chili pepper could also kick your metabolism into high gear? Capsaicin, the compound that gives pepper its heat, has been shown to increase the body's ability to burn calories. Boosting the spice level in your food may boost your metabolism into high gear. Reduce inflammation If you thought capsaicin only had calorie-burning benefits, think again. Reducing inflammation is another perk of this compound. Specifically, capsaicin has been shown to fight low-grade inflammation, a mark of metabolic disorders such as obesity and type 2 diabetes. Not feeling like chili peppers? No worries! Other spices, like turmeric and cinnamon, have anti-inflammatory benefits and are easy to incorporate into meals. Endorphin rush If you've ever felt a rush of euphoria after eating something spicy, you are not imagining things. Spicy foods trigger the release of endorphins, those feel-good hormones that give you an increased sense of well-being. So, the next time you feel down, consider swapping out the chocolate for some hot wings. Clear your sinuses A little heat might be the remedy you need, whether it's the common cold or seasonal allergies leaving you stuffy. Spicy foods can act as natural decongestants, helping to open up your nasal passages and relieve that pesky congestion. A bowl of spicy soup could be just what the doctor ordered. Ideas to spice up your life Now that you know why you should spice up your life, I'm sure you are wondering how you should do it. While the benefits of spice are tempting, you do not need to go full-on ghost pepper at every meal. Start slowly by adding a sprinkle of cinnamon to your morning oats or stirring some chili flakes into your pasta sauce. You can turn up the heat without overdoing it as your tolerance builds. So, whether you are a spice lover or just starting to explore the world of heat, embracing this elevated spice trend can be as fun as it is beneficial. Just remember to have some water, or maybe a glass of milk, on hand and enjoy the burn! Audrey McKinney graduated from Purdue University with a bachelor's degree in nutrition and dietetics. She is completing her master's in clinical nutrition from UW-Madison alongside her dietetic internship at Mayo Clinic in Rochester, Minnesota.Audrey McKinneyPrimary Care in Rochester and KassonBenefits of SpicePrimary Care in Rochester and KassonLearn about constipation in children and how to manage it. <img src="/-/media/ech-media/images/widgets/kids/littlegirlholdingstomach.jpg?h=65&iar=0&w=100&sc_lang=en&hash=2485D46312CB9964173AD21DE72137B9" alt="LittleGirlHoldingStomach" width="100" height="65" DisableNVelocity="true" />Getting the scoop on your child's poop7/10/2025 4:30 AM<img src="/-/media/ech-media/images/widgets/kids/littlegirlholdingstomach.jpg?h=205&iar=0&w=315&sc_lang=en&hash=5511127A3029372F711861D570164A60" alt="LittleGirlHoldingStomach" width="315" height="205" DisableNVelocity="true" />What is constipation, and why does it happen? Constipation is a term used to describe having delayed and/or infrequent bowel movements that cause large, hard and painful stools. While there is no firm number for how often a child should poop per week, a frequency less than three times per week is often associated with hardening of stools and subsequent constipation symptoms. For most children, constipation is not due to a problem with the function or structure of their gut but rather a combination of poor diet and voluntary withholding. Voluntary withholding is when a child ignores or fights the urge to poop for a variety of reasons, including anxiety over pooping in public, embarrassment to poop in front of friends at school, and poor attention span with a preference to play instead of using the bathroom. If these normal urges are ignored, stool builds up and hardens with time. This situation worsens when children fail to drink enough water or eat adequate amounts of fiber, which are both essential to maintaining soft, painless stools. How is constipation diagnosed? Constipation can be diagnosed by scheduling a visit with your healthcare clinician to discuss your child’s bowel habits, along with a general physical examination. Often, a hard stool can be felt when pushing on your child’s belly. Sometimes, your clinician may also recommend an X-ray image of the belly, though this step is often unnecessary to diagnose constipation. Depending on the severity of your child’s constipation, your clinician may also recommend and perform a rectal examination to both feel for hard stool and make sure the anal muscles are functioning normally. This exam can be very important for both diagnosis and treatment. How is constipation treated? Phase 1: Cleanout  Treatment starts with high doses of medications called laxatives to help your child poop and clear out the hardened, built-up stool. Some laxatives, including MiraLAX and magnesium citrate, work by hydrating the stool, almost like a sponge filling with water, resulting in mushy poop. Others, such as Ex-Lax and Senna, work by telling the large intestines (also called the colon) to squeeze and push out stool. We often call this the combination of “mush” and “push.” While these medications are taken by mouth, children often need rectal medications as well, called suppositories and enemas. Rectal medicines both soften and lubricate the hardest poop stored in the rectum (the last part of the colon), allowing for less painful passage of stool. This phase often takes 2-3 days. Phase 2: Maintenance Following a successful cleanout, your child’s colon needs time to regain its strength. This can take months, if not years, depending on the severity of constipation. During the maintenance phase, your clinician will ask your child to continue taking oral laxatives at lower doses every day and will adjust the dosage to maintain easy-to-pass stools. Making lifestyle changes is another important aspect of maintenance. Be sure your child is drinking plenty of water and eating foods rich in fiber. Ask your clinician about starting a fiber supplement if needed. It is also important for your child to sit on the toilet properly with their feet supported and for them to dedicate time every day to sitting on the toilet, regardless of the urge. The best time is after meals. Phase 3: Resolution After 3-6 months of a successful maintenance phase of treatment, your clinician may give recommendations on how to stop laxative therapy completely. Again, it will still be important to maintain those healthy lifestyle changes. Please know that MiraLAX is non-addictive and non-habit forming, so long-term use is safe and approved. What is the prognosis for constipation? In most cases, constipation is treatable, but it requires consistency and a long-term plan. There is often no quick fix, so be prepared to support your child in learning how to get and stay regular. Grant VanNess, M.D., is a former resident in the Department of Pediatric and Adolescent Medicine at Mayo Clinic in Rochester. He started a fellowship in pediatric gastroenterology, hepatology and nutrition this month.Grant VanNess, M.D.Primary Care in Rochester and KassonChildhood ConstipationPrimary Care in Rochester and KassonSetting goals is great, but SMART goals position you for success.<img src="/-/media/ech-media/images/widgets/randomimages/ech_smart_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=C7069BB2C034E5EC09AFED39B4C1B64A" alt="ECH_SMART_widget" width="100" height="65" DisableNVelocity="true" />Get a SMART start on your health goals7/24/2025 4:30 AM<img src="/-/media/ech-media/images/widgets/randomimages/ech_smart_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=08513949A05E96FDFBDB8F94F1FDB283" alt="ECH_SMART_widget" width="300" height="195" DisableNVelocity="true" />When making lifestyle changes, setting SMART goals is a great way to position yourself for success. SMART stands for Specific, Measurable, Attainable, Relevant and Time-bound. Let's break down what each of these terms mean. Specific: Your goals should be clear and specific. Instead of saying "I want to eat healthier," say "I will eat five servings of fruits or vegetables a day." Measurable: Make sure you can track your progress. For example, instead of saying "I will walk more," say "I will walk 30 minutes three days a week." Attainable: Set goals that are challenging but achievable. For example, instead of deciding to never eat out for lunch, say "I will pack my lunch four days a week." This approach allows for some flexibility and keeps your goal realistic. Relevant: Your goals should contribute to your overall well-being. For instance, "I will sleep 8 hours a night" is a pertinent goal as sleep is essential for good health. Time-bound: Each goal should have a clear deadline to help you stay focused and motivated. "I will run a 5K in three months" gives you a time frame to work towards. Here are some examples of SMART goals: <ul> <li>Exercise 30 minutes a day at least four days a week for two months.</li> <li>Eat two meat-free dinners a week for one month.</li> <li>Spend 60 minutes of screen-free time with your children every Saturday.</li> <li>Put away all mobile devices and shut off all screens by 9 p.m. on weeknights for one month.</li> <li>Call your grandparents every Sunday afternoon for six months.</li> <li>Walk at least 10,000 steps tracked on a pedometer at least five days a week.</li> <li>Enjoy lunch with a friend at least one day a month in July, August and September. </li> </ul> By setting SMART goals, you can create a clear plan to improve your health habits. Whether it's eating better, exercising more or getting enough sleep, SMART goals can help you stay on track and achieve lasting lifestyle changes. <a href="/providers/jennifer-bold-cnp">Jennifer Bold, APRN, C.N.P., D.N.P.</a>, is a nurse practitioner in Primary Care in Rochester and Kasson in the Department of Family Medicine. She has completed her Doctor of Nursing Practice and has a special interest in chronic disease management.Jennifer Bold, APRN, C.N.P., D.N.P.Primary Care in Rochester and KassonEating SmartPrimary Care in Rochester and KassonLearn about common causes of elbow pain and how to deal with them. <img src="/-/media/ech-media/images/widgets/activities/elbowinjury.jpg?h=65&iar=0&w=100&sc_lang=en&hash=E47DA95020FF619444690A1AFCD3524D" alt="ElbowInjury" width="100" height="65" DisableNVelocity="true" />Summer sports and elbow pain7/31/2025 4:30 AM<img src="/-/media/ech-media/images/widgets/activities/elbowinjury.jpg?h=205&iar=0&w=315&sc_lang=en&hash=0EDCDC75B14653B316430A06C0E75347" alt="ElbowInjury" width="315" height="205" DisableNVelocity="true" />Summertime brings the perfect opportunity to get outside and have fun. Still, with the return of outdoor activities like golf, tennis, baseball or softball, we often see a rise in patients with elbow pain. These sports are a great way to stay active but can come with common overuse injuries. Here's what to look out for and how to keep your elbows healthy throughout the season. Common causes of elbow pain Tennis elbow (lateral epicondylitis): Tennis elbow isn't just for tennis players. It's a condition caused by repetitive use of the muscles on the back of your forearm, often from gripping or wrist movements. Pain is usually felt on the outside of the elbow and may extend down the forearm. Simple actions like shaking hands or lifting a cup of coffee can trigger discomfort. If the pain persists or interferes with daily activities, it's time to seek medical advice. Golfer's elbow (medial epicondylitis): Golfer's elbow can affect anyone who repeatedly flexes their wrist or grips tightly. This condition causes pain on the inside of the elbow and may also radiate into the forearm. Symptoms include stiffness, weakness in the hands or wrists, and a dull ache that worsens with movement. A professional evaluation is recommended if rest and conservative measures outlined below don't improve symptoms within a couple of weeks. Little League and Big League elbow injuries: Young athletes are especially vulnerable to elbow issues due to growing bones and repetitive throwing motions. Little League elbow typically refers to pain and inflammation on the inner part of the elbow, caused by stress to the area of bone called the growth plate. In more advanced athletes, Big League elbow can involve ligament or cartilage damage from high-velocity, repetitive throwing. Any young player experiencing pain while throwing should stop the activity and be evaluated to prevent long-term damage. Limiting pitch counts and ensuring that these athletes have adequate rest between innings and games is also important. When to see your clinician <ul> <li>Pain persists for more than 1–2 weeks despite rest or interferes with your sport or daily activities.</li> <li>You experience numbness, tingling or weakness.</li> <li>You can't fully bend or straighten your elbow. </li> </ul> Starting treatment at home Most mild elbow pain can be managed at home with the RICE+ method: <ul> <li>[R]est: Avoid aggravating activities for a few days.</li> <li>[I]ce: Apply ice packs to the elbow for 15–20 minutes several times a day.</li> <li>[C]ompression: Use a brace or strap to reduce muscle strain.</li> <li>[E]levation: Keep the elbow elevated to reduce swelling after activities.</li> <li>+ Anti-inflammatories: Over-the-counter or topical medications like ibuprofen or Voltaren gel can reduce pain and swelling. </li> </ul> If symptoms continue or worsen, physical therapy or additional treatment might be needed. To help avoid elbow pain <ul> <li>Warm up properly before sports or activities.</li> <li>Build up endurance by slowly increasing the duration and intensity of the activity over a period of weeks.</li> <li>Use correct technique when swinging, throwing or lifting; this prevention technique may involve getting instructions from more experienced athletes or coaches when starting a new activity.</li> <li>Strengthen forearm muscles with light resistance exercises and free hand weights.</li> <li>Take breaks during repetitive activities.</li> <li>Use appropriate equipment (grip size, weight, length, etc.) for your sport. </li> </ul> Staying active is important, and with a few preventive steps, you can enjoy your favorite summer sports while keeping your elbows strong and pain-free! Jessica Buttinger, M.D., is a physician in Physical Medicine and Rehabilitation at Mayo Clinic in Rochester, Minnesota. <a href="/providers/david-soma-md">David Soma, M.D.</a>, is a general pediatrician in Community Pediatric and Adolescent Medicine and a sports medicine physician in the Department of Orthopedics Surgery in Rochester, Minnesota. He serves as the team physician for Rochester Mayo High School and a Team Physician for the US Ski and Snowboard Team. Dr. Soma also serves as a coach of youth football, basketball and baseball.Jessica Buttinger, M.D., and David Soma, M.D.Primary Care in Rochester and KassonElbow PainPrimary Care in Rochester and KassonCheck out the summer outdoor opportunities in Olmsted County and beyond. <img src="/-/media/ech-media/images/widgets/activities/whitewaterstairs.jpg?h=65&iar=0&w=100&sc_lang=en&hash=D6CD661875045E2F3F897453E9667FC3" alt="WhitewaterStairs" width="100" height="65" DisableNVelocity="true" />A season of wellness7/3/2025 4:30 AM<img src="/-/media/ech-media/images/widgets/activities/whitewaterstairs.jpg?h=205&iar=0&w=315&sc_lang=en&hash=EFE3B4A52EC3EF212F17736BEF1A9927" alt="WhitewaterStairs" width="315" height="205" DisableNVelocity="true" />Summer in Olmsted County is more than just sunshine and warm weather. It's a season of vibrant community activities, family fun and powerful opportunities to support physical and mental well-being. As temperatures rise and nature bursts into full bloom, residents of all ages are encouraged to step outside and take advantage of local parks, recreation programs and nature-based health initiatives. Whether it's paddling across a lake, participating in a mindful forest walk or joining inclusive camps and aquatic programs, summer offers an abundance of ways to move more, stress less and connect deeply with nature and one another. Outdoor recreation and water wellness in Olmsted County From July through September, often known as the dog days of summer, Olmsted County's parks come alive with energy and engagement. <a rel="noopener" href="https://www.olmstedcounty.gov/residents/parks-recreation/parks/chester-woods-park/contact-chester-woods-park" target="_blank" title="Opens in new browser window">Chester Woods Park</a> is a standout destination during this time. It features a beach that is open daily and a full suite of water recreation opportunities — including kayaking, paddle boarding, paddle boating and canoeing. These activities aren't just fun in the water; they come with a wide array of health benefits. Water-based movement is low-impact but highly effective for cardiovascular health, muscle strength and joint flexibility. Being on or near water has also been linked to reduced levels of the stress hormone cortisol and improved mood. <a rel="noopener" href="https://www.olmstedcounty.gov/residents/parks-and-trails" target="_blank" title="Opens in new browser window">Olmsted County Parks and Trails</a> offers a rotating list of programs and activities throughout the summer months. These programs provide opportunities for residents to enjoy the outdoors, connect with others and improve their physical and emotional health in natural settings. Staying current with the latest offerings can be done through the <a rel="noopener" href="https://www.olmstedcounty.gov/residents/parks-and-trails/parks/parks-and-trails-quarterly-newsletter" target="_blank" title="Opens in new browser window">county's quarterly newsletter</a>. <a rel="noopener" href="https://www.rochestermn.gov/departments/parks-and-recreation" target="_blank" title="Opens in new browser window">Rochester Parks & Recreation</a>: 50 Years of Inclusive Wellness: This summer marks a major milestone for the <a rel="noopener" href="https://www.rochestermn.gov/departments/parks-and-recreation/leagues-classes-accessable-recreation/accessable-recreation" target="_blank" title="Opens in new browser window">City of Rochester's AccessABLE Recreation Program</a>, which is celebrating its 50th year. Initially launched in 1975, this program supports people with cognitive and developmental disabilities by offering inclusive activities such as summer day camps, adaptive swimming, sports and social events. Such programs go beyond recreation — they promote independence, improve physical health and reduce social isolation, a key factor in chronic disease and mental health risk. Rochester also boasts an impressive range of <a rel="noopener" href="https://www.rochestermn.gov/departments/parks-and-recreation/parks-trails-recreation-facilities/outdoor-pools-beaches-summer-aquatics" target="_blank" title="Opens in new browser window">aquatic facilities</a>. From the updated Soldiers Field Aquatic Center, complete with lazy rivers, splash pads, slides and climbing walls, to the serene swim spots at Foster Arend Beach and Cascade Lake Beach, the city makes it easy to cool off while staying active. Swimming is one of the best forms of aerobic exercise for people of all ages and fitness levels. It strengthens the heart, enhances lung capacity, supports mobility and helps reduce anxiety and depression. In addition to current facilities, future investments are being made to improve accessibility and enjoyment. The Silver Lake Pool is undergoing complete reconstruction, with a brand-new pool and splash pad scheduled to open in 2026. Similar renovations for the McQuillan Sports Complex are planned, contributing to long-term public health infrastructure. Nature as a healing space: State Park programs and forest therapy <a rel="noopener" href="https://www.dnr.state.mn.us/state_parks/map.html" target="_blank" title="Opens in new browser window">State Parks</a> in southeastern Minnesota also play a central role in promoting wellness through nature education and therapeutic outdoor experiences. At <a rel="noopener" href="https://www.dnr.state.mn.us/state_parks/park.html?id=spk00160#homepage" target="_blank" title="Opens in new browser window">Frontenac State Park</a>, the "Nature Explorers" series offers young children (ages 3–6) the chance to engage in storytelling, crafts and nature discovery. Early exposure to nature fosters curiosity, creativity and resilience. Studies have shown that children who regularly play in natural environments demonstrate reduced symptoms of ADHD, improved emotional regulation, and stronger problem-solving skills. Forest Bathing Walks provide a guided, sensory-rich experience in nature for adults and older youth. Led by certified guide and naturalist Sara Holger, these slow, mindful walks help participants reconnect with the natural world and themselves. Forest bathing originates from the Japanese practice of shinrin-yoku and has been shown to lower blood pressure, improve immune function, reduce anxiety and boost mood. Scheduled walks occur throughout the region, including at <a rel="noopener" href="https://www.dnr.state.mn.us/state_parks/park.html?id=spk00280#homepage" target="_blank" title="Opens in new browser window">Whitewater State Park</a>, <a rel="noopener" href="https://www.dnr.state.mn.us/state_parks/park.html?id=spk00160#homepage" target="_blank" title="Opens in new browser window">Frontenac State Park</a> and <a rel="noopener" href="https://www.dnr.state.mn.us/state_forests/forest.html?id=sft00033#cmp00041" target="_blank" title="Opens in new browser window">Krueger State Forest Unit/Campground</a>, part of the Richard J. Dorer Memorial State Hardwood Forest. Community-based mental health: Nature and mindfulness at Zumbro Valley Nature's healing power extends into clinical settings, too. At <a rel="noopener" href="https://www.zvhc.org/" target="_blank" title="Opens in new browser window">Zumbro Valley Health Center</a> in Rochester, nature-based mindfulness walks are integrated into outpatient Health and Wellness Services. These walks encourage participants to slow down, observe their surroundings and notice internal shifts in breathing, heart rate, thoughts and emotions. Clients benefit from improved self-awareness, reduced symptoms of depression and anxiety, and better stress management. This holistic model of care aligns well with emerging research showing that nature exposure can significantly enhance mental and emotional well-being, especially when paired with therapeutic support. A season to thrive: Health, nature and community connection Summer in Olmsted County is a season rich with opportunity — not only for fun but for healing, growth and connection. Whether through water recreation, adaptive sports, forest walks or natural mindfulness, each program and park offer a path to improved health. Residents are encouraged to take full advantage of these resources while the sun shines and the trails are green. In doing so, they'll make memories and invest in their long-term wellness, building habits and community ties that can last all yearlong. As the days get longer and the outdoors call out louder, let this summer be one of movement, mindfulness and meaningful connection — with ourselves, nature and our neighbors. Muse Abdi, M.B.B.S., B.BiomedSc, M.P.H., has a background in medicine and leads nature-based health initiatives, including Park Rx/Exercise is Medicine, Healing Forest and the cultural liaison program in the parks under the Statewide Health Improvement Partnership (SHIP) grant. He facilitates the SE MN Park Rx Coalition, a key component of the Park Initiative. He also leads health equity and community engagement efforts through SHIP, including the MOVE (Mobilizing Olmsted Voices for Equity) project. <a href="/providers/brian-lynch-md">Brian A. Lynch, M.D.</a>, is a primary care pediatrician at Mayo Family Clinic Northwest in Rochester. He co-chairs the Primary Care Work Group of the Mayo Clinic Obesity Council and chairs the Primary Care Obesity Task Force. Dr. Lynch works closely with the Southeast Minnesota Park Rx Team to promote the physical and mental health benefits of spending time in nature with his patients and colleagues.Muse Absi, M.B.B.S., B.BiomedSc, M.P.H., and Brian Lynch, M.D.Primary Care in Rochester and Kassonpark rx summer 2025Primary Care in Rochester and KassonUntil the first hard frost, beware of poisonous plants when you're outdoors. <img src="/-/media/ech-media/images/widgets/activities/familywalktallgrass.jpg?h=65&iar=0&w=100&sc_lang=en&hash=F692789964847F7AB5ABC4C8D46E43DF" alt="FamilyWalkTallGrass" width="100" height="65" DisableNVelocity="true" />Poisonous wild plants still pack an unpleasant punch7/21/2025 4:30 AM<img src="/-/media/ech-media/images/widgets/activities/familywalktallgrass.jpg?h=205&iar=0&w=315&sc_lang=en&hash=3B7D92C3F676393AC47A1FAA90BBF41E" alt="FamilyWalkTallGrass" width="315" height="205" DisableNVelocity="true" />Whether taking a hike, hunting, cleaning up the garden or camping this summer, wild poisonous plants still can pack an itchy, unpleasant and sometimes painful punch. The devilish duo to be aware of and avoid are wild parsnip and poison ivy (and its cousins, poison oak and poison sumac).  <a href="/-/media/ech-media/images/widgets/plants/ech_wildparsnip_01_widget.jpg?sc_lang=en&hash=3F2E45EC5A9A8409706C2174CBD46F57"><img alt="ECH_WildParsnip_01_widget" src="/-/media/ech-media/images/widgets/plants/ech_wildparsnip_01_widget.jpg?h=123&w=189&hash=A2EEAA127A60F32E730042DDCCC4F5313575E9E8&sc_lang=en" style="float: right; left: 948px; width: 189px; height: 123px;"></a>Wild parsnip. This tall, sturdy plant with its flat, umbrella-like blossom sprinkled with tiny yellow flowers has run rampant this season. All it takes is skin contact with its poisonous sap, a little sunlight and yeow! The chemical reaction, called phytophotodermatitis, is so corrosive that it can cause a rash and blistering as bad as second-degree burns. The blisters can take weeks to clear up and may leave scars and skin discoloration.  This non-native plant, is found along roadsides and fence rows, the edges of prairie areas, woodlands and trails, and in abandoned fields and unmowed pastures. <a href="/-/media/ech-media/images/widgets/plants/ech_parsnip_03_widget.jpg?sc_lang=en&hash=FB66FD56C8DD611C2D7C703BAC703CA9"><img alt="ECH_Parsnip_03_widget" src="/-/media/ech-media/images/widgets/plants/ech_parsnip_03_widget.jpg?h=123&w=189&hash=D0EA756417C7314B2220E256935828D4C6F57231&sc_lang=en" style="float: right; height: 123px; width: 189px; left: 922px;"></a>Your best protection is to wear long sleeves, pants and gloves. If you do come in contact with wild parsnip:  <ul> <li>Cover the affected area with a cool, wet cloth</li> <li>If blisters appear, try not to rupture them for as long as possible</li> <li>To avoid infection, keep the area clean and apply antiseptic cream</li> <li>Contact your care team or clinician if the blisters get worse or there are signs of infection</li> </ul> <a href="/-/media/ech-media/images/widgets/plants/ech_poisonivy_01_widget.jpg?sc_lang=en&hash=29D15D24AE981C3E9638B7E6BBE04F3D"><img alt="ECH_PoisonIvy_01_widget" src="/-/media/ech-media/images/widgets/plants/ech_poisonivy_01_widget.jpg?h=123&w=189&hash=3FB6BEC22C3A7AD64A96124F437B53C225648717&sc_lang=en" style="float: right; height: 123px; width: 189px; left: 922px;"></a>Poison ivy (poison oak, poison sumac). "Leaves of three, let it be." That's the old trick for identifying and steering clear of poison ivy. Good advice! Poison ivy and its cousins can produce an itchy, long-lasting rash caused by an allergic reaction to the oily resin, called urushiol, which is found in the leaves, stems and roots.  You can get the oil on your skin not only from the plant, but also from clothing, tools, equipment or animal fur or hair. If you're burning with poison ivy, inhaling the oil is also dangerous, which may cause difficulty breathing.  If you've come in contact with the oil, wash your skin with soap and water, and even your clothing, as soon as possible to reduce your chance of getting the rash. Poison Ivy doesn’t spread after contact with the plant, but it can seem that way. Symptoms typically occur 4-96 hours after exposure and peak by day 14 but new areas of rash can occur for up to 21 days after exposure. Treat mild cases of poison ivy rash at home with soothing lotions and cool baths. If the rash is severe or widespread, or on your face or genitals, you may need a prescription medication.  See your care team or clinician if:  <ul> <li>Your skin continues to swell.</li> <li>The rash affects your eyes, mouth or genitals.</li> <li>Blisters are oozing pus.</li> <li>You develop a fever greater than 100 F. (37.8 C.).</li> <li>The rash doesn't get better within a few weeks.</li> <li>You're having respiratory symptoms.</li> </ul> Allergic reactions to any poisonous plant can be worse after each new exposure, because your body becomes primed to react to the toxins.  <a href="/-/media/ech-media/images/widgets/plants/ech_nettles_01_widget.jpg?sc_lang=en&hash=7180D656CA213E72A12D8C9A48F1FA42"><img alt="ECH_Nettles_01_widget" src="/-/media/ech-media/images/widgets/plants/ech_nettles_01_widget.jpg?h=123&w=189&hash=84B934FC8BC985BFB51F260EC5698A2F398E27CE&sc_lang=en" style="float: right; left: 926px; top: 634px; width: 189px; height: 123px;"></a>Stinging nettles. While nettles have been used for centuries in herbal teas and remedies, inadvertently coming in contact with tiny spines on the stalk is plenty painful. These tall, spiky plants grow along streams, woodlands, trails and roadsides. If you come in contact with nettles, wash the area with soap and plenty of water to remove the sting.  <a href="/providers/nancy-kirscht-cnp">Nancy Kirscht, APRN, C.N.P.</a>, is a nurse practitioner in the Department of Family Medicine. She practices at Mayo Clinic Express Care in Rochester, Minnesota. Her interests include acute care, women's health and preventing antimicrobial overuse. She enjoys traveling, exploring new places and spending time with her family. Nancy Kirscht, APRN, C.N..P.Primary Care in Rochester and KassonPoisonous Minnesota PlantsPrimary Care in Rochester and KassonRegistration begins Aug. 6 and will close Sept. 10 at 11 p.m.<img src="/-/media/ech-media/images/widgets/kids/kidsschool.jpg?h=65&iar=0&w=100&sc_lang=en&hash=43079E005309F5831DBA82D6E63A8B28" alt="KidsSchool" width="100" height="65" DisableNVelocity="true" />Register your child to be vaccinated for flu in school7/28/2025 4:30 AM<img src="/-/media/ech-media/images/widgets/kids/kidsschool.jpg?h=205&iar=0&w=315&sc_lang=en&hash=32229189F6DE3CFD88DDC2D67B4FCCF4" alt="KidsSchool" width="315" height="205" DisableNVelocity="true" />The time to sign up to have your child vaccinated for flu at school is coming soon. Registration begins Aug. 6 and will close on Sept. 10 at 11 p.m. <a rel="noopener" href="http://www.semnic.org/schoolfluclinics.aspx" target="_blank" title="Opens in new browser window">Online registration is preferred</a>. It's quick and easy, especially for those with two or more children. Paper forms will be available at Meet the Teacher or Step Into Learning events, and in your school office for those without online access. No late online or paper forms will be accepted. Students in kindergarten through grade 12 are eligible to participate at: <ul> <li>Most public and private schools in Olmsted County.</li> <li>Kasson-Mantorville, Hayfield and Triton Public Schools in Dodge County.</li> <li>Pine Island Public Schools.</li> <li>Most public and private schools in Mower County.</li> <li>Janesville-Waldorf-Pemberton School in Waseca County.</li> <li>Cleveland School in Le Sueur County. </li> </ul> Mayo Clinic, Mayo Clinic Health System, Olmsted Medical Center, Olmsted County Public Health, Dodge County Public Health and Goodhue County Public Health support this program. Flu vaccinations will be available as an injection or nose spray, if available. Non-medicine, pain-reducing options will also be available. Teachers will have the option to play a <a rel="noopener" href="https://www.youtube.com/watch?v=rRUAySGFfBI&feature=youtu.be" target="_blank" title="Opens in new browser window">short video</a> on flu vaccination for their elementary classrooms to ease students' concerns. To register your child or for more information about the School-Located Immunization Program, visit the Southeast Minnesota Immunization Connection website at <a rel="noopener" href="https://www.semnic.org/schoolfluclinics.html" target="_blank" title="Opens in new browser window">semnic.org</a>.Primary Care in Rochester and KassonSLIP RegistrationPrimary Care in Rochester and KassonSunburns can lead to more than pain. <img src="/-/media/ech-media/images/widgets/skin/ech_sunprotection_01_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=08D327C871F95E421D7D32B916C82032" alt="ECH_SunProtection_01_widget" width="100" height="65" DisableNVelocity="true" />Protect your skin in the summer sun7/14/2025 4:30 AM<img src="/-/media/ech-media/images/widgets/skin/ech_sunprotection_01_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=3B242FC3E0C956CC081F9D5B34107E84" alt="ECH_SunProtection_01_widget" width="300" height="195" DisableNVelocity="true" />Sunburns can not only ruin a weekend or vacation, but they can also lead to skin cancer. The real problem with spending time soaking up the sun is the ultraviolet, or UV, light. UV light is responsible for sunburn, skin cancer and skin damage. To enjoy warm summer weather and protect your skin from UV light, you should: <ul> <li>Avoid spending time in direct sunlight.</li> <li>Avoid the peak sun hours of 10 a.m.– 4 p.m.</li> <li>Use sunscreen.</li> <li>Wear sun-protective clothing. </li> </ul> If you plan to spend time outside, sunscreen is recommended. The sunscreen aisle at your grocery store or pharmacy has many options to choose from, so it can take time to decide what to pick. When selecting a sunscreen, the most important thing to look for is the sun protection factor, or SPF. The American Academy of Dermatology recommends sunscreen with SPF 30 or greater when participating in outdoor activities. How you apply sunscreen is another key factor. Sunscreen is most protective when applied generously and repeatedly throughout the day. Applying sunscreen 15–30 minutes before going outside is important. Then, it should be reapplied every two hours or after sweating or swimming. You will need about 1 ounce, or 2 tablespoons, of sunscreen for each application. Remember to apply sunscreen over your whole body. The American Academy of Pediatrics recommends that infants under 6 months stay covered to protect against sunburns. Infants should wear sun-protective clothing, hats and sunglasses. Make sure infants remain in shaded areas. If you do get a sunburn, the American Academy of Dermatology recommends these soothing treatments: <ul> <li>Cool baths or showers.</li> <li>Apply a moisturizer that contains aloe vera while your skin is still damp.</li> <li>Stay well hydrated.</li> <li>Use ibuprofen or acetaminophen for discomfort.</li> <li>Don't pop sunburn blisters. Keep them clean and apply petroleum jelly to protect them while healing. </li> </ul> By following these tips, you should be able to enjoy the outdoors without feeling a sunburn later. <a href="/providers/elizabeth-curry-do">Libby Curry, D.O.</a>, is a physician in the Department of Family Medicine at Mayo Clinic in Rochester. She practices at Mayo Family Clinic Northwest. Her practice interests include women's health and full-spectrum care for the entire family.Libby Curry, D.O.Primary Care in Rochester and KassonSummer SunPrimary Care in Rochester and KassonFind tips for safe swimming and boating for your summer season. <img src="/-/media/ech-media/images/widgets/kids/ech_summersafety_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=A84AACF3A54888B9E2E94FE49A9D4BB5" alt="ECH_summersafety_widget" width="100" height="65" DisableNVelocity="true" />Enjoy the Minnesota waters safely this summer7/17/2025 4:30 AM<img src="/-/media/ech-media/images/widgets/kids/ech_summersafety_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=9A58B1249E513297751B3F0B6D97064C" alt="ECH_summersafety_widget" width="300" height="195" DisableNVelocity="true" />Some of my best memories from growing up occurred in and around the water. Families in Minnesota, the land of 10,000 lakes, have ample opportunity to create memories while boating, canoeing, sailing and swimming. In fact, a recent survey found that Minnesota has more shoreline from lakes, rivers and streams than California, Florida and Hawaii combined. However, I wanted to take a moment to review these safety guidelines to ensure that your summer goes "swimmingly." Swimming with kids <ul> <li>When purchasing a life jacket, make sure it is U.S. Coast Guard-approved and that it fits the weight range for your child. Inflatable water wings, tubes and toys are not safe substitutes.</li> <li>Appoint an adult "water watcher" if there is no lifeguard available, and alternate shifts every 15 minutes to stay alert.</li> <li>Always enter unfamiliar water feet first instead of diving to avoid hitting unseen rocks and sandbars.</li> <li>Practice these safety tips with young children: Floating on your back, swimming to the side of the pool, and hoisting yourself out independently.</li> <li>Home swimming pools should be surrounded by a 5-foot fence and have a self-closing gate that can latch and be locked.</li> <li>Choose brightly colored swimsuits to help children be more visible while swimming.</li> </ul> Boating These items should always be quickly accessible on your boat: <ul> <li>Life jackets, fire extinguisher, sound device (whistle or horn), first aid kit and a paddle.</li> <li>A readily accessible wearable life jacket is required for every person onboard a watercraft while moving. Children under 10 years old are always required to wear a life jacket.</li> <li>One Type IV throwable device (such as an approved boat cushion with straps) is required on boats 16 feet or longer, except canoes and kayaks, and must be immediately available.</li> <li>Starting July 1, 2025, in the state of Minnesota, people born after June 30, 2024, will be required to have a valid motorboat operator's permit. The permit requirement will gradually apply to older age groups over the next few years. Visit the Minnesota Department of Natural Resources' <a rel="noopener" href="https://www.dnr.state.mn.us/safety/boatwater/boater-education-law.html" target="_blank" title="Opens in new browser window">New Boater Education Law webpage</a> for more information. Those without a permit can be supervised by permit owners who are 21 years old or older. The supervisor needs to be in immediate reach of the controls.</li> <li>Children less than 12 years old cannot operate a watercraft with a motor over 75 horsepower. If the motor is less than 75 horsepower, they can operate the boat, but only with an accompanying permitted operator.</li> <li>Alcohol is involved in approximately 30% of all fatal boating accidents in Minnesota. Drunk boating is drunk driving. Designate a sober driver and do not operate a boat or personal watercraft if you have been drinking.</li> <li>Access <a rel="noopener" href="https://files.dnr.state.mn.us/rlp/regulations/boatwater/boatingguide.pdf" target="_blank" title="Opens in new browser window">Minnesota's Boating Guide</a> on the Minnesota Department of Natural Resources' website. </li> </ul> Think ahead <ul> <li>Know how to swim. Having your children complete swimming lessons and knowing how to swim is important and can be lifesaving.</li> <li>When going out on the water, always let someone know where you are going, the route you are taking, when you expect to reach your destination and when you plan to return.</li> <li>Be weather-aware. Delay your trip or head immediately to shore if the weather becomes stormy.</li> <li>Carry a well-charged cellphone or radio, as your cellphone may not have service, and keep the device in a waterproof, floatable container.</li> <li>Always make sure you have plenty of food, water, bug spray and sunscreen. </li> </ul> Be smart, be safe and be well-prepared when out on the water. Have fun making lasting memories by enjoying recreational water activities. <a href="/providers/gabriela-kovacikova-md">Ika Kovacikova, M.D.</a>, is a pediatrician in Community Pediatric and Adolescent Medicine at Mayo Clinic in Rochester. She earned her medical degree at the Geisel School of Medicine at Dartmouth and completed her pediatrics residency at Brown University. She has spent numerous years enjoying the health benefits of swimming, educating others about water safety and finding adventure in the water (including swimming across the English Channel).Ika Kovacikova, M.D.Primary Care in Rochester and KassonWater SafetyPrimary Care in Rochester and KassonMigraine frequency increases during adolescence, but migraines can also affect young children. <img src="/-/media/ech-media/images/widgets/kids/mothercomfortingyounggirl.jpg?h=65&iar=0&w=100&sc_lang=en&hash=FE25AAA67DCA71D9CC9E72A553BA2820" alt="MotherComfortingYoungGirl" width="100" height="65" DisableNVelocity="true" />The ache stops here: Understanding migraines in children8/18/2025 4:30 AM<img src="/-/media/ech-media/images/widgets/kids/mothercomfortingyounggirl.jpg?h=205&iar=0&w=315&sc_lang=en&hash=06206F06812171B63B937EF79B30E322" alt="MotherComfortingYoungGirl" width="315" height="205" DisableNVelocity="true" />What are migraines, and who gets them? Migraines are severe, throbbing headaches that last for hours or even days and often recur. They are commonly accompanied by symptoms like nausea, vomiting, and sensitivity to light, sound or smell. Some people experience visual auras before the pain begins, which may include flashing zigzag lines or blind spots in their vision. Most people with migraines find them to be debilitating. Migraines can affect young children; however, they become more common in adolescent youth. Children with migraines tend to have a strong family history of migraine headaches. What triggers migraines? Various factors can trigger migraines in children, including changes in sleep patterns, increased stress, weather fluctuations, hormonal changes and certain foods. Common dietary triggers include chocolate, aged cheeses, citrus fruits, nuts, fermented foods, caffeine, artificial sweeteners and MSG. What treatment options are available for children? When a migraine occurs, resting in a dark, quiet room can help alleviate symptoms. Over-the-counter medications like ibuprofen or acetaminophen are most effective when taken early but should not be used for more than 14 days a month, as overuse can worsen headaches. If these methods are insufficient, a doctor may prescribe triptans, a medication to be taken at the onset of the headache. For children experiencing frequent migraines — eight or more per month — preventive strategies may be necessary. Supplements such as vitamin B2, or riboflavin, and magnesium have shown some efficacy. If these are not effective, daily medications or monthly injections may be recommended. Can lifestyle changes help prevent migraines? Healthy lifestyle changes can also help reduce migraines, including regular sleep, stress management, exercise, a balanced diet with minimal processed foods and proper hydration. When should you seek medical care? Seek medical attention if your child's headaches require frequent medication, wake them up from sleep, or are accompanied by symptoms like fever (100.4F or greater), neck stiffness, double vision, confusion, balance issues or persistent vomiting, as these could indicate a more serious condition. Ellie Baugher, D.O., completed her pediatric residency at Mayo Clinic in Rochester and will begin training in neurology the summer of 2025.Ellie Baugher, D.O.Primary Care in Rochester and KassonChild MigrainesPrimary Care in Rochester and KassonA farm is a wonderful place to be and learn, but it can also be dangerous. <img src="/-/media/ech-media/images/widgets/kids/ech_safefarmchores_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=2558062E97395BF43293D09234A6634E" alt="ECH_safefarmchores_widget" width="100" height="65" DisableNVelocity="true" />Keeping safe on the farm8/4/2025 4:30 AM<img src="/-/media/ech-media/images/widgets/kids/ech_safefarmchores_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=42BE36BD913D30C9EC48CD7251B7EF79" alt="ECH_safefarmchores_widget" width="300" height="195" DisableNVelocity="true" />Being on a farm can be so much fun for families and kids, whether they live, work or are visiting there. Farms are a great place for adventure and learning, and also a common home for many of our neighbors in Minnesota. But farms are dangerous places, too, putting people at risk for injuries and even death from encounters with animals, equipment and just being in the wrong place at the wrong time. Farming is ranked among the world’s most hazardous professions, with factors like long hours, little sleep and dangerous equipment adding to that risk. Here are just a few facts and figures to bring home the danger families face on the farm: <ul> <li>About 60 million people, or 1 in 5, live in rural America and many more will visit a farm over the next year. </li> <li>Every day, about 33 children are injured in agriculture-related incidents and each year, more than 100 children are killed nationwide in farming incidents.</li> <li>Animals are the leading cause of injury, while the leading causes of death on the farm involve machinery (25%), motor vehicles — including all-terrain vehicles (ATVs) (17%) and drowning (16%).</li> <li>For youth who work on a farm, tractors were the main cause of death, followed by ATVs.</li> </ul> Occupational injuries are estimated to be over four times higher than reported. As spring hits and the weather gets warm, activity on the farm shifts into high gear, which increases the risk of accidents and injuries. Many accidental injuries involving farm implements result in long-term disabilities like infections, amputation of extremities, loss of function, and tragically, death. A few of the most devastating farm accidents are overturned tractors, auger mutilations/amputations, grain bin suffocation, chemical poisoning and child accidents/deaths. For naturally curious children, the farm is a great big playground full of things to explore. However, they don’t recognize or understand the risks or remember the rules for situations that may arise. With these quick tips, the farm can be a safer place to live, work and play: <ul> <li>Build a safe play area for children away from the action in the farmyard.</li> <li>Fence areas with water and where animals are held. Even if the animals are seen as gentle, family pets, they’re still unpredictable animals.</li> <li>Install fall protection in haylofts.</li> <li>Keep kids away from and out of tractors. This precaution includes letting them ride in the cab.</li> <li>If children help on the farm, fit the job to the child’s age, understanding and abilities when assigning chores.</li> <li>Make wearing personal protective equipment a habit for doing farm work.</li> <li>Know when your child is capable of safely driving a tractor or ATV. There’s NO evidence that children under 12 can safely operate an ATV, which, because of their design, can be more challenging than driving a car.</li> <li>Create a list of farm rules that visitors must follow. </li> <li>Avoid doing tasks alone, such as running an auger or filling a grain bin.</li> <li>Always carry your cell phone with you, and keep it charged as much as possible.</li> <li>Get enough sleep and eat balanced meals; hunger, dehydration and lack of sleep can affect your ability to think clearly. </li> </ul> If you visit a farm with your family or your children go with a group or as a guest, remember it’s your responsibility to supervise them. Stress that they follow any rules the farm family may have and listen to instructions from adults. Living and working on a farm or just visiting is a wonderful experience. Just remember these common tips for keeping safe from accidents and injuries. <a href="/providers/allison-ducharme-smith-md">Allison Ducharme-Smith, M.D.</a>, is an internal medicine physician in the Division of Community Internal Medicine, Geriatrics, and Palliative Care and practices at Mayo Family Clinic Northeast in Rochester. She is also the Medical Director of the Good Samaritan Free Health Clinic. Her interests include preventive medicine, women's health, chronic disease management and medical education.Allison Ducharme-Smith, M.D.Primary Care in Rochester and KassonFarm SafetyPrimary Care in Rochester and KassonReview tips for helping your child with common school-related issues. <img src="/-/media/ech-media/images/widgets/kids/homeworkfamilyhelp.jpg?h=65&iar=0&w=100&sc_lang=en&hash=BD84922E64780B50791C88FCD06CBA8F" alt="HomeworkFamilyHelp" width="100" height="65" DisableNVelocity="true" />Revisit homework habits for a successful school year8/25/2025 4:30 AM<img src="/-/media/ech-media/images/widgets/kids/homeworkfamilyhelp.jpg?h=205&iar=0&w=315&sc_lang=en&hash=ABD0E789ED968FEA311AC272FC000FAF" alt="HomeworkFamilyHelp" width="315" height="205" DisableNVelocity="true" />With school approaching, it's a good opportunity for kids and families to review goals and habits. Family and community support are essential for children's academic success. Here are some tips for establishing habits to help your child with common school-related issues, in and out of the classroom. Get enough sleep Getting the right amount of rest (9–11 hours for kids ages 6–13 and 8–10 hours for older kids), is the single most important building block for school success. Kids do best with consistent wake-up times and bedtimes. Good sleep hygiene involves removing screens from bedrooms and turning off electronic devices at least one hour before bedtime. You can: <ul> <li>Model these screen habits. </li> <li>Help your kids establish and maintain routines that eliminate screens from bedtime and the bedroom. Positive sleep hygiene practices will support improved sleep for the whole family. </li> </ul> Manage stress Kids of all ages may feel anxious about making friends, doing well in school and finding success in their activities. You can: <ul> <li>Praise effort, not performance. Let your child know you don’t expect perfection, and model learning from mistakes. Help your child set realistic goals in order to have a healthy perspective.</li> <li>Offer reassurance that you have confidence in your child’s ability to manage the situation. Remembering past successes, such as when your daughter did well on a test or your son made a new friend, can boost confidence and calm nerves.</li> <li>Prepare your child by talking through challenging scenarios that might arise at school.</li> <li>Use routines such as family meals to stay connected and provide opportunities to discuss your child's successes and challenges. </li> </ul> Encourage a healthy body image Many students feel pressure to look a certain way. Media images, peers and caregivers may affect their feelings about their bodies. Make your influence a positive one. You can: <ul> <li>Focus on what your child’s body does for them, not how it looks.</li> <li>Validate the difficulty of living in a world that emphasizes appearance as a measure of worth.</li> <li>Encourage and model healthy eating habits, physical activity and positive friendships to help your child develop a positive self-image. </li> </ul> Be aware of bullying Bullying is more common than adults think. A child who is being bullied may have worsening grades or show less interest in going to school. Children who bully are modeling learned behavior. Children should be encouraged to talk with a trusted adult if they see bullying or other unsafe behavior happening at school or online. Prejudice-based bullying is common and particularly harmful. You can: <ul> <li>Check in with your child about how students treat one another at school.</li> <li>Promote respect on and offline by discussing and modeling the importance of diverse perspectives. </li> </ul> Maintain a homework routine and practice time management Work with your child to identify a homework routine, including a consistent time and place. You can help your child: <ul> <li>Avoid the distractions of phones or TV.</li> <li>Prioritize assignments based on due dates and how much effort they require.</li> <li>For some kids, completing an assignment they enjoy the least works best. Others gain a sense of accomplishment by first completing assignments they like best.</li> <li>Kids also benefit from breaking large assignments into smaller, more manageable tasks and using to-do lists.</li> <li>Encourage your child to speak with teachers when questions arise. Having a homework buddy can build self-sufficiency and confidence.</li> <li>Create a schedule to balance academic, extracurricular and social activities. Identify which tasks they need help with and what can be done independently. </li> </ul> Create a family media plan Screen time consumes much of our days. Phones, tablets and video games compete with other important activities. Excessive screen usage decreases creativity and overall productivity. You can: <ul> <li>Create a family media plan to make sure enough time is available for other important activities, such as sleep, exercise, homework and play. </li> <li>Identify “screen-free” zones such as mealtimes, while driving or during specific activities. Instead, use that time to check in on the ups and downs of your child's day. </li> </ul> Assess parenting values As your family navigates through the school years, remember that the ultimate goal of parenting is to raise independent, responsible adults. To do that, children need support and encouragement. But they also need opportunities to make their own decisions — and their own mistakes. Believe it or not, your child wants to talk with you about tough stuff and have honest, meaningful conversations. You can: <ul> <li>Set aside time to connect on the little things and the big things.</li> <li>Encourage the next steps in learning independence.</li> <li>Be the “safety net” that catches them when they inevitably make mistakes. </li> </ul> Stay up to date with well-child exams Well-child exams aren't just for infants and toddlers. Review Mayo Clinic's <a rel="noopener" href="https://mcforms.mayo.edu/mc2800-mc2899/mc2824-10.pdf" target="_blank" title="Link opens in a new window">recommended child and adolescent exam schedule</a> to make sure your child is immunized and has met developmental milestones. At these exams, your primary care clinician should assess your child's nutrition, safety and emotional well-being. <a href="/providers/hannah-mulholland-licswmsw">Hannah Mulholland, L.I.C.S.W., M.S.W.</a>, and <a href="/providers/megan-cassidy-phdlp">Megan Cassidy, Ph.D., L.P.</a>, are clinicians serving children and adolescents in Primary Care in Rochester and Kasson's Division of Integrated Behavioral Health.Hanna Mulholland, L.I.C.S.W., M.S.W., and Megan Cassidy, Ph.D., L.P.Primary Care in Rochester and KassonHomework SuccessPrimary Care in Rochester and KassonLearn about the health benefits of magnesium and what food sources contain this powerful mineral. <img src="/-/media/ech-media/images/widgets/food/magnesiumfoods.jpg?h=65&iar=0&w=100&sc_lang=en&hash=A6ED595BBAE7E19B44DC4E697B607579" alt="MagnesiumFoods" width="100" height="65" DisableNVelocity="true" />Unleashing the magic of magnesium8/7/2025 4:30 AM<img src="/-/media/ech-media/images/widgets/food/magnesiumfoods.jpg?h=205&iar=0&w=315&sc_lang=en&hash=1040282646785EE65BA73E913E9D906E" alt="MagnesiumFoods" width="315" height="205" DisableNVelocity="true" />Magnesium may not always get the attention it deserves. However, this unique mineral is responsible for over three hundred enzymatic reactions and works in several physiological processes, such as protein and DNA synthesis, muscle and nerve function, blood glucose control and blood pressure. Let's dive deeper into magnesium’s “magic” and why it's vital for our health. <ul> <li>Energy production: Magnesium is a key component in energy production. Make sure you consume adequate intakes of magnesium to help boost energy levels throughout the day.</li> <li>Heart health: Adequate magnesium intake reduces the risk of hypertension and cardiovascular disease.</li> <li>Bone health: Magnesium regulates calcium in the body by working with vitamin D to absorb calcium for strong, healthy bones and teeth.</li> <li>Blood sugar control: Magnesium plays a potential role in improving blood sugar control, insulin sensitivity and risk factors for developing type 2 diabetes. </li> </ul> So, how much magnesium do you need? The recommended dietary allowance (RDA) of magnesium for adults 19-51+ years is 400-420 mg daily for men and 310-320 mg for women. Needs are higher during pregnancy and lactation. What foods contain magnesium? Magnesium is found in a variety of plant and animal sources, including: <ul> <li>Legumes, especially black beans, lentils and garbanzo beans (chickpeas).</li> <li>Dark leafy vegetables like spinach and kale.</li> <li>Nuts and seeds like almonds, peanuts and cashews.</li> <li>Whole grains such as brown rice and quinoa.</li> <li>Fruits such as bananas. </li> </ul> Should you be taking a magnesium supplement? First, aim to incorporate more magnesium-rich foods into your diet. If you are concerned about meeting your daily magnesium allowance, talk with your healthcare clinician before starting supplementation. Next time you reach for a snack or sit down for a meal, consider reaching for a magnesium-rich food source and start seeing the benefits of the “magic” of magnesium. Alison Brantner is a dietetic intern at Mayo Clinic in Rochester, Minnesota. She received her bachelor’s and master’s degrees from the University of Wisconsin-Stout. Her passion in the dietetic field is to become a diabetes educator.Alison BrantnerPrimary Care in Rochester and KassonMagnesiumPrimary Care in Rochester and KassonConnect with your clinician for help. <img src="/-/media/ech-media/images/widgets/people/substanceusedisorder.jpg?h=65&iar=0&w=100&sc_lang=en&hash=D10483D6047B84451A8A1BA043F45277" alt="SubstanceUseDisorder" width="100" height="65" DisableNVelocity="true" />The "4 Cs" of substance use disorder8/21/2025 4:30 AM<img src="/-/media/ech-media/images/widgets/people/substanceusedisorder.jpg?h=205&iar=0&w=315&sc_lang=en&hash=E7A567E5205245BEB6471C935C774082" alt="SubstanceUseDisorder" width="315" height="205" DisableNVelocity="true" />What if I told you that there is a condition that, up until recently, has killed more people per year than all types of cancers except for cancer of the lung and the bronchus? This same condition is one of the leading causes of death among adolescents and young adults and has contributed to a decreased life expectancy in the United States. Sadly, only one in four people with this condition receive treatment. Not because the treatment is ineffective, but because of stigma, challenges in getting treatment and shame. Substance use disorders (SUD), including alcohol and opioid use disorder, are chronic medical conditions. It involves biochemical and structural changes in the brain that cause a person to lose CONTROL over using a substance, to use a substance COMPULSIVELY, to experience CRAVINGS, and to use the substance even though they may suffer from negative physical, social and emotional CONSEQUENCES. These are the four pillars of addiction, known as the "4 Cs." The chemical that is most often associated with addiction is dopamine. This chemical is present in the brain and gives the reward sensation when released. It's the same chemical that we get when we hug an old friend or after eating our favorite dessert. Drugs of abuse can cause a sudden and dramatic release of this chemical. For example, the amount of dopamine released after methamphetamine use is almost 1,000% of that when eating a satisfying meal. With repeated use over time, however, the amount of dopamine needed to achieve the same pleasurable and euphoric sensation increases. People also experience a sense of unease and anxiety when they do not use drugs, together with unpleasant and sometimes terrifying symptoms of withdrawal. They no longer use drugs to 'get a high,' but simply to avoid 'feeling bad.' Simply put, SUD results from biochemical changes that could significantly impact a person's physical and mental state. It is NOT because of moral failure or a weak character. There is a strong genetic component to SUD. For example, a person is seven times more likely to develop alcohol use disorder if both of their parents have the condition. The good news is that effective behavioral treatments and medications are available, including medications to help treat alcohol and opioid cravings. People with opioid use disorder who are prescribed buprenorphine, one of three approved medications to treat this condition, are significantly more likely to abstain from further use. This life-changing treatment means that they can now engage in counseling and therapy because their minds are no longer preoccupied with finding ways to avoid unpleasant withdrawal symptoms or dealing with intense cravings. These medications, together with increasing availability of naloxone (also known as Narcan, which is available over the counter), have led to a 27% reduction in overdose deaths in 2024. Naloxone can temporarily reverse an opioid overdose so that Emergency Medical Services can be called to help. There is still much to do. Those with SUD often find it challenging to open up about their drug use. To further reverse the trend of overdoses and to help people and families in need, we must understand that SUD is a chronic but very treatable condition. With the proper support and encouragement, one can achieve long-term recovery. If you or someone you know struggles with SUD, primary care clinicians at Mayo Clinic in Rochester and Kasson can help. <a href="/providers/benjamin-lai-mbbchbao">Benjamin Lai, M.B., B.Ch., B.A.O.</a>, is a family medicine physician in the Baldwin building in Rochester, Minnesota. He is chair of Mayo Clinic's Opioid Stewardship Program Subcommittee and a member of Olmsted County’s Opioid Settlement Funds Workgroup.Benjamin Lai, M.B., B.Ch., B.A.O.Primary Care in Rochester and KassonSubstance Use DisorderPrimary Care in Rochester and KassonThese tips can help teens experiencing depression.<img src="/-/media/ech-media/images/widgets/teens/sadteensittingonbed_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=6D036777C5CC444E155AD53ED66324A8" alt="SadTeenSittingOnBed_widget" width="100" height="65" DisableNVelocity="true" />6 steps to overcoming depression8/11/2025 4:30 AM<img src="/-/media/ech-media/images/widgets/teens/sadteensittingonbed_widget.jpg?h=205&iar=0&w=315&sc_lang=en&hash=22871C28E90917A332E9811E5AB3B375" alt="SadTeenSittingOnBed_widget" width="315" height="205" DisableNVelocity="true" />Do you have a young family member feeling overwhelmed in the face of depression? If so, there’s good news: Mayo Clinic’s pediatricians are here to help. While our understanding of depression continues to evolve, a review of high-quality science suggests that there are six easy, effective and lasting treatments for depression in teens. Let’s take a look. <ul> <li>Therapy: The most effective treatment for depression in kids is counseling, also called therapy. Talking with a therapist helps you understand and overcome your feelings, especially when you find a therapist you can trust and connect with. If you’re up to talking with someone, call us, and we’ll plug you in.</li> <li>Medication: Anti-depressants are just what they sound like – medicines that fight against depression by breaking unhealthy cycles of thought and allowing you to focus on the things that bring meaning to your life. At Mayo Clinic, we use safe, effective antidepressants like fluoxetine to help people get back to their lives. If you think you’d benefit from treatment, we’d love to help. </li> </ul> Unlike therapy and anti-depressants, these four interventions are things you can do entirely on your own, as soon as today. Scientific studies suggest that each is as effective as taking an antidepressant, and their benefits stack up like a big plate of positivity pancakes. <ul> <li>Exercise: Exercise is good for our bodies, brains, and souls. Studies have found that regular, non-competitive exercise (like running or playing soccer with friends) is just as effective against depression as taking an antidepressant medication. Imagine how good you could feel if you did both.</li> <li>Green space: Sorry, beach-lovers, hikers have gotten this right. Spending time outside, surrounded by lush, green living things, has an immediate, positive effect on our brains. The more time you spend outside, the happier you’ll be.</li> <li>Religious participation: For those who are open to it, regular involvement in a religious community, like a church or youth group, has been shown to fight off depression. Spiritual activities give you a sense of meaning and calm that builds a mental barrier against feelings of hopelessness.</li> <li>Cut back screen time: Phones and computers are important to everyday life. Unfortunately, they are also directly linked to depression in teenagers. Try to limit yourself to two hours of screen time each day outside of school, and you’ll find that you have more time to spend with people who care about you, who make you laugh, and who can help you feel like yourself again. </li> </ul> Most importantly, if you’re feeling hopeless or at the end of your rope, know that people at Mayo Clinic care for you and will fight by your side. Give us a call, and we’ll work together to end your depression. Ben Ashby, M.D., completed his Mayo Clinic pediatric residency in June 2025. He attended divinity school at Duke University, where he developed a special focus on human flourishing and disability theology.Ben Ashby, M.D.Primary Care in Rochester and KassonTeen DepressionPrimary Care in Rochester and KassonLighten up your weeknight meals with a few new recipes. <img src="/-/media/ech-media/images/widgets/food/ech_family_dinner_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=BEC7EFEEE8A46F56BA91663D0D8224D1" alt="ECH_family_dinner_widget" width="100" height="65" DisableNVelocity="true" />Modify menus with novel recipes8/28/2025 4:30 AM<img src="/-/media/ech-media/images/widgets/food/ech_family_dinner_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=BD7475C9B747EB58F3CC839DAB4E0922" alt="ECH_family_dinner_widget" width="300" height="195" DisableNVelocity="true" />Sometimes, the addition of just a couple of new recipes to the "usual rotation" can be a boost to evening meal excitement and interest. See the suggestions below from the <a rel="noopener" href="https://diet.mayoclinic.org/us/motivational-tips/recipe-collections/" target="_blank" title="Link opens in a new window">Mayo Clinic Diet Recipe Collections</a>. These recipes are found under the headings of "Simple Meals," "Family Friendly" and "One-Pan Meals." The possibilities are endless with more categories to choose from, including "Tasty Lunches," "Summer Meals" and "Healthy BBQ". Here are a few of my favorites: <ul> <li>Simple Meals – <a rel="noopener" href="https://diet.mayoclinic.org/us/motivational-tips/recipe-collections/simple-meals/one-pan-sweet-chili-chicken-vegetables/" target="_blank" title="Link opens in a new window">One Pan Sweet Chili Chicken and Vegetables</a>.</li> <li>Simple Meals – <a rel="noopener" href="https://diet.mayoclinic.org/us/motivational-tips/recipe-collections/simple-meals/simple-hoisin-beef-stir-fry/" target="_blank" title="Link opens in a new window">Simple Hoisin Beef Stir Fry</a>.</li> <li>Simple Meals – <a rel="noopener" href="https://diet.mayoclinic.org/us/motivational-tips/recipe-collections/simple-meals/baked-pesto-salmon/" target="_blank" title="Link opens in a new window">Baked Pesto Salmon</a>.</li> <li>Family Friendly – <a rel="noopener" href="https://diet.mayoclinic.org/us/motivational-tips/recipe-collections/family-friendly/cheesy-muffin-pizzas/" target="_blank" title="Link opens in a new window">Cheesy Muffin Pizzas</a>.</li> <li>One-Pan Meals – <a rel="noopener" href="https://diet.mayoclinic.org/us/motivational-tips/recipe-collections/one-pan-meals/one-pan-fajita-chicken-tray-bake/" target="_blank" title="Link opens in a new window">One Pan Fajita Chicken Tray Bake</a>. </li> </ul> Ask family members to do some recipe surfing on their own to propose options that might sound good to them. The <a rel="noopener" href="https://www.mayoclinic.org/healthy-lifestyle/recipes" target="_blank" title="Link opens in a new window">Mayo Clinic Healthy Recipes</a> website is another good place to start. This site allows you to adjust the recipe for the number of servings needed. Each recipe also includes a nutritional analysis and dietitian tips on health and how to use the recipe. The <a rel="noopener" href="https://diabetesfoodhub.org/" target="_blank" title="Link opens in a new window">Diabetes Food Hub</a> website also offers recipes and guides to help plan meals and create grocery lists. The recipes on this site are healthful for all, not just for people with diabetes. Finding healthy and easy-to-fix recipe ideas has never been easier! Check out the recipes on these sites and start enjoying the new flair. Which recipes will become new favorites and help to revamp your menu rotation? Michaeleen Burroughs, M.S., R.D.N., L.D., has worked in Primary Care in Rochester and Kasson for 29 years. She helps Mayo Family Clinics - Northwest, Southeast, Northeast and Kasson patients. Her areas of interest are diabetes, child and adult weight management and feeding families.Michaeleen Burroughs, M.S., R.D.N., L.D.Primary Care in Rochester and KassonWeeknight MealsPrimary Care in Rochester and KassonLearn more about the benefits, drawbacks and alternatives to losing weight with a GLP-1 agonist.<img src="/-/media/ech-media/images/widgets/medications/weightlossdrugs.jpg?h=65&iar=0&w=100&sc_lang=en&hash=20D6B78595690427D4F09CA63BB07D50" alt="WeightLossDrugs" width="100" height="65" DisableNVelocity="true" />Pros and cons of GLP-1 agonists for weight loss8/14/2025 4:30 AM<img src="/-/media/ech-media/images/widgets/medications/weightlossdrugs.jpg?h=205&iar=0&w=315&sc_lang=en&hash=1D90DA3A63124E6E6AB55A1E0DACD5F4" alt="WeightLossDrugs" width="315" height="205" DisableNVelocity="true" />When you struggle to lose weight through diet and exercise alone, GLP-1 receptor agonists, medications like semaglutide (Wegovy) and tirzepatide (Zepbound), offer a powerful new tool. But before starting any treatment, it's important to weigh the benefits, drawbacks and alternatives to find what best fits your health goals and budget. Pros: <ul> <li>Effective, clinically-proven weight loss: People typically lose 10% to 15% of their body weight over several months, with some tirzepatide trials showing up to 20% at the highest doses.</li> <li>Better blood sugar control and metabolic health as these drugs mimic a hormone that boosts insulin release, reduces glucagon and slows gastric emptying, resulting in improved HbA1c, lowering insulin resistance, blood pressure and cholesterol.</li> <li>Appetite regulation and satiety: By acting on brain and gut receptors, GLP-1 agonists curb cravings and help you eat smaller, more satisfying meals, supporting long-term habit change. By decreasing "food chatter," many people find that they can better sustain healthy habits when willpower starts to wane. </li> </ul> Cons: <ul> <li>High cost: Out-of-pocket expenses often run $800 to $1200 monthly, and weight-loss insurance coverage is inconsistent. Various direct-to-consumer programs, such as those offered by the drug makers, can lower the cost to around $500 per month. Other online companies offer "compounded" versions of the medications, but this is not a recommended route to obtain weight-loss medications.</li> <li>Potential for lifelong use: Studies have shown that most people who start weight-loss medications regain their weight after stopping the drug. Weight regain can be prevented or slowed by adherence to a healthy diet and regular exercise, but this doesn't work for everyone.</li> <li>Short-term gastrointestinal side effects: Medication initiation and dose increases commonly trigger nausea and vomiting, diarrhea or constipation, bloating and stomach discomfort, fatigue, dizziness, headaches, and injection-site redness or itching. These symptoms often improve as the body adapts to the treatment.</li> <li>Long-term side effects: Emerging data and concerns include: <ul> <li>Loss of muscle mass: Over 30% of weight loss on medications can be from muscle. This is not too different from what is observed with any weight-loss method, but scientists are concerned that muscle is not always regained when weight is regained after stopping treatment.</li> <li>Reduced bone density: Sustained weight loss can accelerate bone mineral loss, raising fracture risk.</li> <li>Rare but serious risks: Pancreatitis, gallbladder disease, acute kidney injury and thyroid C-cell changes have been seen in animal studies.</li> <li>Uncharted decades-long effects: Potential neurocognitive, ocular (NAION optic neuropathy) or other organ-system impacts may only emerge with widespread, prolonged use. </li> </ul> </li> </ul> Comparison to surgical and endoscopic weight loss <ul> <li>Bariatric surgery, including gastric bypass and sleeve gastrectomy, achieves weight loss by 20% to 30%. This often leads to diabetes remission and improves comorbidities. Despite the $18,000 to $23,000 procedure cost, surgery is usually more cost-effective in the long term than GLP1 use.</li> <li>Endoscopic intragastric balloons are less invasive and have lower upfront costs with a 10% to 15% weight loss. Still, the benefits are typically temporary and not as cost-effective as surgery or combined approaches. </li> </ul> A personalized decision GLP-1 agonists are revolutionizing obesity care but are not a one-size-fits-all solution. In primary care, clinicians partner with each patient to evaluate: <ul> <li>Medication history and weight-related condition.</li> <li>Treatment goals (short-term versus long-term).</li> <li>Financial considerations and insurance coverage.</li> <li>Willingness to commit to lifestyle support (e.g., nutrition, exercise, behavior). </li> </ul> Whether you are exploring medication, surgery or non-surgical devices, talk to your primary care clinician to find the path that's right for you. <a href="/providers/david-brennan-md">David Brennan, M.D.</a>, is a primary care physician in the Division of Community Internal Medicine, Geriatrics, and Palliative Care in Rochester, Minnesota. He focuses on prevention and treatment of a wide variety of common diseases.David Brennan, M.D.Primary Care in Rochester and KassonWeight Loss DrugsPrimary Care in Rochester and KassonBrain injuries can happen to anyone, and as you age, it can take longer to heal.<img src="/-/media/ech-media/images/widgets/elderly/ech_concussion_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=34F9337EE25BD8CB90B724243320720F" alt="ECH_concussion_widget" width="100" height="65" DisableNVelocity="true" />Concussions: Not just for kids and athletes9/18/2025 4:30 AM<img src="/-/media/ech-media/images/widgets/elderly/ech_concussion_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=B787EAC428E91EB9F3B25C7F8C6F9904" alt="ECH_concussion_widget" width="300" height="195" DisableNVelocity="true" />Concussions can make headlines, especially when it comes to kids and athletes. Many parents are vigilant — ensuring seat belt use, helmet use and carefully weighing the risks of contact sports. But what about adults? Brain injuries can happen at any age. Whether it's slipping on ice, a car accident, falling off a bike, or bumping one’s head on a cabinet door, adults are also at risk of a concussion. Those who are 65 years old and older tend to be more vulnerable to the effects of head injuries. Even what might seem like a minor bump can cause a concussion — and recovery may also take longer. What is a concussion? A concussion happens when a hit or jolt causes the brain to move inside the skull in a way it should not. There are often no structural changes seen on imaging, but there is a disturbance of brain function causing the symptoms noted below. Therefore, the diagnosis is made with careful history and exam, and imaging is often not needed. A single concussion can have lasting effects, such as trouble with memory. Just like in children, repeated concussions in adults increase the risk of long-term complications. Falls, car accidents and physical assault are just some of the possible causes of concussions. Symptoms might appear within minutes of the injury, but can be delayed for up to 72 hours. Common symptoms in adults <ul> <li>Headaches.</li> <li>Difficulty thinking clearly or concentrating, often called "brain fog."</li> <li>Dizziness.</li> <li>Nausea or vomiting.</li> <li>Fatigue.</li> <li>Mood changes or withdrawal from social activities. </li> </ul> Family and friends might also notice: <ul> <li>Sleeping more or less than usual.</li> <li>Mood swings or increased irritability.</li> <li>Memory problems, like repeating questions or delayed responses.</li> </ul> When to seek medical help Do not dismiss symptoms as just part of getting older or assume they are "not that bad." You should seek emergency care if: <ul> <li>You are on a blood thinner and hit your head. In this instance, head imaging may be indicated.</li> <li>You have a worsening headache, repeated vomiting, seizures, slurred speech or unusual behavior. </li> </ul> For less urgent symptoms that still interfere with daily life, it is a good idea to check in with your healthcare clinician. Earlier involvement of clinical care has been associated with faster recovery after a concussion. Managing a concussion There is no simple cure for a concussion, but symptoms can be treated while working back to prior activity. Prolonged periods of rest are no longer recommended. Instead, a brief period of rest followed by gradual return to activity as tolerated is now recommended. Additional treatment might include medication for headaches or physical and occupational therapy to improve balance and manage dizziness. How to prevent concussions The same safety tips that apply to kids are smart for adults too, and it is good for us to model these behaviors for the kids around us. <ul> <li>Always wear your seat belt.</li> <li>Use helmets when biking, skiing or doing other high-risk activities.</li> <li>Prevent falls at home by removing trip hazards (like extension cords, clutter or loose rugs) and keeping walkways dry and clear. </li> </ul> Stay active and enjoy life — but remember to protect your head. <a href="/providers/kyle-mckenzie-md">Kyle McKenzie, M.D.</a>, is a Community Internal Medicine, Geriatrics, and Palliative Care physician. He is a fellowship-trained geriatrician who provides care in the homebound programs and skilled nursing facilities in Rochester and the surrounding areas.Kyle McKenzie, M.D.Primary Care in Rochester and KassonAdult ConcussionPrimary Care in Rochester and KassonLearn how to navigate the challenges of this life event. <img src="/-/media/ech-media/images/widgets/people/ech_independentliving_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=C72425E6C4451DD657C1893D8755DE0C" alt="ECH_IndependentLiving_widget" width="100" height="65" DisableNVelocity="true" />Are you or a family member transitioning to assisted living?9/4/2025 4:00 AM<img src="/-/media/ech-media/images/widgets/people/ech_independentliving_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=9E9B5D9CC4A01A8AE07F4B024B72F071" alt="ECH_IndependentLiving_widget" width="300" height="195" DisableNVelocity="true" />Transitioning to assisted living facilities (ALF) can be a challenging experience, whether the move is planned or prompted by sudden medical changes. Although I have worked in Mayo Clinic Senior Services for a decade and have navigated this transition with many patients and families, it was not until I walked through this transition with my husband and his parents that I learned so much more about the process. First and foremost, leaving your own home (or moving your parents out of their home) is hard. It represents a loss of independence. You're leaving the home you may have lived in for many years (or decades), which likely holds many memories for your family. It's important to give yourself and your loved ones patience through the process. Plan ahead If you have time to plan, please do so early. Tour several ALFs in your town and ask questions about their services, costs, visiting hours, pet policies and more. Having an idea of which facility (or facilities) you would choose early in the process can prevent the need to find a care venue in a time of crisis, such as when your loved one is in the hospital and cannot safely return home or is in rehab and is not strong enough to return home. Making the move Once you have made the move, give yourself time to settle in. Your routine may be different from what it was before. You may have staff checking in throughout the day to provide medications or help with bathing or toileting. This is also a time to share with staff what works best for your care (such as if you may want to sleep late and don’t eat breakfast until mid-morning). Communication with the ALF caregivers during this transition phase is vital. Routine check-ins Routine check-ins with the ALF team are essential. The ALF team will schedule regular care conferences to discuss what is going well, what can be improved, and identify any unmet needs. They will also review the current service plan to determine if your loved one requires more care than is currently provided. Monitoring weight and blood pressure can be particularly helpful in tracking weight loss or high blood pressure concerns. Caregiver strain Caregiver strain is a genuine concern. Making decisions in the best interest of your parents or other loved ones can be difficult, especially if they are resistant. ALFs are expensive, but knowing your loved one is in a care setting rather than alone at home offers a sense of security worth the price. Find time to care for yourself, which is easier said than done. Navigating this transition requires understanding, patience and open communication. By working together with the ALF team and acknowledging the challenges, you can help ensure a smoother and more supportive transition for everyone involved. And as always, please keep your primary care clinician updated on these decisions so they can support you throughout the process. <a href="/providers/natalie-mohammad-cnp">Natalie Mohammad, APRN, C.N.P.</a>, is a nurse practitioner in Primary Care in Rochester and Kasson. She works in Senior Services and cares for patients in their home, assisted living and nursing home settings. She enjoys caring for patients and their families along the many transitions of care. She is the recent owner of a golden retriever puppy and is comparing potty training a puppy to potty training a toddler.Natalie Mohammad, APRN, C.N.P.Primary Care in Rochester and KassonAssisted LivingPrimary Care in Rochester and KassonFalls can cause broken bones, brain injuries and even death. <img src="/-/media/ech-media/images/widgets/people/ech_fallsimpact_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=37CD076CFACC5DAEA45B0C5B9934AD3C" alt="ECH_FallsImpact_widget" width="100" height="65" DisableNVelocity="true" />Don't take a tumble: Tips to stay upright and avoid falls9/11/2025 4:00 AM<img src="/-/media/ech-media/images/widgets/people/ech_fallsimpact_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=FEBC5CA26F610EDDB07A5B653518455D" alt="ECH_FallsImpact_widget" width="300" height="195" DisableNVelocity="true" />Having a fall can be a life-changing event for an older adult. Besides hurting one's sense of pride, falls cause injuries such as broken bones, brain injuries and death. Yet as children, falling is common — playing sports, chasing siblings or acting on a poorly-thought-out impulse. At what age does falling become a sign of frailty, rather than a sign of fearlessness? Each year, about 1 in 4 adults (27.5%) over the age of 65 has a fall. This number increases with increasing age for many reasons. Aging results in physical changes that make falls more likely. Sense of balance becomes less steady; muscle mass decreases; reflex and reaction times slow; and vision and hearing can worsen. Older adults are also more likely to be taking multiple medications and have chronic health conditions. Together, these factors make certain people vulnerable to having falls. Falling is a common occurrence, not a source of shame or something to hide. If a person experiences multiple falls, it can cue healthcare clinicians to look closer for health changes. It may shift priorities to building strength and balance, or prompt reconsideration of the medication list. It may show a need to modify the home so it better meets a person’s physical needs. Understanding the risks that can lead to falls allows the prevention of falls — for loved ones and oneself. Your primary care team can help strategize how to prevent falls, too. <table style="padding: 1px; margin: 1px;"> <tbody> <tr> <td style="border:1px solid #000000;">Common causes of falls </td> <td style="border:1px solid #000000;">Potential solutions </td> </tr> <tr> <td style="border:1px solid #000000;">Environmental hazards (uneven ground, area rugs, loose cords, wet floors, poor lighting)</td> <td style="border:1px solid #000000;"> <ul> <li>Remove or tape down area rugs and cords. </li> <li>Install lighting in poorly lit areas. </li> <li>De-clutter walkways in the home. </li> <li>Install grab bars in the restroom and handrails along staircases.</li> </ul> </td> </tr> <tr> <td style="border:1px solid #000000;"> Rushing to the restroom (urinary urgency or frequency) Using the bathroom at night </td> <td style="border:1px solid #000000;"> <ul> <li>Stop drinking fluids two hours before bed. </li> <li>Turn on the lights if you get up. </li> <li>Discuss bladder symptoms with your healthcare clinician.</li> </ul> </td> </tr> <tr> <td style="border:1px solid #000000;">Multiple medications</td> <td style="border:1px solid #000000;"> <ul> <li>Ask your healthcare clinician if there are medications you no longer need. </li> <li>Ask if any medications on your list increase the risk of falls. </li> </ul> </td> </tr> <tr> <td style="border:1px solid #000000;">Orthostatic hypotension (blood pressure drops when changing position)</td> <td style="border:1px solid #000000;"> <ul> <li>Change positions slowly. </li> <li>Pause 30–60 seconds after standing up, before you start walking. </li> <li>Tell your healthcare clinician this is happening. </li> </ul> </td> </tr> <tr> <td style="border:1px solid #000000;">Low vision</td> <td style="border:1px solid #000000;"> <ul> <li>Get your vision checked.</li> </ul> </td> </tr> <tr> <td style="border:1px solid #000000;"> Poor balance Back or leg pain </td> <td style="border:1px solid #000000;"> <ul> <li>Enroll in a balance exercise program.</li> <li>Request a referral to physical therapy. </li> <li>Tell your healthcare clinician if you are having trouble moving normally, have numbness, tingling or tremors. </li> </ul> </td> </tr> </tbody> </table> If we are lucky enough, we get to keep aging late into life — which means we get to experience the physical changes that accompany aging. While this comes with challenges, including the potential to fall, it is possible to plan how to get back on one’s feet — and how to stay there. <a href="/providers/libby-doll-md">Libby Doll, M.D.</a>, is an internal medicine physician and geriatric medicine fellow in the Division of Community Internal Medicine, Geriatrics, and Palliative Care. Her passions include maintaining independence Libby Doll, M.D.Primary Care in Rochester and KassonFall PreventionPrimary Care in Rochester and KassonFiber not only helps relieve constipation but also supports a healthy weight and offers several other health benefits. <img src="/-/media/ech-media/images/widgets/food/fiberrichfoods.jpg?h=65&iar=0&w=100&sc_lang=en&hash=E39AF3538C5734FA84F2C16759ADE2D8" alt="FiberRichFoods" width="100" height="65" DisableNVelocity="true" />Convenient high-fiber fixes to boost your diet9/22/2025 4:30 AM<img src="/-/media/ech-media/images/widgets/food/fiberrichfoods.jpg?h=205&iar=0&w=315&sc_lang=en&hash=94E3E325B2520129EE533E3C60276408" alt="FiberRichFoods" width="315" height="205" DisableNVelocity="true" />Healthy eating can feel challenging when life gets busy, especially when trying to meet your daily fiber goals. Luckily, high-fiber convenience options are everywhere; you just need to know where to look. Let's dive into practical ways to add fiber to your day without slowing down. What is Fiber and Why Do You Need It? Dietary fiber, found in plant-based foods, comes in two forms: <ul> <li>Soluble fiber: Regulates blood sugar and cholesterol levels and firms up loose stools. It's found in oats, beans and fruits.</li> <li>Insoluble fiber: Helps prevent constipation and adds bulk to stools. It's found in whole grains and vegetables. </li> </ul> The recommended daily fiber intake is 25 g for women and 38 g for men, but most people fall short. Convenience foods rich in fiber can help fill this gap. Fiber-Packed Convenience Options to Keep You Moving Here is a list of practical, high-fiber options that can be incorporated into a busy schedule: Breakfast Boosts <ul> <li>Oat bowls: Customize with nuts, berries, chia seeds or flaxseeds.</li> <li>Whole-grain muffins or wraps: Top with avocado or nut butter for a filling meal.</li> <li>Smoothie packs: Blend frozen fruits, spinach and nut butter for fiber-rich mornings. </li> </ul> Lunch and Dinner Shortcuts <ul> <li>Microwavable frozen veggies: Choose steam-in-bag options like broccoli to add fiber to any meal without additional preparation time.</li> <li>Canned beans: Rinse and toss into soups and stews for more fiber and protein.</li> <li>Whole-grain sandwiches: Make your sandwiches with a whole-grain tortilla or bread with vegetables like tomato and lettuce. According to the U.S. Department of Agriculture, whole wheat flour offers 10-12 g fiber per 100 g, compared to 2-3 g in refined flour. </li> </ul> Grab-and-Go Snacks <ul> <li>Prepackaged trail mix: Choose options with nuts, seeds, and dried fruits like raisins or cranberries.</li> <li>High-fiber protein bars: Check for brands greater than or equal to 3 grams of fiber and less than 6-8 g of sugar per bar.</li> <li>Popcorn: Enjoy some air-popped popcorn, a whole grain with 3.6 g fiber in 3 cups. </li> </ul> Quick Add-Ons <ul> <li>Prepared salad kits: These are great when short on time to chop veggies. Top with seeds for extra crunch and fiber. Opt for low-fat dressings.</li> <li>Fresh fruit instead of dessert: Apples, bananas and pears provide 3–5 g fiber each. Raspberries can go up to 8 g per cup. </li> </ul> Practical Tips for Maximizing Fiber on the Go <ul> <li>Read labels: Look for "whole" as the first ingredient, like whole wheat or whole oats.</li> <li>Stock your bag: Keep snacks like nuts, low-added sugar protein bars or dried fruit handy to curb hunger between meals.</li> <li>Pair wisely: Combine fiber with protein and healthy fats for lasting energy, like hummus with whole-grain crackers.</li> <li>Hydrate and add fiber gradually: Drink plenty of water and add fiber slowly to allow digestion to adapt. </li> </ul> Aya Elmir was a recent dietetic intern at Mayo Clinic in Rochester, Minnesota. She earned her master’s degree at the University of Wisconsin-Stout and her bachelor’s degree overseas at Beirut Arab University. Special interests include clinical nutrition and nutrition support.Aya ElmirPrimary Care in Rochester and KassonHigh Fiber DietPrimary Care in Rochester and KassonMayo Clinic Pharmacies will now take your unused or expired prescriptions and over-the-counter medications. <img src="/-/media/ech-media/images/widgets/medications/medsafedrugdisposal.jpg?h=65&iar=0&w=100&sc_lang=en&hash=593E76D5FC5DD2F457151DE4A2414634" alt="MedSafeDrugDisposal" width="100" height="65" DisableNVelocity="true" />Medication disposal now more convenient in Rochester9/9/2025 4:30 AM<img src="/-/media/ech-media/images/widgets/medications/medsafedrugdisposal.jpg?h=205&iar=0&w=315&sc_lang=en&hash=DC99171B34B64913F805035A770C02FA" alt="MedSafeDrugDisposal" width="315" height="205" DisableNVelocity="true" />Mayo Clinic provides a safer and more convenient way to dispose of unused or expired prescriptions and over-the-counter medicines. Specially designated receptacles have been placed at several Mayo pharmacies as part of an initiative that received strong support from the Opioid Stewardship Committee. The committee worked with Pharmacy staff to determine convenient locations. Here's where you can find these pharmacies and the hours that medications can be disposed of at these locations: Rochester <ul> <li>Baldwin Building, first floor <ul> <li>Weekdays, 8 a.m. to 5 p.m., Saturday 8 a.m. to noon.</li> </ul> </li> <li>Eisenberg Building, Rochester Methodist Hospital Campus, first floor <ul> <li>Weekdays, 7 a.m. to 8 p.m., weekends and holidays 7 a.m. to 3:30 p.m.</li> </ul> </li> <li>Mary Brigh Building, Saint Marys Campus, first floor <ul> <li>24/7/365.</li> </ul> </li> <li>Mayo Building, Subway <ul> <li>Weekdays, 7:30 a.m. to 6 p.m.</li> </ul> </li> <li>Mayo Family Clinic Northeast, first floor <ul> <li>Weekdays, 8 a.m. to 5 p.m.</li> </ul> </li> <li>Mayo Family Clinic Northwest, first floor <ul> <li>Coming fall 2025, weekdays 8 a.m. to 5 p.m. </li> </ul> </li> </ul> The receptacles are intended for patients, staff and the public to use. However, staff should not use them to throw away medications on behalf of patients or medications used for work. Anything placed in the receptacles, even unintended objects like a cellphone or a child's toy, cannot be retrieved. Medications are sealed in opaque liners that cannot be opened prior to destruction.Primary Care in Rochester and KassonMedication DisposalPrimary Care in Rochester and KassonRegister your children to be vaccinated for flu at school before Sept. 10 at 11 p.m.<img src="/-/media/ech-media/images/widgets/kids/kidsschool.jpg?h=65&iar=0&w=100&sc_lang=en&hash=43079E005309F5831DBA82D6E63A8B28" alt="KidsSchool" width="100" height="65" DisableNVelocity="true" />School flu vaccine sign-up to close soon9/8/2025 4:00 AM<img src="/-/media/ech-media/images/widgets/kids/kidsschool.jpg?h=205&iar=0&w=315&sc_lang=en&hash=32229189F6DE3CFD88DDC2D67B4FCCF4" alt="KidsSchool" width="315" height="205" DisableNVelocity="true" />Vaccinating your kids at school is convenient, easy and protects them from the flu (influenza). It also provides protection to keep your family, school and community healthy throughout the year. There's still time to sign up so your child can receive the flu vaccine at school. Online sign-up is quick and easy. The deadline for signing up, whether online or with paper forms submitted at the school office, is Sept. 10 at 11 p.m. No late online or paper forms will be accepted. The School-Located Immunization Program (SLIP) provides flu vaccines to students in kindergarten through grade 12 at: <ul> <li>Most Olmsted and Mower County public and private schools.</li> <li>Hayfield, Kasson-Mantorville and Triton Public Schools in Dodge County.</li> <li>Pine Island Public Schools.</li> <li>Janesville-Waldorf-Pemberton School in Waseca County.</li> <li>Cleveland School in Le Sueur County. </li> </ul> The program is supported by Mayo Clinic, Mayo Clinic Health System, Olmsted Medical Center and Olmsted, Dodge and Goodhue County Public Health Services. The flu vaccine will be offered in the schools as an injection or nose spray (as available). Non-drug, pain-lessening options will also be offered. Teachers in elementary classrooms can play a <a rel="noopener" href="https://www.youtube.com/watch?v=rRUAySGFfBI&feature=youtu.be" target="_blank" title="Link opens in a new window">short video</a> to ease their students' concerns. To sign up or learn more about the program, visit the school flu program website at <a rel="noopener" href="http://www.semnic.org/schoolfluclinics.aspx" target="_blank" title="Link opens in a new window">semnic.org</a>. Don't miss out. Take a few minutes to register your child today.Primary Care in Rochester and KassonSchool Flu ClosePrimary Care in Rochester and KassonSchool recess is more than fun and games; it supports healthy growth. <img src="/-/media/ech-media/images/widgets/kids/ech_school_recess_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=5028B7E6D18FE1F1C8B19B5B632DCE71" alt="ECH_school_recess_widget" width="100" height="65" DisableNVelocity="true" />Why recess is important: A pediatrician's perspective9/25/2025 4:30 AM<img src="/-/media/ech-media/images/widgets/kids/ech_school_recess_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=5626A5D16A929E16A62DBC9AC21F856C" alt="ECH_school_recess_widget" width="300" height="195" DisableNVelocity="true" />As a pediatrician, I believe recess is critical to every child’s school day. It supports healthy growth — physically, emotionally and socially. Recess allows children to be active. The Centers for Disease Control and Prevention recommends that kids get at least 60 minutes of physical activity each day. Recess helps meet this goal by giving students time to run, play and move their bodies. This improves strength, coordination and overall health. Recess also gives children a chance to build important social skills. Children who play together learn how to cooperate, solve problems and manage emotions. These skills help them succeed both in school and in life. In addition, research shows that students who have regular recess are more focused in the classroom. After a break to move and play, they return ready to learn, with better behavior and attention. Unfortunately, some schools may reduce or remove recess to increase academic time. But without breaks, children can become restless and less able to concentrate. Recess is not a distraction from learning — it helps support it. Families can make a difference. Ask your child’s school about their recess schedule and encourage active play at home. By supporting recess, you are helping your child’s mind and body grow strong. <a href="/providers/k-drew-baker-md">K. Drew Baker, M.D.</a>, is a physician in Community Pediatric and Adolescent Medicine in Rochester, Minn. He has over 30 years of experience as a pediatrician and medical educator. He enjoys walking his two rescue golden retrievers, exercising at the Dan Abraham Healthy Living Center and traveling.K. Drew Baker, M.D.Primary Care in Rochester and KassonSchool RecessPrimary Care in Rochester and KassonTaking steps to reduce suicides at all ages can and should be a priority for everyone. <img src="/-/media/ech-media/images/widgets/people/womanstressbed.jpg?h=65&iar=0&w=100&sc_lang=en&hash=75006FFDDA3AB437629BF87299D0D0C2" alt="WomanStressBed" width="100" height="65" DisableNVelocity="true" />Suicide prevention: Risk factors, warning signs and treatment options9/15/2025 4:00 AM<img src="/-/media/ech-media/images/widgets/people/womanstressbed.jpg?h=205&iar=0&w=315&sc_lang=en&hash=1AA2F482B5D0320C0A467306BB680530" alt="WomanStressBed" width="315" height="205" DisableNVelocity="true" />In 2022, suicide was the 11th leading cause of death in the United States. The Centers for Disease Control and Prevention reported that approximately 49,476 people died by suicide that year. Suicide affects people from a wide range of age groups, races and ethnicities, gender identities and socioeconomic backgrounds. Below are recent statistics regarding suicide from the National Institute of Mental Health and the CDC: <ul> <li>In 2023, an estimated 12.8 million adults reported having serious thoughts of suicide and 1.5 million adults attempted suicide.</li> <li>In 2023, people age 85 and above had the highest rates of suicide.</li> <li>In 2022, suicide was the second leading cause of death for people 10-14 and 25-34.</li> <li>Among females, the suicide rate was highest for those aged 45-64 in 2022. Among males, the suicide rate was highest for those aged 75 and older in 2022.</li> <li>American Indian or Alaska Native people had the highest rates of suicide in 2023 compared with other racial or ethnic groups.</li> <li>In 2021, 42% of LGBTQ youth seriously considered suicide, with more than half being transgender and nonbinary. Transgender and nonbinary adults also have high rates of considering suicide, and those who have been verbally harassed, physically attacked or denied equal treatment have the highest rates. Among LGBTQ youth, Native/Indigenous youth, Black youth, Latinx youth, and multiracial youth were at greater risk of attempting suicide (The Trevor Project). </li> </ul> The effect of suicide is profound, not only because of the thousands of lost lives each year, but also the impact on grieving family and friends who will live with the loss for the rest of their lives. Suicide prevention can and should be a priority for all of us. Be aware of risk factors The first step toward addressing this impact is being aware of the risk factors for suicide. The American Foundation for Suicide Prevention identifies important risk factors falling into three broad categories: <ul> <li>Health (e.g., depression, anxiety, substance use problems, serious medical conditions, chronic pain, traumatic brain injury).</li> <li>Social/environmental (e.g., social isolation, access to firearms and drugs, chronic stress, significant loss or major life transition, discrimination, unemployment, financial crisis, difficulty accessing healthcare, relationship problems, exposure to someone else's suicide).</li> <li>Historical (e.g., previous suicide attempts, family history of suicide, childhood abuse and neglect, generational trauma). </li> </ul> For people from diverse identities, experiencing prejudice, discrimination and/or trauma has been associated with an increased risk of suicidal thoughts and behaviors. Data indicates that American Indian/Alaska Native, LGBTQ+ and older adult populations are particularly vulnerable. For adolescents and children, bullying — both face-to-face and cyberbullying — has been strongly correlated with suicidal thoughts and behavior. Data suggests that being the perpetrator, as well as the victim, of bullying might be linked to an increased risk of suicide in youth. Watch for warning signs Pay attention to certain warning signs from people who may be at risk of harming themselves: <ul> <li>Changes in mood, such as severe depression, anger, anxiety, hopelessness and apathy.</li> <li>Changes in behavior, including isolation, acting impulsively, excessive substance use, deliberately searching for ways to harm themselves, saying goodbye or giving away cherished possessions, fatigue and changes in sleep patterns.</li> <li>Talking about not wanting to live, feeling hopeless that things will get better, having no reason to live or feeling they are a burden to others. </li> </ul> Be aware of protective factors Protective factors, those that help to promote safety and reduce the risk of suicide, include: <ul> <li>Social connections (family, friends, community).</li> <li>Cultural and spiritual beliefs.</li> <li>Access to physical and mental healthcare services.</li> <li>Problem-solving and coping skills.</li> <li>Limited access to lethal means such as firearms.</li> <li>A sense of purpose or reasons for living. </li> </ul> Help is always available Reach out to others, including friends, family and healthcare professionals, to increase social support and feelings of connectedness. Help is always available for those in immediate crisis. Call 911, go to the nearest emergency room or dial 988 to reach the <a rel="noopener" href="https://988lifeline.org/" target="_blank" title="Link opens in a new window">National Suicide Prevention Lifeline</a>, which is available 24 hours a day, seven days a week. Talk with your child For caregivers concerned that their child might be considering suicide, it can be hard to know how to respond. Bringing up your concerns with your child, including asking directly about suicide, is essential. Caregivers sometimes worry that talking about suicide can "plant ideas" in their child's head, but talking openly about your concerns and making a family-wide plan to get help is the best way to ensure your child's safety. Visit the <a rel="noopener" href="https://sptsusa.org/" target="_blank" title="Link opens in a new window">Society for the Prevention of Teen Suicide</a> website for more information. Seek treatment Effective treatments are available to further reduce the risk of suicide, including psychotherapy and medications. Your healthcare team can refer you to local resources. Increasing family and social support can help strengthen connections to your community, promote safety and increase a sense of meaning or purpose in life. Educating yourself about risk factors, warning signs, protective factors and available treatments can begin a new trend toward reducing the risk of suicide. Kyle Schofield, Ph.D., is a clinical health psychology fellow in Primary Care in Rochester and Kasson's Division of Integrated Behavioral Health at Mayo Clinic. <a rel="noopener" href="https://www.mayoclinic.org/biographies/roche-anne-i-ph-d-l-p-abpp/bio-20569110" target="_blank" title="Link opens in a new window">Anne Roche, Ph.D., L.P.</a>, is a clinical psychologist in Primary Care in Rochester and Kasson’s Division of Integrated Behavioral Health. <a href="/providers/jocelyn-lebow-phdlp">Jocelyn Lebow. Ph.D., L.P.</a>, is a child and adolescent psychologist in Primary Care in Rochester and Kasson's Division of Integrated Behavioral Health. <a href="/providers/craig-sawchuk-phdlp">Craig Sawchuk. Ph.D., L.P.</a>, is a clinical psychologist in Primary Care in Rochester and Kasson's Division of Integrated Behavioral Health. He is the co-chair of the Division of Integrated Behavioral Health and co-chair of Clinical Practice with the Department of Psychiatry and Psychology at Mayo Clinic.Kyle Schofield, Ph.D., Anne Roche, Ph.D., L.P., Jocelyn Lebow, Ph.D., L.P., and Craig Sawchuk, Ph.D., L.P.Primary Care in Rochester and KassonSuicide PreventionPrimary Care in Rochester and KassonThis condition is common in children. Find out when to have your child seen by their clinician.<img src="/-/media/ech-media/images/widgets/kids/swollenlymphnodekids.jpg?h=65&iar=0&w=100&sc_lang=en&hash=1314F3C90B5BFDA9D0B78B96E0708866" alt="SwollenLymphNodeKids" width="100" height="65" DisableNVelocity="true" />Swollen lymph nodes: When to watch and when to worry9/29/2025 4:30 AM<img src="/-/media/ech-media/images/widgets/kids/swollenlymphnodekids.jpg?h=205&iar=0&w=315&sc_lang=en&hash=5CAAC58E6A06760EDEC96177BD21A6D9" alt="SwollenLymphNodeKids" width="315" height="205" DisableNVelocity="true" />Swollen lymph nodes are common in children, especially toddlers and young school-aged children. Viral or bacterial infections often cause swollen nodes, but in rare cases, they can be a sign of more serious conditions, like blood cancers (leukemia and lymphoma) or an autoimmune disease. This article will review the function of lymph nodes and common causes of swollen lymph nodes. What are lymph nodes? Lymph nodes are small tissue clusters that house many of the body's immune cells. Lymph nodes detect pathogens like bacteria, viruses and fungi, and they activate specific immune cells to fight off invaders. Lymph nodes are found throughout the body, with large clusters in the head, neck, armpits and groin. When lymph nodes detect an invader, they can grow and become tender. What are the common causes of swollen lymph nodes? Common viruses and bacteria cause many swollen lymph nodes. Children with infections like the common cold or strep throat frequently get swollen head and neck lymph nodes. In other cases, the lymph nodes may become infected with bacteria, and your child's clinician may need to prescribe antibiotics to treat an infected lymph node. If my child has a swollen lymph node, should I be worried? Some parents worry that swollen lymph nodes could be a sign of blood cancer, like leukemia or lymphoma. The vast majority of swollen lymph nodes are not caused by blood cancer. However, there are some warning signs that parents should watch out for. A swollen lymph node is more concerning if the child has had weight loss, drenching night sweats or a fever for over seven days. Larger lymph nodes (greater than or equal to 2 cm) and lymph nodes located just above the collarbone are also more concerning. Most swollen lymph nodes disappear with time, though additional lab tests or imaging are sometimes needed. Some swollen lymph nodes require antibiotic treatment. If you note a new, enlarged lymph node, please get in touch with your child's primary care clinician to determine if your child needs to be evaluated in the clinic. Tyler Benning, M.D., M.S., completed his pediatric residency at Mayo Clinic in Rochester in June 2025. He started his pediatric hematology/oncology fellowship at the University of Minnesota in the summer of 2025.Tyler Benning, M.D., M.S.Primary Care in Rochester and KassonSwollen Lymph NodesPrimary Care in Rochester and KassonAcne is common during puberty, but help is available. <img src="/-/media/ech-media/images/widgets/teens/ech_teenacne_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=18227039E36A6604B4E16C0570343CC1" alt="ECH_TeenAcne_widget" width="100" height="65" DisableNVelocity="true" />Teen acne: What you need to know9/16/2025 4:30 AM<img src="/-/media/ech-media/images/widgets/teens/ech_teenacne_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=47EE968B80FB84B56701F9339D7A2867" alt="ECH_TeenAcne_widget" width="300" height="195" DisableNVelocity="true" />What Is Acne? Pimples, or acne, are a common skin condition that happens when pores become clogged with oil (called sebum) and dead skin cells. Cutibacterium acnes, which naturally lives on your skin, can multiply in the extra oil and lead to inflammation. During puberty, hormones cause more sebum production, increasing the likelihood of pores clogging. Surface-level clogs cause less inflammation and lead to whiteheads (closed comedones) or blackheads (open comedones). Deeper clogs can lead to more inflammation and result in pimples, red bumps, nodules or cysts. Caring for acne-prone skin <ul> <li>Be gentle. Washing too often or using harsh products can dry out your skin and damage its natural barrier, making acne worse. Wash your skin twice daily and after sports or vigorous activity that makes you sweat. </li> <li>Choose non-comedogenic (non-pore-clogging), oil-free, water-based skin care and cosmetic products. </li> <li>Don’t pick or pop pimples. It can lead to scarring and more inflammation. </li> <li>Consistency is key. Stick with a routine for several weeks to see improvement. </li> </ul> Does diet cause acne? There’s no strong evidence that specific foods cause acne, but a balanced diet helps your skin overall. If you notice certain foods seem to trigger breakouts, it’s OK to cut back on them. Does stress make acne worse? While stress doesn’t cause acne, it is linked to more severe acne — especially during busy times like school exams or life changes. Being physically active, getting enough sleep and connecting with supportive friends and family can help lower stress. Over-the-counter treatments You can try over-the-counter (non-prescription) acne treatments available at most pharmacies. <ul> <li>Benzoyl Peroxide (2% to 10%) once or twice daily: This comes in many forms (e.g., cleansers, gels, lotions, creams, pads, masks, washes) and kills acne-causing bacteria and reduces inflammation.</li> <li>Salicylic Acid (2% to 5%): Unclogs pores by exfoliating dead skin.</li> <li>Adapalene Gel (0.1%) once daily at night after washing with a gentle cleanser: A topical retinoid that helps prevent clogged pores and improves skin turnover. </li> </ul> How to use these products Avoid using adapalene and benzoyl peroxide/salicylic acid at the same time, as this reduces the effectiveness of adapalene. If using both, you may try Benzoyl peroxide or salicylic acid in the morning and Adapalene in the evening. Mild irritation and dryness are common when first using these products. If you are known to have sensitive skin, you may start using it every other day and then daily as tolerated. Use sunscreen daily, as some acne treatments can make your skin more sensitive to the sun. If your acne isn’t improving after several weeks of consistent care, contact your primary care clinician for additional support and treatment options. Sheri Pariha, M.B.B.S., is a Department of Pediatric and Adolescent Medicine residency program graduate at Mayo Clinic in Rochester. She is now a primary care pediatrician at Mayo Clinic Health System in Red Wing.Sheri Pariha, M.B.B.S.Primary Care in Rochester and KassonTeen AcnePrimary Care in Rochester and KassonMany forms of birth control can be used for pregnancy prevention. <img src="/-/media/ech-media/images/widgets/medicalimages/ech_contraception_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=A30B3DE876D3DC358D594F1545EBE985" alt="ECH_Contraception_widget" width="100" height="65" DisableNVelocity="true" />Birth control: What are the options?10/9/2025 4:30 AM<img src="/-/media/ech-media/images/widgets/medicalimages/ech_contraception_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=8E1D5CC9A6B4804F1E1660EF9210D529" alt="ECH_Contraception_widget" width="300" height="195" DisableNVelocity="true" />Many forms of birth control can be used for pregnancy prevention. In addition to pregnancy prevention, some forms of birth control can help control menstrual bleeding, improve gynecologic symptoms and have other non-contraceptive benefits. Finding the proper birth control depends on a patient's preference, age, past medical history and risk factors. The recommendations for specific birth control options compared to others may rely on whether the patient has a history of: <ul> <li>Clotting disorder/history of blood clots.</li> <li>Cardiovascular disease.</li> <li>Migraine with aura.</li> <li>Cancer.</li> <li>Tobacco use.</li> <li>Obesity.</li> <li>Severe liver disease.</li> <li>Autoimmune disease.</li> <li>And other conditions that should be discussed with your clinician. </li> </ul> For birth control options that contain estrogen and progesterone, these include most of the oral birth control pills, the ring or the patch. Depending on the type of birth control, the estrogen and progesterone can also help improve irregular or heavy menstrual periods, pelvic pain, premenstrual symptoms, acne, abnormal hair growth and mood. <ul> <li>Pill: taken once per day.</li> <li>Ring: changed every three to four weeks.</li> <li>Patch: changed once per week. </li> </ul> For birth control options that contain progesterone only, these include certain types of oral birth control pills, the shot, the subdermal contraceptive (arm implant) and many of the intrauterine contraceptives. Progesterone-only options do not contain estrogen, so they can be used while breastfeeding as they do not affect milk supply and can be used when estrogen is contraindicated, as in many of the health conditions above. <ul> <li>Pill: taken once per day.</li> <li>Shot: given every three months.</li> <li>Subdermal (arm) implant: changed every three years.</li> <li>Intrauterine contraceptive: changed every three, five or eight years, depending on the type.</li> </ul> For non-hormonal options, these include the copper intrauterine contraceptive and the many barrier methods such as condoms, diaphragms, spermicides, sponges and natural family planning. The non-hormonal options can be used for any patient where hormones are contraindicated, not tolerated well or when the patient desires regular menstrual periods. <ul> <li>Copper intrauterine device: changed every 10 years.</li> <li>Barrier methods: used with each sexual encounter.</li> <li>Natural Family Planning: monitored daily. </li> </ul> <a href="/providers/danielle-olaughlin-pac">Danielle O'Laughlin, P.A.-C.</a>, is a physician assistant in the Division of Community Internal Medicine, Geriatrics, and Palliative Care in Rochester, Minnesota. In addition to her role in primary care, she is the team lead of the Primary Care Obstetrics and Gynecology Clinic and works as the Clinical Skills Co-Director at the Mayo PA Program.Danielle O'Laughlin, P.A.-C.Primary Care in Rochester and KassonBirth Control OptionsPrimary Care in Rochester and KassonLearn about the types of bullying and how you can help.<img src="/-/media/ech-media/images/widgets/kids/ech_bullying_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=4C1CBFE3B69F0D8FEF03D780A9581DC3" alt="ECH_bullying_widget" width="100" height="65" DisableNVelocity="true" />Bullying — What is it?10/27/2025 4:30 AM<img src="/-/media/ech-media/images/widgets/kids/ech_bullying_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=DBC93B5A8E9F8C080A4B9EDA3AD947D0" alt="ECH_bullying_widget" width="300" height="195" DisableNVelocity="true" />The start of the school year is cause for excitement in most children. However, apprehension and anxiety can also surface, especially in children who have experienced bullying. So, what exactly is bullying? Bullying is defined as repeated unwanted and aggressive behaviors toward other children. This typically leads to a real or perceived power imbalance and can have lasting mental health implications and can affect school performance. Bullying can be physical, verbal, social/relational (spreading rumors or leaving someone out on purpose), or digital (also known as cyberbullying). What can we do about it? Adults can help prevent bullying by talking openly about it, building a safe school environment, and creating community-wide bullying prevention strategies. Adults can send a message that bullying is not acceptable by responding quickly and consistently. Even if your child is not the bully, talk to them about the role they play in bullying: <ul> <li>Kids who assist: These children may not start the bullying or lead it, but they serve as an "assistant" to children who are bullying. They may encourage the behavior and occasionally join in.</li> <li>Kids who reinforce: These children aren't directly involved in bullying behavior, but they provide an audience. They often laugh or give support to the bullies. This may encourage it to continue.</li> <li>Outsiders: These children remain separate from the bullying. They neither reinforce the bullying nor defend the child being bullied. Some may watch what is happening, but don't provide feedback to indicate they're on anyone's side. Just providing an audience may encourage the bullying behavior. These kids often want to help, but don't know how and need to learn how to be more than a bystander. </li> </ul> To stop bullying on the spot: <ul> <li>Intervene immediately; it's OK to get another adult to help.</li> <li>Separate the kids involved.</li> <li>Make sure everyone is safe.</li> <li>Meet any immediate medical or mental health needs.</li> <li>Stay calm. Reassure the kids involved, including bystanders.</li> <li>Model respectful behavior when you intervene. </li> </ul> Here are some common mistakes to avoid: <ul> <li>Don't ignore bullying and think kids can work it out without adult help.</li> <li>Don't immediately try to sort out the facts.</li> <li>Don't force other kids to say publicly what they saw.</li> <li>Don't question the children involved together, only separately.</li> <li>Don't make the kids involved apologize or patch up relationships on the spot – wait until tensions settle to address this in a calm environment. </li> </ul> Seek help from law enforcement or medical staff immediately if: <ul> <li>A weapon is involved.</li> <li>There are threats of serious physical injury.</li> <li>There are threats of hate-motivated violence, such as racism or homophobia.</li> <li>There is sexual abuse. </li> </ul> What should I do if my child is the bully? <ul> <li>Children who bully are often assumed to be “bad” kids. It is important to remember that these kids are also likely experiencing their own challenges, either at home or at school, that are contributing to these behaviors. Here are some tips on how to approach this situation:</li> <li>Find time away from school and other distractions to talk openly to your child. Give your child the space to discuss their experience and how they feel about it.</li> <li>Practice “putting yourself in their shoes” with your child. Explore how their behaviors might make them feel.</li> <li>Help your child brainstorm more positive ways to interact with other children in the future. Model these behaviors.</li> <li>Consider making amends by helping your child write an apology note.</li> <li>If you have emotional or behavioral concerns about your child, start by talking to your child’s primary care clinician. </li> </ul> Cyberbullying is also becoming more prevalent as technology reaches younger audiences. Cyberbullies use technology or other electronic communication to disseminate negative, mean, harmful, embarrassing or false information about another person. Cyberbullying is especially harmful as it can be persistent, permanent and public. It can sometimes be harder to recognize, as adults may not be privy to their child’s online activities. To prevent cyberbullying, have transparent discussions about what your child is viewing on their devices. Pay attention to how your children behave around their devices. Some red flags may include: <ul> <li>Sudden increase or decrease in device use.</li> <li>Decreasing willingness to share device with parents, and/or decreased willingness to discuss technology use.</li> <li>Increasing social withdrawal. </li> </ul> If any kind of bullying is happening at school, learn what <a rel="noopener" href="https://www.stopbullying.gov/resources/laws" target="_blank" title="Link opens in a new window">your state's anti-bullying law</a> requires schools to do. Also learn how <a rel="noopener" href="https://www.stopbullying.gov/resources/laws/federal" target="_blank" title="Link opens in a new window">federal laws</a> require schools to address harassment based on race, color, national origin, sex and disabilities, as well as ways to report situations that haven't been adequately addressed to the U.S. Departments of Education and Justice. If you've worked with your child and your school and need additional help, here are some resources: <ul> <li>Become an Upstander to Bullying — <a rel="noopener" href="https://www.youtube.com/watch?v=kelO5bA-xls&feature=youtu.be" target="_blank" title="Link opens in a new window">English video</a> and <a rel="noopener" href="https://www.youtube.com/watch?v=R8iwXsOJztw&feature=youtu.be" target="_blank" title="Link opens in a new window">Spanish video</a>.</li> <li>Stopybullying.gov — <a rel="noopener" href="http://" target="_blank" title="Link opens in a new window">Get Help Nowhttps://www.stopbullying.gov/resources/get-help-now</a>.</li> <li>Stopbullying.gov (<a rel="noopener" href="https://www.stopbullying.gov/" target="_blank" title="Link opens in a new window">English</a> / <a href="http://" target="_parent" title="Link opens in a new window">Spanishhttps://espanol.stopbullying.gov/speedbump/speedbump.html</a>).</li> <li><a rel="noopener" href="https://www.aap.org/en-us/Pages/Default.aspx" target="_blank" title="Link opens in a new window">American Academy of Pediatrics</a> — search "bullying."</li> </ul> <a href="/providers/gabriela-kovacikova-md">Ika Kovacikova, M.D</a>., is a Community Pediatric and Adolescent Medicine physician in Rochester, Minn. She practices primary pediatric care at Mayo Family Clinic Northeast. <a href="/providers/jill-smith-cnp">Jill M. Smith, APRN, C.N.P.,</a> is a certified pediatric nurse practitioner in Community Pediatric and Adolescent Medicine. She has a passion for adolescents, childhood mental health and encourages everyone to remember that children are watching, they are modeling the behavior, beliefs and words of others around them.Ika Kovacikova, M.D., and Jill M. Smith, APRN, C.N.P.Primary Care in Rochester and KassonBullyingPrimary Care in Rochester and KassonWhile treatment won't cure ADHD, it can help a great deal with symptoms.<img src="/-/media/ech-media/images/widgets/medicalimages/ech_adhdtips_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=96E8906B6D073604D1CDB7C6D571A317" alt="ECH_ADHDtips_widget" width="100" height="65" DisableNVelocity="true" />Learn how to manage your child's ADHD10/13/2025 4:30 AM<img src="/-/media/ech-media/images/widgets/medicalimages/ech_adhdtips_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=7F51DD440CB0A81D543828BB57AD4E6B" alt="ECH_ADHDtips_widget" width="300" height="195" DisableNVelocity="true" />While most children occasionally struggle with paying attention, managing impulses and emotions, or navigating social situations, these challenges are more frequent and pronounced in children with attention deficit hyperactivity disorder (ADHD). As a result, they can experience significant difficulties at home, in school, and in their relationships. ADHD is a neurobehavioral condition that impacts how the brain affects learning, behavior and emotions. Essentially, the symptoms occur because your child's brain works uniquely to take in, learn and process information. Your child is not lazy. This was not caused by bad behavior or bad parenting. ADHD does not affect intelligence, but it can affect grades and school success. Along with poor school performance, children with ADHD may struggle with low self-esteem, troubled relationships and school anxiety. ADHD symptoms sometimes lessen with age. While some people never completely outgrow ADHD, they can learn strategies to be successful. While treatment won't cure ADHD, it can help a great deal with symptoms. Treatment typically involves medications and behavioral interventions. Early diagnosis and treatment can make a big difference in the outcome for your child. These behavioral strategies can help you manage your child's ADHD: Praise and reward your child when rules are followed. Children with ADHD often receive and expect more criticism than other children. This can really affect their self-esteem. Some days, you might have to look hard for good behavior, but you should praise good behavior at least five times more often than you criticize bad behavior. Give clear, effective directions or commands. Make eye contact or gently touch your child's arm or shoulder to get their attention. Give brief, simple steps and short commands that get to the point rather than multiple directions or wordy statements/questions. Establish healthy habits. If your child is on medication, it should be taken as prescribed. Contact your child's healthcare clinician if problems arise. Make sure your child is getting enough sleep, eating a well-balanced diet consisting of three meals, a snack and adequate fluid every day, and participating in some form of daily exercise. These healthy habits will help your child feel their best and minimize ADHD symptoms. Develop routines around homework and chores. <ul> <li>Work together to make a checklist of what needs to be done for daily chores, getting ready for bed and school, so your child has something to refer to when they get off task.</li> <li>Encourage your child to use a daily planner so they're aware of all homework assignments.</li> <li>Have an established time and location for homework and use a timer to remind your child two to four times an hour to show you their progress on the work.</li> <li>Factor in brain breaks if your child needs them. Add movement between tasks or let them use an appropriate fidget toy.</li> <li>Help your child build relationships, develop strong social skills and maintain friendships.</li> <li>Be a good role model for the behavior you want your child to practice. </li> </ul> To help maintain a strong parent-child relationship, set aside some special time with your child three to five days a week. Make sure this time doesn't involve a screen and that it's conflict-free. Help your child develop at least one close friendship. With younger children, parents may need to take the lead in arranging and hosting play dates or getting kids involved in activities with other children of the same age. <a href="/providers/renee-breland-aprncnpms">Renee Breland, APRN, C.N.P., M.S.</a>, is a certified pediatric nurse practitioner with a pediatric mental health certification in Primary Care in Rochester and Kasson's Integrated Community Specialty Pediatric ADHD Clinic. She also provides general pediatric primary care at Mayo Family Clinic Northeast in Rochester, Minn.Renee Breland, APRN, C.N.P., M.D.Primary Care in Rochester and KassonChildhood ADHDPrimary Care in Rochester and KassonWhile there is no cure for a congenital disability, treatment may be available. <img src="/-/media/ech-media/images/widgets/kids/congenitaldisability.jpg?h=65&iar=0&w=100&sc_lang=en&hash=F3B23743E35322ABA677127AFD732210" alt="CongenitalDisability" width="100" height="65" DisableNVelocity="true" />Explaining congenital disabilities10/7/2025 4:30 AM<img src="/-/media/ech-media/images/widgets/kids/congenitaldisability.jpg?h=205&iar=0&w=315&sc_lang=en&hash=63353C994B735AEFEE60172E02BAB00E" alt="CongenitalDisability" width="315" height="205" DisableNVelocity="true" />What are congenital disabilities? Congenital disabilities are changes in a person's physical, developmental or intellectual health that are present when a baby is born. They are due to changes that occur during fetal development and may affect the structure or functioning of a person's body. What causes congenital disabilities? Sometimes, congenital disabilities are caused by an underlying genetic change in the developing fetus, such as trisomy 21, causing Down Syndrome, a missing X chromosome causing Turner Syndrome, or a piece of chromosome 15 missing, causing Prader-Willi Syndrome. Sometimes, environmental exposure to which the fetus is exposed can cause changes in their development. Examples of environmental exposures that can cause congenital disabilities in a developing fetus are alcohol, lithium, isotretinoin, warfarin, pesticide exposure and valproic acid. What are examples of congenital disabilities? Some examples of congenital disabilities include anencephaly (being born without parts of the brain and skull), cleft lip or palate, diaphragmatic hernia (a hole in the diaphragm), congenital heart defects, esophageal atresia (an abnormal formation of the esophagus, which connects the mouth to the stomach), gastroschisis (a hole in the abdominal wall near the umbilicus), limb defects (when an arm or leg fails to develop completely), among other examples. How are congenital disabilities diagnosed? Congenital disabilities may be diagnosed during a pregnancy or after a baby’s birth, or in some instances, may not be identified until a child grows up. During pregnancy, routine monitoring, such as ultrasounds, is designed to monitor structural changes as the fetus develops. Other screening tests during pregnancy include blood tests, which can measure protein levels or free fetal DNA in the mother's blood. If a concern is found, other tests may consist of echocardiograms, which are ultrasounds of the fetal heart, and fetal MRI, which examines the fetal brain and nervous system. Chorionic villus sampling occurs when a tiny piece of the placenta is examined for chromosomal or genetic conditions. Amniocentesis is a procedure that analyzes a small amount of amniotic fluid to find genetic changes and certain infections. After birth, some health defects are identified on physical examination of the baby, such as a cleft lip or microcephaly. Other conditions may not be determined until later during childhood or adulthood. Treatment for congenital disabilities Usually, there are no cures for congenital disabilities, and treatment varies depending on the diagnosis. Treatment can include medications, surgeries, physical and occupational therapy, and using adaptive devices such as braces, wheelchairs, hearing aids, etc. Children may also need developmental supports such as speech therapy or special educational supports in school as they grow. <a href="/providers/rebecca-kruc-mdmph">Rebecca Kruc, M.D., M.P.H.</a>, is a Pediatric and Adolescent Medicine resident in Rochester, Minnesota. She has previously worked in public health and plans to blend public health and medicine.Rebbecca Kruc, M.D., M.P.H.Primary Care in Rochester and KassonCongenital DisabilitiesPrimary Care in Rochester and KassonFind out how to keep your home and community safe.<img src="/-/media/ech-media/images/widgets/drugtakeback/drugtakeback2025.jpg?h=65&iar=0&w=100&sc_lang=en&hash=E2488CC061DC631BB36F509624D5C768" alt="DrugTakeBack2025" width="100" height="65" DisableNVelocity="true" />National Drug Take Back Day is Oct. 2510/6/2025 4:30 AM<img src="/-/media/ech-media/images/widgets/drugtakeback/drugtakeback2025.jpg?h=205&iar=0&w=315&sc_lang=en&hash=5E1029BF3BFBE572A3D4B6477814BAE2" alt="DrugTakeBack2025" width="315" height="205" DisableNVelocity="true" />The Drug Enforcement Agency National Drug Take Back Day is a special event that encourages everyone in the community to safely dispose of expired or unused medications. This year, Mayo Clinic, in collaboration with Olmsted County Sheriff's Office, Zumbro Valley Medical Society and Olmsted Medical Center, will once again host this important event in Rochester. Local community partners, including Mayo Ambulance, Olmsted County’s Drug and Alcohol Response Team (DART) and Rochester Fire Department, will also participate. The local Drug Take Back Day event will be held on Saturday, Oct. 25, from 10 a.m. to 2 p.m. at Mayo Family Clinic Northeast at 3041 Stonehedge Drive, NE, in Rochester, Minnesota. Everyone is welcome to drop off leftover prescription and over-the-counter medications on this day. The goal is to prevent drug misuse, protect the environment and keep homes and neighborhoods safe. Importance of removing unused medicine from your home Many people have extra pills or bottles of medicine sitting in their bathroom cabinets or kitchen drawers. These could be from an old illness, injury or surgery. But even if those medicines are no longer needed, they can still be dangerous – especially if children, pets or others take them by accident or on purpose. Taking drugs that were not prescribed for you could lead to serious health problems, addiction or even death. National Drug Take Back Day helps prevent these dangers by giving all community members a safe and easy way to clean out their medicine cabinets. Instead of throwing pills in the trash or flushing them down the toilet. which can pollute our water and soil, you can drop them off at this event so these unused medications can be disposed of in an environmentally friendly and secure manner. This event also raises awareness of the ongoing drug misuse and overdose epidemic across the country. In the United States, millions of people struggle with addiction to medications such as opioid pain killers, sleeping pills or anxiety medications. In many cases, these problems start when someone takes a medicine meant for someone else. Teenagers are especially at risk. Studies show that many teens who misuse prescription drugs get them from a friend or family member – often right out of the medicine cabinet. Clearing out old medicines is a simple action that can save lives. National Drug Take Back Day reminds families to check their supplies and safely remove anything they no longer need. By dropping off unused medications during this event, you are helping your family and your community. It may seem small, but safely disposing of your medicine can make a big difference! Here is a list of prescription and over-the-counter medications you can drop off at the Drug Take Back Day event: <ul> <li>Capsules.</li> <li>Creams.</li> <li>Ointments.</li> <li>Patches.</li> <li>Pills.</li> <li>Vials. </li> </ul> Liquids must be in their original container. Pet medications are accepted. Vape pens are accepted with the batteries removed. Other e-cigarette devices are also accepted, with the batteries removed. Designated drop-off pharmacies If you are unable to go to this event, drop your medications at one of these designated Mayo Clinic Pharmacies: <ul> <li>Mayo Family Clinic Northwest.</li> <li>Mayo Clinic Hospital — Rochester, Saint Marys Campus, Mary Brigh Building.</li> <li>Mayo Family Clinic Northeast.</li> <li>Mayo Clinic Hospital — Rochester, Methodist Campus.</li> <li>Mayo Building Subway.</li> <li>Baldwin Building. </li> </ul> There are also year-round locations in communities nationwide where you can drop off your medications. You can find your closest location by using the DEA’s website, Year-Round Drop-Off Locations - Search Utility. <a href="/providers/benjamin-lai-mbbchbao">Benjamin Lai, M.B., B.Ch., B.A.O.</a>, is a primary care physician in the Department of Family Medicine in Rochester and Kasson. He is chair of Mayo Clinic's Opioid Stewardship Program and participates in medical student and resident education.Benjamin Lai, M.B., B.Ch., B.A.O.Primary Care in Rochester and KassonDrug Take Back 2025Primary Care in Rochester and Kasson<img src="/-/media/ech-media/images/widgets/people/vaccinationbandaid.jpg?h=65&iar=0&w=100&sc_lang=en&hash=F68CAB5F9BABB80BF42F57D42F231109" alt="VaccinationBandaid" width="100" height="65" DisableNVelocity="true" />Schedule your influenza and COVID-19 vaccine today9/15/2025 4:30 AM<img src="/-/media/ech-media/images/widgets/people/vaccinationbandaid.jpg?h=205&iar=0&w=315&sc_lang=en&hash=4142843AED69762657352E6885E7FFCA" alt="VaccinationBandaid" width="315" height="205" DisableNVelocity="true" />As we head into the fall and winter months, it's important to protect your health. The seasonal influenza (flu) and 2025-26 COVID-19 vaccines are now available at our Primary Care in Rochester and Kasson clinics. Mayo Clinic recommends this year's seasonal flu and COVID-19 vaccinations for all people 6 months of age and older. As a primary care patient, you have several options for scheduling these vaccines through our local clinics. If all you need is a flu or COVID-19 vaccine, you should schedule an appointment at our Primary Care Vaccination Clinic through the <a rel="noopener" href="https://onlineservices.mayoclinic.org/content/staticpatient/showpage/patientonline" target="_blank" title="Link opens in a new window">patient portal</a> or by <a href="/contact-us">calling your primary care clinic</a>. If multiple family members would like to receive their vaccines at the same time, each appointment must be separately scheduled. You can also request a flu or COVID-19 vaccine as part of a regularly scheduled primary care clinician visit during our regular operating hours. Primary Care Vaccination Clinic locations and hours of operation Mayo Clinic Medical Complex Northwest — Building B, Door B1 3033 41st Street NW, North Entrance Rochester, Minnesota Monday/Wednesday/Friday: 7 a.m. to 3 p.m. Tuesday/Thursday: 11 a.m. to 7 p.m. Saturday, Oct. 11, Oct. 18, Oct. 25: 8 a.m. to noon Saturday, Nov. 15: Sensory-Friendly Clinic 9 a.m. to 1 p.m. This vaccination clinic closes on Dec. 19 at 3 p.m. Mayo Family Clinic Kasson 411 West Main Kasson, Minnesota Monday through Friday: 8:30 a.m. to 4:30 p.m.Primary Care in Rochester and KassonFlu COVID Vaccine 2025Primary Care in Rochester and KassonYou know your kids should eat more fruits and veggies. Here are five tips to help make that happen. <img src="/-/media/ech-media/images/widgets/food/fruitrainbow.jpg?h=65&iar=0&w=100&sc_lang=en&hash=E905D9F224C838C1E5BD161352DB4B61" alt="FruitRainbow" width="100" height="65" DisableNVelocity="true" />Five tips for fitting fruits and veggies into your kids' meals10/20/2025 4:30 AM<img src="/-/media/ech-media/images/widgets/food/fruitrainbow.jpg?h=205&iar=0&w=315&sc_lang=en&hash=96C56D4DC411E6F9F8C49A5889243FD4" alt="FruitRainbow" width="315" height="205" DisableNVelocity="true" />It's one thing to say, "eat the rainbow," but it's another thing to fit enough — or more — fruits and veggies into your kids' meals. Here are five tips to make that happen: Make them fun <ul> <li>Get kids involved in choosing fruits and veggies at the grocery store or farmers market.</li> <li>Give kids the job of washing and preparing fruits and veggies for storage. Little ones can help with the easy jobs, like stemming grapes. Bigger kids can peel carrots.</li> <li>Cut carrots, cucumbers, radishes, apples, pears and melons with an inexpensive "waffle" cutter to give them a fun, wavy edge.</li> <li>Cut yellow, orange or red sweet peppers into rings instead of slices.</li> <li>Scoop melons into balls and mix and match honeydew, watermelon and cantaloupe.</li> <li>Keep dips like nonfat yogurt and salad dressings on hand for dipping and scooping with sliced fruit or veggies.</li> </ul> Change them up <ul> <li>Roast or boil cauliflower or carrots, mash with salt and pepper and serve instead of mashed potatoes.</li> <li>Cook a spaghetti squash, and when tender, lift out the long noodle-like strands and top just as you would pasta or rice.</li> <li>Switch it up and instead of white potatoes, opt for sweet potatoes: bake, roast, mash or serve as fries. </li> </ul> Mix them in <ul> <li>Making lasagna? Spread a veggie layer of shredded carrots or zucchini between each pasta layer, chopped yellow or green sweet peppers or torn spinach.</li> <li>Add chopped fresh or frozen green beans to a soup or stew. Stir canned, fresh or frozen corn kernels into chili.</li> <li>Sauté chopped green peppers, onions, and sliced mushrooms to boost pasta sauce.</li> <li>Dress up tacos with sweet peppers, cucumbers or avocado. </li> </ul> Puree them <ul> <li>The easiest breakfast ever is a fruit smoothie: Combine frozen fruit (berries, peaches, pineapple) and a cup of nonfat milk in a blender and puree until smooth. (You can even sneak in a carrot.)</li> <li>Cook carrots, potatoes, onions, squash and an apple. When tender, puree with salt, pepper and other seasonings and thin with vegetable or chicken broth for an easy soup.</li> <li>Stir pureed veggies into pasta sauce or tomato soup. </li> </ul> Don't give up OK, so your kids really balk at fruits and vegetables. The rule of thumb is that you must try something 10 times before you develop a taste for it. So don't give up. Keep exposing your kids to a variety of fruits and vegetables; tastes and reasons for disliking foods may change over time. Plus, kids tend to eat different foods if their friends eat and enjoy them too. Remember that the best way to encourage and enhance your children’s love of fruits and veggies is to model consistent eating of fruits and veggies yourself. Consider these sites for more tips to champion fruits and veggies for your family! <ul> <li><a rel="noopener" href="https://www.myplate.gov/" target="_blank" title="Link opens in a new window">MyPlate</a>. </li> <li><a rel="noopener" href="https://myplate-prod.azureedge.us/sites/default/files/2024-06/Tipsheet-2-Focus-On-Fruits.pdf" target="_blank" title="Link opens in a new window">Focus on Whole Fruits</a>.</li> <li><a rel="noopener" href="https://myplate-prod.azureedge.us/sites/default/files/2024-06/TipSheet-3-Vary-Your-Vegetables.pdf" target="_blank" title="Link opens in a new window">Vary Your Vegetables</a>.</li> <li><a rel="noopener" href="https://fruitsandveggies.org/" target="_blank" title="Link opens in a new window">Home - Have A Plant</a>.</li> </ul> In summary, small changes can make a big difference. You can help your kids build lifelong healthy eating habits with creativity and patience. Michaeleen Burroughs, M.S., RDN, LD, has worked in Primary Care in Rochester and Kasson for 28 years. She helps Mayo Family Clinics - Northwest, Southeast, Northeast, and Kasson patients. Her areas of interest are diabetes and child and adult weight management.Michaeleen Burroughs, M.S., RDN, LDPrimary Care in Rochester and KassonFruits and VegetablesPrimary Care in Rochester and KassonReviewing your family history is the first step to understanding inherited cancers. <img src="/-/media/ech-media/images/widgets/people/chinesemultigenerationalfamily_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=AE05AF08B01334E13B79E2A8B4F152A4" alt="ChineseMultigenerationalFamily_widget" width="100" height="65" DisableNVelocity="true" />Understanding inherited cancers and genetic testing10/23/2025 4:30 AM<img src="/-/media/ech-media/images/widgets/people/chinesemultigenerationalfamily_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=818362F735D4DDE52C59BC12C62088EF" alt="ChineseMultigenerationalFamily_widget" width="300" height="195" DisableNVelocity="true" />Cancer results when the growth of cells becomes uncontrolled. Genes, which are the controllers of cell growth, can be damaged after birth or inherited with problems that prevent them from working correctly. These genes, which can be inherited from either parent, are called inherited cancers. But they cause only about 5% to 20% of cancers. As a patient, you may wonder whether you should worry if a family member has cancer. An important clue to an inherited cancer is family history. Answering these questions and discussing them with your healthcare clinician is essential: <ul> <li>Who has cancer? For example, consider siblings, parents, grandparents, aunts and uncles.</li> <li>What kind of cancer did they have?</li> <li>How old were they when they had cancer? </li> </ul> Some groups of cancers seem to be inherited together and are understood, including the genes involved. Two of the most recognized genes are BRCA1 and BRCA2, which increase the risk of breast and ovarian cancer in women. This genetic information led Angelina Jolie to have surgery to remove both of her breasts. Less well-known is that this gene abnormality increases the risk of cancer in men, too. Colon cancer is also associated with increased genetic risk, primarily the Lynch syndrome. It is essential to review your family history and talk to your primary care clinician if you think you may be at risk for an inherited cancer. Your clinician can help you decide if genetic testing is a good idea. What if genetic testing is positive? Not everyone with an abnormal gene gets cancer. Still, genetic testing may change how often your healthcare clinician recommends that you get checked for cancer or if you need treatment to decrease your risk of getting cancer in the future. Bottom line Less than 1 in 5 cancers results from an inherited cancer condition, and the best way for you to determine if you might have an increased risk related to your genes is to look at your family history. <a href="/providers/denise-dupras-md">Denise Dupras, M.D., Ph.D.</a>, is a general internist in the Division of Community Internal Medicine. She completed her medical and doctoral degrees at Mayo Clinic Alix School of Medicine and her residency in internal medicine at Mayo Clinic in Rochester. Her interests include medical education and evidence-based medicine.Denise Dupras, M.D., Ph.D.Primary Care in Rochester and KassonInherited Cancer Genetic TestingPrimary Care in Rochester and KassonA wide range of outdoor events are scheduled in our local parks. <img src="/-/media/ech-media/images/widgets/activities/fallleaveswalk.jpg?h=65&iar=0&w=100&sc_lang=en&hash=50E06902D44E65A237B2D107B4EA3B62" alt="FallLeavesWalk" width="100" height="65" DisableNVelocity="true" />Let nature take care of you this fall10/2/2025 4:30 AM<img src="/-/media/ech-media/images/widgets/activities/fallleaveswalk.jpg?h=205&iar=0&w=315&sc_lang=en&hash=2F5BFEAE9E5F491ADAFE7FC5DAF94CE8" alt="FallLeavesWalk" width="315" height="205" DisableNVelocity="true" />As the leaves turn and the air cools, Southeast Minnesota's parks invite us to step outside and reconnect with the land, with each other and ourselves. This fall, local parks are offering a wide variety of outdoor events that are fun, welcoming and good for your health. Whether walking a trail, watching wildlife or simply sitting quietly under a tree, you're doing something powerful for your body and mind. And science backs it up. Why nature is good for your health Spending time in nature isn't just relaxing; it's backed by decades of research showing real health benefits. Here's what science has to say: Mental health <ul> <li>Reduces stress and anxiety: Natural environments lower cortisol, the body's primary stress hormone. Even 20 minutes in a park can make a difference.</li> <li>Improves mood and focus: Green spaces are linked to lower rates of depression and better attention, especially in children and teens.</li> <li>Supports emotional regulation: Nature helps calm the nervous system, making it easier to manage emotions and feel grounded. </li> </ul> Physical health <ul> <li>Lowers blood pressure and heart rate: Time outdoors can reduce cardiovascular strain and support heart health.</li> <li>Encourages movement: Walking, hiking or even light play in nature increases physical activity, which helps prevent chronic diseases.</li> <li>Boosts immune function: Exposure to natural environments may enhance immune response by increasing natural killer cell activity. </li> </ul> Social and community benefits <ul> <li>Strengthens relationships: Shared outdoor experiences build connection and trust among families, friends and neighbors.</li> <li>Reduces loneliness: Parks offer a welcoming space for people of all ages to gather, which is especially important for older adults and newcomers. </li> </ul> What's happening in our parks Here's a look at some of the events happening this fall. All are open to the public, and many offer accessibility support like ASL interpreters, mobility assistance, and sensory-friendly options. <a rel="noopener" href="https://www.olmstedcounty.gov/residents/parks-recreation/parks/oxbow-park-zollman-zoo" target="_blank" title="Link opens in a new window">Oxbow Park & Zollman Zoo</a> — Byron, Minnesota <ul> <li>Sept. 20: DNR K-9 Demo with Officer Schlag and Trapper.</li> <li>Sept. 21: Feed the Deer and Elk.</li> <li>Sept. 27: Treasure Trek Scavenger Hunt.</li> <li>Oct. 5: Bats and Crafts.</li> <li>Oct. 11: Prairie Hike and Seed Collection.</li> <li>Oct. 19: History of Halloween Animals.</li> <li>Oct. 25: Boo at the Zoo (costumes welcome!). </li> </ul> <a rel="noopener" href="https://www.olmstedcounty.gov/residents/parks-recreation/parks/chester-woods-park" target="_blank" title="Link opens in a new window">Chester Woods Park</a> — Eyota, Minnesota <ul> <li>Sept. 27: National Public Lands Day (Seed Collection and Free Lunch).</li> <li>Oct. 10: Outdoor Storytime with Rochester Public Library.</li> <li>Oct. 18: Friends of Chester Woods Annual Meeting.</li> <li>Oct. 25: Halloween Craze at the Maze.</li> <li>Last night of camping: Oct. 18. </li> </ul> <a rel="noopener" href="https://qhnc.org/" target="_blank" title="Link opens in a new window">Quarry Hill Nature Center</a> — Rochester, Minnesota <ul> <li>Oct. 11: Mindfulness in Nature Walks (separate sessions for adults and families). </li> </ul> <a rel="noopener" href="http://www.mnprojectgo.org/" target="_blank" title="Link opens in a new window">Project Get Outdoors — Youth Programshttp://www.mnprojectgo.org/</a> <ul> <li>Oct. 1: Forest Bathing at <a rel="noopener" href="https://www.dnr.state.mn.us/state_forests/forest.html?id=sft00033#cmp00041" target="_blank" title="Link opens in a new window">Richard J. Dorer Memorial Hardwood State Forest</a>.</li> <li>Oct. 7: Nature Explorers (ages 3–6) at <a rel="noopener" href="https://www.dnr.state.mn.us/state_parks/park.html?id=spk00160#homepage" target="_blank" title="Link opens in a new window">Frontenac State Park</a>.</li> <li>Oct. 13–31: <a rel="noopener" href="https://www.minnesotamasternaturalist.org/" target="_blank" title="Link opens in a new window">Master Naturalist Course</a> in Pine Island. </li> </ul> You're invited Whether you're looking to explore, unwind or enjoy the season, there's a place for you in nature. You don't need to be an expert hiker or a nature lover — just come as you are. The trails, trees and open skies are waiting. Muse Abdi, M.B.B.S., B.BiomedSc, M.P.H., has a background in medicine and leads nature-based health initiatives, including Park Rx/Exercise is Medicine, Healing Forest, and the cultural liaison program in the parks under the Statewide Health Improvement Partnership (SHIP) grant. He facilitates the SE MN Park Rx Coalition, a key component of the Park Initiative. He leads health equity and community engagement efforts through SHIP, including the MOVE (Mobilizing Olmsted Voices for Equity) project. <a href="/providers/brian-lynch-md">Brian Lynch, M.D.</a>, is a primary care pediatrician at Mayo Family Clinic Northwest in Rochester. He co-chairs the Primary Care Work Group of the Mayo Clinic Obesity Council and chairs the Primary Care Obesity Task Force. Dr. Lynch works closely with the Southeast Minnesota Park Rx Team to promote the physical and mental health benefits of spending time in nature with his patients and colleagues.Muse Abdi, M.B.BS., B.BiomedSc, M.P.H., and Brian Lynch, M.D.Primary Care in Rochester and KassonPark Rx Fall 2025Primary Care in Rochester and KassonWater is essential to help keep your body systems up and running. <img src="/-/media/ech-media/images/widgets/beverages/waterglass.jpg?h=65&iar=0&w=100&sc_lang=en&hash=A5CD260C312DC6309F10E3DE2561AF99" alt="WaterGlass" width="100" height="65" DisableNVelocity="true" />Why proper hydration is healthy10/30/2025 4:30 AM<img src="/-/media/ech-media/images/widgets/beverages/waterglass.jpg?h=205&iar=0&w=315&sc_lang=en&hash=87BB947B184D54F091A029AB360CE8B9" alt="WaterGlass" width="315" height="205" DisableNVelocity="true" />Staying hydrated is as important as eating fruits, vegetables and protein daily. Water is essential to keep each bodily system running adequately since it makes up 60% of the body. Hydrating is essential because it: <ul> <li>Prevents constipation and supports digestion.</li> <li>Maintains blood pressure and electrolyte balance.</li> <li>Normalizes body temperature.</li> <li>Supports organs and tissues. </li> </ul> Some baseline recommendations for fluids are about 3.7 liters (15.5 cups) for men and 2.7 liters (11.5 cups) for women, or 1 ounce of fluid per pound of body weight. Of those fluid recommendations, 9 cups of water for women and 13 cups for men is ideal. Recommendations may vary based on a person's activity level, environment, health status, medication use, age and whether they are pregnant or breastfeeding. Drinking fluids/beverages keeps you hydrated, but what beverages are low in calories and sugar? The best option, first and foremost, is water. The majority of fluid consumed in the day should ideally be from water. However, other more tasty options include milk, tea, electrolyte drinks and coffee. It is important to avoid alcohol and sugar-sweetened beverages such as soda, sports drinks, energy drinks and juice. These are more likely to cause weight gain and inflammation. Some foods can have water content, such as cucumbers, iceberg lettuce, celery, radishes, bell peppers and watermelon. Signs of dehydration <ul> <li>Dark-colored urine.</li> <li>Less frequent urination.</li> <li>Feeling faint.</li> <li>Muscle cramps in arms or legs.</li> <li>Dry mouth. </li> </ul> A good sign that you drink enough fluids is when you do not feel thirsty often, and your urine is light-yellow or clear. A way to ensure you reach your fluid goals is having a beverage at each meal or snack, with any medicine or socially. To ensure you take in enough fluid, your goal should be 8 to 10 ounces (about a cup) of liquid each hour you are awake. Drink more when you exercise, when the weather is hot or if you are ill. Here are some recipes from Mayo Clinic to help you stay hydrated: <ul> <li><a rel="noopener" href="https://www.mayoclinic.org/healthy-lifestyle/recipes/mintylime-iced-tea/rcp-20049681" target="_blank" title="Link opens in a new window">Minty-lime iced tea - Mayo Clinic</a>.</li> <li><a rel="noopener" href="javascript:return false" target="_blank" title="Link opens in a new window">Watermelon-cranberry agua fresca - Mayo Clinic</a>.</li> <li><a rel="noopener" href="https://www.mayoclinic.org/healthy-lifestyle/recipes/hurricane-punch/rcp-20049962" target="_blank" title="Link opens in a new window">Hurricane punch - Mayo Clinic</a>.</li> </ul> Melissa Gess was a dietetic intern at Mayo Clinic in Rochester. She received her Bachelor of Science in Dietetics and Master of Science in Nutrition and Dietetics from the University of Wisconsin-Stout. She is exploring the areas of clinical nutrition, but is interested in pediatrics, WIC and diabetes education.Melissa GessPrimary Care in Rochester and KassonProper HydrationPrimary Care in Rochester and KassonYou can take steps to reduce the risk of sudden infant death syndrome.<img src="/-/media/ech-media/images/widgets/kids/babycrib.jpg?h=65&iar=0&w=100&sc_lang=en&hash=FC65CFFEFF77E8702192571A5C21528B" alt="BabyCrib" width="100" height="65" DisableNVelocity="true" />The facts about SIDS10/16/2025 4:30 AM<img src="/-/media/ech-media/images/widgets/kids/babycrib.jpg?h=205&iar=0&w=315&sc_lang=en&hash=42D1286FE85B0743D07027F4F95F64D2" alt="BabyCrib" width="315" height="205" DisableNVelocity="true" />Sudden infant death syndrome (SIDS) is defined as an infant death that occurs in an otherwise healthy infant before 1 year of age and without another identifiable cause. SIDS remains the leading cause of infant death between 1 month and 1 year of age. The risk from SIDS is most significant before 6 months, though this risk extends to 1 year of life. SIDS occurs at a higher incidence in day care settings than in private family homes. While the incidence of SIDS is less than 1 per 1,000 children, the risk of an infant dying from SIDS during the first year of life is greater than 20 times higher than the risk of death during any of the subsequent 17 years of a child's life. Significant research has been conducted to identify factors or causes of SIDS. As a result of these research efforts, many risk factors have been identified that have led to strategies to reduce the risk for infants, including changes in the environment, behaviors of caregivers and promoting safe sleep practices for infants. These changes have successfully reduced the number of infant deaths from SIDS, though they have not eliminated all infant deaths from SIDS. To reduce the risk of SIDS, you should: <ul> <li>Place your baby on their back to sleep every time.</li> <li>Provide a separate sleep surface that is firm and not shared, and in the caregiver's room for the first 6–12 months of life.</li> <li>Remove soft objects and loose bedding from the baby's sleep area, such as bumper pads and stuffed animals or toys.</li> <li>Breastfeed infants.</li> <li>Use pacifiers during sleep.</li> <li>Avoid overheating.</li> <li>Avoid secondhand smoke exposure.</li> <li>Vaccinate infants on schedule with regular visits to clinicians. </li> </ul> In addition, caregivers should avoid tobacco, alcohol and drugs. Regular obstetric medical care and proper nutrition for moms before the infant's birth reduce the risk of premature birth and low birth weight. Preconception care for families is essential to help parents, family members, and other caregivers optimize medical care, encourage healthy behaviors and wellness practices, and update immunizations. Talk to your healthcare team for more information on keeping your new baby safe, happy and healthy. <a href="/-/media/ech-media/images/providers/o-brien-marcia-13575414.jpg">Marcia O'Brien, M.D.</a>, is a physician in the Department of Family Medicine at Mayo Family Clinic Northeast in Rochester. She practices the full spectrum of family medicine, including hospital medicine, newborn nursery and obstetrics care.Marcia O'Brien, M.D.Primary Care in Rochester and KassonSIDS FactsPrimary Care in Rochester and KassonThese tips can help you talk to your child about difficult news. <img src="/-/media/ech-media/images/widgets/teens/teenconversation.jpg?h=65&iar=0&w=100&sc_lang=en&hash=45DE646A80D28A77AE607B34A5EC5D18" alt="TeenConversation" width="100" height="65" DisableNVelocity="true" />Navigating conversations about tragic news events9/23/2025 4:30 AM<img src="/-/media/ech-media/images/widgets/teens/teenconversation.jpg?h=205&iar=0&w=315&sc_lang=en&hash=1887D88F458A7DE45FDC077E178CFBD0" alt="TeenConversation" width="315" height="205" DisableNVelocity="true" />When a tragedy occurs, it may be difficult even for adults to process what's reported on the news. As a parent or guardian, you may wonder how to help your child process these events. It may go against your instincts to bring these events up — you may wonder if this will bring more attention to the situation or cause additional fear or worry. In the end, sitting down with your child and having a conversation is something that all parents or guardians should do. This will help your child learn from you what they may be hearing during school, from the news or social media, or talking with their friends. You know your child and how to support them the best. Here are some tips to help your child process tragic news events: <ul> <li>Start the conversation. Ask an open-ended question like, “Have you heard about what happened?” This helps you understand what they already know. If they haven't heard, gently share what happened so they hear it from you first.</li> <li>Share your feelings. Let your child see that you also feel sadness, confusion or worry. Modeling healthy expression shows them it's OK to talk about emotion</li> <li>Validate their emotions. Thank them for sharing, reassure them their feelings are normal, and let them know you'll always listen.</li> <li>Focus on helpers. Talk about the people who responded — teachers, leaders, police and first responders — and how they work hard to keep others safe. </li> <li>Talk about safety. Please remind your child that schools and community spaces have trusted adults who will guide and protect them in an emergency.</li> <li>Offer guidance. Encourage them to listen to leaders and stay close to trusted adults if they're ever in a difficult situation.</li> <li>Limit media exposure. Too much news or social media coverage can feel overwhelming. Let them know you'll share updates they genuinely need to know.</li> <li>Keep checking in. Children may revisit the topic at unexpected times. Continue to ask questions, listen and remind them of your love and support.</li> <li>Remind your child of the importance of letting you or someone in charge know if they hear that someone wants to hurt themselves or other people. This is a critical way to get others the support they may need. </li> </ul> Most importantly, remind your child they are loved, safe and never alone in their feelings. As parents and guardians, we can continue to help our children during times of uncertainty by having open, honest conversations. Ultimately, this will strengthen your relationship with your child by building trust through processing the information, expressing feelings and learning together. Jennifer Rodemeyer, M.A., CCLS, is manager of the Child Life Program at Mayo Clinic Children's in Rochester, Minnesota.Jennifer Rodemeyer, M.A., CCLSPrimary Care in Rochester and KassonTragic News ConversationsPrimary Care in Rochester and KassonAntibiotics fight bacteria, but they don't work against viruses. <img src="/-/media/ech-media/images/widgets/medications/pharmacistpillbottle.jpg?h=65&iar=0&w=100&sc_lang=en&hash=3562413122B331BA602D095EB36F46AF" alt="PharmacistPillBottle" width="100" height="65" DisableNVelocity="true" />Prescribing with purpose: Why antibiotics aren't always the fix12/18/2025 4:30 AM<img src="/-/media/ech-media/images/widgets/medications/pharmacistpillbottle.jpg?h=205&iar=0&w=315&sc_lang=en&hash=0200F1CE2070E936BF722BB1046B4A6C" alt="PharmacistPillBottle" width="315" height="205" DisableNVelocity="true" />Antimicrobial stewardship is a term that means “using antibiotics wisely.” Antibiotics are medicines that fight bacteria but do not work against viruses like the ones that cause most colds, sinus infections and ear infections. In 2025, antibiotics will remain an essential part of healthcare. However, when clinicians prescribe antibiotics for illnesses that aren’t caused by bacteria, these medications don’t help and can even be harmful. Why this matters Taking antibiotics when they are not needed can lead to antibiotic resistance. That’s when bacteria learn to fight back against the medicine, making future infections much harder to treat. This doesn’t just affect the person taking the drug — it affects everyone in our communities, as resistant bacteria can spread and make common diseases dangerous again. For individual patients, unnecessary antibiotics can cause side effects like stomach problems, allergic reactions, or even more serious issues. More importantly, antibiotics won’t make a viral infection resolve faster, so taking them in these cases only adds risk without any benefit. Clinicians have a responsibility to protect both their patients and the community. By prescribing antibiotics when they’re truly necessary, they safeguard your health and ensure these medicines will still work, for both you and others, in the future. So next time your clinician provides recommendations to treat your symptoms but says, “no antibiotics needed,” they’re not brushing you off. They’re practicing smart medicine with your well-being in mind. Kelsey Jensen, Pharm.D., is an antimicrobial stewardship pharmacist at Mayo Clinic Health System in Minnesota. She is the pharmacist co-chair of the outpatient antimicrobial stewardship program for the Mayo Clinic Enterprise. In her spare time, she enjoys traveling and watching baseball. Ryan Stevens, Pharm.D., is an infectious diseases pharmacist in the Department of Pharmacy in Rochester, Minnesota. He is the pharmacist co-chair of the outpatient antimicrobial stewardship program for the Mayo Clinic Enterprise. In his spare time, he enjoys fishing, spending time with family and riding horses.Kelsey Jensen, Pharm.D., and Ryan Stevens, Pharm.D.Primary Care in Rochester and KassonAntibiotic ResistancePrimary Care in Rochester and KassonEarly detection saves lives. Get screened today. <img src="/-/media/ech-media/images/widgets/medicalimages/breastcancerawareness.jpg?h=65&iar=0&w=100&sc_lang=en&hash=DD365A4F1776F317267BC322DB62F849" alt="BreastCancerAwareness" width="100" height="65" DisableNVelocity="true" />October is Breast Cancer Awareness Month10/14/2025 7:50 AM<img src="/-/media/ech-media/images/widgets/medicalimages/breastcancerawareness.jpg?h=205&iar=0&w=315&sc_lang=en&hash=82EDDDFBA66005BB24C7271F175EB565" alt="BreastCancerAwareness" width="315" height="205" DisableNVelocity="true" />October is Breast Cancer Awareness Month. This is a good reminder to take action and complete your mammogram, an effective screening tool that takes an X-ray of the breasts to detect cancer at its earliest stages, when treatment is most effective. Breast cancer accounts for 30% of all new cancer cases and is the second leading cause of death in American women. Roughly one in eight women in the U.S. will be diagnosed with breast cancer in their lifetime, and one in 39 will die from it. When breast cancer is found early, patients are three times more likely to live beyond five years compared to those diagnosed at a later stage. This is why it's important to be screened before symptoms appear. Mayo Clinic recommends screening mammograms yearly for all women starting at age 40. However, when to begin screening depends on your personal health and family history. Talk with your doctor about the right time to schedule your first mammogram and how often to be screened. Most health insurance policies cover the cost of a screening mammogram. Contact your insurance provider or state health department if you're concerned about the price. There are programs available to help. Don't wait! Schedule your mammogram screening today by contacting your primary care office or scheduling directly through your patient portal.Primary Care in Rochester and KassonBreast Cancer AwarenessPrimary Care in Rochester and KassonWhen giving an electronic game as a holiday or birthday gift, these tips will help you choose wisely and safely. <img src="/-/media/ech-media/images/widgets/kids/ech_egame_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=0F2602DF289B2BA55262EB314FB3B967" alt="ECH_egame_widget" width="100" height="65" DisableNVelocity="true" />Choosing e-games for gifts12/8/2025 4:30 AM<img src="/-/media/ech-media/images/widgets/kids/ech_egame_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=C0C942AB71452FA39DABB0476D7FA39B" alt="ECH_egame_widget" width="300" height="195" DisableNVelocity="true" />Electronic and video games are now as much a part of a child’s world as Legos, dolls or art supplies. From immersive learning adventures to creative sandbox games and competitive esports, e-games span a wide range of genres and platforms. With thousands of options — and new ones released daily — choosing the right game can feel overwhelming. If you're planning to give a young person an e-game as a gift, here are some updated tips to guide your decision: Talk to Parents First <ul> <li>Ask what games they consider appropriate. Every family has different values and rules around screen time and content. Some may avoid violent or multiplayer games, while others may embrace them with limits.</li> <li>Check for a family media plan. Many families now use digital tools to manage screen time and app use. Parents may have specific platforms or parental control systems in place. </li> </ul> Do Your Research <ul> <li>Use trusted review sites. Common Sense Media remains a top resource for age-based reviews and educational value. Also, check sites like Taming Gaming and ESRB.org for ratings and gameplay insights.</li> <li>Look for educational or cooperative games. Many new games are designed to build skills like coding, problem-solving, empathy, and teamwork. Games like Minecraft Education Edition, Roblox Studio, and Toca Life World are popular for these reasons. </li> </ul> Understand Screen Time Guidelines The American Academy of Pediatrics (AAP) continues to emphasize quality over quantity when it comes to screen time. Here’s a quick refresher: <ul> <li>Under 2 years: Avoid screen time except for video chatting.</li> <li>Ages 2–5: Limit to 1 hour/day of high-quality content. Co-play or co-view when possible.</li> <li>Ages 6–12: Encourage balance. Create a media plan to balance screen time with sleep, exercise, and unstructured offline play that fosters social and physical development.</li> <li>Teens: Focus on digital well-being. Discuss online safety, social media use, and the importance of breaks from screens. </li> </ul> Tip: The AAP’s Family Media Plan tool helps families create personalized screen time guidelines. Other Considerations <ul> <li>Check for in-game purchases. Many games now include microtransactions or subscriptions. Make sure parents are aware of whether a game consists of these features.</li> <li>Be mindful of online interactions. Games with chat or multiplayer modes may expose kids to strangers. Look for games with strong moderation or parental controls.</li> <li>Consider accessibility. Many modern games include features for children with disabilities—such as customizable controls, subtitles, or sensory-friendly modes.</li> </ul> Final Thought With a bit of research and open communication, you can give a gift that’s fun, safe, enriching, and aligned with a family’s values. Whether it’s a puzzle game, a creative sandbox, or a story-driven adventure, the right e-game can light up a child or teen’s face with “just what they wanted!”  <a href="/providers/angela-mattke-md">Angela Mattke, M.D.</a>, is a Community Pediatric and Adolescent Medicine pediatrician at Mayo Clinic in Rochester. She is also the host of the "<a rel="noopener" href="https://mcpress.mayoclinic.org/podcasts/mayo-clinic-kids/" target="_blank" title="Link opens in a new window">Mayo Clinic Kids</a>" podcast, where she helps listeners make sense of children’s health and wellness, drawing on the most up-to-date expert medical advice so that they can help the children in their lives grow to be healthy, happy adults.  For more information about pediatric health topics, follow @mayoclinicchildrens on Instagram and <a rel="noopener" href="https://www.facebook.com/MayoClinicChildrens/" target="_blank" title="Link opens in a new window">Mayo Clinic Children’s</a> on Facebook.Angela Mattke, M.D.Primary Care in Rochester and KassonChoosing egamesPrimary Care in Rochester and KassonChronic obstructive pulmonary disease, or COPD, is the third-leading cause of death in the U.S. But what is it and how is it treated? <img src="/-/media/ech-media/images/widgets/people/ech_copd_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=DC227A8DBD3C4B0C926FB04514352EDD" alt="ECH_COPD_widget" width="100" height="65" DisableNVelocity="true" />Q&A: What is COPD?11/10/2025 4:30 AM<img src="/-/media/ech-media/images/widgets/people/ech_copd_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=B7EFC4C7D2D3CC26235633B8C13E4C33" alt="ECH_COPD_widget" width="300" height="195" DisableNVelocity="true" />Chronic obstructive pulmonary disease, or COPD, includes emphysema and chronic bronchitis. It is a chronic and progressive condition. Once people develop COPD, they will have it for life. It usually develops in older adults, but it is preventable and treatable. A survey in 2018 found that 15.8 million people in the U.S. reported they had COPD. The medical community previously thought COPD was a disease mainly affecting men, but since 2000, more women than men have died from COPD. Women seem to develop COPD at younger ages and with lower levels of tobacco exposure. They also may respond differently to COPD treatments. What is emphysema? Emphysema is a condition where the small air sacs within the lungs, called alveoli, are destroyed. This results in larger air spaces and causes less surface to be available to absorb oxygen from the bloodstream. Air becomes trapped in the lungs, and the alveoli don't work correctly. The result of trapped old air prevents new air from entering. This effect, combined with less opportunity for oxygen to be absorbed, results in shortness of breath and lower blood oxygen levels. What is chronic bronchitis? Chronic bronchitis results from inflammation of the linings of the bronchial tubes that carry air to and from the air sacs of the lungs. This inflammation leads to increased mucus production, causing people to have a daily mucus-producing cough. Shortness of breath also is common and is often accompanied by wheezing. Is COPD the same as asthma? COPD is different from asthma. While symptoms may be similar, asthma is an inflammatory reaction caused by spasms of the small airways, which are reversible. COPD is generally not reversible, although symptoms are treatable. Asthma is more likely to present at a younger age, even in children. It may occur in response to exposures to things in the environment, like pollens, or exercise, or be intrinsic, which occurs without exposure. What causes COPD? The most common cause of COPD is tobacco, either used directly or inhaled as secondhand smoke. Exposure to particles in the workplace, such as dust and chemicals, also can contribute to the disease and is much more common. While less common, a genetic deficiency in alpha-I antitrypsin protein can cause or contribute to the development of COPD. Development of COPD at a younger age or multiple family members who develop COPD at a younger age are clues to possible alpha-I antitrypsin deficiency. Approximately 1 in 30 people with COPD may have undetected alpha-I antitrypsin deficiency. What are the symptoms of COPD? Common symptoms include shortness of breath, which is often worse with activity; wheezing; chest tightness; cough, which may produce mucous of variable colors; and frequent respiratory infections. As the condition worsens, weight loss and swelling in the feet, ankles and legs may occur. How can you tell if you have COPD? If you smoke and have shortness of breath and a cough, regardless of whether it produces mucus, you may have COPD. You should discuss these symptoms with your healthcare clinician. Exposure in your home or workplace to things that irritate your lungs, such as dust or fumes, or a family history of COPD in nonsmokers, increases the risk that these symptoms are due to COPD. How is COPD diagnosed? While your healthcare clinician can diagnose COPD based on symptoms, a test called spirometry, which measures air flow in and out of the lungs, can help determine if symptoms are due to emphysema or chronic bronchitis. Additional testing is generally needed to confirm the diagnosis. How is COPD treated? The first step in treating COPD is to remove exposure to smoke, dust and fumes. Smokers should stop smoking, and secondhand smoke should be eliminated. Additional treatments usually include inhalers, beginning with bronchodilators to open airways; additional inhalers may be added if symptoms are not controlled. Other non-inhaled medications are added in special circumstances. Healthcare clinicians will develop action plans to manage infections or flares in COPD. Additional treatment may include gene replacement therapy, specifically for alpha-I antitrypsin deficiency; supplemental oxygen; pulmonary rehabilitation; lung reduction surgery; and lung transplantation. Take-home messages: <ul> <li>COPD can be prevented.</li> <li>Stopping smoking can prevent COPD from developing.</li> <li>COPD is a chronic condition; a patient will have it for life once it develops.</li> <li>If you have COPD symptoms, talk to your healthcare clinician.</li> <li>Medications are available to treat COPD symptoms.</li> <li>Medications can control the symptoms of COPD.</li> <li>Get all recommended vaccinations, including the annual influenza vaccination. </li> </ul> <a href="/providers/denise-dupras-md">Denise Dupras, M.D., Ph.D.</a>, is a Community Internal Medicine, Geriatrics, and Palliative Care physician at Mayo Clinic in Rochester, Minnesota. She earned her medical and doctoral degrees at Mayo Clinic Alix School of Medicine and completed her residency in internal medicine at Mayo Clinic in Rochester. Her interests include medical education, evidence-based medicine and care of LGBTQIA+ patients.Denise Dupras, M.D., Ph.D.Primary Care in Rochester and KassonCOPDPrimary Care in Rochester and KassonFind out why cough medicine is not recommended in kids. <img src="/-/media/ech-media/images/widgets/kids/ech_fluseason_2018_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=121DECE53AD8FE844737D9E0C9C09105" alt="ECH_fluseason_2018_widget" width="100" height="65" DisableNVelocity="true" />Something to cough at: The truth about cough medicine in children11/3/2025 5:30 AM<img src="/-/media/ech-media/images/widgets/kids/ech_fluseason_2018_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=218F8BC3654E4F71B7926EFE73D1F298" alt="ECH_fluseason_2018_widget" width="300" height="195" DisableNVelocity="true" />Nearly every parent has experienced this at least once (if not many times): your child has a cold and can’t seem to stop coughing. You want to do anything you can to help them relieve those pesky cough symptoms and allow them — and you — to finally get some rest. You may think, "Cough medicine has been helpful when I’ve used it; could it also help my little one?" Most clinicians will say cough medicine is not recommended for children, particularly those under age 4. Here’s why: Why is cough medicine not recommended? <ul> <li>Coughing has some benefits: Coughing clears out germs and mucus. Suppressing this process can increase the risk of worsening or prolonging the infection, since mucus remains in the airway and the lungs, allowing bacteria to grow.</li> <li>Evidence shows cough and cold medicines don't work well in children: <ul> <li>Studies show that over-the-counter (OTC) cough medicines don’t help kids get better faster or stop the cough.</li> <li>When the common active ingredients in cough medicine, like dextromethorphan (a cough suppressant), are compared to a placebo in children ages 1–12, there is no significant difference in how often the children cough at night, how much they vomit after coughing, or how well they sleep.</li> </ul> </li> <li>Over-the-counter (OTC) cough medicine ingredients can have serious risks for young children: <ul> <li>Below is the typical cough medicine ingredients and the serious side effects they could cause in children under 4 years old:</li> </ul> </li> </ul> <table> <tbody> <tr> <td style="border: 1px solid #000000; width: 33%; text-align: center;">Ingredient </td> <td style="border: 1px solid #000000; width: 33%; text-align: center;">Common Side Effect(s)</td> <td style="border: 1px solid #000000; width: 33%; text-align: center;">Dangerous Side Effect(s)</td> </tr> <tr> <td style="border: 1px solid#000000; width: 33%;">Dextromethorphan </td> <td style="border: 1px solid#000000; width: 33%;">Nausea, dizziness</td> <td style="border: 1px solid#000000; width: 33%;">Hallucinations, seizures, coma, serotonin syndrome, bromism, death</td> </tr> <tr> <td style="border: 1px solid#000000; width: 33%;">Antihistamines</td> <td style="border: 1px solid#000000; width: 33%;">Drowsiness, dry mouth</td> <td style="border: 1px solid#000000; width: 33%;">Fast heartbeat, hallucinations, seizures, respiratory depression, death</td> </tr> <tr> <td style="border: 1px solid#000000; width: 33%;">Decongestants </td> <td style="border: 1px solid#000000; width: 33%;">Insomnia, jitteriness</td> <td style="border: 1px solid#000000; width: 33%;">High blood pressure, heart rhythm, problems, stroke, seizures</td> </tr> <tr> <td style="border: 1px solid#000000; width: 33%;">Guaifenesin</td> <td style="border: 1px solid#000000; width: 33%;">Nausea, headache</td> <td style="border: 1px solid#000000; width: 33%;>very rare: Severe allergic reaction</td> </tr> <tr> <td style=;" colspan="2">Constipation, sleepiness</td> </tr> <tr> <td style="border: 1px solid#000000; width: 33%;">Codeine / Hydrocodone </td> <td style="border: 1px solid#000000; width: 33%;">Constipation, sleepiness</td> <td style="border: 1px solid#000000; width: 33%;>very rare: Severe allergic reaction</td> </tr> <tr> <td style=;" colspan="2">Dangerous slowed breathing, death</td> </tr> </tbody> </table>   <ul> <li>Many cough medicines have more than one active ingredient. <ul> <li>Acetaminophen: a pain reliever and fever reducer.</li> <li>Dextromethorphan HBr: a cough suppressant.</li> <li>Phenylephrine HCl: a nasal decongestant.</li> </ul> </li> <li>Guaifenesin: an expectorant to help loosen mucus.</li> <li>There is an increased risk of accidental overdoses when the same ingredients are consumed through different medicines. (For example: using both a liquid cough/cold medicine and liquid Tylenol at the same time, both of which contain acetaminophen, could lead to an accidental overdose). </li> </ul> The bottom line is that cough medicine doesn’t work well in kids, and when taking the risks and potentially harmful side effects into account, it isn’t worth it! What works for children’s coughs? <ul> <li>Let the body heal: Most coughs from colds or viral infections improve in 1–2 weeks without cough medicine, and coughing can be essential to healing.</li> <li>Honey for children over 1 year of age: Research shows one teaspoon of honey at bedtime can calm a cough and help kids (and parents) sleep. Never give honey to children under age one because it can cause botulism, which is a rare but serious illness caused by a toxin produced by a bacterium found in honey.</li> <li>Other helpful remedies: <ul> <li>Encourage drinking plenty of fluids (water, decaffeinated tea, clear soup).</li> <li>Use a humidifier in the room.</li> <li>Try saline nasal spray or drops and gentle suctioning for stuffy noses.</li> <li>Make sure the child gets enough rest.</li> </ul> </li> </ul> When to call your healthcare clinician If the cough lasts over a week or is accompanied by trouble breathing, persistent fevers, or other severe symptoms, contact your doctor. <a href="/providers/alexa-jensen-md">Alexa Jensen, M.D.</a>, is a pediatric resident at Mayo Clinic in Rochester, Minnesota. She loves working with children and families and is preparing to become a mom at this year's end. She aspires to be a great pediatrician by providing objective evidence to families while making it easy to understand and practical to use in everyday life.Alexa Jensen, M.D.Primary Care in Rochester and KassonCough ChildrenPrimary Care in Rochester and KassonA Pap test is key to detecting cervical cancer.<img src="/-/media/ech-media/images/widgets/people/ech_pelvicexam_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=5E352F4BC9CDCD6470C701D866E38BA1" alt="ECH_pelvicexam_widget" width="100" height="65" DisableNVelocity="true" />Your first Pap test: When, why and how12/4/2025 4:30 AM<img src="/-/media/ech-media/images/widgets/people/ech_pelvicexam_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=CEFBD9AEE6A3E18641D487072F01DC69" alt="ECH_pelvicexam_widget" width="300" height="195" DisableNVelocity="true" />One of the many changes in early adulthood is navigating your medical care on your own. As a female in your early 20s, there are several preventive services important to your overall health and well-being. Some of these preventive services are: <ul> <li>Keeping your immunizations up to date, including the HPV and yearly influenza vaccinations.</li> <li>Monitoring your blood pressure and body mass index every two years.</li> <li>Lipid screening.</li> <li>Sexually transmitted infections screening if you're sexually active.</li> <li>Cervical cancer screening.</li> </ul> When is cervical cancer screening recommended? Cervical cancer screening is recommended starting at age 21, regardless of your sexual history or HPV vaccination status. Screening before you turn 21 isn't recommended, unless your immune system is compromised by an HIV infection, chronic immunosuppressant medication or an organ transplant. In your 20s, you should be screened for cervical cancer every three years. Why is cervical cancer screening recommended? Worldwide, cervical cancer is the fourth most common cancer in women. It is most often caused by HPV, which is the most common sexually transmitted infection, and at least 80% of sexually active people will be exposed to this virus in their lifetime. Two things can help prevent HPV-associated cervical cancer: <ul> <li>HPV vaccination.</li> <li>Early detection with a Pap test.</li> </ul> You can be vaccinated for HPV as early as age 9, but you also can get the vaccination at any time until you're 26. The HPV vaccine is highly effective and has minimal side effects. How does a Pap test work? A Pap test detects abnormal cervical cells before they cause cancer. It can also detect cells that are already cancerous. It's performed during a pelvic exam. Here's what to expect: <ul> <li>An instrument called a speculum is inserted into your vagina, which allows the clinician to see the cervix and scrape some cells off with a brush and spatula, or a combination of the two.</li> <li>The lab reviews these cells. The technician looks for changes that may be seen with abnormal cells, precancer or cancer of the cervix.</li> <li>A Pap test takes only a few minutes and can be associated with mild discomfort and spotting. </li> </ul> As a young woman, you have endless opportunities. Staying healthy and keeping on track with your healthcare are among your top priorities for living the best life possible. <a href="/providers/marcie-billings-md">Marcie Billings, M.D.</a>, is chair of the Division of Community Pediatric and Adolescent Medicine (CPAM) and a member of Primary Care in Rochester and Kasson. Her primary areas of practice and special interest are pediatric and adolescent care and medicine.Marcie Billings, M.D.Primary Care in Rochester and KassonFirst Pap TestPrimary Care in Rochester and KassonProtein provides quick energy and helps keep you full between meals. <img src="/-/media/ech-media/images/widgets/food/yogurtberries.jpg?h=65&iar=0&w=100&sc_lang=en&hash=B4C826F29A96713649084A22BBF36EAA" alt="YogurtBerries" width="100" height="65" DisableNVelocity="true" />High-protein treats help you power through your day12/1/2025 4:30 AM<img src="/-/media/ech-media/images/widgets/food/yogurtberries.jpg?h=205&iar=0&w=315&sc_lang=en&hash=77745108B35B26AE6DE15129AE17F2C5" alt="YogurtBerries" width="315" height="205" DisableNVelocity="true" />If you're looking for a quick energy boost or need something to keep you full between meals, high-protein snacks are a great option. Protein helps repair tissues, supports muscle health and keeps you full on busy days. Whether working out, on the go, or just looking for snack ideas, protein foods can boost your energy and satisfy you. Five tasty high-protein snacks to fuel your day Greek yogurt with berries and nuts: Greek yogurt is packed with protein and probiotics to support your gut health. Add fresh berries for extra antioxidants and a handful of nuts for a crunchy texture and an additional protein punch. This combination is both delicious and nutritious. (Protein content: 15-20 grams per 1 cup serving.) Tuna salad with whole-grain crackers: Canned tuna is a budget-friendly, high-protein food and a good source of heart-healthy fats. Mix it with a bit of mayonnaise or Greek yogurt and a splash of lemon juice to make a creamy, tangy tuna salad. Pair with some whole-grain crackers on the side for a crunchy, fiber-rich snack that will keep you full. (Protein content: 20-25 grams per 1/2 cup serving.) Protein bars: A protein bar is a great choice if you're in a rush and need something quick and easy. Look for bars with at least 10 grams of protein and minimal added sugars. With so many flavors and varieties to choose from, you can mix it up each day. (Protein content: 10-20 grams per bar.) Hummus with veggies: Hummus is made from chickpeas, a rich plant-based protein source. Pair it with crunchy veggies like carrots, cucumbers or bell peppers for an extra sprinkle of nutrients. This is a wonderful option for a light snack that's also filling. (Protein content: 6-8 grams per 2 tablespoons serving.) Chia pudding: Chia seeds are filled with protein and fiber, making them an excellent morning or afternoon snack choice. Prepare a simple chia pudding by mixing chia seeds with milk (or almond milk for dairy-free) and let them sit overnight in the fridge to thicken. You can top this with berries, nuts or a drizzle of honey for extra flavor. (Protein content: 10 grams per 1/2 cup serving.) Whether you aim to maintain muscle mass, stay energized throughout the day, or ward off afternoon slumps, high-protein snacks will support your goals. Adding a variety of these protein-rich foods into your daily routine can keep you fueled, satisfied, and ready to take on whatever the day may bring. So next time hunger strikes, reach for one of these healthy and delicious snacks to power through your day. Samantha Toy is a dietetic intern at Mayo Clinic in Rochester, Minnesota. She graduated from Bradley University with a bachelor's degree in nutrition and dietetics and is pursuing a master's in clinical nutrition through the University of Wisconsin-Madison. Special interests include nutrition support, pediatrics and neurology.Samantha ToyPrimary Care in Rochester and KassonHigh Protein SnacksPrimary Care in Rochester and KassonThese four tips can help you manage during an often stressful time of year. <img src="/-/media/ech-media/images/widgets/people/holidaystress.jpg?h=65&iar=0&w=100&sc_lang=en&hash=898E7A215E75CF418E11D6278FC13D3B" alt="HolidayStress" width="100" height="65" DisableNVelocity="true" />Don't let stress dampen your holidays12/11/2025 4:30 AM<img src="/-/media/ech-media/images/widgets/people/holidaystress.jpg?h=205&iar=0&w=315&sc_lang=en&hash=20D37F9980453D12E71C72C6FCE2B52E" alt="HolidayStress" width="315" height="205" DisableNVelocity="true" />The holiday season can be the most wonderful time of the year. It can also be one of the most challenging times for many people, for plenty of reasons. Many have expectations that they must "feel great and act great" when, in fact, they feel extremely low due to depression or increased stressors. Seasonal changes, anniversaries of loss or memories of difficult childhood holidays may sometimes bring on depression. Holiday celebrations can also come at a cost — late nights, early mornings, competing demands and less time to finish things. While stress is a regular part of everyday life, it's common for it to build up over the holidays. However, not all stress is bad. It can help you get motivated, stay focused and give you the energy you need to finish important tasks. If stress becomes overwhelming and gets in the way, try some stress management strategies. As the holidays ramp up, these tips can help you fill your tank and build buffers into your day-to-day living. Tip 1: Stick to a healthy sleep routine If there's only one health habit to focus on during the holiday season, it's getting a good night's sleep. Building good sleep practices such as maintaining a regular bedtime and wake-up time, making the room cool, dark, quiet, and keeping electronics out of the bedroom at night. While perfecting all these things can be challenging — especially with young children, visiting family or friends, irregular work hours or traveling — following these healthy sleep practices can have a significant impact. If you wake up during the night and can’t fall back to sleep, get out of bed after 15–20 minutes and go into another room. Do something relaxing in low light, such as reading something interesting enough to hold your attention, doing breathing exercises or gentle stretching, folding laundry or sorting socks. Return to bed when your eyes get heavy and/or your head starts bobbing. This strategy will help your brain associate the bed and nighttime with sleep. To establish healthy sleep hygiene, avoid active, exciting tasks such as answering work emails or watching exciting TV. You can also access a free-to-use online program to help improve your sleep <a rel="noopener" href="https://mccmscontent.mayo.edu/PatientEducation/PatientLearning/index.html#/" target="_blank" title="Link opens in a new window">here</a>. Tip 2: Experiment with stress management skills and set reminders Stress management skills are strategies we use to fill our energy tanks and help us through challenging times. The skills that work best can be different for everyone, but might include things like relaxed breathing, brisk walking or practicing a <a rel="noopener" href="https://communityhealth.mayoclinic.org/featured-stories/mindful-meditation/" target="_blank" title="Link opens in a new window">mindfulness exercise</a>. Sometimes, our days can get hectic, and we forget to practice stress management skills even when we have good intentions. While physical symptoms of stress can look different for everyone, common ones include muscle tension, shallower breathing than usual, and headaches. First, pick an easy, do-anywhere strategy that can help with physical symptoms of stress.. Then, use an external reminder, such as setting a regular notification on your phone or placing a bright-colored sticky note on your computer. These reminders can help you build pressure relief valves throughout your day to disperse the adverse effects of stress. Tip 3: Engage with those who make you feel good, and limit time with those who don't Part of the holiday season's fun — and challenge — is spending more time with others. Some people may make us feel great, while others may have the opposite effect. Surround yourself with those who "fill you up" and you enjoy spending time with, which will help you feel better overall. If some people you spend time with during the holidays drain your energy or are frustrating to be around, limiting the amount of time you spend with them can be helpful. You can do this using the "minimum sufficiency principle." Keep interactions polite but brief, then mingle with others who are not as draining. You can also establish healthy boundaries in these relationships. For example, "I would love to get together for a holiday meal, but let’s avoid discussing [hot-button issue] at the dinner table and instead focus on spending quality time with each other." If spending time with your family of origin (also known as the family you were raised with) is not possible or desirable. It can be helpful to create a family of choice. A family of choice can comprise anyone, regardless of direct biological lineage. Your family of choice accepts you for who you are. Tip 4: Give yourself some grace The past several years have brought unprecedented amounts of stress. The pandemic, geopolitical and economic events have impacted us all. Many of us are tired and could use a break. When we have little control over what is causing our stress, reflecting on what we control can be helpful. Are any of the responsibilities on your plate negotiable? For example, every year over the holidays, you make a homemade pie that is very time and labor-intensive. If the thought of making the pie is stressing you out, consider that a store-bought pie can be a tasty alternative and would save you a lot of time. It's OK to give yourself a break. Sometimes stress can make us too serious about things large and small. Spend less time watching the news or scrolling social media.. It's natural to compare our lives to others; even among "friends," we may feel like we come up short. Happiness and laughter are good for the brain, good for the body and good for the soul. When things get too hectic, we may lose sight of the lighter side of life. Try to weave funny things back into your daily life — movies, TV shows, books, online videos and people who make you smile. Kyle Schofield, Ph.D., is a clinical health psychology fellow in Primary Care in Rochester and Kasson's Division of Integrated Behavioral Health. <a href="/providers/craig-sawchuk-phdlp">Craig Sawchuk, Ph.D., L.P.</a>, and <a rel="noopener" href="https://www.mayoclinic.org/biographies/roche-anne-i-ph-d-l-p-abpp/bio-20569110" target="_blank" title="Link opens in a new window">Anne Roche, Ph.D., L.P.</a>, are clinical psychologists in Primary Care in Rochester and Kasson's Division of Integrated Behavioral Health. Dr. Sawchuk is also the co-chair of Integrated Behavioral Health and also co-chairs Clinical Practice within the Department of Psychiatry and Psychology at Mayo Clinic in Rochester.Kyle Schofield, Ph.D.; Craig Sawchuk, Ph.D., L.P.; and Anne Roche, Ph.D., L.P.Primary Care in Rochester and KassonHoliday StressPrimary Care in Rochester and KassonTalk to your medical care team to make this difficult decision. <img src="/-/media/ech-media/images/widgets/elderly/hospicepalliativecare.jpg?h=65&iar=0&w=100&sc_lang=en&hash=4AA0409651AF4AFDA916F29C9C4E9502" alt="HospicePalliativeCare" width="100" height="65" DisableNVelocity="true" />Hospice vs. Palliative care: What's the difference?11/13/2025 4:30 AM<img src="/-/media/ech-media/images/widgets/elderly/hospicepalliativecare.jpg?h=205&iar=0&w=315&sc_lang=en&hash=EA6E063EB179C24359BD6EB5E80C7A37" alt="HospicePalliativeCare" width="315" height="205" DisableNVelocity="true" />Your mother has just been diagnosed with lung cancer. The cancer has spread to other parts of the body. She is not sure she wants to go through chemotherapy. Now what? The first step is having a discussion with your mother's medical care team. There are options available to provide the best quality of life for patients with a serious illness. Hospice care Hospice care provides symptom management and some nursing care for patients with terminal illnesses. Hospice care is designed to help patients live as well as possible by aggressively treating their symptoms and attending to their quality of life. Palliative care This medical specialty is also designed to help patients live as well as possible by partnering with the patient's care teams to focus on managing symptoms as they undergo disease-directed therapy, such as chemotherapy, dialysis or hospitalization for heart failure. But how do you choose? This decision is best made with the patient's primary care clinician. If the patient's priority is comfort and quality of life, they may be referred to hospice. The hospice team will provide visits from a nurse, chaplain, social worker and home health aide as needed. In addition, the hospice agency will provide durable goods like a hospital bed and medications to provide comfort. The hospice team will work closely with family and friends to provide the hands-on care needed for the patient. The hospice team cares for patients in their home, assisted living facility, nursing home or a free-standing hospice facility if available. Not all patients qualify for hospice. Palliative care may be recommended if the patient wishes to continue disease-directed therapies while receiving advanced symptom management. Palliative care is often provided in an outpatient clinic similar to primary care. Palliative care specialists also see patients in the hospital, nursing home or their homes. The focus of care is to assist with complex medical decision-making and management of symptoms such as pain, nausea, shortness of breath, fatigue, spiritual distress and mood changes. The palliative care specialist provides medication prescriptions to help control symptoms. They can also assist with the decision to transition to hospice care. Discuss your goals and concerns with your primary care clinician if you or your family are unsure which path to take. Andy Bock, D.O., is a physician in the Division of Community Internal Medicine, Geriatrics, and Palliative Care, Section of Palliative Medicine. He is board-certified in Hospice and Palliative Medicine. His interests include improving physician communication and complex medical decision-making, including advanced care planning and end-of-life shared decision-making.Andy Bock, D.O.Primary Care in Rochester and KassonHospice Palliative DifferencePrimary Care in Rochester and KassonThis guide helps parents and caregivers explain how to stay safe online.   <img src="/-/media/ech-media/images/widgets/kids/screentime.jpg?h=65&iar=0&w=100&sc_lang=en&hash=509D5E4267B45CC81DC2B7C7D4103AAF" alt="ScreenTime" width="100" height="65" DisableNVelocity="true" />Talking with your child about internet safety11/24/2025 4:30 AM<img src="/-/media/ech-media/images/widgets/kids/screentime.jpg?h=205&iar=0&w=315&sc_lang=en&hash=506C341C4D3A01A5DD31B40162C27594" alt="ScreenTime" width="315" height="205" DisableNVelocity="true" />Why should I talk to my child about internet safety? Much of today's world takes place online. Kids and teens use the internet as part of their daily life, completing schoolwork, gaming, watching videos and talking with friends. These digital spaces can be great for learning and connection, but they come with known risks, including cyberbullying, exposure to harmful or inappropriate content, online predators and misinformation. With the increasing use of artificial intelligence (AI) online, children may also encounter AI-generated misinformation or content that seems real but is not (also known as "deepfakes"). Parents play a key role in teaching children how to stay safe online. Starting these conversations early and continuing them regularly can help them make safe choices and feel comfortable turning to you for support. What is a family media plan, and why is it important? A family media plan sets expectations for how screens are used in the home. This includes screen time limits, device-free zones (like the dinner table) and guidelines for which websites or apps are OK to use. The American Academy of Pediatrics (AAP) recommends that all families create a family media plan to help children know what's expected and encourage balanced media use across all family members. You can make your own family media plan using this <a rel="noopener" href="https://www.healthychildren.org/English/fmp/Pages/MediaPlan.aspx" target="_blank" title="Link opens in a new window">tool from the AAP</a>. How should I start conversations about internet safety? <ul> <li>Create an open environment for discussion. Ask your child what they enjoy doing online, who they talk to and what makes them uncomfortable or upset.</li> <li>Remain supportive. Let them know they won't get into trouble for being honest, and that your goal is to support them. When children feel safe talking to their parents, they're more likely to approach them early with concerns.</li> <li>Be curious, not confrontational. This helps build trust between you and your child. </li> </ul> What should my child know about privacy and safety on the internet? Children and teens may not fully understand that the internet is public, often permanent, and potentially contains false or misleading content. Teach your child to: <ul> <li>Avoid sharing personal information such as their name, school, address, and phone number.</li> <li>Remember that the internet is public. Posts online can be permanent even if they are deleted.</li> <li>Never send or post images they wouldn't want others to see.</li> <li>Verify sources and question what they see, especially on social media. Building digital literacy and critical thinking skills is essential for navigating today's online environment.</li> <li>Reach out to a trusted adult if they encounter something uncomfortable or if someone online makes them feel unsafe. </li> </ul> How might internet use affect me and my child? Spending time online can affect sleep, mood, and mental and physical health. Encourage regular breaks, outdoor play, creative hobbies and device-free time with family and friends. Help your child create a list of activities they enjoy or are interested in apart from screen time. You can be the best role model for your child. Children are more likely to follow healthy routines if they see adults doing the same. How can my child's clinician help with internet safety? Your child's clinician can help initiate a discussion on internet safety and provide additional resources tailored to your child's needs. They can also identify if your child may be struggling with issues like cyberbullying, addiction or mood disorders, and are trained to recognize warning signs of online predatory behavior. If you are concerned about screen time, social media or emotional changes linked to internet use, bring this up at your child's next well visit. <a href="/providers/maheen-bangash-md">Maheen Bangash, M.D.</a>, is a resident in Pediatric and Adolescent Medicine in Rochester, Minnesota. After residency, she plans to complete a fellowship in Child Abuse Pediatrics and contribute to efforts in child internet safety and child abuse/maltreatment prevention.Maheen Bangash, M.D.Primary Care in Rochester and KassonInternet SafetyPrimary Care in Rochester and KassonIn the early stages of pancreatic cancer, you may not experience symptoms. <img src="/-/media/ech-media/images/widgets/medicalimages/pancreaticcancer.jpg?h=65&iar=0&w=100&sc_lang=en&hash=79D194A08D23A84BBDFFBC9B662ECA2D" alt="PancreaticCancer" width="100" height="65" DisableNVelocity="true" />What is pancreatic cancer?11/17/2025 4:30 AM<img src="/-/media/ech-media/images/widgets/medicalimages/pancreaticcancer.jpg?h=205&iar=0&w=315&sc_lang=en&hash=384AF66BACF382500B0F454F3D995497" alt="PancreaticCancer" width="315" height="205" DisableNVelocity="true" />The pancreas is an organ that lies behind the stomach and releases enzymes that aid in digestion. Both noncancerous and cancerous growths can occur in the pancreas, but the most common pancreatic cancer is pancreatic ductal adenocarcinoma. What symptoms might indicate pancreatic cancer? Early-stage often does not produce noticeable symptoms. In some cases, pancreatic cancers are discovered incidentally during imaging performed to assess for other medical conditions. In the advanced stages of pancreatic cancer, patients may experience: <ul> <li>Unintentional weight loss.</li> <li>Loss of appetite.</li> <li>Yellowing of the whites of the eyes and skin.</li> <li>Dark-colored urine.</li> <li>Pale-colored stools.</li> <li>New diagnosis of diabetes or worsening control of existing diabetes.</li> <li>Blood clots.</li> <li>Fatigue. </li> </ul> Diagnostic Tests To diagnose pancreatic cancer, CT (computed tomography) or MRI (magnetic resonance imaging) scans are often used.. A biopsy may be necessary to confirm this diagnosis. Treatment Options Treatment of pancreatic cancer depends on the stage and location of the tumor at the time of diagnosis. Treatment options include: <ul> <li>Surgery.</li> <li>Radiation therapy.</li> <li>Chemotherapy.</li> <li>A combination of these steps </li> </ul> Prevention You can reduce your risk of developing pancreatic cancer by addressing modifiable risk factors. The most important preventive measure is to avoid or stop smoking. Additional steps include maintaining a healthy weight, exercising regularly, and avoiding or limiting alcohol intake. <a rel="noopener" href="https://www.mayoclinic.org/biographies/hansel-stephanie-l-m-d-m-s/bio-20055204" target="_blank" title="Link opens in a new window">Stephanie Hansel, M.D.</a>, is a gastroenterologist at Mayo Clinic in Rochester. She completed her master's degree at North Dakota State University and her medical degree at the University of North Dakota School of Medicine & Health Sciences. Dr. Hansel completed an internal medicine residency at the University of Nebraska Medical Center and a gastroenterology fellowship at Mayo Clinic in Arizona. Her interests include general gastroenterology, endoscopy and medical education.Stephanie Hansel, M.D.Primary Care in Rochester and KassonPancreatic CancerPrimary Care in Rochester and KassonTips for preventing and coping with a premature baby. <img src="/-/media/ech-media/images/widgets/kids/prematureinfant.jpg?h=65&iar=0&w=100&sc_lang=en&hash=886CEA0B4334BEF07891E16D5E3804F4" alt="PrematureInfant" width="100" height="65" DisableNVelocity="true" />Understanding premature birth11/20/2025 4:30 AM<img src="/-/media/ech-media/images/widgets/kids/prematureinfant.jpg?h=205&iar=0&w=315&sc_lang=en&hash=1D5D40C2A43E8A1AFA49BAB764F44759" alt="PrematureInfant" width="315" height="205" DisableNVelocity="true" />Premature birth occurs when a baby is born before 37 weeks of pregnancy. These babies may be smaller and need extra care in the hospital because their bodies are not yet fully developed. While the exact causes of premature birth are not always known, several strategies can lower the risk. During your prenatal appointments, your clinician may recommend the following to minimize your risk of premature birth: Eating a healthy diet: Consuming plenty of fruits, vegetables and water supports your baby’s growth and development. Avoiding harmful substances: Smoking, alcohol and drugs can increase the risk of premature birth. Managing health conditions: Conditions such as high blood pressure or diabetes should be carefully managed. Reducing stress and prioritizing sleep: Lowering stress levels, getting enough sleep and following medical advice all contribute to a healthier pregnancy, giving your baby the best chance for a full-term, healthy birth. For people who have previously experienced premature birth, clinicians may recommend special treatments or more frequent prenatal visits. If a baby is born early, it can be a scary and stressful time for families. Premature infants may need to stay in the neonatal ICU (NICU), where they receive support for breathing, feeding and temperature regulation. This experience can make parents feel sad, worried or even guilty — but it's important to remember that support is available. Parents are encouraged to ask questions and talk openly with clinicians and nurses. Staying involved in their baby’s care, such as holding or talking to the baby when allowed, helps build a strong bond. Support groups, counseling or talking with other parents of premature babies can also be helpful. Most premature babies grow up healthy with the proper care and love. With time and patience, families can adjust and thrive together. Early medical intervention, emotional support, and hope are key to facing the challenges of premature birth. <a href="/providers/amanda-steiner-doms">Amanda Steiner, D.O., M.S.</a>, is completing her family medicine residency at Mayo Clinic in Rochester. She plans to continue her career by starting a Family Medicine-Obstetrics Fellowship in July 2027.Amanda Steiner, D.O., M.S.Primary Care in Rochester and KassonPremature BirthPrimary Care in Rochester and KassonConsider joining the Great American Smokeout in November.<img src="/-/media/ech-media/images/widgets/randomimages/ech_smoking_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=F81C2F5C10F3581A4A5B28C907569E8F" alt="ECH_smoking_widget" width="100" height="65" DisableNVelocity="true" />Is it time to quit smoking?11/3/2025 4:30 PM<img src="/-/media/ech-media/images/widgets/randomimages/ech_smoking_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=98A6179A7F55406885E834734EB64A03" alt="ECH_smoking_widget" width="300" height="195" DisableNVelocity="true" />Cigarette smoking kills 480,000 people each year in the U.S. and shortens life expectancy by at least 10 years. On the other hand, quitting can reduce the excess risk of death associated with continued smoking by about 90%. The Great American Smokeout, held on the third Thursday in November every year, is an excellent opportunity to quit smoking. Quitting isn't easy Most smokers want to quit, and more than half attempt to quit every year. However, less than 1 in 10 can stop smoking for good on their own. Four out of every nine adult cigarette smokers who saw a healthcare clinician during the past year did not receive advice to quit. Less than one-third of adult cigarette smokers use cessation counseling or medications approved for cessation by the Food and Drug Administration (FDA) when trying to quit smoking. Treatment options Several treatments are available to help you quit smoking. <ul> <li>Varenicline This is one of the most effective medications available. For a prescription, talk to your clinician.</li> <li>Nicotine replacement therapy This includes medications that contain nicotine designed to replace the nicotine obtained from smoking. These are effective and widely available. Consider over-the-counter options, such as a nicotine patch, gum, and lozenges, or prescription options, such as a nasal spray or inhaler.</li> <li>Bupropion This antidepressant medication is used to reduce cravings, and it is effective in helping people quit smoking. For a prescription, talk to your clinician.</li> <li>Electronic cigarettes While these devices may help people quit, the FDA has not approved them. </li> </ul> Support Resources <ul> <li>Call <a rel="noopener" href="tel:8007848669" target="_blank" title="Link opens in a new window">800-784-8669</a> to get connected to a telephone counselor. These counselors can talk you through the quitting process and help you obtain free nicotine replacement therapy.</li> <li>Visit <a rel="noopener" href="https://smokefree.gov/" target="_blank" title="Link opens in a new window">Smokefree.gov</a>, which offers an app and a texting service to help you quit. You can sign up by texting "QUIT" to 47848. The program lasts for six to eight weeks. </li> </ul> If you are considering quitting smoking, talk to your healthcare clinician today. Or join the Great American Smokeout. <a href="/providers/jon-ebbert-md">Jon Ebbert, M.D.</a>, is a physician in Primary Care in Rochester and Kasson's Division of Community Internal Medicine. He is the medical director of the Nicotine Dependence Center.Jon Ebbert, M.D.Primary Care in Rochester and KassonQuit Smoking 2025Primary Care in Rochester and KassonLearn which foods contribute to inflammation and which can help decrease it. <img src="/-/media/ech-media/images/widgets/food/fruitrainbow.jpg?h=65&iar=0&w=100&sc_lang=en&hash=E905D9F224C838C1E5BD161352DB4B61" alt="FruitRainbow" width="100" height="65" DisableNVelocity="true" />Can eating the rainbow help to reduce inflammation?11/6/2025 4:30 AM<img src="/-/media/ech-media/images/widgets/food/fruitrainbow.jpg?h=205&iar=0&w=315&sc_lang=en&hash=96C56D4DC411E6F9F8C49A5889243FD4" alt="FruitRainbow" width="315" height="205" DisableNVelocity="true" />Inflammation is a natural process initiated by the immune system in response to illness, trauma, toxins, physical stress and chronic disease. While acute inflammation is protective and allows our bodies to heal, it can become harmful if it persists, leading to chronic inflammation. Chronic inflammation, in turn, can lead to conditions such as arthritis, heart disease, and diabetes. Several foods can contribute to inflammation. These include highly processed foods, refined carbohydrates, or foods high in added sugars. Conversely, other foods can help calm the immune system, decreasing inflammation. Let’s explore which foods help lower inflammation and how they can be incorporated into an anti-inflammatory diet. <ul> <li>Fruits and Vegetables: Colorful fruits and vegetables naturally contain various phytonutrients and bioactive compounds that help keep inflammation in check. These foods form the foundation of the anti-inflammatory diet and can be enjoyed in abundance. For an extra boost of protection, try drizzling antioxidant-rich olive oil on your veggies..</li> <li>Protein: Choose primarily from plant-based sources such as legumes, soy, nuts, and seeds, with smaller amounts from lean cuts of animal protein and fatty fish. The fats in these proteins, mainly monounsaturated and omega-3, play a significant role in combating inflammation. The American Heart Association recommends 6 to 8 ounces of fatty fish and 5 ounces of legumes, nuts, and seeds per week.</li> <li>Whole grains: Whole grains contain all parts of the grain, whereas refined grains remove the germ and bran, eliminating important inflammation-reducing compounds. Of these, fiber is a bit of a superstar, shown to help reduce blood sugar and cholesterol levels. Aim for at least 50% of your grains from whole grain sources, such as rolled oats and brown rice.</li> <li>Herbs and Spices: Herbs and spices add flavor to your food and help reduce oxidative stress, which can trigger inflammation. Add ginger, turmeric, clove, cinnamon, oregano, and garlic to your next meal. </li> </ul> What change can you make today to shift your body into a less inflamed state? Consider adding one colorful fruit or vegetable to your diet each day. Suggestions include tomatoes, oranges, yellow bell peppers, arugula, blueberries, pumpkin and broccoli. Tamara Soerensen completed her bachelor’s degree in biology at the University of California, Santa Barbara and her master’s in nutrition at Bastyr University. She is currently a dietetic intern at Mayo Clinic in Rochester, Minnesota. Special interests include digestive health and the utilization of diet for disease prevention.Tamara SoerensenPrimary Care in Rochester and KassonReduce Inflammation DietPrimary Care in Rochester and KassonExploring new ways to connect can be refreshing, scary and life-giving at the same time. <img src="/-/media/ech-media/images/widgets/people/ech_-cultivatingvitality_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=FDFB0B78DC14EB19E5BDFA6905BF0834" alt="ECH_ CultivatingVitality_widget" width="100" height="65" DisableNVelocity="true" />Cultivating vitality in your relationship12/15/2025 4:30 AM<img src="/-/media/ech-media/images/widgets/people/ech_-cultivatingvitality_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=9B6569B6F693FBDE888FEEEAC311D446" alt="ECH_ CultivatingVitality_widget" width="300" height="195" DisableNVelocity="true" />Ultimate intimacy may be about the freedom to be ourselves. Knowing our intrinsic worth, we can be present with ourselves and our partners, whatever the circumstances. Here's how Jennifer Wetwood, poet and therapist, describes this: “Willing to experience aloneness, I discover connection everywhere Turning to face my fear, I meet the warrior who lives within Surrendering to my emptiness, I find fullness Each condition I flee from pursues me, each condition I welcome, transforms me.” Moving from our conditioned ways of relating to more authentic ways of connecting can simultaneously be refreshing, scary and life-giving. Communication is the solution. Relearning to communicate is at the heart of intimacy. Learning to be emotionally present to ourselves and to others can be amazing. Why not give it a try? Our Integrated Behavioral Health colleague, Denise Morcomb, L.I.C.S.W., says: "We should expect to have to learn how to communicate better as we grow in our relationships; otherwise, we're destined to continue communicating like we're 18 years old." Moving beyond 18 Skills like problem-solving, negotiation and conflict resolution can be more challenging when we're with someone we think we "know." Over time, we often don't practice being vulnerable to those closest to us because things become comfortable, routine and easy. We think we can predict someone else's behavior. Sometimes it's essential to pause and discover what and who we don't know, which may prompt us to notice how we've changed. We can always be in the midst of discovery. Learning to be vulnerable in a relationship can draw you closer, but it takes practice and time. Exploring new ways to connect may help you connect better and become closer. Consider trying some of these ideas. C-U-L-T-I-V-A-T-E Communicate. Speak and listen from a place of curiosity and non-judgmental awareness, speak of your vulnerability and listen to each other. Communication can be the solution. Take a risk to rediscover who you are individually and together. Understand your partner's love languages. Try to really know what makes that person feel loved. First, you need to understand how they experience love so you can meet their needs and not your own. Move out of your comfort zone to give those things to them without waiting for something in return. Love languages may be expressed through: <ul> <li>Words of affirmation. Tell them what you appreciate about them.</li> <li>Acts of service (actions speak louder than words). "I called the vet today." "I cleaned out the dishwasher."</li> <li>Gifts. Better yet, don't just "do" for the other, put a note in their lunch tote or a thoughtful trinket by her plate.</li> <li>Quality time. Actually listen, respond and pay attention.</li> <li>Physical touch. Sit close, kiss, hug, hold hands.</li> </ul> Listen attentively. Start from a place of not knowing, where you don't need to fix or figure anything out, listen with heart and eyes and ears. Try something new—bowling, dancing, theater, volunteering, community education classes, or a new sport. Invite others into your circle of play. Create moments. Invite a few people for cards or a new game or visit nearby music venues. Validate. Speak about what your partner does and knows, and express awareness of the simple things you appreciate. Appreciate. Show appreciation through small expressions of gratitude, such as notes on the counter in the morning or on the pillow at night. These can be playful and simple. Take time to pause. Be quiet together, go on an electric timeout, slow down the speed of life. Ponder your love maps (that part of your brain where you store meaningful events and moments of your relationship). Engage in physical activity together. Take a hike, a walk, dance around the house, dance in the driveway, practice Tai Chi, yoga, snowshoeing, or take a dip in a nearby pool or lake. V-I-T-A-L-I-T-Y Visit a place or person or try something new that neither of you has done before. Integrate self-care and self-compassion and speak about how each of you has done that. Consider discussing spirituality or what has meaning in your life today. Practice self-kindness. Touch one another with humor. Learn to laugh at yourself or make each other laugh. Feel your feelings and allow emotions. Discover ways to lighten up. Play with not taking yourself so seriously. Allow your partner to have some alone time with others. Authentically let them influence you. Notice what can happen when you leave some space to let go of the need for control. Enjoy. Liberate yourself from your own defensiveness before you try to critique others. Speak about your awareness. Turn toward each other in times of challenge rather than away from each other. "I love you." Say it and identify specific reasons. Write them down with pen and paper, or even on a mirror. Look for opportunities to express love as you say it. Trust transformation. Surrender to the opportunity to be curious. Allow vulnerability to grow and enhance a spiritual connection. Old patterns that once kept us safe can sometimes become limitations. Yes. Say "yes" to doing something you think the other person might like to do. Say yes to naming one thing you would like to do. Say yes to daring greatly. One couple we know takes time out at the end of each year to go away and reflect on questions like: What worked for you and us this year? What would you like to discover or investigate next year? What things can I do for or with you to support you? What do you think you need for self-care? How can we plan for kids, travel, retirement and our next chapter in life? "Relationships can build a spiritual dimension that has to do with creating an inner life together — a culture rich with symbols and rituals — and an appreciation for your roles and goals that link you, that lead you to understand what it means to be a part of the family you’ve become." John M. Gottman, Ph.D. Marcia Johnson, L.I.C.S.W., is a social worker and therapist in Integrated Behavioral Health at Mayo Clinic Health System in Red Wing. She has worked for 25 years in psychiatry and behavioral health at Mayo Clinic in Rochester. She runs groups for senior vitality as well as cognitive behavioral therapy for depression and anxiety. <a href="/providers/kileen-smyth-licswmsw">Kileen Smyth LICSWMSW</a>, is a social worker and therapist in Integrated Behavioral Health at Mayo Family Clinic Northwest in Rochester, Minnesota. She has worked for 28 years providing individual and group therapy for people dealing with anxiety, panic, obsessive-compulsive disorder, depression and an array of other challenges. She also facilitates group supervision and enjoys networking with mental health colleagues in the community.Marcia Johnson, L.I.C.S.W., and Kileen Smyth, L.I.C.S.WPrimary Care in Rochester and KassonRelationship VitalityPrimary Care in Rochester and KassonFive simple stretches can loosen stiff joints and perk up your brain. <img src="/-/media/ech-media/images/widgets/activities/sittingstretches.jpg?h=65&iar=0&w=100&sc_lang=en&hash=0D890A7A57C97322A8080489C6F74F40" alt="SittingStretches" width="100" height="65" DisableNVelocity="true" />Stretch to take the strain out of sitting12/22/2025 4:30 AM<img src="/-/media/ech-media/images/widgets/activities/sittingstretches.jpg?h=205&iar=0&w=315&sc_lang=en&hash=C1D8B608A0A34C0148905CCDE769CECF" alt="SittingStretches" width="315" height="205" DisableNVelocity="true" />Sitting strains our bodies, making us stiff, sore, and sleepy. To wake up our brains and bodies, here are some simple techniques and stretches . Get up and move. Every half hour or so, make sure to get up. Walk to get a drink of water, check the mailbox, check in with a colleague, take a bathroom break or throw a load of clothes in the laundry. Neck stretches. Sit/stand tall. Bring your chin to your chest and hold for 15 to 30 seconds. Then, rotate your head left and then right, holding 15 to 30 seconds on each side. Finally, tilt your head to the side, leaning your ear toward your shoulder. Hold for 15 to 30 seconds on each side. Standing stretches. While standing, put your hands on your desk or chair to stabilize yourself. Begin with a wide stance of your legs and bring your trunk forward while keeping your arms extended straight in front of you on the chair or desk. Hold this position 15-30 seconds. Forearm stretches. Lift one of your arms and hold it comfortably in front of you, palm facing down, elbow straight. Bend your hand downward and gently pull it toward you using the other hand. Hold for 15 to 30 seconds and repeat on the other side. Then, lift one of your arms and hold it comfortably in front of you, palm facing up, elbow straight. Bend your hand downward and gently pull it toward you using your other hand. Again, hold for 15 to 30 seconds on each side. Shoulder stretches. Bring your hands behind your head, palms touching the back of your head, bending your elbows and keeping your chest upright. Next, bring your hands behind your low back, the back of your hand touching your low back. Keep your chest upright. Remember, never do anything that feels painful or unsafe. <img alt="SittingStretches" style="height: 559px; width: 839px; left: 777px; top: 779px;" src="/-/media/ech-media/images/sittingstretches.jpg?h=559&w=839&sc_lang=en&hash=BB31D2ECC25335534B2C86A1C1310890"> Danielle P. Johnson, M.S., P.T., is a wellness physical therapist at the Mayo Clinic Healthy Living Program in Rochester. She combines physical therapy with whole-body wellness, integrating fundamental and natural movement patterns and practical and playful movement into daily experiences.Danielle P. Johnson, M.S., P.T.Primary Care in Rochester and KassonSitting StretchesPrimary Care in Rochester and KassonThere's no cure for the common cold. Instead try treating symptoms and letting the virus run its course. <img src="/-/media/ech-media/images/widgets/people/familyuri.jpg?h=65&iar=0&w=100&sc_lang=en&hash=4FA6103CC8C54093DB5252DB5ED6172B" alt="FamilyURI" width="100" height="65" DisableNVelocity="true" />Which cold medicine is the best one to use? 1/23/2024 12:00 AM<img src="/-/media/ech-media/images/widgets/people/familyuri.jpg?h=205&iar=0&w=315&sc_lang=en&hash=B118615EA84699C8B3C03F928F20A0FB" alt="FamilyURI" width="315" height="205" DisableNVelocity="true" />It's that time of year. Winter is the high season for the common cold. There's no cure for the common cold, but there are tips to help treat the symptoms. Stop the spread. <ul> <li>Hand-washing is key. The germs from a cold are spread through sneezes or coughs, and then you are breathing the germs in. Wash your hands well — and often — with soap and water. If you can't wash with soap and water, an over-the-counter hand sanitizer works well.</li> <li>Wear a face covering when around others to stop the spread.</li> <li>Avoid touching your face, eyes and nose. That's how germs get in.</li> <li>Disinfect highly touched surfaces around you, like doorknobs and counters.</li> <li>Stay home if you are not feeling well. This tip includes not bringing your children to daycare or school if they are ill.</li> <li>Be wary of herbal or other remedies, as many of these have not been studied to determine their impact and whether they may be harmful. </li> </ul> What about cold medicines? <ul> <li>Cold medicine is not recommended for children, and certainly not for those under age 6, as they're more susceptible to side effects. Instead, use an over-the-counter nasal saline. This solution comes in drops for infants and a spray for older children. Using the nasal saline and then suctioning the nose can provide relief.</li> <li>Be mindful of antihistamines, as these can be sedating or have other side effects. In a small percentage of children, these medicines can cause agitation or hyperactivity.</li> <li>Have a cough? Try honey. It's been shown to be as effective as some of the over-the-counter cold medicines. You can take one teaspoon of raw honey every couple of hours as needed or mix it with warm water to thin it out. Do not give honey to babies under age 1, as it can make them sick with botulism.</li> <li>Adults also benefit from nasal saline sprays or rinses for congestion. If you have a cough, you can try an antitussive, also known as a cough suppressant.</li> <li>Cool mist humidifiers are important for people of all ages. These give off a mist that puts moisture in the air, soothing nasal passages and softening up that congestion.</li> <li>Be wary of combination cold remedies. It's easy to take too much of one or more ingredients. Be sure to read labels carefully</li> <li>Avoid oral decongestants – they don't work. A recent review suggests that while the nasal spray — phenylephrine — provides temporary relief of nasal congestion, taking a pill doesn't relieve a stuffy nose. </li> </ul> Talk to your primary care clinician or pharmacist to find the best medication to help relieve your symptoms. Some over-the-counter medicines will interfere with prescription medications. When should you schedule an appointment? <ul> <li>If you or your child are feeling short of breath, have a high fever or there's pain or discomfort in your chest, you should seek medical attention immediately.</li> <li>Fevers in infants younger than 3 months of age need to be checked out right away.</li> <li>For older children and adults, if a fever lasts longer than 3 to 4 days, you should contact your primary care clinician.</li> <li>If symptoms last longer than 7 to 10 days or you continue to get worse, contact your primary care clinician. </li> </ul> And remember, antibiotics do not work for colds. A cold is caused by a virus, while antibiotics are used for fighting bacteria. Taking antibiotics when you don't need them can lead to side effects. <a href="/providers/denise-dupras-md">Denise Dupras, M.D., Ph.D.</a>, is a physician in Community Internal Medicine, Geriatrics and Palliative Care at Mayo Clinic in Rochester, Minn. She earned her medical and doctoral degrees at Mayo Clinic Alix School of Medicine and completed her residency in internal medicine at Mayo Clinic in Rochester. Her interests include medical education, evidence-based medicine and care of LGBTQIA+ patients.Denise Dupras, M.D., Ph.D.Primary Care in Rochester and KassonCommon ColdPrimary Care in Rochester and KassonThe first step is to control your portion size.<img src="/-/media/ech-media/images/widgets/food/hearthealthyfoods.jpg?h=65&iar=0&w=100&sc_lang=en&hash=E013C7D63E8485F117268A6405D31D01" alt="HeartHealthyFoods" width="100" height="65" DisableNVelocity="true" />Preventing heart disease starts with a healthy diet2/5/2024 12:00 AM<img src="/-/media/ech-media/images/widgets/food/hearthealthyfoods.jpg?h=205&iar=0&w=315&sc_lang=en&hash=5AAD1EB677CEF9B47A5269F204A38011" alt="HeartHealthyFoods" width="315" height="205" DisableNVelocity="true" />Making healthy choices when shopping and at mealtime can go a long way towards keeping your heart healthy. The first step is to control your portion size. Take a smaller plate to ensure you eat a smaller portion of the things you like.  But what to eat? In general, a good place to start is eating low-calorie, nutrient-rich foods like fruits and vegetables and cutting down on high-salt, processed and fast foods.  <table style="width: 100%; height: 800px;"> <tbody> <tr style="height: 24px;"> <td style="border: 1px solid #000000; width: 50%; height: 24px; background-color: #ded9d9; text-align: center;" colspan="2"> FRUITS</td> </tr> <tr style="height: 24px;"> <td style="border: 1px solid #000000; width: 50%; text-align: center; height: 24px; background-color: #f5f7c6;">Eat MORE</td> <td style="border: 1px solid #000000; text-align: center; height: 24px; background-color: #f7a3a3;">Eat LESS</td> </tr> <tr style="height: 24px;"> <td style="border: 1px solid #000000; width: 50%; height: 24px; background-color: #f5f7c6;">Fresh and frozen</td> <td style="border: 1px solid #000000; height: 24px; background-color: #f7a3a3;">Frozen with sugar</td> </tr> <tr style="height: 24px;"> <td style="border: 1px solid #000000; width: 50%; height: 24px; background-color: #f5f7c6;">Canned in fruit juice or water</td> <td style="border: 1px solid #000000; height: 24px; background-color: #f7a3a3;">Canned in heavy syrup</td> </tr> <tr style="height: 24px;"> <td style="border: 1px solid #000000; width: 50%; height: 24px; background-color: #ded9d9; text-align: center;" colspan="2"> VEGETABLES</td> </tr> <tr style="height: 24px;"> <td style="border: 1px solid #000000; width: 50%; text-align: center; height: 24px; background-color: #f5f7c6;"> Eat MORE</td> <td style="border: 1px solid #000000; text-align: center; height: 24px; background-color: #f7a3a3;">Eat LESS</td> </tr> <tr style="height: 24px;"> <td style="border: 1px solid #000000; width: 50%; height: 24px; background-color: #f5f7c6;">Fresh and frozen</td> <td style="border: 1px solid #000000; height: 24px; background-color: #f7a3a3;">Fried, breaded or in cream sauce</td> </tr> <tr style="height: 24px;"> <td style="border: 1px solid #000000; width: 50%; height: 24px; background-color: #f5f7c6;">Low-sodium canned</td> <td style="border: 1px solid #000000; height: 24px; background-color: #f7a3a3;"></td> </tr> <tr style="height: 24px;"> <td style="border: 1px solid #000000; width: 50%; height: 24px; background-color: #ded9d9; text-align: center;" colspan="2"> GRAINS</td> </tr> <tr style="height: 24px;"> <td style="border: 1px solid #000000; width: 50%; text-align: center; height: 24px; background-color: #f5f7c6;"> Eat MORE</td> <td style="border: 1px solid #000000; text-align: center; height: 24px; background-color: #f7a3a3;"> Eat LESS</td> </tr> <tr style="height: 24px;"> <td style="border: 1px solid #000000; width: 50%; height: 24px; background-color: #f5f7c6;">Whole wheat bread or pasta</td> <td style="border: 1px solid #000000; height: 24px; background-color: #f7a3a3;">White bread, muffins or biscuits</td> </tr> <tr style="height: 24px;"> <td style="border: 1px solid #000000; width: 50%; height: 24px; background-color: #f5f7c6;">Whole grain bread, brown rice, barley, buckwheat</td> <td style="border: 1px solid #000000; height: 24px; background-color: #f7a3a3;">Donuts and waffles</td> </tr> <tr style="height: 24px;"> <td style="border: 1px solid #000000; width: 50%; height: 24px; background-color: #f5f7c6;">High-fiber cereal</td> <td style="border: 1px solid #000000; height: 24px; background-color: #f7a3a3;">Cakes and pies</td> </tr> <tr style="height: 24px;"> <td style="border: 1px solid #000000; width: 50%; height: 24px; background-color: #f5f7c6;">Oatmeal</td> <td style="border: 1px solid #000000; height: 24px; background-color: #f7a3a3;"></td> </tr> <tr style="height: 24px;"> <td style="border: 1px solid #000000; width: 50%; height: 24px; background-color: #ded9d9; text-align: center;" colspan="2"> FATS</td> </tr> <tr style="height: 24px;"> <td style="border: 1px solid #000000; width: 50%; text-align: center; height: 24px; background-color: #f5f7c6;"> Eat MORE</td> <td style="border: 1px solid #000000; text-align: center; height: 24px; background-color: #f7a3a3;">Eat LESS</td> </tr> <tr style="height: 56px;"> <td style="border: 1px solid #000000; width: 50%; height: 24px; background-color: #f5f7c6;">Olive oil</td> <td style="border: 1px solid #000000; height: 24px; background-color: #f7a3a3;">Butter</td> </tr> <tr style="height: 24px;"> <td style="border: 1px solid #000000; width: 50%; height: 24px; background-color: #f5f7c6;">Canola oil</td> <td style="border: 1px solid #000000; height: 24px; background-color: #f7a3a3;">Gravy</td> </tr> <tr style="height: 24px;"> <td style="border: 1px solid #000000; width: 50%; height: 24px; background-color: #f5f7c6;">Vegetable and nut oil</td> <td style="border: 1px solid #000000; height: 24px; background-color: #f7a3a3;">Cream sauce</td> </tr> <tr style="height: 24px;"> <td style="border: 1px solid #000000; width: 50%; height: 24px; background-color: #f5f7c6;">Margarine</td> <td style="border: 1px solid #000000; height: 24px; background-color: #f7a3a3;">Non-dairy creamers</td> </tr> <tr style="height: 24px;"> <td style="border: 1px solid #000000; width: 50%; height: 24px; background-color: #f5f7c6;">Nuts and seeds</td> <td style="border: 1px solid #000000; height: 24px; background-color: #f7a3a3;">Coconut, palm and cottonseed oils</td> </tr> <tr style="height: 24px;"> <td style="border: 1px solid #000000; width: 50%; height: 24px; background-color: #f5f7c6;">Avocados</td> <td style="border: 1px solid #000000; height: 24px; background-color: #f7a3a3;">Lard</td> </tr> <tr style="height: 24px;"> <td style="border: 1px solid #000000; width: 50%; height: 24px; background-color: #f5f7c6;"></td> <td style="border: 1px solid #000000; height: 24px; background-color: #f7a3a3;">Trans fat</td> </tr> <tr style="height: 24px;"> <td style="border: 1px solid #000000; width: 50%; height: 24px; background-color: #ded9d9; text-align: center;" colspan="2">PROTEINS</td> </tr> <tr style="height: 24px;"> <td style="border: 1px solid #000000; width: 50%; text-align: center; height: 24px; background-color: #f5f7c6;"> Eat MORE</td> <td style="border: 1px solid #000000; text-align: center; height: 24px; background-color: #f7a3a3;">Eat LESS</td> </tr> <tr style="height: 24px;"> <td style="border: 1px solid #000000; width: 50%; height: 24px; background-color: #f5f7c6;">Low-fat dairy</td> <td style="border: 1px solid #000000; height: 24px; background-color: #f7a3a3;">Full-fat dairy</td> </tr> <tr style="height: 24px;"> <td style="border: 1px solid #000000; width: 50%; height: 24px; background-color: #f5f7c6;">Eggs</td> <td style="border: 1px solid #000000; height: 24px; background-color: #f7a3a3;">Liver</td> </tr> <tr style="height: 24px;"> <td style="border: 1px solid #000000; width: 50%; height: 24px; background-color: #f5f7c6;">Salmon</td> <td style="border: 1px solid #000000; height: 24px; background-color: #f7a3a3;">Hot dogs and sausage</td> </tr> <tr style="height: 24px;"> <td style="border: 1px solid #000000; width: 50%; height: 24px; background-color: #f5f7c6;">Skinless poultry</td> <td style="border: 1px solid #000000; height: 24px; background-color: #f7a3a3;">Bacon</td> </tr> <tr style="height: 24px;"> <td style="border: 1px solid #000000; width: 50%; height: 24px; background-color: #f5f7c6;">Legumes</td> <td style="border: 1px solid #000000; height: 24px; background-color: #f7a3a3;">Fried and breaded meats</td> </tr> <tr style="height: 24px;"> <td style="border: 1px solid #000000; width: 50%; height: 24px; background-color: #f5f7c6;">Tofu</td> <td style="border: 1px solid #000000; height: 24px; background-color: #f7a3a3;">Fatty, marbled meats</td> </tr> <tr style="height: 24px;"> <td style="border: 1px solid #000000; width: 50%; height: 24px; background-color: #f5f7c6;"></td> <td style="border: 1px solid #000000; height: 24px; background-color: #f7a3a3;"></td> </tr> </tbody> </table> If you want more information, check out <a rel="noopener noreferrer" href="https://www.dietaryguidelines.gov/resources/2020-2025-dietary-guidelines-online-materials" target="_blank" title="Opens in new browser window">Dietary Guidelines for Americans, 2020-2025</a>. <a href="/providers/denise-dupras-md">Denise Dupras, M.D., Ph.D.</a>, is a physician in Community Internal Medicine, Geriatrics and Palliative Care at Mayo Clinic in Rochester, Minn. She earned her medical and doctoral degrees at Mayo Clinic Alix School of Medicine and completed her residency in internal medicine at Mayo Clinic in Rochester. Her interests include medical education, evidence-based medicine, and care of LGBTQIA+ patients.Denise Dupras, M.D., Ph.D.Primary Care in Rochester and KassonHeart Healthy DietPrimary Care in Rochester and KassonHuman papillomavirus — or HPV — can be prevented by receiving a vaccination.<img src="/-/media/ech-media/images/widgets/teens/teenvaccinearm.jpg?h=65&iar=0&w=100&sc_lang=en&hash=BA461E49AC792E1B67B77F4BD8EED8EE" alt="TeenVaccineArm" width="100" height="65" DisableNVelocity="true" />How best to prevent this common cancer2/19/2024 12:00 AM<img src="/-/media/ech-media/images/widgets/teens/teenvaccinearm.jpg?h=205&iar=0&w=315&sc_lang=en&hash=43B2525F9CB106168CC82F7EB04C82F9" alt="TeenVaccineArm" width="315" height="205" DisableNVelocity="true" />Every year 34,000 adults in the U.S. get diagnosed with cancer caused by human papillomavirus, or HPV. The cancers are mainly of the cervix, head and neck. The HPV infection that often leads to these cancers can occur decades before, usually in later adolescence or young adulthood. We can prevent these cancers. We have an amazingly effective and safe vaccine. But it has to be given long before any exposure, and it should be given when a child's immune response is the strongest. Mayo Clinic, the American Cancer Society and the Minnesota Department of Health all recommend that children receive the first dose of the HPV vaccine at 9 years of age. When the vaccine is given this young, the child gets the best response and only needs two doses, with the second dose six months after the first. Parents often ask: <ul style="margin-top: 0in; list-style-type: disc;"> <li>"Isn't this vaccine optional?" No, it's just as routinely and universally recommended as the tetanus-diphtheria-acellular pertussis, or Tdap, and meningococcal conjugate, or MenACWY, vaccines. </li> <li>"Isn't this vaccine still too new for everyone to get it?" No, it's just as old as the Tdap and MenACWY vaccines. These were all licensed for universal use in adolescents in 2005 and 2006.</li> <li>"Doesn't this vaccine have some big safety concerns?" No, studies both before licensure and since have repeatedly shown the vaccine to be safe with no longstanding harm or injury.</li> <li>"But is this really the best way to prevent these cancers? Won't chastity and fidelity prevent them?" The infections are silent and can persist for months and years. Not all exposures are preventable. Date rape and second marriages are both common. Eighty percent of U.S. adults have had an HPV infection by age 50.</li> </ul> As disheartening as HPV cancers and the infections that lead up to them are, we can prevent them. We can make sure our children get the two doses of the vaccine they need when they are young — long before they are exposed and when they are most likely to respond. <a href="/providers/robert-jacobson-md">Robert M. Jacobson, M.D.</a>, is the medical director of the Primary Care Immunization Program in Southeast Minnesota. He is a physician in Community Pediatric and Adolescent Medicine at Mayo Clinic in Rochester and practices in the Baldwin building. Robert M. Jacobson, M.D.Primary Care in Rochester and KassonHPV VaccinePrimary Care in Rochester and KassonHuman trafficking happens everywhere. Find out how to protect yourself and your loved ones.<img src="/-/media/ech-media/images/widgets/people/ech_sextrafficking_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=A26F17C6E0805C71A1239CC5FC8CB124" alt="ECH_SexTrafficking_widget" width="100" height="65" DisableNVelocity="true" />Human trafficking: Slavery in Minnesota2/26/2024 12:00 AM<img src="/-/media/ech-media/images/widgets/people/ech_sextrafficking_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=6F4BD0C27451E9D70C9D0EEC9A53895C" alt="ECH_SexTrafficking_widget" width="300" height="195" DisableNVelocity="true" />What is human trafficking? Human trafficking is modern-day slavery. There are two categories of human trafficking: sex trafficking and labor trafficking. Sex trafficking is when someone forces or influences a person to perform sexual acts against their will, while labor trafficking is when someone forces or influences a person to work without appropriate training, safety, breaks, pay or appropriate living conditions. Who are the victims of human trafficking? ANYONE can be a victim of human trafficking. <ul> <li>The most common age for a victim to enter "the life" is 12 to 14 years old. </li> <li>Once victims enter "the life," they are only expected to live for seven more years. </li> <li>Women and girls are more likely to be victims of sex trafficking, but men and boys are victims as well. </li> <li>Black, "Latinx" and American Indian individuals are more likely to be victims than white individuals. </li> </ul> Who are johns? Johns are the people who traffic victims. ANYONE can be a john, but most commonly they know the victim very well — boyfriend/girlfriend, husband/wife, parent, family member or close friend. It's uncommon for johns to be a stranger to the victim. People who buy victims are typically trusted members of the community, like government representatives, business owners, CEOs and even members of law enforcement. So how do victims become victims? Unlike what we see in movies, human trafficking is usually NOT a violent crime. Victims are typically NOT abducted or held somewhere against their will. Instead, johns use lies to manipulate their victims. Johns pretend that they love their victims, care for them, will protect them and will give them everything they need if they simply do what they say. Over time, the johns threaten to take away everything the victim cares about if they ever try to leave "the life" — family, friends, money, love or acceptance. This vicious, psychological cycle is what holds victims captive. But human trafficking doesn't happen in Minnesota, right? Human trafficking happens EVERYWHERE – your neighbor's home, the hotel down the street, or the farm on the outskirts of town. Here are some statistics specific to Minnesota: <ul> <li>Human trafficking has been reported in every county. </li> <li>The majority of human trafficking is sex trafficking. </li> <li>In 2015, Minnesota had the third-highest number of human trafficking cases in the U.S. </li> <li>The Twin Cities is in the top 13 U.S. cities for child sex trafficking. </li> <li>In 2020-2021, there were 21 labor trafficking victims and 401 sex trafficking victims identified. </li> <li>Labor trafficking victims are most commonly both men and women over the age of 18, Hispanic/"Latinx" individuals, and are typically trafficked in the household, restaurant and agriculture industries. </li> <li>Sex trafficking victims are most commonly girls and women of any age, Black, white and American Indian. Johns are most commonly an intimate partner. </li> </ul> What should I do if I'm concerned that someone is a victim? It would be best if you first talked to the person you are concerned about. Sometimes they do not think they are a victim, as they believe they are willingly in their situation, but they are still a victim! Give them the following numbers and tell them that they will remain anonymous. <ul> <li>Safe Harbor Regional Navigator: 507-328-7293 <ul> <li>For victims 26 years old and younger in Olmsted County. </li> </ul> </li> <li>Victim Services: 507-328-7270 <ul> <li>For victims in Southeast Minnesota. </li> </ul> </li> <li>Sexual Assault 24-hour Crisis Line: 507-289-0636 <ul> <li>For victims in Olmsted County. </li> </ul> </li> <li>Day One Crisis Hotline: 866-223-1111 <ul> <li>For a victim anywhere in Minnesota.</li> </ul> </li> </ul> Marissa Cepress, M.D., is a Pediatric and Adolescent Medicine resident in Rochester, Minn. After residency, she plans to complete a fellowship in pediatric hematology/oncology and bone marrow transplant. She also has a strong interest in advocating for victims of human trafficking.Marissa Cepress, M.D.Primary Care in Rochester and KassonHuman TraffickingPrimary Care in Rochester and KassonThese tips can help you decide if your child is ready.<img src="/-/media/ech-media/images/widgets/kids/ech_kids_smartphone_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=56C819C44ED8E8CE518CFCE1D4534798" alt="ECH_kids_smartphone_widget" width="100" height="65" DisableNVelocity="true" />My kid wants a smartphone — are they ready for the responsibility?2/22/2024 12:00 AM<img src="/-/media/ech-media/images/widgets/kids/ech_kids_smartphone_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=50D351A168F18418F7A45FB3A49CF25D" alt="ECH_kids_smartphone_widget" width="300" height="195" DisableNVelocity="true" />Many parents wonder at what age they should provide their child with a phone. Smartphones offer access to the internet and social media. Media in all forms can affect how children think, feel and behave. COVID-19 and smartphones: Positives and negatives During the COVID-19 pandemic, the positives of using smartphones included virtually talking or playing with friends during isolation at home. But the pandemic also showed negatives of more time spent online, including age-inappropriate videos and encounters with online sexual predators. Is your child ready for a smartphone? These tips can help you decide if your child is ready for the responsibility of carrying a smartphone. Be sure to set guidelines for its use. <ul> <li>Does your child have a reason for needing a smartphone? It's common for children to want a phone — because all their friends have one. Some teens have said they regret getting a smartphone early. If children need phones only for communication, such as calling parents, then a flip phone may be a better option. This option avoids all the distractions associated with using a smartphone (such as social media). </li> <li>Will your child follow rules around smartphone use? The American Academy of Pediatrics has developed a <a rel="noopener noreferrer" href="https://www.healthychildren.org/English/fmp/Pages/MediaPlan.aspx" target="_blank" title="Opens in new browser window">Family Media Plan tool</a>, which can help ensure that you and your child are on the same page. You'll also want to protect your child and ensure they're sticking to the rules: <ul> <li>Set parental controls for things such as apps, privacy restrictions, etc.</li> <li> Monitor text, video and social media posting. </li> </ul> </li> <li>Do you have time to check in with your children regarding digital life? You can help your children have a positive experience using digital media by checking in with them regularly and mentoring their needs. Car rides and mealtimes could be a great window to check in with your child and find out how life is going — generally and online. </li> <li>Have a plan for when rules get broken. As a parent, your first reaction may be to take the phone away. In this situation, it's helpful to have set agreed-upon rules and the consequences for breaking them. You may want to consider consequences of varying severity based on the infraction. For example: <ul> <li> First-time offense. </li> <li>Your child tells you about it (before you discover it). </li> <li>Repeat offense. </li> </ul> </li> </ul> My child is not ready yet … It's okay if you and your child determine they are not yet ready to use a smartphone. This conversation can be an opportunity for you to help your child hone skills related to developing responsibility and impulse control. You can find additional practical tips and recommendations on <a rel="noopener noreferrer" href="https://www.commonsensemedia.org/articles/cellphones-and-devices" target="_blank" title="Opens in new browser window">Common Sense Media's website</a> and the <a rel="noopener noreferrer" href="https://www.healthychildren.org/English/family-life/Media/Pages/Cell-Phones-Whats-the-Right-Age-to-Start.aspx" target="_blank" title="Opens in new browser window">American Academy of Pediatrics' website</a>. Sushmitha Srinivasan, M.B.B.S., is a pediatric resident at Mayo Clinic in Rochester, Minn., and practices general pediatrics in the Baldwin building.Sushmitha Srinivasan, M.B.B.S.Primary Care in Rochester and KassonKids SmartphonesPrimary Care in Rochester and KassonPreserving your vision is critical for quality of life.<img src="/-/media/ech-media/images/widgets/people/eyeexamman.jpg?h=65&iar=0&w=100&sc_lang=en&hash=B8690630AB6FF603BF744EA05B0AF76C" alt="EyeExamMan" width="100" height="65" DisableNVelocity="true" />A glancing look at macular degeneration2/15/2024 12:00 AM<img src="/-/media/ech-media/images/widgets/people/eyeexamman.jpg?h=205&iar=0&w=315&sc_lang=en&hash=4E0AFF3EC847E5CA8298B0FDF22247CD" alt="EyeExamMan" width="315" height="205" DisableNVelocity="true" />The macula is found in the center of the retina in the back of the eye. It's responsible for high-quality central and color vision. Your medical clinicians will see the macula as a subtle dark spot when they examine your retina. If the macula becomes diseased, significant problems in vision may develop. You can notice these changes through the blurring of central vision, trouble reading, and difficulty driving and recognizing faces. Vision changes vary greatly from one person to another with some experiencing a crippling loss of vision and others noticing only mild changes. The outer areas of vision, or the peripheral vision, are not affected. Your clinician can differentiate between macular degeneration and Drusen deposits, which can be normal and are usually associated with older age. Small deposits of Drusen made of proteins and fats under the surface of the retina are usually asymptomatic. However, a large accumulation of Drusen may cause loss of vision and is also associated with the development of macular degeneration. There are two types of age-related macular disease, and both develop similar vision difficulties. <ul style="margin-top: 0in; list-style-type: disc;"> <li>Dry macular degeneration is caused by thinning of the macula, decreasing the eye's ability to function properly. Unfortunately, there is no way to reverse the damage done by dry macular degeneration, but your clinician may have recommendations on supplements, rehabilitation for vision or even surgical options, depending on how severe the vision loss has become. </li> <li>Wet macular degeneration is caused by leaking blood vessels within the macula, causing an accumulation of fluid and blood. An important distinction to realize between dry and wet macular degeneration is that the symptoms of wet degeneration develop suddenly and worsen rapidly. It's important to note that wet macular degeneration might be reversible if treated quickly. </li> </ul> Preserving our precious vision is critical for quality of life. Following a balanced diet, avoiding toxins like cigarette smoke, exercising regularly, seeing your eye specialist and regular visits with your medical team may help reduce the risk of developing macular degeneration. Ashley Stantz, M.D., is a geriatric medicine resident at Mayo Clinic in Rochester. She has specialized in the care of older adults to preserve their dignity and quality of life for over 20 years, starting long before her interest in medicine. Ashley Stantz, M.D.Primary Care in Rochester and KassonMacular DegenerationPrimary Care in Rochester and KassonIf you have a health condition, talk with your healthcare clinician about fasting during Ramadan.<img src="/-/media/ech-media/images/widgets/randomimages/ramadan.jpg?h=65&iar=0&w=100&sc_lang=en&hash=AD0736DF6B9B1737FAF58E415501A7F7" alt="Ramadan" width="100" height="65" DisableNVelocity="true" />Managing your health during Ramadan2/29/2024 12:00 AM<img src="/-/media/ech-media/images/widgets/randomimages/ramadan.jpg?h=205&iar=0&w=315&sc_lang=en&hash=3BE53DA56B901268696B11466C24545C" alt="Ramadan" width="315" height="205" DisableNVelocity="true" />Fasting during Ramadan involves abstaining from food and drink from dawn to sunset. Depending on geography and the time of year when Ramadan occurs, daily fasting can range from as little as 10 hours in the winter months to more than 17 hours during the summer. This daily fast should not hurt the health of most individuals. Even if you have a chronic condition, including coronary artery disease, kidney disease, high blood pressure or diabetes, you can fast safely if your condition is well-managed and uncomplicated. Anyone with a chronic health condition who chooses to fast — especially if they have complications or take medications to manage it — should take time to plan and prepare to avoid experiencing problems or worsening their condition. Because fasting is not intended to cause harm, it's important to consider consulting your healthcare clinician before Ramadan — or any time you plan to fast — to plan how best to maintain good health or determine whether fasting is safe for you. Some questions to ask include: <ul> <li>Is fasting safe based on my health conditions? </li> <li>How can I best take my medications? </li> <li>Could medications that are taken multiple times a day be changed to once-a-day dosing? </li> <li>Should I check blood glucose (sugar) levels more frequently, or change my insulin or other medication dosing? </li> </ul> Taking medications Medications taken by mouth or intravenous feeding are considered to break your fast. As a result, if it is safe to do so, these types of medications should be given or administered before dawn or after sunset if you choose to fast and if it's safe to do so after consulting with your healthcare clinician. However, Islamic scholars generally recognize that other types of medications do not break the fast and may be taken during hours of fasting. These include medicated skin patches or creams, eye and ear drops, injections given in the skin or muscle (including insulin), supplemental oxygen and mouthwash or gargles that are not swallowed. In addition, many scholars also hold that nasal sprays and inhalers do not break your fast. For those planning to fast, it's recommended you drink plenty of liquids when you're not fasting and limit caffeinated or highly sugared beverages. It's also recommended that you avoid or limit highly processed foods or foods high in fat and eat healthy, balanced meals with moderate portion sizes. Vaccinations The consensus among Islamic scholars is that getting a vaccine does not break a fast. As such, it is completely acceptable to receive any recommended vaccination, even during the day while fasting. Helpful resources If you have a health condition or a concern, you are encouraged to consult with your healthcare clinician or a pharmacist to ensure you remain in the best possible health during Ramadan. Other helpful resources: <ul> <li><a rel="noopener noreferrer" href="https://www.aafp.org/afp/2015/0501/p640.html" target="_blank" title="Opens in new browser window">Caring for Muslim patients who fast during Ramadan</a> (American Academy of Family Physicians). </li> <li><a rel="noopener noreferrer" href="https://www.aafp.org/afp/2015/0501/p640.html" target="_blank" title="Opens in new browser window">Fasting in Ramadan and Muslim patients</a> (IMANA). </li> </ul> <a href="/providers/muhamad-elrashidi-md">Muhamad Elrashidi, M.D.</a>, is a physician in Community Internal Medicine, Geriatrics and Palliative Care in Rochester, Minn.Muhamad Elrashidi, M.D.Primary Care in Rochester and KassonRamadan HealthPrimary Care in Rochester and KassonEverything's better after a good night's sleep, and here's how nutrition can help.<img src="/-/media/ech-media/images/widgets/people/sleepingwoman.jpg?h=65&iar=0&w=100&sc_lang=en&hash=D5A25D328CAF567748CA03903C5225D1" alt="SleepingWoman" width="100" height="65" DisableNVelocity="true" />Get better ZZZs with some nutrition ABCs2/1/2024 12:00 AM<img src="/-/media/ech-media/images/widgets/people/sleepingwoman.jpg?h=205&iar=0&w=315&sc_lang=en&hash=7FC4072D313C9FFD93062AA370FA204C" alt="SleepingWoman" width="315" height="205" DisableNVelocity="true" />It's clinically proven that sleep helps improve the immune system, memory and brain function, and it also promotes growth. Sleep disruptions can lead to the development of diseases such as cancer, depression and cardiovascular disease. But did you know nutrition affects sleep? You may realize that lack of sleep makes you eat more and make fewer healthy food choices. Think about that extra candy bar or donut you gobble when you need a "pick me up." That's just part of the story. <ul> <li>Those who consume diets with higher amounts of vegetables and fish have better quality sleep than those who have a diet high in sweets and sugar-sweetened beverages.</li> <li>Consuming too many calories can lead to poorer sleep quality.</li> <li>Foods containing omega-3 and omega-6 fatty acids have been shown to improve sleep because these nutrients help regulate hormones related to sleep.</li> <li>People who consume complex carbohydrate- and fiber-containing foods hours before sleep had an easier time falling asleep than those who consume simple carbohydrates and added sugars.</li> <li>Those who eat foods rich in vitamin D tend to be more alert, sleep longer and have better sleep quality.</li> </ul> The Mediterranean diet has gotten much good press in recent years and good sleep is another of its benefits. Many foods prescribed in the Mediterranean diet are rich in melatonin, serotonin and vitamin D — all enhancing good sleep. In short, paying attention to your diet will pay off in better sleep. Overall, consuming a well-balanced diet containing complex carbohydrates, fruits, vegetables, unsaturated fats and adequate protein can improve sleep and help prevent chronic diseases associated with poor sleep quality. Taylor Dale is a dietetic intern at Mayo Clinic in Rochester, Minn. She earned her Bachelor of Science at Western Michigan University in Dietetics and Biomedical Sciences. Currently, she is completing a Master of Science in Clinical Nutrition from the University of Wisconsin-Madison. Upon graduation, she would like to pursue a career in pediatric nutrition focusing on gastrointestinal disorders.Taylor DallePrimary Care in Rochester and KassonSleep And NutritionPrimary Care in Rochester and KassonThese tips will help you recognize healthy and unhealthy relationships and prepare you for helping your teen.<img src="/-/media/ech-media/images/widgets/teens/ech_teen_violence_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=21DD67123327FA2F81DD916D58469221" alt="ECH_teen_violence_widget" width="100" height="65" DisableNVelocity="true" />Intimate partner violence in teens: What is it, and what can you do?2/8/2024 12:00 AM<img src="/-/media/ech-media/images/widgets/teens/ech_teen_violence_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=8AD1E74F9174C48D7D968DDB0A103C13" alt="ECH_teen_violence_widget" width="300" height="195" DisableNVelocity="true" />According to the American Academy of Pediatrics (AAP), intimate partner violence (IPV) in teens — teen dating violence — is an "adolescent health problem." It's common and is associated with poor health and social outcomes. IPV in teens involves physical, emotional and/or sexual abuse in a teen relationship. It affects millions of teens in the U.S. each year. According to the Centers for Disease Control and Prevention (CDC), nearly 1 in 11 female teens and 1 in 15 male teens reported experiencing physical dating violence in the last year, and about 1 in 9 female high school students and 1 in 36 male high school students reported experiencing sexual dating violence in the last year. Additionally, 26% of women and 15% of men report experiencing IPV for the first time before the age of 18. According to the CDC, sexual minority groups are disproportionately affected by all forms of violence, and some racial/ethnic minority groups are disproportionately affected by many types of violence. Teen dating violence can occur in person or electronically. It can include physical injury, forced sexual contact, reproductive coercion (or pressuring the partner to become pregnant or manipulating birth control attempts), isolation, intimidation and controlling partner behaviors. These controlling behaviors include demanding constant access to a partner, frequent checking of the partner's text messages, social media sites and cell phone, and texting or posting sexual pictures of a partner online. Healthy and unhealthy relationships: Recognizing both According to the AAP, signs of a healthy relationship include: <ul> <li>Being respectful of each other.</li> <li>Knowing that you make each other better people.</li> <li>Sharing common interests but also having outside activities and friends.</li> <li>Settling disagreements peacefully and with respect. </li> </ul> According to the AAP, signs of an unhealthy relationship include: <ul> <li>Lack of respect for each other.</li> <li>Being held back from things you like or are good at.</li> <li>Controlling and/or possessive behaviors.</li> <li>Blaming.</li> <li>Jealousy.</li> <li>Trying to change the other person.</li> </ul> According to the AAP, signs that "cross the line" in a relationship and are reasons to end a relationship and get help include: <ul> <li>Abuse (verbal, physical, sexual).</li> <li>Threats.</li> <li>Explosive anger. </li> </ul> The health impact Teen dating violence has a major impact on adolescent health. It's associated with unintended teen pregnancy, sexually transmitted infections, injuries, substance use, antisocial behaviors, poor mental health and thoughts of suicide. It also sets the stage for future relationship problems and the potential for being a victim or perpetrator of subsequent IPV. What can parents do? Parents have an important role to play in promoting healthy relationships from an early age, recognizing teen dating violence among children and their peers, and supporting teens as they navigate their early relationships. <ul> <li>Talk to your teens about healthy relationships. See the AAP Healthy Children website <a rel="noopener" href="https://www.healthychildren.org/English/ages-stages/teen/dating-sex/Pages/Expect-Respect-Healthy-Relationships.aspx" target="_blank" title="Opens in new browser window">Expect Respect: Healthy Relationships - HealthyChildren.org</a>.</li> <li>Role model healthy relationships. Show your children what it means to be engaged in a healthy relationship. This includes demonstrating loving and peaceful conflict resolution with friends and partners.</li> <li>Recognize signs of an unhealthy relationship. If your teen shows signs that he or she may be in an abusive or violent relationship, talk to them about it and get help. Your healthcare clinicians are happy to help connect you and your teen with resources for developing more positive relationships and getting out of potentially dangerous relationships.</li> <li>Empower your teen to intervene. Encourage all teenagers to be "positive upstanders" when they see peers who are engaged in disrespectful, harmful or violent behaviors.</li> <li>Engage in community activities. Teenagers who are involved in community groups, sports and other activities are less likely to engage in violence.</li> <li>Promote healthy use of the internet, which includes balance (with non-internet activities<a rel="noopener" href="https://www.healthychildren.org/English/ages-stages/teen/dating-sex/Pages/Helping-Teens-Resist-Sexual-Pressure.aspx" target="_blank" title="Opens in new browser window">), boundaries and communication with parents.</a></li> <li>Help your teen resist sexual pressure. The AAP's <a rel="noopener" href="https://www.healthychildren.org/English/ages-stages/teen/dating-sex/Pages/Helping-Teens-Resist-Sexual-Pressure.aspx" target="_blank" title="Link opens in a new window">Helping Teens Resist Sexual Pressure</a> outlines strategies for parents and teens on this important topic. </li> </ul> Tips for teens These strategies can help teens avoid an abusive relationship: <ul> <li>Respect your partners and yourselves.</li> <li>Have a life, friends and family outside of your relationship.</li> <li>Resolve disagreements with your significant other with love and respect.</li> <li>Recognize healthy and unhealthy relationships.</li> <li>Stand up when you see signs of abuse. </li> <li>Know your support in your family and community.</li> <li>If you or your friends are involved in an abusive or violent relationship, ask an adult for help. Your parents, healthcare clinicians and teachers are good places to start. </li> </ul> Other resources for parents and teens include: <ul> <li><a rel="noopener" href="https://www.cdc.gov/intimate-partner-violence/about/about-teen-dating-violence.html" target="_blank" title="Opens in new browser window">Fast Facts: Preventing Teen Dating Violence</a> (Centers for Disease Control and Prevention).</li> <li><a rel="noopener" href="https://www.healthychildren.org/English/ages-stages/teen/dating-sex/Pages/Dating-Violence-Tips-for-Parents.aspx" target="_blank" title="Opens in new browser window">Signs of Teen Dating Violence</a> (American Academy of Pediatrics).</li> </ul> <a href="/providers/marcie-billings-md">Marcie Billings, M.D.</a>, is chair of Mayo Clinic's Division of Community Pediatric and Adolescent Medicine. Her special areas of practice are adolescent medicine and eating disorders.Marcie Billings, M.D.Primary Care in Rochester and KassonTeen Dating ViolencePrimary Care in Rochester and KassonThyroid disease affects 5% to 10% of the U.S. population.<img src="/-/media/ech-media/images/widgets/people/thyroidexam.jpg?h=65&iar=0&w=100&sc_lang=en&hash=AF22C2345E0DCFF3234E1FBFBE8C649A" alt="ThyroidExam" width="100" height="65" DisableNVelocity="true" />Answering common questions about thyroid disease2/12/2024 12:00 AM<img src="/-/media/ech-media/images/widgets/people/thyroidexam.jpg?h=205&iar=0&w=315&sc_lang=en&hash=AB381BEE2D4D8AC5AA3A703E6D55A8E6" alt="ThyroidExam" width="315" height="205" DisableNVelocity="true" />Thyroid hormone is vital for a healthy metabolism and overall health. If the thyroid level is too low or too high, it can be harmful to both physical and mental health. The thyroid hormone is produced by the thyroid gland, a small gland in the middle of the lower neck. Thyroid diseases affect roughly 5% to 10% of the U.S. population, and many are unaware of their condition. Women are more likely than men to have thyroid problems. If you suspect you're having a problem with your thyroid, answers to these common questions may provide clarity. What is thyroid disease? There are multiple types of thyroid disease, and they can either cause the body to produce too little or too much thyroid hormone. When thyroid hormone levels are too low, patients can develop conditions such as heart failure, high cholesterol, depression or weight gain. When thyroid hormone levels are too high, patients can develop atrial fibrillation, anxiety or osteoporosis. Nodules in the thyroid gland are also very common. They may or may not be associated with altered thyroid hormone levels. Most are benign and do not cause any problem, but if you find a lump in your neck it's best to speak with your primary care clinician to determine if further testing is needed. What are the symptoms of thyroid disease? Since thyroid hormone affects so many systems in the body, there are many symptoms which could be an indication of thyroid problems: <ul> <li>People with hypothyroidism, or not enough thyroid hormone, commonly experience fatigue, intolerance to cold, weight gain, constipation, dry skin and irregular menstrual cycles.</li> <li>People with hyperthyroidism, or too much thyroid hormone, can experience anxiety, exaggerated emotions, weakness, tremors, heart palpitations, intolerance to heat, increased perspiration, irregular menstrual cycles and weight loss. </li> </ul> How are thyroid problems diagnosed? Because symptoms of thyroid hormone imbalance are so common and are often caused by health conditions unrelated to thyroid disease, the first step is to evaluate the function of your thyroid using a test for thyroid stimulating hormone, or TSH. TSH is secreted by the pituitary gland in response to your body's levels of thyroid hormone. A normal TSH in adults is 0.3 to 4.2 milli-international units per liter. Levels can be higher as we age. If there isn't enough active thyroid hormone, TSH levels will rise as the pituitary gland tries to stimulate the thyroid to make more. If there's too much thyroid hormone, TSH levels fail to stop stimulating production. People whose TSH is in the normal range are unlikely to have thyroid disease. If you're diagnosed with this condition, your clinician will request that your TSH be checked periodically to monitor your response to treatment. It's also possible to have an abnormal TSH level but a normal thyroid hormone level. This is called "subclinical" hyperthyroidism or hypothyroidism. These conditions generally don't need to be treated. However, there are important exceptions that you should discuss with your healthcare clinician. All patients with subclinical thyroid disease should have their TSH and thyroid hormone levels checked regularly to detect if the condition has progressed or if there's a need for treatment. How are thyroid problems treated? Treatment for thyroid problems depends on whether your thyroid hormone levels are too high or too low. <ul> <li>Hypothyroidism (hormone levels too low, TSH too high). This condition is more common and tends to affect women more than men. It can be caused by autoimmune thyroid diseases, such as Hashimoto's thyroiditis, radiation to the thyroid or pituitary gland, certain medications or other health conditions. It is treated with hormone replacement therapy (a medication called levothyroxine). Your dose will be adjusted based on regular TSH tests.</li> <li>Hyperthyroidism (hormone levels too high, TSH too low). This condition can be caused by autoimmune thyroid disease, such as Grave's disease, certain medications, hyperactive nodules, infection or injury to the thyroid gland. The most common cause is taking too much thyroid hormone for hypothyroidism. Treating hyperthyroidism is more challenging than hypothyroidism, and treatment depends on the cause of elevated thyroid hormone levels. </li> </ul> It's important for all patients taking levothyroxine to have their TSH monitored and doses adjusted to maintain TSH in the normal range. Keep in mind that symptoms suggestive of thyroid problems are common and most often not caused by thyroid disease. It's important to discuss your symptoms and concerns with your healthcare clinician and be screened and treated for thyroid disease, if necessary. Richard Lindsey, M.D., Ph.D., is a resident physician in the Department of Medicine Primary Care Clinic in Rochester, Minnesota. He earned his medical and doctoral degrees at Loma Linda University School of Medicine in Southern California. In July 2024, he will be an Endocrinology fellow at Mayo Clinic in Rochester. His interests include endocrine physiology, osteoporosis and mechanisms of bone metabolism and aging.Richard Lindsey, M.D., Ph.D.Primary Care in Rochester and KassonThyroid FAQPrimary Care in Rochester and KassonTake time to walk through your home to identify potential hazards. <img src="/-/media/ech-media/images/widgets/kids/babysafetyhazard.jpg?h=65&iar=0&w=100&sc_lang=en&hash=B37A54E23BC98F7C8D3C96B14A6C2620" alt="BabySafetyHazard" width="100" height="65" DisableNVelocity="true" />'Zap! Ouch! Mom!' A baby proofing guide for new parents3/18/2024 12:00 AM<img src="/-/media/ech-media/images/widgets/kids/babysafetyhazard.jpg?h=205&iar=0&w=315&sc_lang=en&hash=F15A7776923167B8EDA3EF6954C10B8E" alt="BabySafetyHazard" width="315" height="205" DisableNVelocity="true" />Infants and toddlers have a knack for finding the most dangerous places in your home and making it their preferred play space. That's why it's important to take the time to walk through your home and identify any potential hazards to prevent accidents. One strategy is to walk (or crawl — we won’t judge) through each room in your house with a critical and mischievous eye. All rooms <ul> <li>Cover those outlets.</li> <li>Ensure your home has a carbon monoxide and fire detector.</li> <li>Keep cords and drapes out of reach.</li> <li>Avoid floor lamps.</li> <li>Consider installing a stop that prevents windows from opening more than 4 inches, especially if furniture is near a window. Alternatively, move furniture away from windows to prevent kids from climbing up, peering out and falling. </li> </ul> Kitchen — a play of joy, a place of peril <ul> <li>Stove: Young children love to turn knobs and flick switches. Stove knob covers can prevent inadvertent fires. Pot handles should be turned inwards to prevent children from grabbing them and spilling hot liquid on themselves. Oven locks are recommended to prevent burns. Never leave your child unattended in the kitchen while the stove or oven is on.</li> <li>Cupboards: Move all glass or ceramic (easily breakable) dishware and sharp kitchen tools like cheese graters, knives, blenders and food processors to elevated cupboards — out of reach of those small hands. If this is not an option, consider cupboard safety latches or locks. This is especially important for the cupboard under the sink, where many people like to store cleaning products. Packaging for cleaning products is often bright and catches the eye of children. Detergent pods can also be mistaken for candy and are dangerous for children to ingest.</li> <li>Pantry: Place choking hazards like open bags of raw pasta and dried legumes on higher shelves.</li> <li>Dishwasher: Avoid leaving dishwashers open as this can lead to trips and falls. Additionally, consider moving the utensil holder to the upper level, so that little hands are less likely to reach in and grab knives. This is another place to consider a lock or latch.</li> <li>Fridge: Alcohol should always be out of reach of children. Refrigerators should be secured or anchored to the wall (they can tip over onto your children if they try to climb up the shelves).</li> <li>Knives: Stow away your knives and avoid leaving them out on countertops. You never know when little hands might grab out or when a knife might be knocked onto the ground by a busy passerby.</li> </ul> Living room <ul> <li>Coffee tables: These can have sharp edges. Corner guards for tables can soften falls and help prevent cuts and eye injuries.</li> <li>TV: If you have a freestanding television, fasten or secure your TV to the wall to prevent it from falling forward onto your child. This precaution is especially important for children who are learning to stand by pulling on furniture. </li> </ul> Firearms Keep guns in a lockbox or safe. Store guns unloaded, with ammunition locked away separately. Kids are safest when firearms are kept outside of the home. Nursery <ul> <li>Place cribs and nursery furniture away from windows.</li> <li>Use a firm mattress that fills the crib with no gaps. Keep the crib free from loose blankets, toys or bumpers. Use a fitted crib sheet that is snug.</li> <li>Crib slats should be less than 2-3/8 inches apart. This recommendation helps prevent arms and legs from getting stuck.</li> <li>Never leave a baby unsupervised on the changing table. One hand should always be on the infant. Place wipes and creams at arm's length to avoid needing to leave the baby unattended.</li> <li>Dressers and bookshelves should be anchored to the walls.</li> </ul> Bathroom <ul> <li>Bathroom cleaning products should be kept out of reach or in a locked or secure cabinet.</li> <li>Never leave a child unattended in the bathtub.</li> <li>Use a slip-proof mat in the bottom of the bathtub.</li> <li>Consider installing a baby gate or keep the bathroom door closed until your child is old enough to be unsupervised in the bathroom.</li> <li>Decrease the temperature of your hot water heater to prevent scalds or burns. Always test the temperature of the water before placing your child into the bath.</li> <li>Always mop up excess water to prevent slips and falls.</li> <li>Cover faucets with faucet covers to prevent cuts and concussions.</li> <li>Consider a toilet lid lock to help prevent unwanted splashes and swims.</li> </ul> <a href="/providers/gabriela-kovacikova-md">Ika Kovacikova, M.D.</a>, is a physician in Community Pediatric and Adolescent Medicine in Rochester, Minn. She practices primary pediatric care at Mayo Family Clinic Northeast.Ika Kovacikova, M.D.Primary Care in Rochester and KassonBabyproofing HomePrimary Care in Rochester and KassonIntroduce foods slowly and watch for these symptoms.<img src="/-/media/ech-media/images/widgets/kids/littlegirlholdingstomach.jpg?h=65&iar=0&w=100&sc_lang=en&hash=2485D46312CB9964173AD21DE72137B9" alt="LittleGirlHoldingStomach" width="100" height="65" DisableNVelocity="true" />Worried your child might have a food allergy?3/14/2024 12:00 AM<img src="/-/media/ech-media/images/widgets/kids/littlegirlholdingstomach.jpg?h=205&iar=0&w=315&sc_lang=en&hash=5511127A3029372F711861D570164A60" alt="LittleGirlHoldingStomach" width="315" height="205" DisableNVelocity="true" />Food allergies might not be a concern for some families, but they are more widespread than most people think. Thirty-three million people in the U.S. have reported food allergies. In children, 1 in 13 are found to have a food allergy. An allergy can be life-altering for some families, especially since there is a risk for anaphylaxis after ingestion of an allergenic food. Anaphylaxis is a full-body reaction after ingesting certain foods. It can cause a person to experience hives, lip or tongue swelling, difficulty breathing, nausea, vomiting and abdominal pain. A person who is undergoing anaphylaxis can experience any combination of these symptoms. As a parent, you may be afraid to introduce foods to your baby. The introduction of pureed foods typically starts at around 4-6 months of age. Learn what to watch for as you introduce new foods. Signs your child may be having an allergic reaction to a food If a child is having an allergic reaction to food, they can be at risk for anaphylaxis. Symptoms of potential anaphylaxis include: <ul> <li>Nausea.</li> <li>Vomiting.</li> <li>Abdominal pain.</li> <li>Diarrhea.</li> <li>Shortness of breath</li> <li> Lip and tongue swelling.</li> <li>Hives.</li> </ul> Anaphylaxis often occurs within minutes. People who develop anaphylaxis will have two-organ system involvement. People experiencing anaphylaxis must have gastrointestinal symptoms and respiratory symptoms or skin involvement. If you are introducing a new food and your child experiences any of these symptoms within minutes, bring them to the closest emergency department to be evaluated. Are there foods to avoid in case my child has a food allergy? These foods are most commonly found to cause food allergies: <ul> <li>Milk.</li> <li>Egg.</li> <li>Fish.</li> <li>Shellfish.</li> <li>Tree nuts.</li> <li>Peanuts.</li> <li>Wheat.</li> <li>Soy.</li> <li>Sesame</li> </ul> That doesn’t mean you need to avoid them. Even though these foods are the most common foods that people have allergies to, children should not start with a restrictive diet for fear of a food allergy. The <a rel="noopener noreferrer" href="https://www.foodallergy.org/resources/learning-early-about-peanut-allergy-leap" target="_blank" title="Link opens in a new window">Learning Early About Peanut Allergy (LEAP)</a> study done in 2015 concluded that early exposure to peanuts in infants at high risk of peanut allergy decreased the risk of subsequently developing a peanut allergy. How can I prevent my child from developing a food allergy? Don't restrict foods that have not previously caused a reaction in your child. Restricting foods might cause the body’s immune system to develop an allergy to foods instead. For more information about food allergies, visit the <a rel="noopener noreferrer" href="https://www.foodallergy.org/resources/facts-and-statistics" target="_blank" title="Link opens in a new window">Food Allergy Research & Education website</a>. <a href="/featured-stories/food-allergy">Tiffany Ngo, M.D.</a>, is a resident in Community Pediatric and Adolescent Medicine in Rochester, Minn. Her interests include allergies, asthma, eczema and immunodeficiencies.Tiffany Ngo, M.D.Primary Care in Rochester and KassonFood AllergyPrimary Care in Rochester and KassonNo matter your age, friendships can improve your physical health and well-being. <img src="/-/media/ech-media/images/widgets/people/familybaking.jpg?h=65&iar=0&w=100&sc_lang=en&hash=7B0585B0CCD1627343BF778CB885959B" alt="FamilyBaking" width="100" height="65" DisableNVelocity="true" />Friendship: The common denominator3/25/2024 12:00 AM<img src="/-/media/ech-media/images/widgets/people/familybaking.jpg?h=205&iar=0&w=315&sc_lang=en&hash=E8CD3C22BA9F6E92906CC2DD7E0B5540" alt="FamilyBaking" width="315" height="205" DisableNVelocity="true" />Friendships changed when the COVID-19 pandemic hit. People learned to connect virtually, without sharing physical space. The pandemic taught us the importance of human connection and new ways of connecting, no matter the distance. Those connections continue to promote health and well-being throughout various life stages as friendships remain important across the lifespan. Friendships are important throughout life Young children. Friends are typically found among those nearby, perhaps children of family friends, or children in the neighborhood. Preschool friendships help children develop social and emotional skills, increase a sense of belonging and decrease stress. At this stage, parents need to model good friendship skills and help encourage friendships that are important to the child. Adolescents and young adults. Adolescents typically choose to be close to those who share the same interests. Young adulthood is a time when individuals start finding their sense of identity. Young adults need people around them who challenge them to try new things or encourage them when starting new careers. Friendships also evolve when romantic relationships begin. Adulthood. This is a time when friendships can take a backseat as individuals start families or become preoccupied with their careers. It takes effort to meet up with friends given the needs of family members, whether that be children or elderly parents. However, friends tend to understand (as they are often in the same boat), and when time is spent together, they can often pick up as if no time has passed. Later adulthood. Friendship circles often begin to decrease due to death, limited mobility or relocation. Depression and loneliness can impact individuals as they experience a shrinking friend group. It's essential that people stay as active as they are able, whether that be participating in religious groups, visiting neighbors, volunteering or engaging in other social activities. How to care for and nurture friendships No matter what stage, friendships can protect against loneliness, decrease anxiety and improve one's physical health and well-being, but they do require continued care and nurturing. Here are some ways to make and maintain friendships: Acts of kindness help maintain friendships. It's not always about buying gifts for a special occasion. Make plans to spend quality time together or go to a family event. Get together as often as possible, even if that's inviting a friend to do something you're already planning to do. Even with busy schedules, friends can meet to exercise, run errands or have a cup of coffee. Stay connected, even if you're separated by distance. Do little things — send a care package, pick up the phone instead of sending a text, send an email or a letter in the mail. Plan a virtual connection if you are separated by distance — plan a video chat, play virtual games together or plan a time to watch a movie or TV show in synchronicity. <a href="/providers/lisa-burke-licswmsw">Lisa Burke, L.I.C.S.W., M.S.W.</a>, is a clinical social worker serving adults in Primary Care in Rochester and Kasson at the Baldwin building. Candice Kimbrough, M.S.W., L.C.S.W., is a clinical social worker who works with hospitalized patients at Mayo Clinic Hospital in Phoenix, Arizona.Lisa Burke, L.I.C.S.W., M.S.W., and Candice Kimbrough, M.S.W., L.C.S.W.Primary Care in Rochester and KassonFriendship ImportancePrimary Care in Rochester and KassonTraveling across more than two time zones can bring on jet lag. <img src="/-/media/ech-media/images/widgets/people/ech_jetlag_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=171489AF17FEEF152395CEEDFF4B7065" alt="ECH_JetLag_widget" width="100" height="65" DisableNVelocity="true" />Jetting off on a vacation? Avoid the lag3/7/2024 12:00 AM<img src="/-/media/ech-media/images/widgets/people/ech_jetlag_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=D0D358E1C46AFB9B41549B700517AF46" alt="ECH_JetLag_widget" width="300" height="195" DisableNVelocity="true" />Whether you're a frequent or infrequent flier, traveling across more than two time zones can put you at risk for jet lag. The more time zones you cross, the more likely you are to experience symptoms. Symptoms usually occur within a day or two after traveling. Jet lag results when your body's internal clock (circadian rhythm) is out of sync with the time zone you're in at your destination. The major influence on your internal clock is sunlight, which affects the production of melatonin by the pineal gland in your brain that synchronizes your internal clock. That's why going east may be more difficult than going west because it's later in the day when you arrive. Common symptoms include: <ul> <li>Difficulty falling asleep or waking up too early.</li> <li>Daytime sleepiness.</li> <li>Difficulty concentrating or making decisions.</li> <li>Feeling unwell.</li> <li>Diarrhea, upset stomach or constipation.</li> <li>Mood changes.</li> </ul> Jet lag can't be prevented, but there are things you can do before, during and after travel to minimize your symptoms. Before the trip: Get plenty of rest. If you can, gradually adjust your schedule to the destination time zone. Consider moving your wake, meal and sleep times by an hour each day for a few days so that you're closer to the schedule you'll be on when you arrive. If you have an important event at your destination, consider arriving a few days early so your body can adjust. During the trip: Avoid alcohol, drink plenty of water, get sleep (if you can) on a night flight and set your watch to the destination time. Don't forget to move your legs on long trips to decrease the risk of blood clots. When you arrive: If it's morning where you are, don't go to bed. Nap, if you must, for a short period, but plan to go to bed at local time. If you normally go to bed at 10, that's when you'll hit the hay at your destination. Exposure to sunlight will help you wake up your brain and reset your inner clock. About your medications: Talk to your doctor about adjusting the timing of your insulin or other medications you take at a regular time. Safe travels! <a href="/providers/denise-dupras-md">Denise Dupras, M.D., Ph.D.</a>, is a physician in Community Internal Medicine, Geriatrics and Palliative Care at Mayo Clinic in Rochester, Minn. She earned her medical and doctoral degrees at Mayo Clinic Alix School of Medicine and completed her residency in internal medicine at Mayo Clinic in Rochester. Her interests include medical education, evidence-based medicine and care of LGBTQIA+ patients.Denise Dupras, M.D., Ph.D.Primary Care in Rochester and KassonJet LagPrimary Care in Rochester and KassonCheck your child's vaccination record to ensure they are up to date. <img src="/-/media/ech-media/images/widgets/kids/ech_measles_widget_1.jpg?h=65&iar=0&w=100&sc_lang=en&hash=98BD68CF9851BC8BDE37E7CBECEDB3AA" alt="ECH_Measles_widget_1" width="100" height="65" DisableNVelocity="true" />Measles is back — We need to act2/28/2024 12:00 AM<img src="/-/media/ech-media/images/widgets/kids/ech_measles_widget_1.jpg?h=195&iar=0&w=300&sc_lang=en&hash=D59F98A4B2222C9EB7195FA8445304E7" alt="ECH_Measles_widget_1" width="300" height="195" DisableNVelocity="true" />Measles is back in the news. During the pandemic, U.S. children suffered delays in preventive services. Early pandemic precautions prevented many clinics from providing routine care. Also, leaders wrongly questioned if the new COVID-19 vaccines were safe, if they worked and if people needed them. As a result, people began to question routine vaccination in general.  This impact has left a large fraction of people not getting the vaccines they are due, including young children being vaccinated against measles. While 93% of kindergarteners in Minnesota had both measles vaccines in 2019, now only 87% have. We need a 95% vaccination rate to achieve herd immunity that protects the other 5%.  Three Minnesota children this year so far have contracted measles. One got measles through travel to another country. The other two got measles from this child. Across the U.S., so far in 2024, 35 children across fifteen states have developed measles. And we are not even three months through the new year.  In the U.S. <ul> <li>Most children with measles end up in the hospital.</li> <li>Up to 30% of U.S. children who get measles suffer complications (including diarrhea, middle ear infections, pneumonia, brain inflammation and death). </li> </ul> Measles also dampens one's immunity for a year or more afterward. In developing countries, death is more common.  We eliminated measles from the United States in the year 2000 through routine childhood vaccination.  We need all parents to get their children up to date now against measles to put an end to this disease. Please check your child's vaccination record and schedule an appointment with your primary care team to get caught up on measles vaccination if necessary.  <a href="/providers/robert-jacobson-md">Robert M. Jacobson, M.D.</a>, is the medical director of the Primary Care Immunization Program in Southeast Minnesota. He is a physician in Community Pediatric and Adolescent Medicine at Mayo Clinic in Rochester and practices in the Baldwin building. Robert M. Jacobson, M.D.Primary Care in Rochester and KassonMeasles 2024Primary Care in Rochester and KassonYou may lose weight if you are mindful of natural hunger cues. <img src="/-/media/ech-media/images/widgets/randomimages/mindlessmindful.jpg?h=65&iar=0&w=100&sc_lang=en&hash=2FBE1FA771E1F013FFC108618CF7828B" alt="MindlessMindful" width="100" height="65" DisableNVelocity="true" />Eating mindfully and intuitively3/4/2024 12:00 AM<img src="/-/media/ech-media/images/widgets/randomimages/mindlessmindful.jpg?h=205&iar=0&w=315&sc_lang=en&hash=617672D61F95691B5707487CFCF8A7B7" alt="MindlessMindful" width="315" height="205" DisableNVelocity="true" />Does it ever feel like you've tried so many diets that it's hard to stay in touch with your natural hunger cues or fuel your body without a blueprint? Trusting our bodies and responding to internal hunger and safety cues can become more difficult as we age. Responding to external cues may become more prevalent as an adult. Some external cues are: <ul> <li>Environment.</li> <li>Stressors and emotions.</li> <li>Societal pressures and social media.</li> </ul> Intuitive and mindful eating share similar concepts, but they're a bit different.  Characteristics of intuitive eating: <ul> <li>Highlights rejecting the typical 'diet' mentality of restriction.</li> <li>Respecting your body for where it's at. </li> <li>Not judging food based on its nutrition information. </li> </ul> Characteristics of mindful eating: <ul> <li>Encourages presence and attention with food. </li> <li>Enjoying your food, where it came from and showing gratitude. </li> <li>Observing how you feel before, during and after eating. </li> </ul> Both intuitive and mindful eating: <ul> <li>Are an approach to eating that does not count calories, fat or restrict your diet. </li> <li>Honor your natural hunger and safety cues and reject emotional or distracted hunger. </li> <li>Release judgment surrounding food and your body. </li> </ul> Ways to incorporate intuitive/mindful eating: <ul> <li>Reserve time and be present during meals.  <ul> <li>Ditch the TV and cell phone.</li> <li>Share meals with others. </li> <li>Think about where the food came from and show appreciation. </li> </ul> </li> <li>Be conscious about eating.  <ul> <li>Understand your natural hunger cues or ones associated with stress or emotions. </li> <li>Decide if you are truly hungry or just bored. </li> <li>Eat slowly and savor the flavors of the meal. </li> </ul> </li> <li>Practice acceptance.  <ul> <li>Release judgment about food and your body. </li> <li>Start slow and give yourself grace if you misstep. </li> <li>Each meal is a new opportunity to learn about yourself and your body. </li> </ul> </li> </ul> Why should you eat this way? Research shows that you may lose weight when you become more mindful of your natural hunger cues as doing so can help with portion control. It can also help regulate the body's stress response and optimize digestive function. There are hundreds of books written on this topic if you want to learn more.  If you or a loved one struggle with an eating disorder, many options go beyond the scope of this practice. Get in touch with your healthcare clinician to learn more. Natalie Johnson graduated from Bradley University in Illinois with her bachelor's degree in nutrition and dietetics. She is currently completing her master's in clinical nutrition from UW-Madison alongside her dietetic internship at The Mayo Clinic campus in Rochester, Minn. Special interests include gastroenterology/digestion, counseling/weight management and baking allergen-free dessertsNatalie JohnsonPrimary Care in Rochester and KassonMindful EatingPrimary Care in Rochester and KassonNot different — unique!<img src="/-/media/ech-media/images/widgets/randomimages/personality.jpg?h=65&iar=0&w=100&sc_lang=en&hash=BD9414A93D790A772A3B5868BF914C2E" alt="Personality" width="100" height="65" DisableNVelocity="true" />Does your personality make you different?3/11/2024 12:00 AM<img src="/-/media/ech-media/images/widgets/randomimages/personality.jpg?h=205&iar=0&w=315&sc_lang=en&hash=C08591C973ACA0FB5D68759DF6A1594F" alt="Personality" width="315" height="205" DisableNVelocity="true" />We all have different personality traits that make us unique. She is intelligent and introverted. He is kind and ambitious. They are adventurous and confident. Describing people's personalities with specific traits helps us to understand their distinct qualities. When we think about these traits, we also think about relatively longstanding things. Personality traits are often present by adolescence and extend into adulthood. What happens when the terms that are used to describe you or someone close to you are not so flattering (e.g., He is a narcissist; they are so self-absorbed.)? Everyone has some traits that they are less proud of than others — it's part of being human. However, there are times when someone's personality can lead to problems. It can be helpful to think about the concepts of "distress" and "impairment." Is someone's personality leading to significant distress to oneself (or sometimes those around them), or is it interfering with that person's ability to function in life as desired? Many people have heard the term "personality disorder" discussed in popular culture. You may wonder, what does that really mean? The DSM-5-TR (American Psychiatric Association, 2022) provides an outline of personality disorders, along with specific criteria to determine if someone meets the criteria for a certain personality disorder. In summary, the DSM defines a personality disorder as "an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual's culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, is stable over time and leads to distress and impairment." Importantly, the patterns of thoughts, emotions and behavior that occur in personality disorders are typically longstanding, persistent across many different situations and cause substantial distress and impairment for the person. For example, these patterns may lead to problems in the person's social or work life, can make it challenging to relate to others and can result in unhealthy coping strategies. We won't describe every personality disorder in this article (and, likely, you wouldn't have the time to read it anyway). Instead, we have included a fictional example below to help put this in context. Dennis is a 46-year-old male. He often brags about his achievements around others, including how well he did when he was in school and how intelligent he thinks he is. He often dreams of being famous or in high political offices, even though he doesn't know much about politics or the government. He has been feeling depressed lately because he feels like those around him don't recognize how special and talented he is. He also believes his current job is "beneath him." He has difficulty establishing and maintaining relationships with those around him because other people perceive him as not really caring about them and using them for his own gain. They also get tired of his constant bragging. In addition, Dennis has not been promoted to the supervisory position that he would like at work because his supervisors have concerns about how he interacts with his colleagues. This behavior is a longstanding pattern for Dennis, and it has caused problems for him since he was in high school. In this case example, we see that Dennis's personality traits are ultimately linked to emotional distress, as he is feeling depressed and dissatisfied with his work and relationships. They also impair his ability to function to the best of his ability in the workplace. Importantly, this is a longstanding problem for Dennis. In this case, Dennis would likely meet the DSM-5-TR's criteria for narcissistic personality disorder. If you are concerned about aspects of your personality or those of a loved one, it could be helpful to talk with a primary care clinician or a mental health professional about it. Regardless of the source of your distress, getting appropriate support from someone trained in the diagnosis and treatment of mental health concerns is a good first step. There are many types of personality traits and disorders. Any mental health treatment will depend on the type of problems a person is experiencing. You should know that for some personality disorders, evidence-based treatment (treatment that has been shown to be effective through research) can be life-changing. Some people no longer experience distress and impairment related to personality disorders after successful treatment because they have learned new coping strategies and communication skills that change the way they interact with those around them. Just like with many other health problems, loved ones who struggle with personality traits or a personality disorder may or may not be ready to reach out for help. If you are struggling in your relationship with a loved one because of their personality, it's okay to seek therapy for yourself. A trained mental health professional can teach you communication skills, like boundary setting and coping skills to help. Important: If you or a loved one is considering suicide or plans to harm another person, don't wait to reach out for help. You can call 911 in an emergency or go to your nearest emergency department. You can also reach out to the Suicide and Crisis Lifeline by dialing 988 or visiting <a rel="noopener noreferrer" href="https://988lifeline.org/" target="_blank" title="Link opens in a new window">988lifeline.org</a>. Alisson Lass, Ph.D., Rachel Wasson, Ph.D., and Kyle Schofield, Ph.D., are clinical health psychology fellows at Mayo Clinic in Rochester, Minn.   Anne Roche, Ph.D., L.P., is a psychologist in Primary Care in Rochester and Kasson's Integrated Behavioral Health Division.  Alisson Lass, Ph.D.; Rachel Wasson, Ph.D.; Kyle Schofield, Ph.D.; Anne Roche, Ph.D.Primary Care in Rochester and KassonPersonality TraitsPrimary Care in Rochester and KassonLearn about common symptoms and prevention tips. <img src="/-/media/ech-media/images/widgets/people/heatingpadstomach.jpg?h=65&iar=0&w=100&sc_lang=en&hash=250C4D1FEF1A8684A75994B7BE5C552F" alt="HeatingPadStomach" width="100" height="65" DisableNVelocity="true" />What you should know about urinary tract infections3/28/2024 12:00 AM<img src="/-/media/ech-media/images/widgets/people/heatingpadstomach.jpg?h=205&iar=0&w=315&sc_lang=en&hash=64D8C90F110C6171F0B0CFDA9502A8AC" alt="HeatingPadStomach" width="315" height="205" DisableNVelocity="true" />Urinary tract infections, often referred to as UTI, are one of the most common diagnoses made in the clinical setting. UTIs are typically infections of the bladder, and they are most common in young, sexually active females and older adults with certain medical problems. Children may also get these infections while they are being toilet-trained. Female patients are more likely to be affected due to the female genital anatomy, which has a shorter distance between the urinary opening (urethra) and the bladder. This structure allows bacteria to enter the bladder. People who have trouble emptying their bladders due to prostate or spinal cord problems are also at greater risk for infection. When infections are not treated, bacteria can spread to the kidneys and bloodstream and make people very sick. Common symptoms include: <ul> <li>Low belly pain or pressure above the pubic bone.</li> <li>Burning with urination.</li> <li>Needing to urinate more frequently.</li> <li>Stronger smelling urine (though this symptom is not consistently a sign of an infection).</li> <li>Small amounts of blood in the urine.</li> </ul> Mid-back pain, fevers, chills and vomiting with these symptoms may indicate a more serious infection and should prompt a medical evaluation. If you are concerned that you may have a UTI, contact your primary care clinician. A urine test will be ordered to confirm this problem. How can you prevent UTIs? <ol> <li>Be well hydrated: Staying hydrated flushes urine from the bladder, preventing bacteria that may be present from remaining in the bladder and causing infection.</li> <li>Urinate after sexual activity to remove bacteria that may have been introduced into the urethra.</li> <li>For females, utilize good urinary and genital hygiene and wipe only from front to back.</li> <li>Avoid douching and other feminine hygiene sprays. These have been linked to an increased risk of infection. </li> </ol> Talk to your primary care clinician if you have issues with recurrent urinary tract infections. They may be able to prescribe a medication to prevent infections in the future. <a href="/providers/melissa-bogin-md">Melissa Bogin, M.D.</a>, is a board-certified internal medicine physician and geriatrician-in-training in the Mayo Clinic Department of Community Internal Medicine, Geriatrics and Palliative Care. Her clinical interests include caring for older adults in both the outpatient and nursing home settings.Melissa Bogin, M.D.Primary Care in Rochester and KassonUrinary Tract InfectionPrimary Care in Rochester and KassonAutism Acceptance Month emphasizes promoting acceptance, celebrating differences and being more inclusive toward people with autism.<img src="/-/media/ech-media/images/widgets/randomimages/autism.jpg?h=65&iar=0&w=100&sc_lang=en&hash=B262F87DBB5E810C13F8A2F408942EEB" alt="Autism" width="100" height="65" DisableNVelocity="true" />April is Autism Acceptance Month4/2/2024 12:00 AM<img src="/-/media/ech-media/images/widgets/randomimages/autism.jpg?h=205&iar=0&w=315&sc_lang=en&hash=3C4571D023C8A21A6ACF7904C2C2788D" alt="Autism" width="315" height="205" DisableNVelocity="true" />April is Autism Acceptance Month in the United States. World Autism Day occurs on April 2 every year and is observed by United Nations members. Both are times to celebrate the uniqueness of neurodiverse people and foster inclusivity. These occasions are also a time to reflect more deeply on how we can improve care for our patients and this population in particular. I have been learning how ableism — discrimination in favor of able-bodied people — has impacted disabled and autistic individuals. Humbly I am still educating myself on how to promote anti-ableism. Ableism is the privilege of people without disabilities and a structural system of stigma, discrimination and oppression of people with disabilities. This can take different forms such as inaccessible spaces, language usage or bias that results in substandard quality of care and thus poor health outcomes. Temple Grandin, Ph.D., is an autism rights advocate who said, "different, not less" to simply describe fellow autistic individuals. Caregivers of autistic individuals can assist healthcare professionals with better incorporating disability-conscious best practices in many ways, including: <ul> <li>Bringing up the unique and beautiful ways the child enriches their lives and other’s lives. It is incredibly important not to associate autism and disability with the idea of “something wrong.”</li> <li>Encouraging medical clinicians to examine autistic patients as closely as they would any other patient and assisting as needed.</li> <li>Providing information on the best ways to communicate and interact with the patient in ways that will help them feel more comfortable.</li> <li>Telling medical professionals if a patient prefers identity-first language (autistic girl) or person-first language (girl with autism). </li> </ul> It’s also very important to not underestimate autistic individuals’ quality of life. So let’s celebrate Autism Awareness Month with a renewed sense of purpose and work toward more inclusivity and anti-ableism. <a href="/providers/jessica-davis-md">Jessica Davis, M.D.</a>, is a pediatrician in Primary Care in Rochester and Kasson's Division of Community Pediatric and Adolescent Medicine. She has a special interest in the care of children with autism spectrum disorder.Jessica Davis, M.D.Primary Care in Rochester and KassonAutism AwarenessPrimary Care in Rochester and KassonWhat to do if you suspect your baby might have an abnormal head shape. <img src="/-/media/ech-media/images/widgets/kids/babycrib.jpg?h=65&iar=0&w=100&sc_lang=en&hash=FC65CFFEFF77E8702192571A5C21528B" alt="BabyCrib" width="100" height="65" DisableNVelocity="true" />'My baby's head has a flat spot'4/29/2024 12:00 AM<img src="/-/media/ech-media/images/widgets/kids/babycrib.jpg?h=205&iar=0&w=315&sc_lang=en&hash=42D1286FE85B0743D07027F4F95F64D2" alt="BabyCrib" width="315" height="205" DisableNVelocity="true" />You're at home playing with your beautiful new baby. They're starting to smile. You've been doing tummy time, and today there hasn't been a single diaper blowout. All is right in the world. But then, as you stare at the top of their head, you notice that one side looks a little different than the other. Should you be worried? Is it nothing? What do you do? Abnormal head shape, or plagiocephaly, is extremely common in newborns and infants. The vast majority of kids with abnormal head shapes will grow and develop a normally shaped head, though a small group may need further interventions. Most head shape differences are related to the positioning of the head against surfaces. Regardless, if you have any questions or concerns, you should talk to your child's clinician about your baby's head shape. What causes a baby's head shape to change? A baby's skull has soft, bony plates that haven't yet fused. The bony plates can move a bit, which helps the baby's head to pass through the birth canal. The plates also allow room for the brain to grow. These bones typically fuse when babies are about 1 year old. Many things can cause a positional skull deformity: <ul> <li>Preferred head position. Some babies like sitting or sleeping with their heads turned a certain way.</li> <li>Not enough tummy time. Tummy time is for babies who are awake and being watched. It helps babies master milestones like head lifting, turning over, sitting up and crawling.</li> <li>Torticollis. An estimated 85% of babies with torticollis, a condition where the neck muscles are tight or imbalanced, have a positional skull deformity. Infants who have torticollis also will need physical therapy.</li> <li>Twin or triplet. Cramped or unusual positions in the womb can lead to changes in head shape.</li> <li>Birth complications. The baby's position when moving through the birth canal can affect the head shape. Some other things that affect a baby's head shape at birth are using forceps, vacuum extraction or even a difficult labor.</li> <li>Abnormal fusion of skull plates. Occasionally plates of the skull can fuse early or abnormally, leading to differences in head shape. This effect is known as craniosynostosis. </li> </ul> But what if your baby has a positional skull deformity? Thankfully, positional skull deformities DO NOT affect brain growth or intellectual development. It is typically a purely cosmetic issue. The majority do not require surgery. What is the treatment? The best treatment is to prevent a positional skull deformity. When it is found early, simple changes to your baby's position will help. For example: <ul> <li>Avoid too much time in a car seat, bouncy seat, baby swing or other carrier.</li> <li>Increase tummy time. It is important to put babies on their backs to sleep. But babies need supervised time on their tummy to play during the day. Start with short spurts of time, at least 5 to 10 minutes, 3 to 4 times a day. Gradually work up to an hour per day in several short sessions.</li> <li>Switch or alternate arms when holding and feeding your baby. </li> </ul> Even with all these interventions, it's still possible that your baby can develop positional plagiocephaly. Your doctor can recommend further treatments such as physical therapy, evaluation by a head shape specialist, or you may be referred to a facility that does formal head shape measurements and helmeting. Early intervention and therapy for positional skull deformity <ul> <li>Physical therapy. The therapist will check your baby for delayed motor skills caused by poor head and neck control. They will also check for torticollis. You will learn stretching and positioning exercises to do with your baby. Depending on the severity, your baby may need weekly therapy.</li> <li>Helmet therapy. If your baby has moderate or severe head flattening that does not respond to treatment by 5 or 6 months of age, they may benefit from helmet therapy. Molding helmets work by re-shaping the baby's head. They are typically worn 23 hours a day for 3-6 months.</li> <li>Surgery should only be considered when all other options have been exhausted. In addition, surgery should only be considered after consulting with a neurosurgeon or pediatric plastic surgeon who specializes in these types of cases. </li> </ul> In short, differences in head shape are common. Even without treatment, mild to moderate differences in head shape typically resolve by 2 years of age, even without helmeting. However, if there are significant differences, it's worth talking to your primary care clinician. There are many interventions to help normalize your baby's head shape, from at-home exercises to helmeting. Here are additional references to help you navigate head shape evaluation and management: <ul> <li><a rel="noopener" href="https://www.healthychildren.org/English/health-issues/conditions/Cleft-Craniofacial/Pages/Positional-Skull-Deformities-and-Torticollis.aspx" target="_blank" title="Link opens in a new window">When a Baby's Head is Misshapen: Positional Skull Deformities</a>.</li> <li><a rel="noopener" href="https://publications.aap.org/aapnews/news/12256/New-guidelines-review-evidence-on-PT-helmets-for" target="_blank" title="Link opens in a new window">New guidelines review evidence on PT, helmets for positional plagiocephaly</a>.</li> <li><a rel="noopener" href="https://www.cns.org/publications/neurosurgery-watch-detail/guidelines-management-of-patients-with-positional-" target="_blank" title="Link opens in a new window">Guidelines for the Management of Patients with Positional Plagiocephaly</a>.</li> </ul> Aaron Downs, M.D., is a resident in his second year at Mayo Clinic in Rochester, Minn. He loves spending time with his cat and dog, long walks on the beach and chocolate chip cookies. He is interested in Pediatric Epilepsy and Functional Neurologic Disorders.Aaron Downs, M.D.Primary Care in Rochester and KassonBaby Head ShapePrimary Care in Rochester and KassonBlack beans are a great source of protein and fiber, and they can help with weight loss, too!<img src="/-/media/ech-media/images/widgets/food/blackbeans.jpg?h=65&iar=0&w=100&sc_lang=en&hash=80029D7EF79F051A5C6D868189C10E35" alt="BlackBeans" width="100" height="65" DisableNVelocity="true" />The benefits of black beans4/1/2024 12:00 AM<img src="/-/media/ech-media/images/widgets/food/blackbeans.jpg?h=205&iar=0&w=315&sc_lang=en&hash=DA02DE90F6EA4894BA54CAABD2F6F262" alt="BlackBeans" width="315" height="205" DisableNVelocity="true" />Have you ever wondered how to add healthy options to your diet? Let's explore black beans — the versatile, nutrient-rich, plant-based legume.  Black beans are a great source of protein and fiber. They are rich in antioxidants, can help with weight loss and promote gut health.  Here is the nutritional composition for a serving, or 1/2 cup, of black beans: <ul> <li>Calories: 115 kcals.</li> <li>Carbohydrates: 20 grams.</li> <li>Protein: 8 grams. </li> <li>Fat: 0.5 grams.</li> <li>Fiber: 8 grams. </li> </ul> Some of the health benefits of black beans include:  <ul> <li>Increase volume without excess calories. </li> <li>Help you feel full for longer periods and prevent you from overeating. </li> <li>Regulate blood sugar levels. </li> <li>Reduce cholesterol and triglyceride levels. </li> <li>Prevent the development of diseases. </li> </ul> A serving of black beans a day offers 28% to 32% of the recommended daily value of fiber. Eating just one serving of black beans will help you meet these recommended daily intake goals needed to better your health. The recommended fiber intake for women is 21 to 25 grams per day and for men, it is 30 to 38 grams per day.  Use black beans in recipes as a bonus ingredient:  <ul> <li>Add them to tacos, burritos and enchiladas. </li> <li>Mix them into soups, chili, salads, burger, smoothies — even brownies!</li> </ul> This <a rel="noopener noreferrer" href="https://www.mayoclinic.org/healthy-lifestyle/recipes/black-bean-cakes/rcp-20049745" target="_blank" title="Link opens in a new window">Black bean cake recipe</a>, found on the Mayo Clinic website, is a great way to add black beans to your diet in a different — and delicious — way! Anna Santoro is a dietetic intern at Mayo Clinic in Rochester, Minn. She earned her Bachelor of Science at Pennsylvania State University in Dietetics. Currently, she is completing a Master of Science in Clinical Nutrition from the University of Wisconsin — Madison. Upon graduation, she would like to contribute to mitigating various disease states through preventive nutritional care while empowering individuals to make behavioral changes conducive to their individual needs. Anna SantoroPrimary Care in Rochester and KassonBlack Bean BenefitsPrimary Care in Rochester and KassonMom of premature baby recognizes the gift of life a blood donation brings. <img src="/-/media/ech-media/images/widgets/blooddonation/blooddonationcaelis.jpg?h=65&iar=0&w=100&sc_lang=en&hash=20707CA2D1B576919B6C811504AC4295" alt="BloodDonationCaelis" width="100" height="65" DisableNVelocity="true" />Blood donations help the littlest survive4/11/2024 12:00 AM<img src="/-/media/ech-media/images/widgets/blooddonation/blooddonationcaelis.jpg?h=205&iar=0&w=315&sc_lang=en&hash=368EA557C1A5EF7E6F93A627F4468258" alt="BloodDonationCaelis" width="315" height="205" DisableNVelocity="true" />Brigitte's daughter, Caelis, was born premature and spent her first four months in the neonatal intensive care unit. During that time, she underwent heart duct surgery, suffered from an infection that put her on the brink of sepsis, and had so many blood tests and needle pricks that she was constantly needing blood transfusions to keep her tiny, 1.5-pound body fighting. "It was then that I realized how important blood donation was," says Brigitte. "All these anonymous donors were keeping my first and only child alive while I stood there helpless. The donors were able to do something that I, as her mother, couldn't even do." Following Caelis' hospitalization, Brigitte noticed an advertisement for the "Pints for Preemies" blood drive challenge. "I felt that this was a very small way we could give back to other babies what our daughter received. I had given blood for the first time maybe 15 years ago, and it didn't go over too well. I remember feeling really faint and sick, partly because of nerves, I imagine. This time I went in to give blood with a lot of joy and peace, even excitement, and it went very well. My husband, unfortunately, wasn't able to donate because he had contracted Malaria in Africa several years before, but once he is able to give again, we are both eager to participate in the blood donation program in hopes of continuing to help many people the way others have helped us." To schedule a blood donation appointment at the Northwest Blood Donor Center or the Hilton Building Blood Donor Center, call the Mayo Clinic Blood Donor Center at <a rel="noopener" href="tel:5072844475" target="_blank" title="Link opens in a new window">507-284-4475</a>. Be sure to watch for more information by visiting the <a rel="noopener" href="https://connect.mayoclinic.org/page/blood-donor-program/" target="_blank" title="Opens in new browser window">Blood Donor Program blog</a>, the <a rel="noopener" href="http://www.mayoclinic.org/donateblood" target="_blank" title="Opens in new browser window">Minnesota Blood Donor Program website</a> or <a rel="noopener" href="https://www.facebook.com/blooddonorcentermc?ref=br_tf" target="_blank" title="Opens in new browser window">Facebook</a> page.Primary Care in Rochester and KassonBlood Donation CaelisPrimary Care in Rochester and KassonOther forms of discipline may be more effective than yelling or spanking. <img src="/-/media/ech-media/images/widgets/kids/ech_bestwaytodiscipline_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=EB41BB492F2E33C7B34EC3F0AF94063E" alt="ECH_BestwaytoDiscipline_widget" width="100" height="65" DisableNVelocity="true" />Struggling to discipline your child? Here's what works4/8/2024 12:00 AM<img src="/-/media/ech-media/images/widgets/kids/ech_bestwaytodiscipline_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=3E54590A43C9983F30D5043D6F870D80" alt="ECH_BestwaytoDiscipline_widget" width="300" height="195" DisableNVelocity="true" />"I was spanked, and I turned out okay." "Spare the rod, spoil the child." "Spanking isn't hitting, and it's not abuse." "It works!" "It's part of our culture." These are just some of the common responses from parents and caregivers in the U.S. — and worldwide — in support of spanking or hitting children as a form of discipline.  These are often disciplines ingrained in families, cultures and religions, not just in the U.S. but worldwide. However, a growing volume of research is showing that spanking or hitting children actually can have the opposite effect parents are trying to achieve. According to research:   <ul style="list-style-type: disc;"> <li style="color: #131313;">Spanking can increase anger and aggression, instead of teaching responsibility for behaviors. </li> <li style="color: #131313;">It can confuse children, especially if you're also teaching them that hitting others isn't right. </li> <li style="color: #131313;">Kids learn that hitting is acceptable. </li> <li style="color: #131313;">Physical punishment can foster depression and anxiety in children and even affect their performance in school. </li> <li style="color: #131313;">Spanking damages the whole parent/child relationship because someone a child loves hurts them. </li> <li style="color: #131313;">Infants don't understand hitting — they expect love and comfort from adults — and it won't change any behavior, but it will scare them. </li> </ul> The <a rel="noopener noreferrer" href="https://www.healthychildren.org/English/news/Pages/AAP-Updates-Corporal-Punishment-Policy.aspx" target="_blank" title="Link opens in a new window">American Academy of Pediatrics</a> (AAP) recommends against using spanking or other physical punishment to discipline children. Through discipline, the goal is to teach children appropriate behavior. As a result, they learn skills to manage emotions, solve problems and interact with others around them. It's up to parents to model these successful behaviors and skills.  Some discipline techniques that are proven to be more effective include:  <ul style="list-style-type: disc;"> <li style="color: #131313;">Redirecting or distracting. This method is particularly effective with young children. For instance, if a child is upset that a sibling took their toy, give them another toy to play with. Redirection/distraction takes some practice to find out what works in different situations. </li> <li style="color: #131313;">Catching them being good. Paying attention to kids is a powerful tool for parents. If you try to catch kids being good, they'll respond by wanting to repeat the good behavior. Give positive praise and do it right away. If you see your child sharing, say, "Oh, I love that you asked your sister nicely for the toy." Sometimes all that's needed is a smile to let them know you've noticed. It's about downplaying the bad behavior and rewarding the good. For a rule of thumb, use a ratio of five positive "catches" to one negative catch. </li> <li style="color: #131313;">Taking a time out. This technique works for both parent and child! Sometimes parents need to step away from the situation with their child. While their child is in a time-out, they can put themselves in one, too. That can mean going to another room or sitting outside. Or, if the parent prefers, they can sit next to their child and say something like, "I need to calm down, too. Let's both take a break." Once everyone is calm, the parent and child can discuss what happened and what would have been a better behavior. This approach makes time-outs effective on two levels: the situation is handled more calmly and parents model self-control for their kids. </li> </ul> Mayo Clinic is currently working on introducing No-Hit-Zones at its clinics and hospitals. These zones are a way to promote calm, safe and caring environments for children where no hitting of any kind is allowed. Learning new discipline techniques takes thought and practice on the part of parents. If you need help, talk about it with your primary care clinician. The AAP also offers tips about <a rel="noopener noreferrer" href="https://www.healthychildren.org/English/family-life/family-dynamics/communication-discipline/Pages/Disciplining-Your-Child.aspx" target="_blank" title="Link opens in a new window">discipline</a> and <a rel="noopener noreferrer" href="https://www.healthychildren.org/English/family-life/family-dynamics/communication-discipline/Pages/Time-Outs-101.aspx" target="_blank" title="Link opens in a new window">giving a time out</a>.  <a rel="noopener noreferrer" href="https://www.mayoclinic.org/biographies/derauf-chris-c-m-d/bio-20055380" target="_blank" title="Link opens in a new window">Chris Derauf, M.D.</a> is a consultant in the Department of Pediatric and Adolescent Medicine at Mayo Clinic. He specializes in pediatric medicine and child abuse and is on the staff of the Mayo Clinic Center for Safe and Healthy Children and Adolescents in Rochester.  <a href="/providers/angela-mattke-md">Angela Mattke, M.D.</a>, is a pediatrician in the Division of Community Pediatric and Adolescent Medicine, which is part of Primary Care in Rochester and Kasson. She also hosts Mayo Clinic's "<a rel="noopener noreferrer" href="https://www.facebook.com/search/top/?q=%40askthemayomom" target="_blank" title="Link opens in a new window">#AskTheMayoMom</a>" interactive Facebook Live show, where she discusses and answers audience questions about common pediatric health topics. You can follow her on Twitter at <a rel="noopener noreferrer" href="https://twitter.com/DrAngelaMattke" target="_blank" title="Link opens in a new window">@DrAngelaMattke</a>. For more information about pediatric health topics, follow <a rel="noopener noreferrer" href="https://twitter.com/search?q=mayoclinickids&src=typd" target="_blank" title="Link opens in a new window">@mayoclinickids</a> on Twitter.Chris Derauf, M.D., and Angela Mattke, M.D.Primary Care in Rochester and KassonChild DisciplinePrimary Care in Rochester and KassonThese tips can help you help those you care about manage medications safely. <img src="/-/media/ech-media/images/widgets/elderly/managingmedications.jpg?h=65&iar=0&w=100&sc_lang=en&hash=73C5BB29A62C47CEEA92BC90FEF151E6" alt="ManagingMedications" width="100" height="65" DisableNVelocity="true" />Managing loved ones medications4/25/2024 12:00 AM<img src="/-/media/ech-media/images/widgets/elderly/managingmedications.jpg?h=205&iar=0&w=315&sc_lang=en&hash=5B5B3075F180B7B64A05E3339BE2CDDC" alt="ManagingMedications" width="315" height="205" DisableNVelocity="true" />It's estimated that in any given year, over 20% of American adults provide care for a family member or friend who has a chronic illness, disability or is elderly. If you find yourself in this position, you are not alone. Many challenges come with caring for a loved one, and managing medications is no small task. Here are several important tips to keep in mind if you find yourself helping to manage a loved one's medications: <ul> <li>Organize medications. A pill box or other organizational system can be an invaluable tool in ensuring the correct administration of medication regimens. Ensure you have an accurate and current medication list when you are filling the organizer. Keeping medications that are used "as needed" in a separate area can be an effective way to ensure medications are not accidentally mixed.</li> <li>Utilize reminders. If medications are dosed multiple times daily, establishing a consistent routine can be key to ensuring medications are taken. Many people like to use alarms to alert them when it's time to take a dose. Another helpful technique is tying medication administration to another activity that is done every day, such as brushing teeth or feeding the cat.</li> <li>Understand the medications. To support your loved one with their medications, it's a great benefit for you to understand what the medications are for. If you are able, go to visits with your loved one and ask questions when needed. Understanding key side effects to monitor for can help keep your loved one safe.</li> <li>Optimize pharmacy services. Many pharmacies offer medication synchronization services which allow all refills to be completed at the same time. This service minimizes the number of trips to the pharmacy and also reduces errors by streamlining the process. Filling prescriptions at just one pharmacy is also helpful to minimize medication errors and drug interactions. Does your pharmacy deliver? If so, it may be a beneficial service for you. </li> </ul> These tips may be helpful, but what do you do if your loved one doesn't want help? For various reasons, there are sometimes barriers to helping someone manage his or her medications. It's important to respect their wishes, but also to emphasize the importance of medication safety. Set them up for success the best you can and provide tools such as pill boxes. Laurel Lake, Pharm.D., R.Ph., is a clinical pharmacist in Primary Care at Mayo Clinic. She received her Doctor of Pharmacy degree from the University of Wyoming School of Pharmacy and completed pharmacy residency training at the Cheyenne Veterans Affairs Medical Center and Mayo Clinic. Her clinical practice interests include diabetes, geriatrics and polypharmacy.Laurel Lake, Pharm.D., R.Ph.Primary Care in Rochester and KassonManaging MedicationsPrimary Care in Rochester and KassonFind out more about Medicaid, who is eligible and how to apply. <img src="/-/media/ech-media/images/widgets/randomimages/medicaid.jpg?h=65&iar=0&w=100&sc_lang=en&hash=ACF9F252A885B6A98C0AD20E38072270" alt="Medicaid" width="100" height="65" DisableNVelocity="true" />Are you eligible for Medicaid?4/18/2024 12:00 AM<img src="/-/media/ech-media/images/widgets/randomimages/medicaid.jpg?h=205&iar=0&w=315&sc_lang=en&hash=C3AE08F4A3CE5F760A0B619C84F7402F" alt="Medicaid" width="315" height="205" DisableNVelocity="true" />What is Medicaid, who is eligible, and how do I apply? These are common questions when someone is struggling with financial means and resources. Medicaid is a state and federal program assisting in covering medical costs for low-income eligible citizens. The federal government has general rules for Medicaid, but each state has its own eligibility guidelines. This means benefits may vary from state to state. If you have Medicaid, you will not pay for any directly covered medical expenses; however, you may have a small co-pay for certain items or services.  In all states, Medicaid may cover some individuals and families, including children, parents, women who are pregnant, elderly people with certain incomes, and people with disabilities. Some states have expanded their Medicaid programs to cover other adults below a certain income level. There are two ways you can apply for Medicaid: <ol> <li>Through the Health Insurance Marketplace. <ul> <li>Visit <a rel="noopener" href="https://www.healthcare.gov/" target="_blank" title="Link opens in a new window">HealthCare.gov</a> to create a Marketplace account and complete an application.</li> <li>Reply "yes" when asked if you'd like to see if you can get help paying for coverage.</li> <li>If the information on your application shows someone in your household might qualify for Medicaid, the Marketplace will forward your application to your state for a final eligibility decision.</li> <li>You can also call the Marketplace Call Center at <a rel="noopener" href="tel:8003182596" target="_blank" title="Link opens in a new window">800-318-2596</a> to apply. TTY users can call <a rel="noopener" href="tel:8558894325" target="_blank" title="Link opens in a new window">855-889-4325</a>.</li> </ul> </li> <li>Through your state. <ul> <li>If you are a Minnesota resident, you can visit: <a rel="noopener" href="https://mn.gov/dhs/health-care-coverage/#healthcarecoverage" target="_blank" title="Link opens in a new window">mn.gov/dhs/health-care-coverage/#healthcarecoverage</a> or call <a rel="noopener" href="tel:8006573672" target="_blank" title="Link opens in a new window">800-657-3672</a>. </li> </ul> </li> </ol> Lacey Pegram-Olson, L.A.D.C., is a Licensed Alcohol and Drug Counselor and Master's Social Work student at Mayo Clinic in Rochester, Minn. She specializes in treating co-occurring disorders including substance dependence. She also does crisis work for Southeast Minnesota and has a history of working with adults who have severe and persistent mental illnesses and adults and adolescents who struggle with addiction and mental illness.Lacey Pegram-Olson, B.A., L.A.D.C.Primary Care in Rochester and KassonMedicaid AwarenessPrimary Care in Rochester and KassonWhile relatively uncommon, it's the most common cancer in males aged 15 to 35. <img src="/-/media/ech-media/images/widgets/people/youngadultmalefemaledoctor.jpg?h=65&iar=0&w=100&sc_lang=en&hash=9A302C23EEEB0BDF4BDBAD552611FF78" alt="YoungAdultMaleFemaleDoctor" width="100" height="65" DisableNVelocity="true" />What you need to know about testicular cancer4/22/2024 12:00 AM<img src="/-/media/ech-media/images/widgets/people/youngadultmalefemaledoctor.jpg?h=205&iar=0&w=315&sc_lang=en&hash=2B3611E1CF41C68F5ECB3401981908C1" alt="YoungAdultMaleFemaleDoctor" width="315" height="205" DisableNVelocity="true" />Testicular cancer is an abnormal growth of tissue in the testicles that can result in a mass or spread to other parts of the body. Although testicular cancer is relatively uncommon, it is one of the most common cancers in males between ages 15 and 35. Early detection is ideal, but even later-stage cancers are highly treatable and even curable. Recognizing symptoms The first sign of testicular cancer often presents as a bump or lump on one of the testicles. Other symptoms may include: <ul> <li>Heaviness in the scrotum.</li> <li>Dull ache in the lower belly or groin.</li> <li>Pain or discomfort in a testicle or the scrotum.</li> <li>Enlargement or tenderness of breast tissue.</li> <li>Back pain. </li> </ul> If you experience any of these symptoms for more than two weeks, consult your healthcare team promptly. Diagnosing testicular cancer The evaluation for testicular cancer starts in the doctor's office with a medical history and physical examination. The process may entail the following: <ul> <li>Physical examination: Your doctor will assess for any abnormalities in the testicles and the abdomen, and check for lymph node enlargement.</li> <li>Ultrasound: The first diagnostic test is usually an ultrasound scan, which is a noninvasive imaging test providing detailed images of the testicles.</li> <li>Blood test: If testicular cancer is suspected, a blood test can provide additional information about the type of cancer.</li> <li>Surgery: In some cases, a biopsy may be performed, but most often when cancer is highly suspected, removal of the affected testicle is recommended to confirm the diagnosis and remove the tumor. </li> </ul> Self-examination and prevention Regular self-examination for the detection of testicular cancer has conflicting evidence. While periodic palpation can lead to earlier detection, studies have shown that the benefits of earlier detection may not warrant making this practice routine. Consider monthly self-examination (carefully palpating both testicles to feel for lumps) if you have any of the following: <ul> <li>Cryptorchidism, which is when one of the testicles does not fully descend into the scrotum during childhood.</li> <li>Family history of testicular cancer.</li> <li>Other testicular abnormalities including atrophy, or shrinkage of a testicle. </li> </ul> Treatment options Treatment for testicular cancer depends on the type and stage of the disease. Common approaches include: <ul> <li>Surgery: Surgical removal of the affected testicle, called orchiectomy, is often the initial step.</li> <li>Chemotherapy: Administered to destroy cancer cells.</li> <li>Radiation therapy: Targeted radiation to eliminate remaining cancer cells.</li> <li>Surveillance: Close monitoring for low-risk cases. </li> </ul> Remember that testicular cancer is highly treatable and often curable, even when it spreads. Consult your healthcare clinician for personalized guidance and support. <a href="/providers/david-brennan-md">David Brennan, M.D.</a>, is a primary care physician in the Division of Community Internal Medicine, Geriatrics and Palliative Care in Rochester, Minnesota. He focuses on prevention and treatment of a wide variety of common diseases.David Brennan, M.D.Primary Care in Rochester and KassonTesticular CancerPrimary Care in Rochester and KassonFind out when to worry about memory issues. <img src="/-/media/ech-media/images/widgets/randomimages/eyeglassesfridge.jpg?h=65&iar=0&w=100&sc_lang=en&hash=9693FF10D6F66EA05B8BC25B5CBC523C" alt="EyeglassesFridge" width="100" height="65" DisableNVelocity="true" />'Where did I put my glasses?'5/16/2024 12:00 AM<img src="/-/media/ech-media/images/widgets/randomimages/eyeglassesfridge.jpg?h=205&iar=0&w=315&sc_lang=en&hash=E1880555C581737F3D41AF268911D7F7" alt="EyeglassesFridge" width="315" height="205" DisableNVelocity="true" />Memory concerns are common as people age. Many people commonly struggle to recall a person's name or find where they put their glasses. It may require more effort to remember things, and people may need to write information down. However, these memory issues should not impair a person's ability to live and function independently. Memory issues that affect people's daily lives are abnormal and could represent an underlying medical problem or developing dementia. When should you be concerned about your memory or the memory of your loved one? Here are a few warning signs <ul> <li>Memory problems in people with certain medical conditions, such as recurrent strokes.</li> <li>Memory problems in people with a strong family history of dementia, such as Alzheimer's Disease.</li> <li>Prominent changes to personality.</li> <li>Difficulty or inability to perform familiar tasks, such as baking an old family recipe.</li> <li>Getting lost in familiar places, especially while driving a car.</li> <li>Not remembering how to drive to a familiar place (church, family member's house, store or doctor's office).</li> <li>Persistent and frequent word substitutions (for example, calling a "dog" a "horse").</li> <li>Persistent and frequent word-finding difficulties (unable to find the right word despite adequate time to do so).</li> <li>Asking recurrent questions about the same topic.</li> <li>Difficulty or inability to balance a checkbook, pay bills or do other complex cognitive tasks that you were previously able to perform. </li> </ul> In addition to dementia, other possible causes for memory problems include untreated or undertreated depression or anxiety, thyroid problems, obstructive sleep apnea, substance use problems (such as alcohol or stimulants), certain vitamin deficiencies and medication side effects, among others. Stressful life circumstances can also worsen memory problems. If there are concerns about your memory, talk to your healthcare clinician for further evaluation. <a href="/providers/melissa-bogin-md">Melissa Bogin, M.D.</a>, is a board-certified Internist and geriatrician-in-training in Community Internal Medicine, Geriatrics and Palliative Care at Mayo Clinic in Rochester. Her clinical interests include caring for older adults in both the outpatient and nursing home settings.Melissa Bogin, M.D.Primary Care in Rochester and KassonMemory ConcernsPrimary Care in Rochester and KassonThese self-help resources may be just what you need if you are struggling<img src="/-/media/ech-media/images/widgets/people/blackwomanstress_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=09D53ECA5562FDF1EF52D1060CFA1FB2" alt="BlackWomanStress_widget" width="100" height="65" DisableNVelocity="true" />Help yourself to mental health resources5/20/2024 12:00 AM<img src="/-/media/ech-media/images/widgets/people/blackwomanstress_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=AED6CD2BD6B169AC926125883AB35EC4" alt="BlackWomanStress_widget" width="300" height="195" DisableNVelocity="true" />Mental health is just like other parts of our health – it's a good idea to be aware of how we are doing, stay engaged with healthy habits and seek additional advice and help if we are struggling. Self-help resources are one of several treatment options available to help support you in your mental health journey. From workbooks, to apps, to websites, there are many ways to learn how to cope with stress, insomnia, anxiety and depression on your own. The benefits of self-help include being flexible — you can use them anytime, anywhere — and cost-effective, as many of these resources are either low-cost or free. The drawbacks of self-help are that they can feel like a "one-way street." The material may not be tailored to your particular situation and they offer limited accountability, so you have to make sure you keep up with using the information and skills you are learning. But how do you choose? There are seemingly endless amounts of self-help materials out there. For example, over 20,000 mental health apps are currently available, yet only a fraction of them have any evidence supporting their effectiveness. Cognitive behavioral therapy (CBT) is a highly effective, skill-building approach that teaches people ways to cope with distressing thoughts, difficult emotions and behavior change. Research has shown that CBT delivered in a self-help format can be very helpful for a wide range of mental health problems. The <a href="/-/media/ech-media/documents/selfhelpresources.pdf?sc_lang=en&hash=69489F94EC57F8285E15A19FD3B6F0DB">attached document</a> shares a number of self-help books, apps, websites and free Mayo-developed online resources that are based on CBT principles for stress, insomnia, anxiety and depression. If you need additional mental health support beyond self-help, we encourage you to talk with your primary care team about other available treatment options. Kyle Schofield, Ph.D. is a clinical health psychology fellow in Primary Care in Rochester and Kasson. Anne Roche, Ph.D., L.P., and <a href="/providers/craig-sawchuk-phdlp">Craig Sawchuk, Ph.D., L.P.</a>, are clinical psychologists in Primary Care in Rochester and Kasson in Integrated Behavioral Health.Kyle Schofield, Ph.D.; Anne Roche, Ph.D., L.P.; Craig Sawchuk, Ph.D., L.P.Primary Care in Rochester and KassonMental Health Self HelpPrimary Care in Rochester and KassonDaily physical activity in childhood is critical for long-term health. <img src="/-/media/ech-media/images/widgets/kids/ech_kidsatplay_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=52CFE3716453DDB63230DAEA16720F3E" alt="ECH_KidsAtPlay_widget" width="100" height="65" DisableNVelocity="true" />Keeping kids active in every season5/13/2024 12:00 AM<img src="/-/media/ech-media/images/widgets/kids/ech_kidsatplay_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=B38C829BC37E116B0FA934C02AADF1A2" alt="ECH_KidsAtPlay_widget" width="300" height="195" DisableNVelocity="true" />Daily physical activity in childhood is critical for long-term heart, bone, muscle, cognitive and mental health. For children less than 5 years of age, getting the daily recommended activity time can be easier given the amount of unstructured time they may have in their day. School-aged children have busier schedules and have a lot more sedentary time. The American Heart Association, World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC) recommend at least 60 minutes of activity per day for children ages 6 to 17. As children get older, this activity goal can become harder with many other competing daily tasks that need to be accomplished. In a global poll of 1.6 million adolescents ages 11 to 17 years, 81% had insufficient physical activity. Overcoming barriers There can be many barriers to participating in physical activity every day. Not every child has access to gyms, sports teams, equipment, safe sidewalks/streets or transportation. There are also seasonal barriers like weather which can be a large deterrent to regular exercise in climates that prevent outdoor activities or summer school breaks where there is less structure for sports teams or gym class. Certain types of physical activity are not always interesting, and children will choose more stimulating sedentary activities such as watching television, playing on tablets or gaming. Below are a few strategies to include a little more physical activity into your family’s everyday life regardless of the time of year. <ul> <li>Make it fun! Find games, activities or tasks at home that can raise the heart rate and not feel like another chore. Children are more likely to continue to exercise regularly when it is enjoyable.</li> <li>Turn the table on tablet time. There is a time and place for tablets, especially as they are becoming a more regular part of learning and school. They can also be used as part of activity with many apps and videos developed specifically for getting kids moving. If there is a game or TV show they enjoy, use commercial time or breaks between episodes to move the body, such as dancing or acting out the favorite part of the episode.</li> <li>Get the whole family involved. Studies show that children who have regular exercise as a family are more likely to continue those habits into adulthood and have improved health outcomes. Scheduling physical activity as a family can also become another opportunity to give autonomy to children and make them feel more empowered. Each family member could pick the activity for a day of the week. Putting activities into a displayed calendar can also help with accountability for the whole family and keep everyone moving.</li> <li>Be creative and unstructured. You don’t have to have a gym membership or go to a local park every day to find activities that raise the heart rate. Each family member could pick their favorite song and make up a dance that everyone has to try and copy. Or play a game of charades that involves mimicking animal movements or sounds. Chores can even be made into a fun activity that raises the heart rate, such as shooting clothes into the washer/laundry baskets like a basketball or having a scavenger hunt with often out-of-place items such as shoes, mail, backpacks or clothes.</li> <li>Break it up. The recommendation for 60 minutes of activity per day is cumulative. If there is no time to do a long activity, even small 10- to 15-minute spurts are still important. This approach can also be helpful for older children to build up endurance for certain activities. It never has to be all or nothing. Any physical activity is better than nothing! Walking pets several times a day, taking out the garbage, carrying loads of laundry up and down stairs — all of these small activities add up to improved overall health.</li> <li>Scope out your surroundings. There are usually many free community parks, trails and outdoor/indoor activities. Adding one of these areas to your week or month can be something fun to look forward to and can encourage diversity in the type of physical activity. </li> </ul> For more information about getting children involved in physical activity, visit the <a rel="noopener" href="https://www.cdc.gov/physicalactivity/index.html" target="_blank" title="Link opens in a new window">CDC</a> or <a rel="noopener" href="https://www.heart.org/en/healthy-living/fitness/fitness-basics/aha-recs-for-physical-activity-in-children#:~:text=Reduce%20or%20limit%20sedentary%20screen,scooters%2C%20jump%20ropes%20and%20balls" target="_blank" title="Link opens in a new window">American Heart Association</a> websites on physical activity. Kara Anderson, M.D., is a resident in Community Pediatric and Adolescent Medicine in Rochester, Minn. Their interests include complex chronic care and palliative care.Kara Anderson, M.D.Primary Care in Rochester and KassonPower of PlayPrimary Care in Rochester and KassonFunctional foods are those that provide benefits beyond basic nutritional needs. <img src="/-/media/ech-media/images/widgets/food/healthyrestaurantmeal.jpg?h=65&iar=0&w=100&sc_lang=en&hash=381D8501A873C555AFD7659C5177E9E4" alt="HealthyRestaurantMeal" width="100" height="65" DisableNVelocity="true" />Finding functional foods on restaurant menus5/2/2024 12:00 AM<img src="/-/media/ech-media/images/widgets/food/healthyrestaurantmeal.jpg?h=205&iar=0&w=315&sc_lang=en&hash=1809ED2F42FBF2CD720158DF4E8A9273" alt="HealthyRestaurantMeal" width="315" height="205" DisableNVelocity="true" />The food industry is filled with health and nutrition claims. Have you ever heard the term “functional food?" When foods provide benefits beyond meeting basic nutritional needs, they may be termed “functional foods.” The concept of functional foods was popularized in Japan in the 1980s to improve quality of life by increasing life expectancy and reducing disease risk. In the United States, health claims on food packaging are regulated by the Food and Drug Administration (FDA). Examples of topics that can be referred to in health claims include the relationship between sodium and hypertension or the association between whole oats and lower heart disease risk. The bottom line is that no single food can cure or prevent diseases alone, but there is research that links food to potential health benefits. Most foods are functional foods are filled with vitamins and minerals that perform specific physiological functions. For instance, vitamin C is abundant in citrus fruits and tomatoes and helps produce collagen in connective tissues. It acts as an antioxidant in the body. In line with consumers’ demand for health-forward choices, trendy functional foods are becoming more prevalent as menu selections. Hand-crafted juice. Juices packed with fruits, vegetables and plants can be found on many café menus. These juices may feature combinations of ingredients such as carrots, apples, pineapple, berries, ginger, beets, limes, spinach, kale, celery, turmeric and more. Ginger and turmeric are thought to provide health benefits through their antioxidant and anti-inflammatory properties, among other benefits. Avocado toast. Avocado toast is on the rise on restaurant menus, especially for breakfast. Avocadoes tout an impressive nutritional profile, providing healthy unsaturated fat and fiber – both soluble and insoluble fiber. Superfood bowls. Acai berries or Greek yogurt can serve as a base to be topped with items such as fresh fruit, dried coconut flakes and chia seeds. Acai berries are known for their antioxidant content. Consumers may choose them in hopes of boosting their immune system or protecting against cancer; however, additional research is needed to support these relationships. Plant-based burgers. When it comes to meat alternatives, the sky's the limit. Veggie burgers can be made with ingredients such as black beans, soy, peas, mushrooms and much more. Choosing plant-based meat can help reduce saturated fat intake, which is associated with heart disease. Plant-based foods can also provide additional fiber, which is thought to support gut health and more favorable cholesterol levels. Salmon. Salmon can complete a perfect poke bowl with rice, vinegar, cucumbers, purple cabbage, avocado, salad greens, edamame, ginger and sriracha sauce. It may also be prepared with lemon dill butter, bourbon sauce or as a sandwich. Regardless of how it is prepared, salmon is a source of omega-3 fatty acids, which may help decrease blood pressure, lower blood triglycerides and help with heart health overall. One might think that functional foods must be sourced from a home garden or specialty health foods store. However, functional foods are everywhere, including on restaurant menus. Chloe Loersch completed her bachelor’s and master’s degrees in dietetics at the University of Wisconsin-Stout. She is currently a dietetic intern at Mayo Clinic in Rochester, MN. She is interested in a career in clinical nutrition.Chloe LoerschPrimary Care in Rochester and KassonRestaurant MenusPrimary Care in Rochester and KassonPractical tips and guidelines to help discuss issues happening in the world. <img src="/-/media/ech-media/images/widgets/kids/scaredchildrennews.jpg?h=65&iar=0&w=100&sc_lang=en&hash=A53832E50D4EED1F3796618A6806BDDC" alt="ScaredChildrenNews" width="100" height="65" DisableNVelocity="true" />How to talk to children about scary things on the news5/6/2024 12:00 AM<img src="/-/media/ech-media/images/widgets/kids/scaredchildrennews.jpg?h=205&iar=0&w=315&sc_lang=en&hash=7ECCB5EB5D4EF746D6F92A96B774BDF4" alt="ScaredChildrenNews" width="315" height="205" DisableNVelocity="true" />Between conflicts overseas, gun violence and natural catastrophes, it's an understatement to say that the news these days can be scary. In addition, media is now streamed to us from many different sources — television, radio, smartphones and even through screens at gas station pumps. It can be overwhelming for even the most well-adjusted adult. Now imagine this stream of information through the eyes of a child. It can be hard to know how to talk to your child about scary news. Here are some practical tips and guidelines to get you started. Children should hear news from you, as opposed to other unfiltered sources. As much as we try to shield our children from scary news, it can be impossible to completely prevent exposure to media today. In addition, if your child is in school, they might hear staff or other children discussing the events. To avoid scary information catching your child off guard, they should hear this information from you, someone they trust and feel safe around. This approach also allows them to ask questions immediately instead of letting their imaginations run wild. Discuss events in honest yet simple terms. First, ask your child what they have already heard. This tactic can be a good way to start a conversation and allows you to correct any misinformation. Be clear about what happened but skip the gory details. Children need to know what and why an event happened — but they don't necessarily need to know the specifics. You can tailor this information based on your child's developmental age. For example, a younger child might not know what a gun is, while a school-aged child might be familiar with guns. To a preschooler, you might say. "A person hurt a lot of people in 'X' place far away." They don't necessarily need to know about the gun. To a school-aged child, you might say, "A person used a gun to hurt people," as they are old enough to hear about a shooting and know what that means. They don't necessarily need to know that an automatic rifle was used. Remind your child that they are safe. Discuss what steps are being taken to rectify the situation and discuss how people are being helped after the catastrophe. Remind them that they are safe at home and consider using this time to create emergency action plans in the event of weather emergencies, fire or if they get separated from you outside or in a store. In addition, practice finding "helpers" when in the community or while out doing chores with your kids. This could mean spotting police officers, firefighters, store clerks or even other families with children. This approach helps children feel empowered during scary events. Be mindful of the media your child is exposed to. The goal of many media outlets is to try to attract more viewers. They often achieve this goal by repeatedly showing the most stark, scary images. Instead of keeping the TV playing in the background, turn the TV off while not actively watching it or watch the news after your child goes to bed. In addition, be mindful of unsupervised screen time on apps such as YouTube. Computer algorithms can lead children to watch more mature content unknowingly. Keep your feelers out for signs of anxiety. Toddlers and young children can absorb more than they initially let on. Unfortunately, most don't yet have the skills to verbalize how they are feeling. Anxiety is thus more likely to manifest as physical symptoms (such as headaches or belly pain), sleep disturbances or irritability and aggression. Talking about feelings, naming feelings, and reminding children that they are safe are the first steps to addressing these big emotions. The American Academy of Pediatrics has created "<a rel="noopener" href="https://www.healthychildren.org/English/family-life/Media/Pages/Talking-To-Children-About-Tragedies-and-Other-News-Events.aspx" target="_blank" title="Link opens in a new window">How to Talk With Kids About Tragedies & Other Traumatic News Events</a>" to help families with these difficult discussions. <a href="/providers/gabriela-kovacikova-md">Ika Kovacikova, M.D.</a>, is a physician in Community Pediatric and Adolescent Medicine in Rochester, Minn. She practices primary pediatric care at Mayo Family Clinic Northeast.Ika Kovacikova, M.D.Primary Care in Rochester and KassonScary NewsPrimary Care in Rochester and KassonSuperfoods grab the headlines, but they're just the start of healthy eating for seniors.<img src="/-/media/ech-media/images/widgets/food/ech_cooking_for_two_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=9CB9474F1F1FDAB5833B71DDD6D519E3" alt="ECH_cooking_for_two_widget" width="100" height="65" DisableNVelocity="true" />Superfoods for seniors: Beyond the 'list'5/23/2024 12:00 AM<img src="/-/media/ech-media/images/widgets/food/ech_cooking_for_two_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=6A47FA178365DA0E22F83B21CD0AB728" alt="ECH_cooking_for_two_widget" width="300" height="195" DisableNVelocity="true" />Blueberries! Acai berries! Salmon! They grab the headlines for being "superfoods" that will prolong life and fend off disease, along with a host of ailments associated with aging. What makes them "super" is that they're usually packed with nutrients. Take blueberries. They're pretty tasty, make a great pie and are full of antioxidants, potassium and vitamin C, which can help reduce the risk of heart disease and inflammation. That does make them pretty super. But blueberries, along with others on the superfoods top 10 list, aren't the only foods that are super for seniors. While they get all the hype, almost all other fruits, vegetables, lean meats, fish, eggs, dried beans and peas, whole grains and dairy products are just as beneficial. Research doesn't show any evidence that eating more of a certain food will make you healthier and doing so may keep you from getting the other nutrients you need. Food, not supplements or vitamins, is the best way to get the nutrients you need as you age. Super eating for seniors means choosing a wide variety of foods, especially whole foods like fresh or frozen fruits and veggies, fresh or frozen cuts of meat or fish and dairy products. Your plate should look like a rainbow — full of life and color. Here's a handy guide for what should be on your plate: <ul> <li>One-half: Fruits and vegetables. Whether they made the superfood list or not, all fruits and vegetables help lower your risk of death, heart attack, stroke and some cancers. They also provide natural fiber, which is good for digestion. Put them on your plate at every meal.</li> <li>One-quarter: Grains. This category includes whole-wheat pasta, 100% whole-grain bread, brown rice and steel-cut oats. Grains not only help prevent diabetes, but if you have it, they can help control your blood sugar.</li> <li>One-quarter: A source of protein, which could be lean meat, fish, eggs or tofu. These are easy sources of high-quality protein that you still need for building muscle and a variety of body-maintenance functions.</li> <li>On the side: Water. As we age, we lose our sense of thirst. And water is a simple way to provide the fluid our bodies need for everything from blood pressure to keeping mentally sharp. Tip: Instead of a glass, fill a bottle with water so you can keep track of how much you're drinking. A couple of sips aren't enough! </li> </ul> About dairy and nondairy substitutes (soy, almond and other "milks"): Your body still needs 1,200 mg of calcium a day, along with vitamin D, to build and strengthen bones and prevent osteoporosis, especially in women. <ul> <li>Healthy eating is doable, no matter your age. These tips can help you make it happen:</li> <li>Shop along the perimeter of your grocery store — not down the aisles — for most whole foods.</li> <li>Choose fresh fruits and veggies. If this isn't an option, go for frozen. They're flash-frozen, preserving the flavor and texture without added sodium or other preserving agents.</li> <li>Visit a farmers' market with family or friends. Not only will you have an excellent selection to choose from, but it's also a fun outing.</li> <li>Keep a bowl of fresh fruit for snacking on the table as a reminder. Fruit in the fridge might not get eaten.</li> <li>Use herbs, spices and other seasonings (not just salt!) to boost the flavor and aroma of foods to make them more appealing as our sense of taste dulls.</li> <li>Cook fruits and veggies a bit to make them softer and easier to chew and swallow. Bananas, grapes, berries, pears, tomatoes and dark leafy greens are just a few choices that can be eaten raw without the chewing challenge.</li> <li>Try smoothies. With a blender, veggies or fruits, milk and ice, you've got an easy breakfast or snack.</li> <li>White bread and rice will never be super. Go for the whole grain. </li> </ul> Is there room for treats and sweets? If you're generally in good health, you can say "yes" to occasional treats without feeling guilty. They will make your taste buds happy and add pleasure to your day. Healthy eating of a wide variety of foods is one key to being a super senior. Enjoy! <a href="/providers/maria-mendoza-delagarza-md">Maria Mendoza De la Garza, M.D.</a>, is a geriatrician in Community Internal Medicine, Geriatrics and Palliative Care. She practices across the community in clinics, skilled nursing facilities and home-care-based settings.Maria Mendoza De la Garza, M.D.Primary Care in Rochester and KassonSenior SuperfoodsPrimary Care in Rochester and KassonHelp your teen deal with this normal development to adulthood. <img src="/-/media/ech-media/images/widgets/teens/stressedteen.jpg?h=65&iar=0&w=100&sc_lang=en&hash=6DA5EF25A31A65D7782FC711C06CB316" alt="StressedTeen" width="100" height="65" DisableNVelocity="true" />Teenager emotions: What's normal? What's not?5/9/2024 12:00 AM<img src="/-/media/ech-media/images/widgets/teens/stressedteen.jpg?h=205&iar=0&w=315&sc_lang=en&hash=824E93DAF28CA43E1A47F35C0C536381" alt="StressedTeen" width="315" height="205" DisableNVelocity="true" />The teenage years are full of emotional ups and downs. This time is crucial as your teen becomes more aware of their emotions as well as the emotions of others. These emotional ups and downs are a developmental task of identity formation for teens through developing self-concept and understanding how they relate to the world around them. Teens do this through asserting independence, working towards a sense of competency and establishing social relationships. All of these tasks involve many feelings, ranging from disappointment to pride. Emotions are not inherently problematic, and even negative emotions serve a purpose. Anxiety can be helpful when preparing for a test or performance. Anger can motivate us to reach our goals. Showing emotional regulation involves identifying our own emotions and then learning how to express them most appropriately to get our needs met. We all experience times of emotional dysregulation in which we don't positively express our emotions. Forgiveness and understanding are key. This just happens WAY more often in teenagers. Teens display outbursts of anger, tears, withdrawal, irritability and hostility — sometimes daily. During adolescence, emotions rule our lives. This behavior is consistent with brain development science. Most of a teen's response to the world is driven by emotion, not reason. The prefrontal cortex is what helps adults use logic and problem-solving, but this area of the brain still has a lot of developing to do in teenagers. As much as you want to save them from emotional turmoil and distress, it is inherently a part of their development into adults. But you can create an environment where it's safe to express their wide range of emotions. It's normal to want to tell them the right way to feel and impose our logic, but it ends up being dismissive. Tips to help your teen Teens benefit most from being shown empathy, compassion and validation. They need to hear from the adults in their lives that life is hard and that their feelings are real and valid given the situation. They do not want to hear what you think they should do differently. They are striving to be understood. Another strategy that can be helpful is approaching the situation with curiosity — in a nonjudgmental manner — once the intensity has decreased. Ask your teenager what they were feeling and if they know why. Wonder out loud with them. What made it get better or worse? The question many ask is, "How do we know when this is more than normal teenage angst?" Watch for how your teenager is functioning. Are they eating? Sleeping? Connecting with friends? Going to school? If they are no longer acting like you would expect or difficult emotions are lasting days or weeks, it may be time to get help. If you have concerns that your child may be suffering from a mood disorder, their primary care clinician is a great place to start. <a href="/providers/hannah-mulholland-licswmsw">Hannah Mulholland, L.I.C.S.W., M.S.W.</a>, is a clinical social worker serving children and adolescents in Primary Care in Rochester and Kasson's Division of Integrated Behavioral Medicine.Hannah Mulholland, L.IC.S.W., M.S.W.Primary Care in Rochester and KassonTeen EmotionsPrimary Care in Rochester and KassonUnderstanding HIV screening guidelines, high-risk groups, and legal considerations in Minnesota is crucial.<img src="/-/media/ech-media/images/widgets/teens/groupteens.jpg?h=65&iar=0&w=100&sc_lang=en&hash=B2DE9E85D4D0F7A7825181612418E8C8" alt="GroupTeens" width="100" height="65" DisableNVelocity="true" />Routine HIV screening for adolescents6/13/2024 12:00 AM<img src="/-/media/ech-media/images/widgets/teens/groupteens.jpg?h=205&iar=0&w=315&sc_lang=en&hash=C59EEEDAFE29AC7148B1DE0F0CB88B8D" alt="GroupTeens" width="315" height="205" DisableNVelocity="true" />Although there has been much progress over the past few decades to combat the human immunodeficiency virus, or HIV, epidemic, there continue to be more than 30,000 new HIV diagnoses in the United States annually. People aged 13 to 24 make up almost 20% of the new diagnoses. Unfortunately, adolescents often do not believe they are at risk for HIV infection. A recent survey of high school students found that only 13% reported ever having been tested for HIV. It is also estimated that HIV is undiagnosed in 45% of 13- to 24-year-old patients. Who should be screened for HIV? The American Academy of Pediatrics (AAP) currently recommends that routine HIV screening should be done at least once for all youth 15 years or older. Who is at higher risk and may need to be screened more frequently? Higher-risk individuals who may need more frequent screening include men who have sex with men (MSM), transgender individuals, and active injection drug users. What are the consent/confidentiality laws in Minnesota? Parental consent for sexual and reproductive health is a barrier to seeking and obtaining care. In the state of Minnesota, minors (under the age of 18 years) may consent to the testing and treatment of sexually transmitted infections including HIV without parental consent. What is PrEP? Those who are at higher risk should consider asking their physician about HIV preexposure prophylaxis (PrEP), which are antiretroviral medications that are either taken orally daily or injections every couple of months. HIV PrEP is effective in preventing HIV when used as part of a comprehensive prevention strategy that also includes adherence to daily administration and safe sex practices (such as barrier protection). Benjamin Hamel, M.D., is a resident in the Department of Pediatric and Adolescent Medicine at Mayo Clinic in Rochester, Minnesota. He earned his medical degree at the Medical College of Wisconsin in Milwaukee, Wisconsin. He will be continuing his education with an allergy/immunology fellowship at the University of Pittsburgh Medical Center starting in July 2024. Some of his interests include food allergies, immunological diseases, evidence-based medicine and care of LGBTQIA+ patients.Ben Hamel, M.D.Primary Care in Rochester and KassonAdolescent HIVPrimary Care in Rochester and KassonWhile common, ankle sprains can lead to chronic issues if not treated properly. <img src="/-/media/ech-media/images/widgets/activities/sprainedankle.jpg?h=65&iar=0&w=100&sc_lang=en&hash=A1D3CDDA4E6A58CDF573A9ED096C0DC1" alt="SprainedAnkle" width="100" height="65" DisableNVelocity="true" />Sprained your ankle? Now what6/24/2024 12:00 AM<img src="/-/media/ech-media/images/widgets/activities/sprainedankle.jpg?h=205&iar=0&w=315&sc_lang=en&hash=533A6A3CA300772528072290C098FDC2" alt="SprainedAnkle" width="315" height="205" DisableNVelocity="true" />As the weather gets nicer, summer activities (sand volleyball, hiking and outdoor activities) are ramping up. So can ankle sprains. An ankle sprain can happen any time the ligaments supporting the ankle are stretched or torn. This most often occurs when you "roll" your ankle and your foot turns inward (inversion injury). This results in injury to one or more of the ligaments on the outside part of your ankle. This is one of the most common injuries among athletes but can happen to anyone — even with a misstep. After this type of injury it's common to notice swelling, bruising, tenderness to touch or a feeling of instability of the ankle (like the ankle will give out).  When should I be seen? You should seek professional care if you notice any of the following after the injury: <ul style="list-style-type: disc;"> <li>Unable to bear weight on the ankle.</li> <li>Deformity in how your ankle looks. </li> <li>Heard or felt a crack or pop during the injury. </li> <li>Notice a loss of sensation in your foot. </li> <li>Unable to move your foot in certain directions.</li> </ul> Management after an ankle sprain Initial management includes RICE. <ul style="list-style-type: disc;"> <li style="color: #131313; line-height: normal;">Rest: Minimize walking and do not return to the activity that caused the injury. </li> <li style="color: #131313; line-height: normal;">Ice: Apply ice to the area, typically for 20 to 30 minutes, three or four times daily  Do not apply ice directly to your skin.   </li> <li style="color: #131313; line-height: normal;">Compression: A compression sleeve, wrap or brace can help reduce swelling and support the injured ankle. </li> <li style="color: #131313; line-height: normal;">Elevation: Elevate the extremity at or above the heart level as often as possible for the first 1-2 days to reduce pain and swelling.  </li> </ul> Additionally, you may use over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, naproxen or aspirin — if you can safely take them — to help reduce swelling and control pain.  After the initial management — and depending on the severity of your symptoms — beginning early pain-free motion (such as drawing each letter of the alphabet with your foot), gradual strengthening exercises and proprioception (balance) training is important to regain normal function to return to desired activities. Generally, discontinue an exercise if it causes pain while doing the activity. This return to motion, strength and balance can often be facilitated in physical therapy. It's important to note, you may progress through these exercises in a couple of weeks with mild sprains but may take 6 to 12 weeks with more severe sprains. After an ankle sprain, you are more likely to have repeat sprains in the future. Using an ankle sleeve or brace can add support and stability. The most important part of your recovery is to complete your rehabilitation to normalize motion, strength and balance. Incomplete rehabilitation is a common cause of continued ankle instability. While common, if not treated appropriately ankle sprains can lead to chronic issues, such as ankle instability and degenerative arthritis. It's also possible a more severe injury has occurred to a tendon, cartilage (smooth lining of the joint) or even a fracture. If you do not see improvement after the first week of initial treatment, consider following up with a healthcare professional, such as your primary care clinician, sports medicine/orthopedic specialist or physical therapist.  If you experienced a more significant injury and saw a healthcare professional, you may experience a longer recovery with additional treatments that might include: <ul style="list-style-type: disc;"> <li style="color: #131313; line-height: normal;">A period of immobilization in a boot, splint or cast. </li> <li style="color: #131313; line-height: normal;">Protected weight-bearing in a boot or using a gait aid such as crutches.</li> <li style="color: #131313; line-height: normal;">Physical therapy to increase stability, strength and balance. </li> <li style="color: #131313; line-height: normal;">Surgery.  </li> </ul> If your health care professional suspects a more significant injury or there is a lack of improvement with treatment, you will undergo X-rays and possibly an advanced imaging study (MRI) to determine the extent of the injury.    You may be referred to meet with a surgeon or a surgical podiatrist if:  <ul style="list-style-type: disc;"> <li style="color: #131313; line-height: normal;">You fail to improve with the non-operative treatments.</li> <li style="color: #131313; line-height: normal;">You demonstrate continued ankle instability.</li> <li style="color: #131313; line-height: normal;">You have an associated injury, such as a fracture, damage to the ankle cartilage or a torn tendon.</li> </ul> While ankle sprains are common, proper treatment is important to regain your function and reduce future instability.  Ryan Yennie, P.A.-C., is a certified physician assistant in the Department of Orthopedic Surgery and Director of Advanced Practice Providers. He practices in the adult Integrated Community Specialties — Musculoskeletal Division at Mayo Clinic in Rochester, where he helps patients with hip, knee, shoulder, foot and ankle orthopedic conditions.Ryan Yennie, P.A.-C.Primary Care in Rochester and KassonAnkle Sprain 2024Primary Care in Rochester and KassonBeing stable on your feet boosts your longer-term health.<img src="/-/media/ech-media/images/widgets/activities/ech_balancetraining_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=0323CB0757FFB8643D02163018EC635A" alt="ECH_BalanceTraining_widget" width="100" height="65" DisableNVelocity="true" />Add balance to your life6/17/2024 12:00 AM<img src="/-/media/ech-media/images/widgets/activities/ech_balancetraining_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=0DD16E075A1A52BF9C8B2B710F660822" alt="ECH_BalanceTraining_widget" width="300" height="195" DisableNVelocity="true" />Balance is the ability to stay upright and steady, whether you're standing, kneeling, sitting or squatting. Balance is very complex and several systems in your body contribute to maintaining good balance — including vision, inner ear and joint receptors that provide a sense of where your body is in space. Falls are a leading cause of injury among older adults. Fear of falling is also common, but building balance skills at any age can reduce fall risk. Work balance training into your workout Balance training is an essential aspect of any well-rounded fitness routine. It improves your body's ability to react quickly to everyday missteps. Incorporating balance training in your life can significantly reduce the risk of falls, help maintain independence and may significantly improve performance. Depending on your exercise routine, it can often be skipped or forgotten. The great news is that with a few simple exercises, balance training can easily be incorporated into your cardiovascular and resistance training sessions. Exercises such as step-ups, lunge clocks, side stepping and single-leg deadlifts all challenge your balance while building strength. Try a trail run, jumping rope or side-to-side jumps to work on balance during a cardio session. Just getting started? Try these tips Balance training outside your regular workouts can be easy and fun. Aim to incorporate balance exercises tailored to your skill level into your daily activities for at least a few minutes each day. Remember safety first, you should be challenged, but not to the point that it's difficult to perform the exercises safely. You may want to start your balance exercises with a partner or by using a counter or chair back for extra security. When getting started, give these tips a try: Change your base of support Start by standing with your feet close together and walk by putting one foot directly in front of the other, working your way up to balancing on one leg. <ul> <li>Pretend you're on a balance beam. This will require you to stand with your feet closer together and to walk by putting one foot directly in front of the other.</li> <li>Pretend you're a flamingo. This will help you practice balancing on one foot and can be done while making dinner, watching the news or waiting for your coffee to brew.</li> </ul> Change the surface While many of us are used to standing on flat ground, part of balance training is learning to stand on uneven surfaces, try doing your exercises on different surfaces including: <ul> <li>Pillows.</li> <li>Mats.</li> <li>Foam pads or disks.</li> <li>Balance balls flat-side down (more stable) or up (less stable) </li> </ul> Try standing with your feet close together or on one leg if you're able. You also can look for variable terrain to walk on, such as a hiking trail or sandy beach. Standing on a floating dock or bridge can be a fun challenge. Close your eyes Closing your eyes while balancing can be tricky, but it's a good exercise to work up to. Try closing your eyes while standing with your feet together, pretending to walk on a balance beam, balancing on one leg or walking on a varying surface. You may need to rely on a partner for support. Turn your head or look up and down While engaging in the foot and leg positions previously described, turn your head or look up and down. You also can try this while balancing on an unstable surface. If you feel up to the challenge, try both at the same time while closing your eyes. Add movement elsewhere While standing on one leg, put your arms out in a "T" position. Make circular motions for 30 seconds, and then try it in the opposite direction. Work your way up to increase your time. Try simultaneously turning your head side to side once this becomes easy. More tips for preventing falls Balance training is an excellent way to stay steady, upright and avoid falls. Some other tips for preventing falls include: <ul> <li>Keep moving. Physical activity can go a long way toward fall prevention. Consider activities such as walking, water workouts or tai chi.</li> <li>Wear sensible shoes. Consider changing your footwear as part of your fall prevention plan. High heels, floppy slippers and shoes with slick soles can make you slip, stumble and fall. So can walking in your stocking feet. Instead, wear properly fitting, sturdy shoes with nonskid soles.</li> <li>Take a look around your home. Remove throw rugs and electrical or phone cords from walkways. Move furniture that narrows walking paths to eliminate tripping hazards. Consider a nonslip mat in your bathtub or shower.</li> <li>Keep your home brightly lit to avoid tripping on hard-to-see objects. Place a night light in your bedroom, bathroom and hallways.</li> <li>Try a balance class. Classes designed to challenge and enhance your balance include tai chi, Pilates or yoga. Balance classes are offered at some facilities.</li> </ul> Danielle Johnson, MPT, is a wellness physical therapist at the Mayo Clinic Healthy Living Program in Rochester, Minnesota. She specializes in combining physical therapy with whole-body wellness and integrating fundamental and natural movement patterns, as well as practical and playful movement, into daily experiences.Danielle Johnson, MPTPrimary Care in Rochester and KassonBalance Training 2024Primary Care in Rochester and KassonEveryone's bowel habits are different, but if you experience persistent changes to your 'norm,' it's time to contact your clinician.<img src="/-/media/ech-media/images/widgets/elderly/elderlymanbed.jpg?h=65&iar=0&w=100&sc_lang=en&hash=39849B2C83675215D37C68E6DDAED456" alt="ElderlyManBed" width="100" height="65" DisableNVelocity="true" />Bowel habits as you age6/6/2024 12:00 AM<img src="/-/media/ech-media/images/widgets/elderly/elderlymanbed.jpg?h=205&iar=0&w=315&sc_lang=en&hash=F6A13FBE69632FE92CC8E3A072DFAFD0" alt="ElderlyManBed" width="315" height="205" DisableNVelocity="true" />Bowel habits vary from person to person, but everyone has their own “normal,” including time of day and frequency of evacuation. Some people may have bowel movements three times per day, while for others, it may be three times per week. Each person may also experience day-to-day changes in consistency and frequency based on their diet, hydration status, activity level, hormones and age. Generally, individuals should have bowel movements regularly, without pain, discomfort or bleeding. It's important to know what's normal for you! Often the terms 'diarrhea' and 'constipation' are mistaken for soft or hard stools. It's important to know the difference so that you become aware of abnormal changes in your habits and discuss these with your clinician. Occasional episodes of diarrhea or constipation may be within an individual's pattern of normal, but persistent symptoms should be addressed with your clinician. Diarrhea By definition, diarrhea is the passage of three or more loose, watery stools per day. Individuals may have looser stools, but passing formed stools multiple times per day is not considered diarrhea. Diarrhea can be caused by many factors, including infection, inflammation, diet changes, food intolerances, irritable bowel syndrome, antibiotic use — and much more. Constipation Constipation is defined as having less than three bowel movements per week. These stools are often hard and difficult to pass. Constipation may be caused by inadequate hydration, changes in diet, certain medical conditions — and much more. What happens as we age? As individuals get older, constipation may become more common. This occurs due to several reasons — decreased activity, inadequate fiber and fluid intake, decreased muscle tone in the abdomen and pelvic floor, slowed transit through the gut, certain medications and medical conditions. Treatment options <ul> <li>Eat regularly scheduled meals rich in fiber — such as whole grains, fruits and vegetables.</li> <li>Drink eight to ten (8-ounce) non-caffeinated beverages per day.</li> <li>Exercise regularly, as you are able.</li> <li>Start a fiber supplement, such as Metamucil or Citrucel. If adding a fiber supplement does not help, you may consider starting MiraLAX or Milk of Magnesia once daily.</li> <li>Consistency is key! Treatment should be part of your daily routine. </li> </ul> When to see your clinician Treatments mentioned above do not help or they make your symptoms worse. <ul> <li>Blood in your stool or on the toilet paper when you wipe.</li> <li>Black, tarry-colored stools.</li> <li>Weight loss, fevers, chills, abdominal pain.</li> <li> Persistent change in your normal bowel habits for two or more weeks, such as "pencil-thin" stools or new onset constipation or diarrhea.</li> </ul> <a href="/providers/laura-kek-mdms">Laura Kek, M.D., M.S.</a>, is a resident physician at Mayo Clinic in Rochester, Minnesota. She earned her medical degree and Master of Biomedical Sciences at Rosalind Franklin University of Medicine and Science in North Chicago, Illinois. She is interested in gastrointestinal health and patient education.Laura Kek, M.D., M.S.Primary Care in Rochester and KassonBowel Habits AgingPrimary Care in Rochester and KassonWhen it comes to kids and water, grown-ups have lots of questions. Here are the answers to a few. <img src="/-/media/ech-media/images/widgets/kids/ech_summersafety_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=A84AACF3A54888B9E2E94FE49A9D4BB5" alt="ECH_summersafety_widget" width="100" height="65" DisableNVelocity="true" />'Is it safe to drink pool water?' FAQs about kids and water6/20/2024 12:00 AM<img src="/-/media/ech-media/images/widgets/kids/ech_summersafety_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=9A58B1249E513297751B3F0B6D97064C" alt="ECH_summersafety_widget" width="300" height="195" DisableNVelocity="true" />When it comes to kids and water, grown-ups have lots of questions. The answers can give you peace of mind and let your kids splish and splash safely all summer long. Can babies or toddlers wear diapers in the water? Swim diapers and swim pants are water-repellent and fit snugly around a child's thighs and waist, but they're not waterproof. If your child has a bowel movement in the water, fecal material might escape the diaper. A dirty diaper may contain diarrhea-causing germs, including the parasite cryptosporidium, which can contaminate pool water or other swimming areas. In healthy people, a cryptosporidium infection is less concerning but may cause diarrhea. The consequences can be more severe for the elderly and people with a chronic condition or weak immune system. Urine in the water is less risky than feces, but it's difficult to separate the two when children wear diapers. If you allow your child to swim in a diaper, take bathroom breaks to use the toilet or change the diaper. If your child has diarrhea, keep them out of the water. Is it risky for children to swallow pool water? Your child is bound to gulp pool water, especially when first learning to swim. Swallowing pool water typically isn’t a cause for concern, but too much can lead to illness. Encourage your child to spit out any water that gets in their mouth. If my child has a splint, brace or cast, can they go swimming? It depends: <ul> <li> Most casts are made of fiberglass. Some are made of plaster. The majority of casts should not be used in the water unless your medical clinician specifically tells you that your cast is waterproof. </li> <li>Certain braces or splints are waterproof, but this should also be cleared by your medical clinician. </li> <li> Pediatric Primary Care Sports Medicine does have some offerings for waterproof devices.</li> </ul> If you have your clinician's go-ahead to get your cast, brace or splint wet, after swimming, thoroughly rinse the inside of the cast with clean water and allow it to air dry. Can children be in the water if they have ear tubes? If your child has ear tubes — tiny cylinders placed through the eardrum to drain fluid and allow air into the middle ear — ask their clinician about ear protection and if it’s okay for your little fish to go in the water. Many times, kids can swim in pools without ear plugs or other ear protection, but regular use might be needed when they dive or swim in untreated water, such as lakes and rivers. What's the best way to prevent swimmer's ear? Swimmer's ear is an infection that's often treated with prescription eardrops. To prevent this painful condition: <ul> <li> Keep ears dry. Encourage your child to wear earplugs while swimming. After being in the water, dry their ears by gently wiping the outer ears with a soft towel or using a hair dryer. Put the hair dryer on the lowest setting and hold it at least a foot away from the ear. </li> <li>Avoid using cotton swabs. Don't use cotton swabs in your child's ears, these can pack material deeper into the ear canal and irritate or break the thin skin inside the ear. </li> </ul> What about red eyes after swimming? Exposure to chlorine used to treat pool water might leave your child with red eyes. To ease discomfort and reduce redness, rinse your child's eyes with a sterile eyewash or an artificial tears solution. To prevent red or puffy eyes, encourage your child to wear goggles while in the water. What's the best age to begin swimming lessons? Swimming lessons can be beneficial for children. The American Academy of Pediatrics supports swimming lessons for most children ages four and older. Lessons can be considered for children ages one to four but should be based on how frequently your child is exposed to water and the program. New evidence shows that children in this age group may be less likely to drown if they have formal swimming instruction. Can children swim when they're sick or have cuts and scrapes? It's fine for children who have colds or other minor illnesses to swim if they feel well enough. It’s also okay for them to swim with cuts and scrapes if the wounds aren't bleeding. Is it okay to swim right after eating? Waiting an hour to go in the water after eating to prevent stomach cramps and drowning is an old summertime myth. It’s okay for kids to swim right after a light meal or snack. But if they feel full or sleepy, encourage them to take a break before swimming. Are hot tubs safe for kids? Young children can quickly become overheated in a hot tub or spa. Although these pools are often shallower, there’s also a risk of drowning. The Centers for Disease Control (CDC) recommends no child five years old or younger be allowed to use a hot tub or spa. If you let your older child into a hot tub or spa, be sure to supervise them, keep their time in the water short and don’t allow them to use the spa for swimming. <a href="/providers/david-soma-md">David Soma, M.D.</a>, is a pediatrician in Community Pediatric and Adolescent Medicine in Rochester, Minnesota. He serves as the volunteer team physician for the Mayo High School football team and provides education and guidance on medical issues for the Rochester Youth Football Association (RYFA). David Soma, M.D.Primary Care in Rochester and KassonKids Water SafetyPrimary Care in Rochester and KassonTips to help your infant learn to sleep on their own.<img src="/-/media/ech-media/images/widgets/people/postpartumdepression.jpg?h=65&iar=0&w=100&sc_lang=en&hash=FF089B77DCC63A75CE3A9F204FFB098B" alt="PostpartumDepression" width="100" height="65" DisableNVelocity="true" />Taking back the bedroom6/27/2024 12:00 AM<img src="/-/media/ech-media/images/widgets/people/postpartumdepression.jpg?h=205&iar=0&w=315&sc_lang=en&hash=70DADA0C68543B2FC5AC2813084D7649" alt="PostpartumDepression" width="315" height="205" DisableNVelocity="true" />It's common for infants to have nighttime awakenings (also known as nocturnal wakefulness) during infancy. This is your baby's way of telling you that they need comfort — they are hungry, experiencing gas pains, need a diaper change, are feeling ill or want to be held. During the first few months of life, a baby doesn't have "homeostatic pressure," which is the drive to sleep that most people have. At this early age, no circadian rhythm is established and your baby has metabolic needs which are crucial for organs to develop and grow. Circadian rhythm utilizes environmental cues, such as the presence of light or dark, and even physical and mental cues to conserve energy. The circadian rhythm becomes stabilized around 3 to 6 months of age. Once this occurs, nighttime awakening will decrease. Your baby's growth has also established that they can maintain body temperature and energy without needing frequent feeding. Once your child can start maintaining nighttime sleep (around 4 to 6 months), they can move to their crib, in a separate room. Isn't sleeping on their own risky? Once your baby starts sleeping on their own, they still require supervision and "safe sleep" practices to reduce the risk of Sudden Infant Death Syndrome (SIDS). Safe sleep entails: <ul style="list-style-type: disc;"> <li>Lay your baby on their back on a flat, firm surface.</li> <li>Do not elevate the head of the bed, as this can cause the child to slouch down. Studies have shown that elevating the head of the bed has no decrease in the number of reflux events.</li> <li>Remove stuffed animals and loose blankets from the crib.</li> <li>Eliminate tobacco and vaping smoke. If you choose to smoke, do so outside and wear a "smoker's jacket" that can be removed and left outside the home. The best way to minimize second and third-hand smoke is to stop smoking completely.</li> <li>Install smoke and carbon monoxide detectors. They are not the same device, so having both types and keeping them in working order is important. Carbon monoxide is an odorless gas and cannot be detected by smell alone. Use your baby's birthday as a date reminder to check every detector in the house to ensure they are in working order.</li> <li>Do not "co-sleep" or sleep in the same bed together. This carries the risk of accidentally rolling onto your baby.</li> </ul> But my baby still wakes up at night. From about 6 months, as many as 16% to 21% of infants still experience nighttime awakenings. Both the parent and baby need to have a good night's sleep. Help your child learn to soothe themself. Sometimes, the constant response to a crying child can promote wakefulness. It's normal for you to want to comfort your child, but learning to soothe themselves results in more restful sleep for you and your baby. There are many ways to help build an infant's sleep endurance. No single method is right or wrong. The key is to implement a consistent routine and use a strategy that fits your parenting methods and environment. The Ferber Method utilizes gradual timing before a parental response occurs to the infant's cry. What is a good bedtime routine? The most important thing is to establish a familiar routine. <ul> <li>Set a bedtime to help promote a biological clock.</li> <li>Ensure they have a clean diaper and sleeping clothes before starting the process.</li> <li>Shut off most if not all lights to mimic how they will sleep in darkness.</li> <li>Offer a feed before bedtime so they go to sleep on a full stomach.</li> <li>Utilize a sound machine for calming noises. Some have projectors that are not light-disruptive.</li> <li>Read a short story. Reading to your child every day is important for speech and language development. Infants respond well to their parents' voices.</li> <li>Rock together.</li> <li>Transition the bottle to a pacifier if needed.</li> <li>Minimize distractors in the room. Remove pets and other children from the room if possible.</li> <li>Promote a quiet environment.</li> </ul> Tell me more about the Ferber Method Each night when the baby cries you will perform what is called a "check-in." Your baby should undergo a specific amount of time before you respond. You can utilize a phone timer if needed. It's normal for a child to wake up and "stir" or make babbling noises. This is a form of self-soothing. Only start the timer for crying that does not stop. A "check-in" consists of entering the room to briefly comfort them. Use a calming voice or soft shushing sounds, combined with patting your child or rubbing their belly. You can turn on the light to have them see that a parent is present. You can also replace the pacifier if it has fallen out. This should only last a couple of minutes. What you should not do is pick up or feed the child. Then shut off the light, exit the room, and repeat the process as needed, adding a longer time to respond. The response length should increase by a couple of minutes per day. The hopeful outcome is that your child will then be able to either continue to sleep through the night or self-soothe on their own without parental intervention. Ferber Method daily schedule: <ul style="margin-top: 0in; list-style-type: disc;"> <li>Day 1: First check-in at three minutes; second check-in five minutes later; third check-in 10 minutes later; subsequent check-ins at 10-minute increments. </li> <li>Day 2: First check-in at five minutes; second check-in 10 minutes later; third check-in 12 minutes later; subsequent check-ins at 12-minute increments. </li> <li>Day 3: First check-in at 10 minutes; second check-in 12 minutes later; third check-in 15 minutes later; subsequent check-ins at 15-minute increments. </li> <li>Continue increasing the check-in delay by a couple of minutes each day. </li> </ul> A child typically has a "honeymoon" phase where the first few nights go well and then they regress to old habits and it's perfectly normal for this to happen. If you feel this method is not working, it's okay to stop and try again in 1 to 2 weeks or to try something different. This is not a "one-size-fits-all" model. It's also important to recognize that this process can feel stressful. It's a normal response to want to instantly comfort your child. Take turns with your partner to reduce this burden. Find more information about sleep methods Craig Canapari, M.D., is a pediatric sleep physician and father who shares resources and advice on childhood sleep and sleep training <a rel="noopener" href="https://drcraigcanapari.com/" target="_blank" title="Link opens in a new window">on his website</a>. Joe Novak, M.D., is a resident in his third and final year at Mayo Clinic in Rochester, Minnesota. He loves spending time with his wife and his infant son, and enjoys collecting antique comic books, working on vintage cars, basketball, and is an avid movie-goer. He will be working in full-scope primary care pediatrics in Wisconsin this coming year.Joe Novak, M.D.Primary Care in Rochester and KassonSleep TrainingPrimary Care in Rochester and KassonLearn more about 'ultra-processed' foods and the potential health risks. <img src="/-/media/ech-media/images/widgets/food/yogurtparfait.jpg?h=65&iar=0&w=100&sc_lang=en&hash=C71AD06B7AF6388676FE37BD5260CC39" alt="YogurtParfait" width="100" height="65" DisableNVelocity="true" />Skip 'Ultra-Processed' to be 'Ultra-Nutritious'6/3/2024 12:00 AM<img src="/-/media/ech-media/images/widgets/food/yogurtparfait.jpg?h=205&iar=0&w=315&sc_lang=en&hash=5CCB6912EF615390BE38F39ACF2A65A9" alt="YogurtParfait" width="315" height="205" DisableNVelocity="true" />While "ultra" might be a prefix you want to see in front of the word "comfort" when buying a pillow or mattress, when describing processed foods "ultra" does not necessarily mean better. New research is linking ultra-processed foods to potential health risks. You can buy food at the grocery store "au naturel" – in its natural state, nothing added. Fresh fruits and vegetables are examples. These foods are not manufactured by processing. Many processing techniques enhance food storage but do not add sugar, salt, oils, fats or additives to the original foods. Freezing, pasteurization and vacuum packaging are examples that improve shelf life and help consumers eat a wide variety of nutritious foods. Then there are ultra-processed foods. These foods are industrially formulated or synthesized from natural foods or other organic compounds such as food additives, preservatives, colorings and flavorings. You can easily spot ultra-processed foods with their long ingredient lists. Examples are ready-to-eat packaged snacks, mixes, pastries, instant meals or soups. While convenient, these foods should be used in moderation in a healthy diet. A diet with excessive amounts of ultra-processed food can be linked to health conditions ranging from poor sleep and obesity to diabetes, cancer and heart disease. Some simple changes can help limit ultra-processed foods from your diet. <ul> <li>Swap regular soda for water flavored with fresh fruit slices.</li> <li>Choose whole fruits and vegetables for snacks.</li> <li>Choose whole wheat bread with few additives instead of white bread.</li> <li>Make homemade boiled, baked or roasted potatoes rather than pre-made mashed potatoes or potato flakes.</li> <li>Eat oatmeal with berries for breakfast instead of sweetened cereals.</li> <li>Make homemade yogurt parfaits instead of ice cream.</li> </ul> A healthy diet includes a variety of fruits, vegetables, whole grains and protein sources. In short, for an ultra-nutritious diet, go light on ultra-processed foods! Michaeleen Burroughs, MS, RDN, LD, has practiced at Mayo Clinic for 33 years. Primary care has been the focus of her practice. Her special interests are in diabetes, weight management and building healthy eating habits for individuals and families.Michaeleen Burroughs, M.S., RDN, LDPrimary Care in Rochester and KassonUltraProcessed FoodsPrimary Care in Rochester and KassonThe Caleb Eide Memorial Foundation helps patients in need of blood transfusions. <img src="/-/media/ech-media/images/widgets/blooddonation/070824blooddonationeide.jpg?h=65&iar=0&w=100&sc_lang=en&hash=504C814FE5D8627B2D6736ADC3BB46F0" alt="070824BloodDonationEide" width="100" height="65" DisableNVelocity="true" />Family honors their son with blood donation foundation7/8/2024 12:00 AM<img src="/-/media/ech-media/images/widgets/blooddonation/070824blooddonationeide.jpg?h=205&iar=0&w=315&sc_lang=en&hash=4F4073E2B054F576A103C43881983CEB" alt="070824BloodDonationEide" width="315" height="205" DisableNVelocity="true" />"It's easy to want to highlight the positive stories, but unfortunately those outcomes are not always the case," said Crystal Eide. In 2014, the Eide family's world was shaken when their 5-year-old son Caleb was diagnosed with leukemia. Despite his diagnosis, Caleb lived life to the fullest. "He took this diagnosis on headstrong and was never willing to give up. He was only 5 years old when it started and the things he went through, I don't know if I could have even done it," recalls Crystal. "The happiness he shared with us despite what he was going through was just amazing, his zest for life, he was just so beautiful. No matter what he was going through he seemed to always have a smile on his face." During Caleb's treatment, he received several transfusions of both blood and platelets. "Those products helped him significantly; without blood donors, he would not have gotten those extra two-and-a-half years of life. These donors helped give us time together, which we spent as a family with a new perspective on life," said Crystal. "Hopefully donors know we are so grateful for them and how big of an impact they had, even though Caleb is not here. It's not the outcome we wanted, but we are so thankful for that extra time we got to spend together." In memory of Caleb, the Caleb Eide Memorial Foundation was started. "It's not until life puts you in a situation that you fully understand and appreciate what blood donation really means," shared Crystal. "We are just 100% thankful for the people out there who selflessly give their time to help others in need." To schedule your blood donation appointment at the Northwest Blood Donor Center or the Hilton Building Blood Donor Center, call the Mayo Clinic Blood Donor Center at <a rel="noopener" href="tel:5072844475" target="_blank" title="Link opens in a new window">507-284-4475</a>. Be sure to watch for more information by visiting the <a rel="noopener" href="https://connect.mayoclinic.org/page/blood-donor-program/" target="_blank" title="Link opens in a new window">Blood Donor Program blog</a> or the <a rel="noopener" href="http://http://www.mayoclinic.org/donateblood" target="_blank" title="Link opens in a new window">Minnesota Blood Donor Program website</a> or <a rel="noopener" href="https://www.facebook.com/blooddonorcentermc?ref=br_tf" target="_blank" title="Link opens in a new window">Facebook</a> page.Primary Care in Rochester and KassonBlood Donation EidePrimary Care in Rochester and KassonConstipation is common in childhood, but it's not something to be accepted as normal. <img src="/-/media/ech-media/images/widgets/kids/littlegirlholdingstomach.jpg?h=65&iar=0&w=100&sc_lang=en&hash=2485D46312CB9964173AD21DE72137B9" alt="LittleGirlHoldingStomach" width="100" height="65" DisableNVelocity="true" />Talking about poop7/22/2024 12:00 AM<img src="/-/media/ech-media/images/widgets/kids/littlegirlholdingstomach.jpg?h=205&iar=0&w=315&sc_lang=en&hash=5511127A3029372F711861D570164A60" alt="LittleGirlHoldingStomach" width="315" height="205" DisableNVelocity="true" />Constipation is a common issue in childhood, but it's not something that has to be accepted as normal. Acting early can help prevent complications like anal fissure, stool withholding and fecal incontinence, also known as encopresis. How often should your child have a bowel movement? <ul> <li>In the first week of life, most babies should have four or more soft or liquid bowel movements each day.</li> <li>During the first 3 months, children may have two or more bowel movements each day, while others may have just one each week.</li> <li>By age 2, most children have at least one soft but solid bowel movement each day </li> </ul> Signs of constipation <ul> <li>Fewer bowel movements than normal.</li> <li>Hard or larger-than-normal bowel movements.</li> <li>Pain during bowel movements.</li> <li>Arching their back and crying during infancy.</li> <li>Avoidance behaviors like doing a "dance" or hiding when they feel a bowel movement coming — especially during potty training or starting school.</li> <li>Small amounts of bowel movement leakage into their underwear if they have been toilet trained. </li> </ul> Preventing constipation The key to avoiding constipation includes simple steps related to diet, toilet training and toileting behaviors. Timely guidance in these areas can make a significant difference. For mild or brief constipation, consider these steps: <ul> <li>Increase fruits, vegetables, cereal and other fiber-rich foods in your child's diet.</li> <li>Offer prune juice, apple juice or pear juice.</li> <li>Ensure your child drinks at least 32 ounces of water and non-milk drinks daily (for children older than 2 years).</li> <li>Temporarily avoid dairy products like milk, yogurt, cheese and ice cream.</li> <li>Encourage your child to sit on the toilet for 5 or 10 minutes after meals, providing rewards for cooperation.</li> <li>Consider pausing potty training if currently in progress.</li> </ul> Treating constipation Treatment for constipation depends on the child's age and how long they have been experiencing symptoms. Treatment may include: <ul> <li>Education. Understanding the factors contributing to constipation.</li> <li>Dietary changes. Adjusting the child's diet to include more fiber and fluids.</li> <li>Behavior changes. Encouraging healthy toilet habits and routines.</li> <li>Pharmacotherapy. In some cases, medications may be recommended, either alone or in combination with other measures </li> </ul> When to seek medical attention: <ul> <li>Children younger than 4 months who are experiencing constipation.</li> <li>Constipation is occurring frequently.</li> <li>Following the above steps for 24 hours has not resulted in a bowel movement.</li> <li>You noticed blood in the bowel movement, diaper or underwear.</li> <li>Your child is in significant pain. </li> </ul> Understanding Remember, addressing constipation early can lead to better outcomes and a happier, healthier child. Remember, each child is unique. If you have concerns or questions, do not hesitate to reach out to your primary care clinician — they can provide personalized advice based on your child's specific needs. More information You can find more information in the following links: <ul> <li><a rel="noopener" href="https://www.mayoclinic.org/diseases-conditions/constipation-in-children/symptoms-causes/syc-20354242" target="_blank" title="Link opens in a new window">Constipation - Symptoms and causes - Mayo Clinic</a></li> <li><a rel="noopener" href="https://www.mayoclinic.org/diseases-conditions/constipation/diagnosis-treatment/drc-20354259" target="_blank" title="Link opens in a new window">Constipation - Diagnosis and treatment - Mayo Clinic</a></li> <li><a rel="noopener" href="https://www.mayoclinic.org/diseases-conditions/constipation/care-at-mayo-clinic/mac-20354263" target="_blank" title="Link opens in a new window">Constipation - Care at Mayo Clinic - Mayo Clinic</a> </li> </ul> Camila C. Cardenas Fernandez, M.D., is a Pediatric and Adolescent Medicine resident in Rochester, Minnesota. After residency, she will complete her fellowship at Boston Children’s Hospital in Pediatric Gastroenterology and Hepatology.Camila C. Cardenas Fernandez, M.D.Primary Care in Rochester and KassonConstipation KidsPrimary Care in Rochester and KassonLearn about symptoms, causes and treatment.<img src="/-/media/ech-media/images/widgets/people/ech_ibs_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=6F4EE09EAE17434FD441FC2A7CFEDBCA" alt="ECH_IBS_widget" width="100" height="65" DisableNVelocity="true" />What is inflammatory bowel disease?7/11/2024 12:00 AM<img src="/-/media/ech-media/images/widgets/people/ech_ibs_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=E904955D4700B0A67C01E8F45C0CBB51" alt="ECH_IBS_widget" width="300" height="195" DisableNVelocity="true" />What is inflammatory bowel disease (IBD)? IBD is a chronic, inflammatory illness involving the digestive tract. It's an umbrella term that describes two specific conditions — ulcerative colitis and Crohn's disease. These conditions differ by the locations affected, their associated risks and complications, and their treatment protocols. They are both autoimmune diseases, meaning the body mistakenly injures healthy tissue, causing problems. Ulcerative Colitis can involve the large intestine, or colon, and rectum. Usually, the inflammation seen is continuous and causes ulcerations. Crohn's disease can involve any part of the gastrointestinal tract (GI), including the upper GI tract, small intestine and colon. The inflammation caused by Crohn's can skip around different portions of the GI tract, causing intermittent areas of damage. Some individuals with IBD may have mild disease that does not require treatment, but others may need medications and surgery. What are the symptoms of IBD? <ul> <li>Diarrhea.</li> <li>Abdominal pain.</li> <li>Bloody stool.</li> <li>Weight loss.</li> <li>Fatigue.</li> <li>Fevers.</li> <li>Anemia or a low blood count. </li> </ul> Symptoms of IBD can often come in "flares," which refers to episodes of the symptoms mentioned above. Everyone's bowel habits are different, but it's important to see your clinician if you experience new and persistent changes. What causes IBD? While the exact cause of IBD is unknown, there is research ongoing to determine what specific causes can be found. Initially, there was some thought that diet and stress caused IBD. However, while certain factors can exacerbate the severity and frequency of flares, diet and stress are not causes of IBD. What increases my risk of getting IBD? <ul> <li>Family history — having close relatives with IBD can put you at higher risk.</li> <li>Race or Ethnicity — while any race or ethnic group can get IBD, those who are White, of European descent, or Ashkenazi Jewish may have a higher risk.</li> <li>Smoking — cigarette smoking increases the risk of Crohn's disease, but it's interestingly protective against ulcerative colitis. Smoking is very harmful to your body and overall health, so the benefit of avoiding cigarettes outweighs any preventive advantage. </li> </ul> Complications IBD increases the risk of colon cancer. Regular screening usually begins 8 to 10 years after diagnosis, but your clinician will help decide the best screening interval for you. Despite being a gastrointestinal illness, IBD can affect the entire body and cause problems in different organ systems: <ul> <li>Eye inflammation such as uveitis or scleritis.</li> <li>Skin inflammation in the form of pyoderma gangrenosum, erythema nodosum and oral ulcers.</li> <li>Joint inflammation or arthritis.</li> <li>Blood clots and vasculitis.</li> <li>Liver and biliary systems such as primary sclerosing cholangitis and fatty liver. </li> </ul> Untreated or undertreated IBD can also cause inflammatory damage to the GI tract over time, resulting in: <ul> <li>Bowel obstruction from narrowing in the gut wall, which can block intestinal movement.</li> <li>Fistulas, which are abnormal connections between two parts of the body, such as the colon and the bladder.</li> <li>Abscesses, which are pockets of infection that usually require draining. </li> </ul> Some of the complications of IBD are independent of disease activity, meaning they can happen even if your illness is very well-controlled. It's important to pay attention to changes and communicate any new symptoms to your clinician. How IBD is diagnosed: A thorough history and physical exam should always be the first step in evaluation. Laboratory testing: Blood tests to check for anemia (low blood count), evidence of infection, or other IBD-associated markers, such as ASCA. Stool tests to evaluate for evidence of infection or inflammation. Procedures: <ul> <li>Colonoscopy — a tube with a camera allows visualization of the colon. Small pieces are removed for biopsy, which is the definitive way to diagnose IBD.</li> <li>Upper endoscopy — a tube with a camera allows visualization of the esophagus, stomach and first portion of the small intestine. Biopsies are also taken for evaluation.</li> <li>Capsule endoscopy — a capsule with a camera inside is swallowed to allow for visualization of the small intestine </li> </ul> Imaging: X-ray, CT scan or MRI. Not all testing mentioned above is always done to diagnose IBD. Other, more specialized tests may be needed if your diagnosis is uncertain. Your clinician will decide which test is best for you. How is IBD treated? There is no cure for IBD, so the goal of treatment is to control flares, minimize intestinal damage and control symptoms occurring in other parts of the body. This may involve medications, surgeries and evaluations by other specialists. Multiple categories of medication can help with immune system suppression, pain and diarrhea. It's important to take these medications as prescribed and continue to take them until directed otherwise. Sometimes, medical therapy is not enough to control symptoms and surgery may be required to remove the affected portion of the gut. This can result in the formation of a stoma, which is when the remaining portion of the intestine empties into a bag on the outside of the abdomen. Your clinician will help choose the best treatment regimen for you based on your condition's unique characteristics. <a href="/providers/laura-kek-mdms">Laura Kek, M.D., M.S.</a>, is a resident physician at Mayo Clinic in Rochester, Minnesota. She earned her medical degree and Master of Biomedical Sciences at Rosalind Franklin University of Medicine and Science in North Chicago, Illinois. She is interested in gastrointestinal health and patient education.Laura Kek, M.D., M.S.Primary Care in Rochester and KassonInflammatory Bowel DiseasePrimary Care in Rochester and KassonHave a conversation about over-the-counter medication use with your care team.<img src="/-/media/ech-media/images/widgets/medications/ech_otcsafety_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=2D0DF10F070FA0FE28C1A97D155DCF1E" alt="ECH_OTCsafety_widget" width="100" height="65" DisableNVelocity="true" />OTC safety — what you need to know about pain relievers7/30/2024 12:00 AM<img src="/-/media/ech-media/images/widgets/medications/ech_otcsafety_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=29475A3DC6C9A4584FE255AFDD669627" alt="ECH_OTCsafety_widget" width="300" height="195" DisableNVelocity="true" />Most people assume over-the-counter (OTC) medications are safe and then overlook discussing their use with their care team. Pain relievers can effectively manage minor aches and pains, but if you take them regularly, talk to your care team about the risks and benefits. NSAIDS OTC nonsteroidal anti-inflammatory drugs (NSAIDs) are taken to temporarily treat minor aches and pains, such as headache, muscle aches, arthritis and backache, or to reduce fever. While products containing ibuprofen, including Advil and Motrin, and naproxen, such as Aleve, are effective pain relievers, they also have several safety concerns. <ul> <li>Bleeding is a common and potentially serious side effect.</li> <li>NSAIDs increase your risk for ulcers in the stomach and intestine, which also may be related to serious bleeding.</li> <li>They may affect blood flow to the kidneys and cause damage, particularly in people with underlying kidney disease and/or taking other medications with this risk factor.</li> <li>NSAIDs may increase fluid retention and can lead to increased blood pressure, which may be particularly unsafe for people with heart failure.</li> <li>"Rebound headaches," also known as medication overuse headaches, are daily headaches that may be due to frequent NSAID use.</li> <li>NSAIDs may increase the risk of a heart attack or stroke. The risk increases with higher doses or extended use. </li> </ul> Newer topical NSAIDs such as diclofenac (Voltaren) gel provide relief from arthritis in the hand, wrist, elbow, foot, ankle or knee. Because the medication works locally, it may be a safer alternative. Talk to your care team about NSAIDs if you take blood thinners or have been diagnosed with heart disease, stroke, high blood pressure, heart failure, kidney disease, asthma or have had gastric bypass surgery. If you take an NSAID more than 15 days a month for headaches, discuss alternative strategies for managing them. Aspirin While some people have been prescribed or recommended to take aspirin daily, the <a rel="noopener" href="https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/aspirin-to-prevent-cardiovascular-disease-preventive-medication" target="_blank" title="Link opens in a new window">U.S. Preventive Services Task Force</a> guides who may benefit most from daily aspirin for disease prevention. Consider discussing aspirin use with your care team if you do not have a personal history of heart disease. Taking aspirin daily, even low-dose or "baby" aspirin, may increase your risk for serious bleeding. This risk increases if you also take blood-thinning (anticoagulant) medication or even other OTC medicines, such as ibuprofen or naproxen. Be sure to review your personal need for aspirin with your care team if you also take blood thinners. Acetaminophen Acetaminophen is found in more than 600 OTC products. A common brand name is Tylenol®. Often, acetaminophen is the primary ingredient in multi-ingredient OTC products. It can also be found in some prescription medications abbreviated as APAP, Mapap or Q-Pap. While the risk is low for acetaminophen interacting with prescription medications, people may unintentionally exceed safe doses when combining various OTC and/or prescription sources of acetaminophen. This may lead to serious liver damage. Talk with your care team about the safe use of acetaminophen if you have been diagnosed with a headache disorder or liver disease or consume three or more alcoholic beverages per day. Pediatric dosing Pediatric formulations of pain medications may be more prone to accidental dosing errors. Be sure to read the package instructions every time. Formulations may change or look similar but be different concentrations of similar products. Be sure the active ingredient is the one you intended to give. Use the correct dosing device and measure carefully. If you are uncertain of the package instructions, ask for clarification at the pharmacy counter. Heed the "Keep out of reach of children" warning; many flavored OTC medications may be enticing to little ones. Read the labels Read all OTC product labels carefully, especially for the active ingredient. Use this checklist when shopping for OTC medications to ensure you're familiar with the package label and important information. When starting a new prescription medication, be sure to discuss with your care team if it is compatible with the OTC medications you're currently using. Laurie Danielson, Pharm.D., R.Ph., is a clinical pharmacist in Primary Care at Mayo Family Clinic Southeast. She enjoys meeting with patients to optimize their medication regimens and solve medication-related problems.Laurie Danielson, Pharm.D., R.Ph.Primary Care in Rochester and KassonOTC SafetyPrimary Care in Rochester and KassonHome remedies are the most effective way to treat this common eye condition. <img src="/-/media/ech-media/images/widgets/kids/ech_pinkeye_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=36397020749E02F61694F9FCE7DB7553" alt="ECH_pinkeye_widget" width="100" height="65" DisableNVelocity="true" />Understanding pink eye: A guide for families7/25/2024 12:00 AM<img src="/-/media/ech-media/images/widgets/kids/ech_pinkeye_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=5DFC1968CDDB187377F189F30B2A9A2A" alt="ECH_pinkeye_widget" width="300" height="195" DisableNVelocity="true" />Your child wakes up with scratchy, red eyes and goopy drainage. They’ve come down with a case of pink eye (also known as conjunctivitis). While this condition can be distressing for children and families, understanding what pink eye is, its causes, symptoms, and treatment options can empower families to manage it effectively. What is Pink Eye? Pink eye refers to inflammation of the conjunctiva or the white part of the eye and the inner surface of the eyelids. This inflammation can be caused by viruses, bacteria or allergies. Most cases of pink eye are caused by a virus. In these cases, antibiotic drops or ointments do not relieve symptoms or make you less contagious. Even among cases of bacterial conjunctivitis, antibiotic eye drops have only been shown to reduce the duration of symptoms by about 8 hours. Both viral and bacterial conjunctivitis are considered self-limited, which means they will resolve on their own. What are the symptoms of Pink Eye? The primary symptoms of pink eye include red, itchy eyes and goopy discharge. Often, the eye drainage is significant enough that the eye can become crusted shut first thing in the morning. Eye symptoms may occur alone, but viral conjunctivitis can be accompanied by a runny nose, sore throat, cough or fever. When should I see my doctor for pink eye? The first line of treatment for pink eye is home care. Children with conjunctivitis who have any of the following symptoms should be evaluated by their primary care provider: <ul> <li>Any eye pain that is more than mild.</li> <li>Blurry vision that doesn’t clear with wiping away discharge.</li> <li>Vision loss.</li> <li>Warm, red swelling that extends beyond the eyelid.</li> <li>Worsening symptoms after 3 days.</li> </ul> Certain groups of patients should also be seen for any case of conjunctivitis, including infants less than 6 months old, immunocompromised patients, contact lens wearers experiencing any eye pain, and anyone with recent trauma or surgery to or around the eye. How can I treat pink eye at home? Home treatment of conjunctivitis includes the following: <ul> <li>Warm or cool compresses.</li> <li>Lubricating eye drops, such as artificial tears.</li> <li>For allergy-like symptoms, antihistamines such as cetirizine may help.</li> <li>Those with allergy symptoms may also benefit from topical antihistamine/decongestant eye drops, such as Olopatadine.</li> <li>Most cases of pink eye do not benefit from antibiotic drops. </li> </ul> When is it safe to return to work, school, or daycare? Symptoms of pink eye can last up to two weeks but are typically worse at the beginning of the illness. It is safe to return to work or school if the drainage is controllable and you or your child can follow good hand hygiene. If your child is in daycare, you may want to check with them about their specific policy for pink eye. It’s important to remember to practice good hand hygiene and avoid sharing personal items such as pillows or towels. Any contaminated eye makeup should be discarded, regardless of the cause of your pink eye. These practices will help to stop the spread of pink eye. Scott Anjewierden, M.D., is a pediatric resident in his third and final year at Mayo Clinic. He lives in Rochester, Minnesota, with his wife, three children and a sheepadoodle. He is interested in Pediatric Cardiology and congenital heart disease.Scott Anjewierden, M.D.Primary Care in Rochester and KassonPink EyePrimary Care in Rochester and KassonThat ringing in your ears is called tinnitus. It's annoying, it's common, and it has many causes. <img src="/-/media/ech-media/images/widgets/people/ech_tinnitus_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=B0400F3AE06E2BEC92DEBF166070D872" alt="ECH_tinnitus_widget" width="100" height="65" DisableNVelocity="true" />'My ears are ringing'7/18/2024 12:00 AM<img src="/-/media/ech-media/images/widgets/people/ech_tinnitus_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=3817122AA02E0F788A72D88861958DE5" alt="ECH_tinnitus_widget" width="300" height="195" DisableNVelocity="true" />Tinnitus, or hearing "ringing" in your ears, is common. It affects 1 in 5 people. You may also experience buzzing, hissing, clicking, or even a roaring sensation when there are sounds no one else can hear. What causes tinnitus? Tinnitus is not a disease, but rather, it's a symptom caused by another condition. The most common cause is inner ear damage to delicate hairs that transmit sound waves to your brain. Other common causes include age-related hearing loss, exposure to loud noise, earwax in your outer ear canal, and changes in the bones in your middle ear that transmit sounds. Less common causes include problems related to head and neck injuries; acoustic neuroma (benign tumors on the cranial nerve); underlying medical conditions, including diabetes, high blood pressure or thyroid disease; and Meniere's disease, which is often associated with severe dizziness. Even medications can cause tinnitus or worsen your symptoms. Should you worry about tinnitus? Whether you should worry about tinnitus depends. If it occurs suddenly, or you have dizziness or hearing loss associated with the noise, you should see your healthcare team. Evaluation and treatment depend on the cause of tinnitus. While tinnitus can't be cured, it can be managed. This may involve removing excess earwax, treating an underlying condition, changing medications, using white or masking noise, or being properly fitted with hearing aids. Sometimes, tinnitus can be reduced so you can hear sound better. Exercise and relaxation techniques also may help since tinnitus can worsen with stress. Tinnitus can affect your mental health as well and may require counseling and medication to help you deal with your symptoms and the impact on your life. Several promising therapies include music therapy, which trains your brain to ignore the sound, and cognitive behavioral therapy, which focuses on replacing negative thoughts with positive ones to change your reaction to tinnitus. How to prevent tinnitus Most importantly, you can take actions to prevent tinnitus: <ul> <li>Wear ear protection when around loud machines, including firearms and chainsaws.</li> <li>Turn down the volume when listening to music. </li> <li>Take care of your health, both physical and mental.</li> </ul> <a href="/featured-stories/tinnitus">Denise Dupras, M.D., Ph.D.</a>, is a general internist in Primary Care in Rochester and Kasson's Division of Community Internal Medicine, Geriatrics and Palliative Care. She completed her medical and doctoral degrees at Mayo Clinic Alix School of Medicine and her residency in internal medicine at Mayo Clinic in Rochester. Her interests include medical education and evidence-based medicine.Denise Dupras, M.D., Ph.D.Primary Care in Rochester and KassonTinnitusPrimary Care in Rochester and KassonHere's how to avoid heat-related illnesses during your hot-weather workouts. <img src="/-/media/ech-media/images/widgets/activities/ech_overheating_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=A8CFBC4B97E225F78E0FB979DF3D0FBB" alt="ECH_overheating_widget" width="100" height="65" DisableNVelocity="true" />Exercising in the summer heat? Play it safe8/12/2024 12:00 AM<img src="/-/media/ech-media/images/widgets/activities/ech_overheating_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=4CAA9740042E46C58AD58B95D31422D7" alt="ECH_overheating_widget" width="300" height="195" DisableNVelocity="true" />Whether you're running, playing a pickup game of basketball or going for a power walk, take care when outdoor temperatures rise. Exercising in hot weather puts extra stress on your body. Exercise, plus the air temperature and humidity, can increase your core body temperature. Under normal conditions, your skin, blood vessels and perspiration serve as natural cooling systems. But these systems may fail if you're on certain medications, exposed to high temperatures and humidity for too long, sweat heavily, drink alcohol or don't drink enough fluids. Pay attention to warning signs During hot-weather exercise, watch for signs and symptoms of heat-related illnesses, including heat cramps, heat collapse, heat exhaustion and heatstroke. If you ignore these symptoms, your condition can worsen and result in a medical emergency. Warning signs include: <ul> <li>Muscle cramps.</li> <li>Nausea or vomiting.</li> <li>Weakness.</li> <li>Fatigue</li> <li> Headache.</li> <li>Excessive sweating ― or in extreme cases, not sweating at all.</li> <li>Dizziness or lightheadedness.</li> <li>Confusion.</li> <li>Irritability.</li> <li>Low blood pressure.</li> <li>Increased heart rate.</li> <li>Rapid breathing.</li> <li>Visual problems, including blurred vision.</li> <li>Temperature of 104 degrees Fahrenheit or higher </li> </ul> If you develop any of these symptoms, stop exercising, get out of the heat and sun, lower your body temperature, and get hydrated immediately. Have someone stay with you to monitor your condition. If your temperature is higher than 104 F, seek emergency care immediately. To cool down: <ul> <li>Remove sports equipment and extra clothing.</li> <li>Spray yourself with water from a hose or shower.</li> <li>Place cool, wet towels or ice packs on your neck, forehead and under your arms.</li> <li>Sit in a tub filled with cold water.</li> <li>Drink fluids, such as water or a sports drink. </li> </ul> If you don't feel better within about 20 minutes, seek emergency medical care. Tips for avoiding heat-related illnesses These commonsense tips can help you keep your cool and play it safe while exercising and enjoying outdoor activities this summer: <ul> <li>Watch the temperature. Pay attention to weather forecasts and heat alerts. Know what the temperature and humidity will be when you're exercising.</li> <li>Get acclimated. If you're used to exercising indoors or in cooler weather, it can take up to two weeks to adapt to the heat. As your body acclimates, gradually increase the length and intensity of your workouts.</li> <li>Know your fitness level. If you're unfit or new to exercise, be extra cautious when working out in the heat. Reduce your exercise intensity and take frequent breaks.</li> <li>Drink plenty of fluids. Dehydration is a key factor in heat illness. Don't wait until you're thirsty to drink fluids, including water and sports drinks, which are formulated to replace the sodium, chloride and potassium you lose through sweating. Avoid alcoholic beverages, as they only dehydrate you faster.</li> <li>Dress for the heat. Lightweight, loose-fitting clothing helps sweat evaporate and keeps you cooler. Avoid dark colors, which can absorb heat. If possible, wear a light-colored, wide-brimmed hat.</li> <li>Avoid midday sun. Exercise in the morning or evening when it's likely to be cooler outdoors. If possible, exercise in shady areas, or work out in a pool.</li> <li>Wear sunscreen. A sunburn decreases your body's ability to cool itself.</li> <li>Have a backup plan. If you're concerned about the heat or humidity, stay indoors. Work out at the gym, walk laps inside the mall or climb stairs inside an air-conditioned building</li> <li> Avoid drinking alcohol. Alcohol can affect your body's ability to regulate temperature.</li> <li>Understand your medical risks. Certain medical conditions, including heart or lung disease, or medications for blood pressure or mood disorders, can increase your risk of a heat-related illness. If you plan to exercise in the heat, talk to your healthcare clinician about precautions. </li> </ul> By taking some basic precautions, your exercise routine doesn't have to be sidelined when the heat is on. <a href="/providers/denise-dupras-md">Denise Dupras, M.D., Ph.D.</a>, is a general internist in the Division of Community Internal Medicine, Geriatrics and Palliative Care. She completed her medical and doctoral degrees at Mayo Clinic Alix School of Medicine and her residency in internal medicine at Mayo Clinic in Rochester, Minnesota. Her interests include medical education and LGBTI medicine.Denise Dupras, M.D., Ph.D.Primary Care in Rochester and KassonExercise Summer HeatPrimary Care in Rochester and KassonContact your primary care clinician if you are concerned about your child.<img src="/-/media/ech-media/images/widgets/kids/broccolieyes.jpg?h=65&iar=0&w=100&sc_lang=en&hash=7F5B1A9A08EBB52493C92478F37B20A8" alt="BroccoliEyes" width="100" height="65" DisableNVelocity="true" />Healthy Blood, Happy Kids: Tackling iron deficiency anemia8/5/2024 12:00 AM<img src="/-/media/ech-media/images/widgets/kids/broccolieyes.jpg?h=205&iar=0&w=315&sc_lang=en&hash=B96578088ABB8771F4A594102A7BA2B5" alt="BroccoliEyes" width="315" height="205" DisableNVelocity="true" />What is iron deficiency anemia? Iron deficiency anemia occurs when a child's body lacks enough iron to produce adequate hemoglobin, the substance in red blood cells that carries oxygen. Daily requirements of iron are fulfilled by iron rich foods in the diet. It's a common problem in children and can affect their growth and development. This is why it is important to recognize the problem and treat it in a timely manner. Symptoms of iron deficiency <ul> <li>Fatigue and weakness.</li> <li>Pale skin.</li> <li>Shortness of breath.</li> <li>Dizziness or lightheadedness.</li> <li>Slow growth and development.</li> <li>Behavioral issues (irritability, lack of concentration).</li> <li>Unusual cravings for things that contain few or no nutrients — such as ice, dirt, paint or starch. </li> </ul> How is iron deficiency anemia diagnosed? To diagnose iron deficiency anemia, one or more of the following tests may be performed by your healthcare team: <ul> <li>Complete Blood Count (CBC): This test measures the levels of red blood cells and hemoglobin. If your child has anemia, this number will be low.</li> <li>Serum Ferritin Test: This test measures stored iron and will be low in iron deficiency anemia.</li> <li>Serum Iron and Total Iron-Binding Capacity (TIBC): This test evaluates iron levels and capacity to carry iron.</li> <li>Reticulocyte Count: This test measures young red blood cells to assess bone marrow function. </li> </ul> How is iron deficiency anemia treated? <ul> <li>Oral Iron Therapy: Iron supplements are usually the first line of treatment. Supplements should be prescribed by your healthcare clinician and are available as ferrous sulfate, ferrous gluconate or ferrous fumarate. They are commonly prescribed as 3-6 mg of elemental iron per kilogram of body weight per day, divided into two or three doses, taken on an empty stomach for optimal absorption. They can be taken with food to avoid stomach upset. Vitamin C (orange juice) can enhance absorption. Side effects include nausea, constipation, dark stools and stomach cramps. Adjustments in dosage or formulation can help mitigate these effects. </li> <li>Intravenous (IV) Iron Therapy: If oral iron is ineffective, not tolerated, or if rapid replenishment is needed, your healthcare clinician may prescribe IV iron therapy which may include iron sucrose, ferric gluconate and iron dextran. IV therapy is given under medical supervision, typically in a clinic or hospital. While the benefit of this therapy is faster improvement in iron levels and symptoms, the risks include possible allergic reactions, including anaphylaxis, although very rare. </li> </ul> Dietary recommendations <ul> <li>Iron-Rich Foods: Red meat, poultry, fish, beans, lentils, tofu, spinach and iron-fortified cereals.</li> <li>Enhancing Absorption: Pairing iron-rich foods with vitamin C-rich foods (e.g., oranges, strawberries) can improve absorption.</li> <li>Avoiding Inhibitors: Limit intake of calcium-rich foods, tea and coffee around mealtimes, as they can inhibit iron absorption. </li> </ul> Follow-up and monitoring Regular follow-up with a healthcare clinician is crucial to monitor the effectiveness of treatment and to adjust as necessary. Blood tests will help track improvements in hemoglobin and iron levels. Asma Ali, M.B.B.S., was a third-year resident in the Department of Pediatrics at Mayo Clinic in Rochester, Minnesota, at the time this article was written. She is now a Pediatric Hematology/Oncology and Genetics fellow at Mayo Clinic.Asma Ali, M.B.B.S.Primary Care in Rochester and KassonIron Deficiency AnemiaPrimary Care in Rochester and KassonThese tips can help you support your young adult in taking charge of their own health and well-being. <img src="/-/media/ech-media/images/widgets/teens/ech_college_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=93B1C1BD6F8C66F7A7972B4F323E2602" alt="ECH_college_widget" width="100" height="65" DisableNVelocity="true" />Empower your young adult8/8/2024 12:00 AM<img src="/-/media/ech-media/images/widgets/teens/ech_college_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=E4BD62C8B612932C62024E3B09FAA764" alt="ECH_college_widget" width="300" height="195" DisableNVelocity="true" />Are you getting ready to send your teen off to college or full-time work? Is it time to start thinking of your teen as a young adult? We all want our children to be as well prepared for the future as possible, but navigating these transitions can often be tricky with adolescents. Here are some suggestions for helping your young adult on their journey to independence — and taking charge of their own health. Be prepared The American Academy of Pediatrics (AAP) recommends that all young adults see their primary clinician before heading to college or moving away. This will help them successfully transition to taking over their own care. At this visit, your young adult will be able to: <ul> <li>Discuss and receive recommended vaccines.</li> <li>Get help with planning for future evaluations of chronic health conditions, such as ADHD.</li> <li>Renew prescription medications they may need to take with them.</li> <li>Discuss safe sex practices and contraception.</li> <li>Talk about the increased accessibility and risks of alcohol and drug use.</li> <li>Address healthy relationships and ways to avoid or prevent situations that increase the risk of sexual assault.</li> <li>Review the importance of continuing daily healthy lifestyle habits including adequate sleep hygiene, healthy eating and exercise.</li> <li>Get help setting up online access to their patient portal. This will be important if they need to reach their regular clinician for questions and advice.</li> </ul> Be knowledgeable If they haven't already, make sure your young adult is starting to take charge of their health and has researched their new home-away-from-home. Make sure they know: <ul> <li>What health services are offered, and where to access these services (i.e., on-campus health services, virtual services, local clinic)?</li> <li>Where the nearest Emergency Department is located.</li> <li>Their health insurance coverage and information. Have them take a picture of their insurance card, store it on their phone, and keep a hard copy.</li> <li>The names, dosages and side effects of their medications. Also, identify the nearest pharmacy for any medication refills needed.</li> <li>All the facts about any medical conditions or health issues they may have. They should be able to provide this information to a clinician if they are seen in another medical facility.</li> <li>Where to get help with mood concerns, homesickness, sadness or other social situations. Help them locate the college health center or counseling services on campus or in their new community. </li> </ul> Be safe Don't shy away from talking about drugs, alcohol, relationships and sex. New pressures will arise, and you want your child to have a plan for when they're on their own and can't use their parents as an excuse to get out of tricky situations. Approach the conversation with curiosity, identifying your child as the expert. Ask permission to give advice before giving it. Expect lots of requests for friend time and minimal engagement in the family system. It's normal for your teen to want to spend all their time with friends. When they're on their own, almost all interactions will be with peers, and they need to practice skills for navigating these relationships. Don't take it personally when they don't want to hang out with their parents. However, set aside family time, such as meals, to stay connected. If your young adult is away and can only come home periodically, make sure to check in, especially within the first month, to find out how they're doing academically and emotionally. It's normal for them to miss home or feel a little lost. However, if these feelings are getting in the way of academics or the ability to function, make sure they seek help. Be successful <ul> <li>Encourage problem-solving. Don't automatically jump in with a suggestion or solution when your child comes to you with a problem. Prompt them to think through their options and weigh the pros and cons. Let them know you will support whatever choice they make but understand that mistakes are the best teachers. As parents, please don't pay for those mistakes or bail them out of the consequences.</li> <li>Decrease your financial support. If you haven't already, have your teen take some financial responsibility for themselves. Start with gas, food and/or entertainment, then move on to other expenses. This will help them understand the cost of living when they are no longer at home.</li> <li>Help your child define success. What leads them to feel their life has value? Help your young adult weigh the importance of the different aspects of their life — income and money, relationships, career, health, family, spirituality and leisure. Avoid instilling fear and competition in them. Instead, please do your best to convey excitement and a sense of adventure for what lies ahead and your confidence in their ability to manage their lives successfully. </li> </ul> <a href="/providers/hannah-mulholland-licswmsw">Hannah Mulholland, L.I.C.S.W., M.S.W..</a>, is a clinical social worker serving children and adolescents in Integrated Behavioral Health at Mayo Clinic in Rochester, Minnesota. <a href="/providers/chelsea-willson-aprncnpdnp">Chelsea Willson, APRN, C.N.P., D.N.P.</a>, is a nurse practitioner caring for children and adolescents in Community Pediatric and Adolescent Medicine at Mayo Clinic in Rochester, Minnesota.Hannah Mulholland, L.I.C.S.W.; Chelsea Willson, APRN, C.N.P., D.N.P.Primary Care in Rochester and KassonKids CollegePrimary Care in Rochester and KassonPolycystic ovarian syndrome is a common cause of delayed conception.<img src="/-/media/ech-media/images/widgets/people/doctorcounselingyoungcouple.jpg?h=65&iar=0&w=100&sc_lang=en&hash=E43DA7704175C1708678B8494B15C00E" alt="DoctorCounselingYoungCouple" width="100" height="65" DisableNVelocity="true" />Why am I not getting pregnant?8/15/2024 12:00 AM<img src="/-/media/ech-media/images/widgets/people/doctorcounselingyoungcouple.jpg?h=205&iar=0&w=315&sc_lang=en&hash=3A703EF22DF2190046EB4DEB371A6507" alt="DoctorCounselingYoungCouple" width="315" height="205" DisableNVelocity="true" />Infertility is defined as not achieving pregnancy after one year of regular, unprotected intercourse. This can be a common concern for many couples trying to start a family. Of the many causes of infertility, one of the more common is polycystic ovarian syndrome, commonly known as PCOS. Polycystic ovarian syndrome is a hormonal disorder involving excess androgens, or male hormones. The ovaries may have numerous fluid-filled follicles that can delay or prevent regular ovulation, which is the release of an egg. Women often experience irregular periods, weight gain, abnormal distribution of body hair and difficulty achieving pregnancy. This is due to the irregularity of ovulation. Polycystic ovarian syndrome will often go undiagnosed until women are trying to get pregnant. How do you know if you have polycystic ovarian syndrome? If a woman is having trouble getting pregnant and the signs and symptoms of polycystic ovarian syndrome are present, the work-up for diagnosis will often include laboratory hormone testing for the male hormone and testosterone, and commonly a pelvic ultrasound to evaluate the ovaries for the presence of greater than 25 follicles. Obesity, elevated blood sugar and high cholesterol can be associated conditions. Additional evaluations may be performed for these conditions, as well. How is polycystic ovarian syndrome treated? Treatment depends on the goal. If a woman hopes to become pregnant, achieving a healthy weight range is the first step. Even a 5% reduction in body weight can improve PCOS. This will often stimulate ovulation. Letrozole also can be used to stimulate ovulation in women with polycystic ovarian syndrome. Metformin — a drug commonly used to treat diabetes — is also sometimes used to reduce insulin resistance and reduce blood sugar, promoting ovulation. In addition to infertility, endometrial cancer is a secondary complication of polycystic ovarian syndrome. In women who are not trying to become pregnant, combined hormone contraceptive pills can be used to regulate the menstrual cycle and reduce androgen production. Progesterone-based, long-acting and reversible contraception options, like an IUD, can be used for endometrial protection and to reduce the risk of cancer. Overall, polycystic ovarian syndrome is a treatable condition, and most women can become pregnant and effectively manage the symptoms associated with it. <a href="/providers/lindsey-grace-cnp">Lindsey Grace, APRN, C.N.P., M.S.N.</a>, is a family medicine nurse practitioner in the Department of Family Medicine at Mayo Clinic in Rochester, Minnesota. She has a special interest in women's health and is a staff member in the Primary Care Integrated Community Specialties Gynecology Clinic.Lindsay Grace, APRN, C.N.P., M.S.N.Primary Care in Rochester and KassonPolycystic Ovarian Syndrome 2024Primary Care in Rochester and KassonSome vaccinations are needed to attend school.<img src="/-/media/ech-media/images/widgets/kids/kidsinschool.jpg?h=65&iar=0&w=100&sc_lang=en&hash=FC52637553DED55CF68AF2C5360E1332" alt="KidsInSchool" width="100" height="65" DisableNVelocity="true" />Update your child's vaccines before school8/26/2024 12:00 AM<img src="/-/media/ech-media/images/widgets/kids/kidsinschool.jpg?h=205&iar=0&w=315&sc_lang=en&hash=1276903FF9AF97CD65C13F76A6433AED" alt="KidsInSchool" width="315" height="205" DisableNVelocity="true" />August is National Immunization Awareness Month. Are you aware that most school-aged children catch up on their vaccines due during the summer? <ul> <li>Nine-year-olds are due for their first human papillomavirus vaccine (HPV).</li> <li>Eleven-year-olds are due for their first adolescent/adult tetanus-diphtheria-acellular pertussis (Tdap). They are also due for their first meningococcal conjugate vaccine (MCV4) against the ACWY strains.</li> <li>Sixteen-year-olds are due for their second MCV4 dose. </li> </ul> Summertime makes for easy preventive care visit scheduling. You can schedule vaccination visits either with your primary care clinician or a nurse. Vaccines are not just for kids. Adults should be aware of what vaccines they are due for as well. All adults need a Tdap vaccine every ten years. Those turning fifty years of age need their shingles vaccine doses. Adults may also find they are overdue for vaccines that were missed in childhood. These often include the hepatitis A and B vaccines. Depending on their health or age, adults may also need the 20-valent pneumococcal conjugate vaccine and the new respiratory syncytial virus (RSV) vaccine. The seasonal flu and COVID-19 vaccines will only be available in September or October. All of us will have to wait until then to get both of those. Vaccines prevent a lot of disease and expense. There is no advantage in delaying. The vaccines are safe and effective, and, if you are due, you need them now. Check your patient portal to determine if you are up to date or message your primary care team for a vaccination review. <a href="/providers/robert-jacobson-md">Robert M. Jacobson, M.D.,</a> is the medical director of the Primary Care Immunization Program in Southeast Minnesota. He is a physician in Community Pediatric and Adolescent Medicine at Mayo Clinic in Rochester, Minnesota and practices in the Baldwin building.Robert Jacobson, M.D.Primary Care in Rochester and KassonSchool VaccinePrimary Care in Rochester and KassonThese tips can help your family maintain a healthy weight.<img src="/-/media/ech-media/images/widgets/activities/familyexercise.jpg?h=65&iar=0&w=100&sc_lang=en&hash=2FF425FC5CFCCB3402EEAD0C9A99234A" alt="FamilyExercise" width="100" height="65" DisableNVelocity="true" />Work as a team to tackle obesity8/29/2024 12:00 AM<img src="/-/media/ech-media/images/widgets/activities/familyexercise.jpg?h=205&iar=0&w=315&sc_lang=en&hash=476CB906F53AA8AA0D8F2598364E0BB5" alt="FamilyExercise" width="315" height="205" DisableNVelocity="true" />When parents and their children hear the news from their care team that they may be overweight or obese, it's essential for their current and future health to make changes in the family's lifestyle. This includes becoming more active and making healthier food choices. You can do it! Family teamwork is the best path to success in developing healthy habits. A healthy lifestyle is important for people of all shapes and sizes. And it starts with parents. Children form their ideas about a healthy lifestyle by watching their parents' behavior rather than listening to "advice" from them or others. So how can your family work as a team to tackle obesity? Here are some tips to make this happen: The same rules apply to everyone. That means adopting the same eating and exercise habits for everyone in your family. Allowing one family member (child or parent) to eat whatever they want while putting restrictions on another is not modeling “team effort.” Be available to discuss how the same rules apply to everyone in sports or games. Similarly, the same principles apply to making healthy choices for activities and food. Healthy living is about adopting a routine with lifelong benefits. If it's not healthy for everyone in the house, don't buy it. It's easier to say "no" once to juice, soda, unhealthy snacks and sugary cereals when you are at the grocery store than to say "no" all the time at home. Not buying — and removing — unhealthy foods from your home puts the responsibility on parents to make good choices for their kids. Packing lunches for school or work can help everyone learn what makes up a healthy midday meal. Turn it into a family ritual after dinner. It's a natural time to talk about healthy food choices so kids adopt them when they're on their own. Eat as a family. Eating together can be so beneficial, allowing families to bond and take kids (and parents) away from the distractions of cell phones, tablets and TVs. Eating as a family supplies time for plenty of conversation that slows the pace of eating and allows brains to register fullness and signal when one is full. Family meals don't always need to be dinner. Your time together could be breakfast before everyone rushes off for their day. Set aside at least three meals per week to eat — and even prepare — together. Remember to consider weekends as an opportunity for family mealtimes too. Exercise together. Many families think they need to go to the gym to lose weight, but this doesn't have to be the case. Think about playing an active game such as kickball, tag, or touch football, shooting baskets, going roller skating, an after-supper “dance party,” entering a 5K walk and training together. Kids should have one hour of vigorous exercise (something that makes you sweat) each day. Sometimes, this isn't possible, and if you haven't been active, it may mean working your way up to that one-hour goal. Even small steps toward a more active lifestyle, such as after-supper family walks or riding your bike for a few minutes a day, can get you and your team on track to tackle obesity. For more information, visit these websites: <ul> <li><a rel="noopener" href="https://www.myplate.gov/" target="_blank" title="Link opens in a new window">MyPlate | U.S. Department of Agriculture</a>.</li> <li><a rel="noopener" href="https://thefamilydinnerproject.org/" target="_blank" title="Link opens in a new window">The Family Dinner Project - The Family Dinner Project</a>.</li> <li><a rel="noopener" href="https://www.nhlbi.nih.gov/health/educational/wecan/index.htm" target="_blank" title="Link opens in a new window">Welcome to We Can!, NHLBI, NIH</a>.</li> </ul> Go Team Family! Michaeleen Burroughs, MS, RDN, LD, has worked in Primary Care in Rochester and Kasson for 28 years. She helps patients at Mayo Family Clinics - Northwest, Southeast, Northeast, and Kasson. Her areas of interest are diabetes and child and adult weight management.Michaeleen Burroughs, MS, RDN, LDPrimary Care in Rochester and KassonTackling ObesityPrimary Care in Rochester and KassonThe psychological benefits of team sports participation are important for mental health. <img src="/-/media/ech-media/images/widgets/activities/ech_sports_clinic2018_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=BA4BF257D3C4FEC0870814BC202C6492" alt="ECH_sports_clinic2018_widget" width="100" height="65" DisableNVelocity="true" />The importance of team sports8/19/2024 12:00 AM<img src="/-/media/ech-media/images/widgets/activities/ech_sports_clinic2018_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=14B3D89D68B5FACB73B5420DC215D154" alt="ECH_sports_clinic2018_widget" width="300" height="195" DisableNVelocity="true" />Summer is winding down, and it's time to prepare for the new school year. With a new school term comes the Fall sports season, and many families are looking to sign their children up for team sports. There are countless benefits to team sports, and we'll further discuss the psychological benefits that young athletes receive as members of a team. Team sports are an excellent way for young people to get exercise to keep their bodies strong and healthy. But the benefits of team sports go far beyond just keeping our physical bodies healthy. Equally as important as our physical health is our mental health. There is a lot of research showing that young people who participate in team sports have lower rates of depression and anxiety. Athletes who still suffer from depression and anxiety often improve their symptoms. In addition to their physical and mental health benefits, kids playing team sports develop many life skills throughout the season. Skills needed to succeed as a team include learning communication and social skills. Young people can further develop these important skills by playing a team sport. These skills are important during both good and challenging times. Every team experiences adversity throughout the season, and teammates learn how to deal with this adversity by working together. Having supportive teammates can be helpful during difficult moments not only in the sport but also in their lives. Teammates are a valuable part of one's support system. During the team sports season, athletes usually feel a sense of belonging and accomplishment. The success and the time a team enjoys together build camaraderie and create lifelong memories, which have immeasurable psychological benefits. As we head into the Fall sports season, consider signing your child up for a team sport. If you have further questions about whether team sports are right for your child, reach out to their primary care clinician for more information. <a href="/providers/luke-radel-md">Luke Radel, M.D.</a>, is a pediatrician in Community Pediatric and Adolescent Medicine in Rochester, Minnesota. He is board-certified in pediatrics and sports medicine. Dr. Radel is the volunteer team physician for Rochester John Marshall High School and has experience treating youth, collegiate and professional athletes.Luke Radel, M.D.Primary Care in Rochester and KassonTeam SportsPrimary Care in Rochester and KassonFind out if one of the new anticoagulants is right for you.<img src="/-/media/ech-media/images/widgets/people/femalephysiciancounselingpatient.jpg?h=65&iar=0&w=100&sc_lang=en&hash=ED4290341EE9A3CF38720909E39D76EB" alt="FemalePhysicianCounselingPatient" width="100" height="65" DisableNVelocity="true" />Are you on warfarin?8/22/2024 12:00 AM<img src="/-/media/ech-media/images/widgets/people/femalephysiciancounselingpatient.jpg?h=205&iar=0&w=315&sc_lang=en&hash=B344B15FE7D13805BD0C4685A47A3CEE" alt="FemalePhysicianCounselingPatient" width="315" height="205" DisableNVelocity="true" />Warfarin (Coumadin, Jantoven) has been used for blood thinning for decades. While it has been effective for millions of patients, it also requires careful monitoring. Many factors including diet, medicines and health status can impact its anticoagulant effect. Specialized clinics, usually staffed by pharmacists and nurses, have achieved outstanding safety records for patients taking warfarin. Protocols that utilize knowledge and experience to achieve optimal care lower the risk of bleeding or clotting events. While most patients taking warfarin do so without complication, there may be considerable effort required to complete necessary monitoring. While half of the patients on warfarin often go months without the need for a dose adjustment, the remainder can require blood testing and dose adjustment much more often. This can be very burdensome. For that reason, many have switched to one of the newer blood thinners known as Direct-Acting Oral Anticoagulants (DOACs) which are consistent in their blood thinning effects and don't require the active monitoring required of warfarin. Might you be able to switch from warfarin to a DOAC? The answer depends on several factors. First, there are some indications for anticoagulation for which DOACs are not effective and cannot be used, such as mechanical heart valves. If you aren't sure, you should speak with your healthcare clinician. Second, if you are taking warfarin and have experienced good stability of the dose and don't find the monitoring to be bothersome, the benefits of switching will be limited. While overall DOACs have slightly better safety than warfarin, the difference is not large. If you don't fall into one of those two categories and are interested in switching, the next factor to consider is out-of-pocket cost for the newer medications. If you have commercial (that is, not government-sponsored) insurance, you should be able to use a manufacturer's coupon to lessen your costs. If your health insurance is government-sponsored, you will need to learn the specifics of coverage for your plan. For those with Medicare part D plans, reimbursement is often quite limited, and out-of-pocket costs can be prohibitive. While one of the DOACs has a generic equivalent available, this drug (dabigatran) is still expensive for most. Thomas Jaeger, M.D., is emeritus staff, having practiced in the Division of Community Internal Medicine, Geriatrics and Palliative Care for 34 years until his retirement in 2023. He served as medical director of Primary Care Anticoagulation for over 10 years.Thomas Jaeger, M.D.Primary Care in Rochester and KassonWarfarinPrimary Care in Rochester and KassonSleep problems are one of the most common symptoms reported by primary care patients. <img src="/-/media/ech-media/images/widgets/people/ech_sleeping_therapy_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=0251DE10052573B205813B8269CCE3D2" alt="ECH_sleeping_therapy_widget" width="100" height="65" DisableNVelocity="true" />Trouble sleeping? Behavioral therapy can help12/5/2024 12:00 AM<img src="/-/media/ech-media/images/widgets/people/ech_sleeping_therapy_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=0E4FA279E891076BADDB4A0E684DFD7A" alt="ECH_sleeping_therapy_widget" width="300" height="195" DisableNVelocity="true" />You're not alone if you're not getting a good night's sleep. Difficulty falling asleep, fragmented sleep, early awakening and nonrestorative sleep are common problems. As many as 30%–40% of adults experience sleep issues. Sometimes, your sleep cycle may get off track, whether it's due to stress, a change in sleep habits, or you're going through a medical issue. Thankfully, it usually rebounds on its own or after you make minor adjustments in your habits or the stress or medical problems are resolved. However, for some, sleep problems can persist, leading to problems associated with insomnia. Approximately 10%–30% of people meet the criteria for insomnia, which is usually defined as disruptions in falling asleep, staying asleep or waking early for at least three nights a week over three months. Unaddressed sleep problems can lead to difficulties functioning in almost every aspect of life and can have detrimental effects on your health. Sleep problems also tend to occur along with depression, anxiety and stress-related disorders. These conditions can cause sleep problems or make them more difficult to manage. When your sleep isn't restorative, you tend to change your habits to make up for this lack of restful sleep, such as: <ul> <li>Increasing caffeine use during the day.</li> <li>Taking more frequent or longer naps.</li> <li>Going to bed earlier or trying to sleep in longer.</li> <li>Using electronics, such as TV, tablets or smartphones, during the night as distractions. </li> </ul> While these habit changes make sense, they quickly become part of the insomnia problem. Tossing and turning results in more time in bed without sleeping. Worry and frustration start to build about not being able to sleep. Unfortunately, the brain begins to associate the bed and nighttime with sleeplessness. Cognitive behavior therapy for insomnia, also known as CBT-I, is a highly effective treatment that can lead to long-lasting beneficial improvements. The American Academy of Sleep Medicine and the American College of Physicians recommend this therapy as the first-line treatment for chronic insomnia. It's a straightforward approach that can be delivered in various ways: self-help, internet, apps, individual or group therapy. Cognitive behavioral therapy for insomnia doesn't necessarily focus on how insomnia started. Instead, it focuses on how sleep problems are maintained. It helps you learn skills and change habits to reassociate the bed with nighttime and sleep, with the goal of reducing the amount of wakeful time during the night. Among the elements of cognitive behavioral therapy for insomnia are: Sleep hygiene Sleep hygiene involves changing your sleep habits and sleep environment to maximize the likelihood that your body is ready for sleep, such as: <ul> <li>Making the bedroom dark, quiet and cool.</li> <li>Reducing daily caffeine use.</li> <li>Removing all electronics from the bedroom.</li> <li>Reducing or eliminating daytime naps and limiting sleep to nighttime.</li> <li>Establishing a routine time for going to bed and waking up. </li> </ul> Stimulus control When sleep hygiene isn't enough, stimulus control can effectively help people reassociate the bed with nighttime and sleep using strategies such as: <ul> <li>Using the bedroom only for sleeping and sexual activity — no reading, watching TV, using electronics, or even spending time in your bedroom during the day.</li> <li>Going to bed only when sleepy rather than just feeling tired. When tired, your head tends to bob, and your eyes are heavy. These signs tell you your body is ready to call it a night.</li> <li>Get out of bed if you've been lying awake for more than 15–20 minutes. Go to another room, such as the living room, keep the lights low and only participate in quiet activities, such as listening to light music, practicing relaxation or reading something boring. Return to bed only when you're sleepy. </li> </ul> Keep a regular wake-up routine and get up at the same time each morning, even on weekends, holidays and days off. Sleep restriction Sleep restriction reduces the amount of wakeful time in bed and promotes a stronger association between the bed, nighttime and sleep by: <ul> <li>Tracking the amount of time you spend in bed and the amount of time you spend asleep. For example, you may go to bed at 10 p.m., toss and turn from 2 to 4 a.m. and get up at 6 a.m. for a total of eight hours in bed. But you only had six hours of sleep.</li> <li>Moving your bedtime later and limiting the time in bed to the actual time spent sleeping. For example, you go to bed at midnight and wake up at 6 a.m., giving you six hours of sleep. </li> </ul> Wake up at the same time each day while maintaining good sleep hygiene and continuing to practice getting out of bed when you're not sleeping. Challenging negative thoughts Lying awake in bed with a "busy brain" can be frustrating. Schedule thinking time so that it is less likely to come up while you are in bed. This can be achieved by: <ul> <li>Take 10 minutes each night to write down your thoughts, worries or ideas that often come up while lying in bed.</li> <li>Give yourself at least two hours before your scheduled bedtime to give your brain time to settle down after this activity.</li> <li>The following day, review the list within one hour of waking up. Reviewing the list each morning builds trust with your brain so you do not forget what is on the list.</li> <li>This exercise allows your brain to unhook from your thoughts while in bed and pick them up again in the morning. </li> </ul> Relaxation training or stress management As you start to sleep more solidly through the night, you can gradually begin to go to bed earlier. It may take some practice until you find the optimal sleep schedule. Other cognitive behavioral therapy for insomnia skills include: <ul> <li>Learning ways to challenge nighttime negative thoughts and worries, such as "I must get eight hours of sleep to function."  For example, you might identify a more helpful thought such as “I’ve been able to get through the day on less than 8 hours before, even if it was tough!”</li> <li>Practicing relaxation skills, such as deep breathing, guided imagery and passive or progressive muscle relaxation.</li> <li>Learning stress management techniques to reduce stress during the day, including time management and problem-solving. </li> </ul> Resources to help improve your sleep <ul> <li>Cognitive behavioral therapy for insomnia. Individual and group therapy is available through Primary Care in Rochester and Kasson. In-person and video visits are also available. Ask your care team about your options.</li> <li>Cognitive behavioral therapy for insomnia online interactive module. This <a rel="noopener" href="https://mccmscontent.mayo.edu/PatientEducation/PatientLearning/index.html#/" target="_blank" title="Link opens in a new window">free online, self-paced, interactive skill-building module</a> created by Mayo Clinic will guide you through implementing cognitive behavioral therapy for insomnia techniques independently.</li> <li>Overcoming Insomnia. This self-help workbook by Jack Edinger and Collen Carney is a helpful resource for independently implementing cognitive behavioral therapy for insomnia.</li> <li>Insomnia Coach. This <a rel="noopener" href="https://www.ptsd.va.gov/appvid/mobile/insomnia_coach.asp" target="_blank" title="Link opens in a new window">free app</a> was developed by the Veterans Administration to help users learn and apply cognitive behavioral therapy for insomnia skills.</li> <li>Sleepwell. This <a rel="noopener" href="https://mysleepwell.ca/" target="_blank" title="Link opens in a new window">website</a> from Dalhousie University has valuable information and resources on improving sleep. </li> </ul> Cognitive behavioral therapy for insomnia takes time and patience to be effective. The good thing is that nighttime always comes, so there is always an opportunity to practice, implement and refine these skills. Kyle Schofield, Ph.D., is a clinical health psychology fellow in Primary Care in Rochester and Kasson's Division of Integrated Behavioral Health. <a rel="noopener" href="https://www.mayoclinic.org/biographies/roche-anne-i-ph-d-l-p/bio-20569110" target="_blank" title="Opens in new browser window">Anne Roche, Ph.D., L.P.</a>, and <a rel="noopener" href="https://communityhealth.mayoclinic.org/providers/craig-sawchuk-phdlp" target="_blank" title="Link opens in a new window">Craig Sawchuk, Ph.D., L.P.</a>, are clinical psychologists in Primary Care in Rochester and Kasson's Division of Integrated Behavioral Health.Kyle Schofield, Ph.D.; Anne Roche, Ph.D., L.P.; Craig Sawchuk, Ph.D., L.P.Primary Care in Rochester and KassonBehavioral Sleep TherapyPrimary Care in Rochester and KassonAs a blood donor, you never expect to be a recipient, but you understand the constant need. <img src="/-/media/ech-media/images/widgets/blooddonation/blooddonationkirtz.jpg?h=65&iar=0&w=100&sc_lang=en&hash=6B490A85963FA6D2229FC3847F702DF5" alt="BloodDonationKirtz" width="100" height="65" DisableNVelocity="true" />Blood donor recounts how he became a recipient10/10/2024 12:00 AM<img src="/-/media/ech-media/images/widgets/blooddonation/blooddonationkirtz.jpg?h=205&iar=0&w=315&sc_lang=en&hash=EAFF9B103C98CCBF7B65E2E809572C58" alt="BloodDonationKirtz" width="315" height="205" DisableNVelocity="true" />"I am in the hospital now. I have been there since last Wednesday," says Mike Kirtz during a 2023 interview. "I have acute myeloid leukemia." Mike was undergoing his second treatment cycle at Mayo Clinic Hospital — Rochester, Methodist Campus. "In my first cycle of treatment, I had something like four or five units of blood and a couple of units of platelets. This cycle, I have not received any blood or platelets. My blood counts have not gone down low enough to where I will need one." Mike started the year healthy. He was even a blood donor. "I last donated in February sometime," recounts Mike. "It makes me really glad that I took the time to donate when I did. It makes me wish I had done it more often, though." Because as the year went on, his health seemed to be just a bit off. Initially, doctors attributed Mike's growing number of aches and pains to aging. It wasn't until he went in with a swollen knee that tests showed low blood counts, which eventually led to his diagnosis. "Blood donation is something that is needed all of the time," says Mike. "I had never received a unit of blood before this. How many units of blood is my next treatment going to take? I don't know, and I am just one story. Blood donation is such a constant need." Mike is currently in remission and working his way toward complete remission, but because of the diagnosis of bloodborne cancer, he will no longer be eligible to donate blood. Still, in the wake of his diagnosis, Mike's loved ones came in to donate because of him as a way to show their love and support. To schedule your blood donation appointment at the Northwest Blood Donor Center or the Hilton Building Blood Donor Center, call the Mayo Clinic Blood Donor Center at <a rel="noopener" href="tel:5072844475" target="_blank" title="Link opens in a new window">507-284-4475</a>. Watch for more information by visiting the <a rel="noopener" href="https://connect.mayoclinic.org/page/blood-donor-program/" target="_blank" title="Link opens in a new window">Blood Donor Program blog</a>, the <a rel="noopener" href="https://www.mayoclinic.org/blood-donor-program/minnesota" target="_blank" title="Link opens in a new window">Minnesota Blood Donor Program website</a> or the <a rel="noopener" href="https://www.facebook.com/blooddonorcentermc?ref=br_tf" target="_blank" title="Link opens in a new window">Facebook page</a>.Primary Care in Rochester and KassonBlood Donation KirtzPrimary Care in Rochester and KassonOctober is National Breast Cancer Awareness Month. Have you had your mammogram? <img src="/-/media/ech-media/images/widgets/randomimages/ech_breastcancer_01_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=4B65CBFD73986071B91AD41BA5A2E797" alt="ECH_BreastCancer_01_widget" width="100" height="65" DisableNVelocity="true" />Breast cancer screening: Choosing the option best for you10/7/2024 12:00 AM<img src="/-/media/ech-media/images/widgets/medicalimages/ech_breastcancer_01_widget.jpg?h=195&iar=0&w=300&hash=27A10C2E2F2D8535C56E68DB3A1C5CF0" alt="ECH_BreastCancer_01_widget" width="300" height="195" DisableNVelocity="true" />Breast cancer is the most common cancer in women, regardless of race or ethnicity. One in eight women will develop breast cancer throughout their lifetime (by about age 80), according to the Centers for Disease Control. What are the screening options for breast cancer? Mammograms are X-rays of the breast, with or without tomosynthesis (3D imaging), and remain the mainstay of breast cancer screening. Mammography detects whether there are abnormal collections of calcium or an abnormal look to the tissue (asymmetry) that could indicate breast cancer before a lump can be felt. Mammograms also reveal breast density. Increased density, typically density C and D, is associated with an increased risk of breast cancer. Recommendations generally suggest that average-risk women begin having mammograms at age 40. If you receive care at Mayo Clinic, you can schedule your mammogram using the patient portal. There's more than one kind of breast screening examination, so it's important to talk with your primary care clinician about the options for screening and whether you're at average or increased risk. Together, you can make a choice that best suits your situation. Keep in mind that these options don't replace regular screening mammograms: <ul> <li>Molecular breast imaging (MBI), a supplemental breast cancer screening test, doesn't replace mammograms, but an injected dye "sees" through dense breasts. MBI can also be used if the patient is at an elevated risk of breast cancer and needs specialized screening.</li> <li>Breast magnetic resonance imaging (MRI) is used in addition to a mammogram for women with a high risk of breast cancer, including greater than 20% lifetime risk, having a strong family history, certain genetic mutations or being treated with chest radiation for Hodgkin lymphoma before the age of 30.</li> <li>Automated whole-breast ultrasound (ABUS) is another tool for screening women with dense breasts. It uses sound waves to see through the breast. This test has a high false positive rate and isn't offered at Mayo Clinic.</li> <li>Thermography uses infrared technology to record different skin surface temperatures. Thermography is NOT approved by the Food and Drug Administration (FDA) for breast cancer screening because it detects only about half of breast cancers. </li> </ul> Can I do anything to decrease my risk of breast cancer? The good news is that the answer is "yes." There are things you can do to decrease your risk of breast cancer. <ul> <li>We know that, especially for women who have gone through menopause, being at a healthy body weight decreases the risk of breast cancer.</li> <li>Regular aerobic exercise, 30 minutes at least five days per week, can lower the risk of breast cancer by 10% to 20%.</li> <li>Alcohol is also known to increase the risk of cancer, and women who have two to three beverages per day have a 20% higher risk than women who don't drink alcohol.</li> <li>Smoking also increases the risk of breast cancer. If you smoke and are ready to quit, consider asking your primary care clinician for help.</li> <li>Women at a very high risk of breast cancer may choose to take medication to reduce their risk in discussions with a clinician.</li> <li>Studies have NOT shown an increased risk of breast cancer by wearing bras, drinking caffeine, or using cellphones or deodorant/antiperspirant.</li> </ul> <a rel="noopener" href="https://www.mayoclinic.org/biographies/gilman-liz-a-m-d-msm/bio-20055507" target="_blank" title="Link opens in a new window">Liz Gilman, M.D., MSM</a>, is an Internal Medicine physician in the Division of General Internal Medicine. She spends time in the Breast Clinic and has a special interest in breast cancer prevention and women at a high risk of breast cancer.Liz Gilman, M.D.Primary Care in Rochester and KassonBreast Cancer ScreeningPrimary Care in Rochester and KassonMake sure you're up to date on the new recommendations.<img src="/-/media/ech-media/images/widgets/kids/ech_car_seat_01_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=315C9B1E5A394427513CC31FCB1D2FA0" alt="ECH_Car_Seat_01_widget" width="100" height="65" DisableNVelocity="true" />Keeping kids safe: Updates to car seat use10/31/2024 12:00 AM<img src="/-/media/ech-media/images/widgets/kids/ech_car_seat_01_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=66F9663C4F9B3966861518ACA5F310AC" alt="ECH_Car_Seat_01_widget" width="300" height="195" DisableNVelocity="true" />Motor vehicle crashes continue to be a leading cause of preventable death for children ages 1 to 13 years old. Using child car seats and belt-positioning boosters properly is one of the best ways to keep your kids safe while on the road. According to the American Academy of Pediatrics (AAP), child safety seats reduce the risk of injury by 71% to 82%. To help reduce the risk even further, the AAP and National Highway Traffic Safety Administration (NHTSA) provide best practice recommendations for choosing and using car seats and restraints for kids from birth to adolescence. The AAP calls for children to use rear-facing car seats for as long as possible, according to the seat's height and weight requirements. Minnesota has also updated its child passenger restraint law to reflect best practices. Best-practice recommendations include: <ul> <li>Children remain in a rear-facing seat until reaching the height or weight limit, according to the seat manufacturer.</li> <li>Change to forward-facing car safety seats when the kids outgrow rear-facing seats based on the manufacturer’s specifications.</li> <li>Children should be in child passenger restraints with a harness until they reach the seat's upper height or weight limit.</li> <li>Switch to belt-positioning booster seats once the child outgrows a forward-facing child passenger seat.</li> <li>Children should ride in a booster seat until the adult lap-and-shoulder belt fits properly.</li> <li>Install and use car seats according to the manufacturer's instructions.</li> <li>Due to the force when an air bag deploys, children should not sit in the front seat until they're 13. </li> </ul> Choosing and using car seats is important but installing them correctly is essential. According to the Centers for Disease Control and Prevention (CDC), three out of four child car seats aren't installed properly. Car seats only protect your child in a crash if installed correctly. To learn more, the below video demonstrates proper installation. You can also read more tips <a rel="noopener" href="https://newsnetwork.mayoclinic.org/discussion/mayo-clinic-minute-how-to-properly-install-kid-car-seats/?utm_source=facebook&utm_medium=sm&utm_content=post&utm_campaign=mayoclinic&geo=national&placementsite=enterprise&mc_id=us&cauid=100502&linkId=57935197" target="_blank" title="Link opens in a new window">here</a>. <iframe width="560" height="315" src="https://www.youtube.com/embed/StaeGY55Mto?si=JXe6Excz3asTlQ6j&enablejsapi=1&origin=https:%2F%2Fsncs.mayo.edu" frameborder="0" id="ytVideoPlayer1" title="Mayo Clinic Minute: How to properly install kid car seats"></iframe>  Check for safety seat recalls on the <a rel="noopener" href="https://www.nhtsa.gov/recalls" target="_blank" title="Link opens in a new window">National Highway Traffic Safety Administration website</a>.  Nicole Guertin, M.S., is an injury prevention coordinator at Mayo Clinic Level 1 Pediatric Trauma Center. Nicole Guertin, M.S.Primary Care in Rochester and KassonCar Seat UpdatesPrimary Care in Rochester and KassonTips to tame eczema in your child.<img src="/-/media/ech-media/images/widgets/kids/childhandlotion.jpg?h=65&iar=0&w=100&sc_lang=en&hash=1F69C691E42ABF915142F1012EA84DF0" alt="ChildHandLotion" width="100" height="65" DisableNVelocity="true" />Understanding eczema: The 'ecz-asperating' rash9/16/2024 12:00 AM<img src="/-/media/ech-media/images/widgets/kids/childhandlotion.jpg?h=205&iar=0&w=315&sc_lang=en&hash=07771E5C4C9D966177A1621DBE9865C2" alt="ChildHandLotion" width="315" height="205" DisableNVelocity="true" />What is eczema? Eczema, or atopic dermatitis, is a common skin condition affecting at least 1 in 10 children. It causes dry, red and itchy skin and is associated with sensitive skin. Why does eczema happen? Eczema occurs because of breaks in the skin barrier. Kids with eczema don't have enough filaggrin protein in their skin. Without enough filaggrin, the skin has a harder time holding in moisture and keeping out irritants. Both genes and the environment play a role so it can run in families. It is tied to other allergic diseases like asthma and seasonal allergies. Some kids will start to outgrow it by age 4. Some children have eczema flares after eating certain foods, but the actual food does not cause eczema. Focusing on taking care of the skin barrier is more important than eliminating the food. Where does eczema typically show up? Can others catch it? Eczema can appear differently and change location based on age. In babies, it typically occurs on the cheeks, face, around the mouth and scalp. In school-aged children, it often happens on the neck, elbow creases and behind the knees. It is NOT contagious. Although kids with eczema are more prone to skin infections, the condition itself doesn’t spread from person to person. How to tame the 'ecz-asperating' rash <ul> <li>Moisturize: Use creams or ointments right after bathing to help hold in moisture. Choose products without fragrances, like plain Vaseline or Vanicream.</li> <li>Avoid triggers: Avoid soaps and laundry detergent with fragrance or itchy fabric.</li> <li>Use over-the-counter hydrocortisone 1% twice a day: This helps reduce itching and inflammation. Buy one that is unscented and apply it first before lotion. Use it for no more than 14 days at a time and take a 1-week break before resuming it if still needed.</li> <li>Don't scratch: Teach your child to tap or gently rub their skin instead. </li> </ul> When to see a healthcare clinician If the rash still bothers your child after trying these tips, or if their skin becomes very red, swollen, or starts to ooze or has yellowish crusting, call their clinician for an evaluation. Afia Brago Adu-Gyamfi, M.D., is a third-year Mayo Clinic Pediatric and Adolescent Medicine resident. She graduated from the Medical College of Wisconsin in Milwaukee and is interested in atopic dermatitis, food allergies, immunodeficiencies and asthma.Afia Brago Adu-Gyamfi, M.D.Primary Care in Rochester and KassonChildhood EczemaPrimary Care in Rochester and KassonTips to cope with this common winter ailment.<img src="/-/media/ech-media/images/widgets/people/familyuri.jpg?h=65&iar=0&w=100&sc_lang=en&hash=4FA6103CC8C54093DB5252DB5ED6172B" alt="FamilyURI" width="100" height="65" DisableNVelocity="true" />Coping with the common cold12/23/2024 12:00 AM<img src="/-/media/ech-media/images/widgets/people/familyuri.jpg?h=205&iar=0&w=315&sc_lang=en&hash=B118615EA84699C8B3C03F928F20A0FB" alt="FamilyURI" width="315" height="205" DisableNVelocity="true" />We've all had a common cold—runny nose, sore throat, stuffy nose, feeling unwell, body aches and low-grade fever. Adults may experience two or three colds each year, while it can be more often for young children. The common cold is: <ul> <li>NOT like the flu (influenza), which has a sudden onset of severe body aches, high fever, bad headache and cough.</li> <li>NOT like COVID-19, which causes symptoms similar to the common cold plus loss of taste or smell, nausea or vomiting, and a dry cough.</li> <li>NOT treated with antibiotics even though your mucus changes from clear to thick yellow or green. </li> </ul> Like other viruses, the cold virus enters the body through the nose, eyes or mouth and is spread by droplets in the air. You can also get the cold virus by hand-to-hand contact with someone with a cold or sharing objects others have touched. Symptoms typically start 1 to 3 days after exposure to the cold virus and can last 7 to 10 days. If you smoke, your symptoms may last longer. The best way to protect yourself is to reduce your chances of getting the virus by washing your hands, using hand sanitizer, cleaning and disinfecting surfaces and staying away from those who are sick. It is also important to eat well, exercise and rest. If you do get a cold, you do not need medical care unless your symptoms worsen. If you do get a cold, here are tips to cope: <ul> <li>Rest and drink lots of liquid.</li> <li>Humidify the air.</li> <li> Use a saline nasal rinse.</li> <li>Adults may take Tylenol or Ibuprofen for pain relief.</li> <li>If your child is younger than three months of age, talk to their primary care clinician before administering any medications.</li> <li>Do not give Ibuprofen to babies younger than six months or to children who are vomiting.</li> <li>Do not give children aspirin.</li> <li>Be careful when using over-the-counter decongestants and cough medication, as they have similar active ingredients. </li> </ul> If your fever lasts more than three to five days, or you have chest pain, ear pain, or are coughing up blood or cough so hard that you vomit or pass out, you should contact your care team immediately. <a href="/providers/fahma-mohamed-md">Fahma Mohamed, M.D.</a>, is a family medicine physician who practices at Mayo Family Clinic Northeast in Rochester. She lives in Rochester, Minnesota, with her family. She finished her residency at Hennepin County Medical Center. Her interests include preventive medicine, women’s health, chronic disease management and medical education.Fahma Mohamed, M.D.Primary Care in Rochester and KassonCoping Common ColdPrimary Care in Rochester and KassonFind out things to be aware of when planning your next cruise. <img src="/-/media/ech-media/images/widgets/activities/cruiseship.jpg?h=65&iar=0&w=100&sc_lang=en&hash=FA03514A67D7086E4E664686B30D1051" alt="CruiseShip" width="100" height="65" DisableNVelocity="true" />Thinking about a cruise? Things to consider11/4/2024 12:00 AM<img src="/-/media/ech-media/images/widgets/activities/cruiseship.jpg?h=205&iar=0&w=315&sc_lang=en&hash=A2C0B63A0077AF891FB50C7CCF9E7082" alt="CruiseShip" width="315" height="205" DisableNVelocity="true" />Now that the COVID-19 pandemic is over, more and more people have returned to travel — in particular, cruises. There are things you should know about cruise ship travel. Centers for Disease Control and Prevention (CDC) has a great <a rel="noopener" href="https://wwwnc.cdc.gov/travel/page/cruise-ship" target="_blank" title="Link opens in a new window">resource page</a> just for that. Before you travel <ul> <li>Update your routine vaccines and check if other vaccines are needed for any of your destinations.</li> <li>Consider seeing your primary care team or a travel specialist at least one month in advance for destination-specific recommendations including vaccines, medications and other information. Be sure to bring your itinerary with you.</li> <li>Prepare a travel kit of things you might need or that could be difficult to obtain while on the cruise. <ul> <li>Prescriptions and over-the-counter medications.</li> <li>Insect repellent.</li> <li>Sunscreen.</li> <li>Hand sanitizer.</li> <li>Health insurance card.</li> </ul> </li> <li>Consider travel insurance. </li> </ul> Preventing illness <ul> <li>Protect yourself from the sun. Wear clothing or sunscreen with an SPF 15 or higher. Skin can burn even if it is cloudy or cold outside.</li> <li>Use insect repellent to avoid bug bites. Mosquitos and ticks can spread diseases including malaria, dengue, Zika, Lyme and others.</li> <li>Use medications to prevent seasickness if needed. Options include pills or patches which can be obtained from your healthcare team before you leave.</li> <li>Wash your hands. <ul> <li>Vomiting and diarrhea are frequently caused by outbreaks of norovirus. Ensuring that you wash your hands with soap and water before eating, after using the bathroom, or touching things that others have touched, can prevent you from contracting this infection.</li> <li>This may also protect you from contracting respiratory viral illnesses such as COVID-19, flu and RSV.</li> </ul> </li> <li>Consider wearing a mask in crowded or indoor areas — particularly where there are others with respiratory illnesses. This precaution will help protect you from contracting respiratory viral illnesses. </li> </ul> The CDC has other webpages with additional information to keep you healthy and safe during your upcoming cruise: <ul> <li><a rel="noopener" href="https://wwwnc.cdc.gov/travel/yellowbook/2024/air-land-sea/cruise-ship-travel" target="_blank" title="Link opens in a new window">Cruise Ship Travel: CDC Yellow Book 2024</a> (Travel by Air, Land & Sea).</li> <li><a rel="noopener" href="https://www.cdc.gov/vessel-sanitation/communication-resources/tips-for-healthy-cruising.html" target="_blank" title="Link opens in a new window">Tips for Healthy Cruising</a>. </li> </ul> Have a great trip — and stay safe. <a href="/providers/denise-dupras-md">Denise Dupras, M.D., Ph.D.</a>, is a general internist in Community Internal Medicine, Geriatrics and Palliative Care. She completed her medical and doctoral degrees at Mayo Clinic Alix School of Medicine and her residency in internal medicine at Mayo Clinic in Rochester. Her interests include medical education and evidence-based medicine.Denise Dupras, M.D., Ph.D.Primary Care in Rochester and KassonCruise ConsiderationsPrimary Care in Rochester and KassonThe quick answer is anything that gets your body moving. <img src="/-/media/ech-media/images/widgets/people/vacuumdance.jpg?h=65&iar=0&w=100&sc_lang=en&hash=EE814628DD57ECBF9FFA75D31C757C32" alt="VacuumDance" width="100" height="65" DisableNVelocity="true" />What counts as exercise?11/21/2024 12:00 AM<img src="/-/media/ech-media/images/widgets/people/vacuumdance.jpg?h=205&iar=0&w=315&sc_lang=en&hash=0E6E75BA47F83D58A688F4CD51944415" alt="VacuumDance" width="315" height="205" DisableNVelocity="true" />Physical activity is anything that gets your body moving. The Centers for Disease Control and Prevention recommends that healthy adults aim for 150 to 300 minutes of moderate activity or 75 to 150 minutes of vigorous activity throughout the week. Dedicating significant blocks of time to exercise each day can be challenging for many. An alternative can be to commit to short periods of movement throughout the day. Spreading activity out and being consistent with activity during the day can add up to significant health benefits. It all counts. Even walking a few minutes every hour can significantly lower many disease risk factors. Look for opportunities to fit movement into your day. That's the key to getting your "move" on. Remember the acronym NEAT, or Non-Exercise Activity Thermogenesis. NEAT describes movement throughout the day that is not designated as a "workout." Consider looking for NEAT opportunities like these to move more throughout the day: <ul> <li>Have a walking meeting.</li> <li>Schedule your meeting in a location that requires a short walk.</li> <li> If you've been sitting for a while, stand up or take a quick walk, even if it's just throughout the house.</li> <li>Stand while you talk on the phone.</li> <li>Try a standing desk.</li> <li>Walk up the steps instead of taking the elevator to increase your energy and focus. </li> <li>Formal exercise is important, but choosing to move throughout the day burns calories and helps improve your health. </li> </ul> Here are some other ideas to get moving: <ul> <li>Go "old school" with chores — use a vacuum instead of the Roomba or pick up that snow shovel instead of using the snowblower.</li> <li>Play tag with your kids.</li> <li>Wash the windows.</li> <li>Go sledding or make snow angels with your kids.</li> <li>Dig out the hula hoop.</li> <li>Hear your favorite song? Break into a dance. </li> </ul> Any and all movement counts. What you do is limited only by your imagination. Have fun. Danielle P. Johnson, M.S., P.T., is a wellness physical therapist at the Mayo Clinic Healthy Living Program in Rochester. She specializes in combining physical therapy with whole-body wellness and integrating fundamental and natural movement patterns and practical and playful movement into daily experiences.Danielle P. Johnson, M.S., P.T.Primary Care in Rochester and KassonDaily ExercisePrimary Care in Rochester and KassonOne in 10 Americans has diabetes. Take a quiz to find out if you're at risk.<img src="/-/media/ech-media/images/widgets/diabetes/ech_diabetes_01_widget.jpg?h=65&iar=0&w=100&hash=C4A7FBA0B99357EEF70C4B213948C37B" alt="ECH_Diabetes_01_widget" width="100" height="65" DisableNVelocity="true" />Diabetes — Are you at risk?9/30/2024 12:00 AM<img src="/-/media/ech-media/images/widgets/diabetes/ech_diabetes_01_widget.jpg?h=195&iar=0&w=300&hash=4B193D747F254B2AC0901CAC7743463C" alt="ECH_Diabetes_01_widget" width="300" height="195" DisableNVelocity="true" />About 1 in 10 Americans, more than 38 million people, have diabetes, and 1 in 5 adults don't know they have it. If you're 65 or older, your chance of having diabetes is 29%. Most people with diabetes, 90-95%, have type 2 diabetes. This condition develops when your body doesn't use insulin well. Type 1 diabetes occurs when your body can't make insulin and accounts for most of the remaining cases of diabetes. Type 2 diabetes can happen for many reasons, including personal lifestyle, environmental and genetic causes. It's possible to change many of the risk factors for diabetes. These changes could delay or prevent type 2 diabetes. This prevention is why it's important to understand what contributes to the development of diabetes and know whether you have it or are at risk for it. Prediabetes means your blood sugar is higher than average but not high enough to be diabetes. In prediabetes, your fasting blood sugar is 100-125 mg/dl, or you have a hemoglobin A1c of 5.7-6.4%. In diabetes, your fasting blood sugar is 126 mg/dl or above, or your hemoglobin A1c is 6.5% or above. One in three American adults has prediabetes, but more than 8 in 10 people don't know it. Prediabetes may progress to diabetes over time if risk factors aren't identified and addressed. If you have prediabetes, small changes can help. Improvement in weight (losing 5 to 7% of your body weight) and being active for 30 minutes a day, five days a week, could lower your risk of getting type 2 diabetes. Lifestyle changes not only lower your risk of type 2 diabetes but can also improve your overall physical and emotional well-being. Take a quick quiz The American Diabetes Association has a quick quiz to help you see if you're at risk for diabetes. You can <a rel="noopener" href="https://www.diabetes.org/risk-test" target="_blank" title="Link opens in a new window">take it here</a> and find out your score. A higher score means a higher risk of having or developing type 2 diabetes. If you score five or higher, talk to your healthcare clinician to see if you need to be screened. There are many ways to stay healthy, like being active, keeping a healthy weight, and eating a balanced diet. Your healthcare team can help, along with community-based health programs like the Diabetes Prevention Program. <a rel="noopener" href="https://diabetes.org/about-diabetes/diabetes-prevention" target="_blank" title="Link opens in a new window">Find a program</a> near you. Elizabeth Miles, APRN, CNP, is a family nurse practitioner in the Department of Endocrinology, Diabetes, Metabolism, and Nutrition. She specializes in managing type 1 and type 2 diabetes and has over 15 years of experience in endocrinology. Elizabeth is an Instructor in Medicine and is the Associate Program Director for the Mayo Clinic School of Health Sciences Nurse Practitioner Program.Elizabeth Miles, APRN, C.N.P., M.S.Primary Care in Rochester and KassonDiabetes RiskPrimary Care in Rochester and KassonWhile Down syndrome is common and not treatable, people with Down syndrome can still lead a meaningful life. <img src="/-/media/ech-media/images/widgets/people/downsyndrome.jpg?h=65&iar=0&w=100&sc_lang=en&hash=229F352D718370ECD2846578D85FA2FB" alt="DownSyndrome" width="100" height="65" DisableNVelocity="true" />What is Down syndrome?10/14/2024 12:00 AM<img src="/-/media/ech-media/images/widgets/people/downsyndrome.jpg?h=205&iar=0&w=315&sc_lang=en&hash=A85218D9E5E5E7F239A8BB856936636C" alt="DownSyndrome" width="315" height="205" DisableNVelocity="true" />One in 700 babies, or about 6,000 per year, are born with Down syndrome. Babies are usually born with 46 chromosomes, or "groups" of material, inherited from their parents. However, babies with Down syndrome have an extra copy of a chromosome, and this extra copy changes their bodies. People with Down syndrome usually have multiple medical and learning challenges. What is the test for Down syndrome? Your healthcare clinician can test for Down syndrome during pregnancy using a blood test or other procedures, depending on when you are tested during pregnancy. You can choose whether you would like this testing during pregnancy. After birth, babies can be tested for Down syndrome using a blood test if a healthcare clinician sees signs of Down syndrome. What medical problems accompany Down syndrome? People with Down syndrome can have multiple possible medical complications, including vision and hearing problems, heart defects, sleep difficulties, or stomach issues. Your child's healthcare clinician will check for these potential problems. Not all people with Down syndrome have all these medical issues. What learning issues accompany Down syndrome? Children with Down syndrome learn motor and language skills slower than children without Down syndrome. This is known as "developmental delay." Almost all people with Down syndrome have intellectual disability or low IQ, which includes difficulty learning and trouble with activities of daily life. These difficulties can be mild to severe. Can people with Down syndrome lead a meaningful life? Yes, people with Down syndrome can still have meaningful friendships, and they can date and marry. Many job opportunities are available as well, including in banks, hotels, hospitals and offices, as well as in the entertainment industry and child care. How can I learn more about Down syndrome? You can find more information on the<a rel="noopener" href="https://www.ndss.org/" target="_blank" title="Link opens in a new window"> National Down Syndrome Society</a> or the <a rel="noopener" href="https://www.cdc.gov/birth-defects/about/down-syndrome.html" target="_blank" title="Opens in new browser window">Centers for Disease Control and Prevention</a> websites. You can also speak to your child's healthcare clinician for more information about Down syndrome. <a rel="noopener" href="https://www.mayoclinic.org/biographies/katusic-maja-z-m-d/bio-20491622" target="_blank" title="Link opens in a new window">Maja Katusic, M.D.</a>, is a developmental and behavioral pediatrician at Mayo Clinic in Rochester. In addition to her clinical activities, she is involved in research focusing on risk factors and outcomes in autism spectrum disorder.Maja Katusic, M.D.Primary Care in Rochester and KassonDown SyndromePrimary Care in Rochester and KassonVaccine administration will begin Oct. 14. <img src="/-/media/ech-media/images/widgets/people/multigenerationalfamily.jpg?h=65&iar=0&w=100&sc_lang=en&hash=0E1398648E063109E493DC62899D48D6" alt="MultigenerationalFamily" width="100" height="65" DisableNVelocity="true" />Influenza and COVID vaccination scheduling to begin Sept. 259/18/2024 12:00 AM<img src="/-/media/ech-media/images/widgets/people/multigenerationalfamily.jpg?h=205&iar=0&w=315&sc_lang=en&hash=37FCE57E3BBEA6B33E09BFBCF96B186E" alt="MultigenerationalFamily" width="315" height="205" DisableNVelocity="true" />All people 6 months of age and older are encouraged to get their flu vaccination when available in their local community. The Centers for Disease Control and Prevention (CDC) recommends that people are vaccinated for flu by the end of October to ensure they have the best protection for the influenza season. This year's COVID vaccination is recommended for all people 6 months of age and older. Young children, immunocompromised people and adults age 65 and older will need more than one dose. Primary care patients can request a flu or COVID vaccine as part of a regularly scheduled primary care clinician visit during normal operating hours. If you just need a vaccine, you should schedule an appointment at a Primary Care Vaccination Clinic.  Online scheduling will be available Wednesday, Sept. 25, through your patient portal account. You also can schedule by calling your primary care clinic. Vaccination visits will begin on Monday, Oct. 14, at the locations and hours listed below. Vaccine clinic hours beyond the first four weeks will be updated and expanded based on demand.Mayo Clinic staff members should plan to receive their flu and COVID vaccinations at one of the many on-campus walk-in clinics if possible.  <table style="border-width: 1px; border-color: #000000;"> <tbody> <tr> <td style="border: 1px solid #000000; text-align: left; vertical-align: middle;"> </td> <td style="border: 1px solid #000000; text-align: center; vertical-align: middle;">Mayo Clinic Medical Complex Northwest (formerly 41st Street Professional Building) 3033 41st Street NW, North Entrance Rochester, Minn.</td> <td style="border: 1px solid #000000; text-align: center; vertical-align: middle;">Mayo Family Clinic Kasson 411 West Main Kasson, Minn.</td> </tr> <tr> <td style="border: 1px solid #000000; text-align: left; vertical-align: middle;">Monday</td> <td style="border: 1px solid #000000; text-align: center; vertical-align: middle;">8 a.m. to 5 p.m.</td> <td style="border: 1px solid #000000; text-align: center; vertical-align: middle;">8 a.m. to 5 p.m.</td> </tr> <tr> <td style="border: 1px solid #000000; text-align: left; vertical-align: middle;">Tuesday </td> <td style="border: 1px solid #000000; text-align: center; vertical-align: middle;">10 a.m. to 7 p.m.</td> <td style="border: 1px solid #000000; text-align: center; vertical-align: middle;">8 a.m. to 5 p.m.</td> </tr> <tr> <td style="border: 1px solid #000000; text-align: left; vertical-align: middle;">Wednesday</td> <td style="border: 1px solid #000000; text-align: center; vertical-align: middle;">8 a.m. to 5 p.m.</td> <td style="border: 1px solid #000000; text-align: center; vertical-align: middle;">8 a.m. to 5 p.m.</td> </tr> <tr> <td style="border: 1px solid #000000; text-align: left; vertical-align: middle;">Thursday </td> <td style="border: 1px solid #000000; text-align: center; vertical-align: middle;"> 10 a.m. to 7 p.m. Oct. 31: 8 a.m. to 5 p.m. </td> <td style="border: 1px solid #000000; text-align: center; vertical-align: middle;">8 a.m. to 5 p.m.</td> </tr> <tr> <td style="border: 1px solid #000000; text-align: left; vertical-align: middle;">Friday</td> <td style="border: 1px solid #000000; text-align: center; vertical-align: middle;">8 a.m. to 5 p.m.</td> <td style="border: 1px solid #000000; text-align: center; vertical-align: middle;">8 a.m. to 5 p.m.</td> </tr> <tr> <td style="border: 1px solid #000000; text-align: left; vertical-align: middle;">Saturday</td> <td style="border: 1px solid #000000; text-align: center; vertical-align: middle;"> Oct. 19: 8 a.m. to 4 p.m. Oct. 26: 8 a.m. to noon Nov. 2: 8 a.m. to noon </td> <td style="border: 1px solid #000000; text-align: center; vertical-align: middle;">Closed</td> </tr> <tr> <td style="border: 1px solid #000000; text-align: left; vertical-align: middle;">Sunday</td> <td style="border: 1px solid #000000; text-align: center; vertical-align: middle;">Closed</td> <td style="border: 1px solid #000000; text-align: center; vertical-align: middle;">Closed</td> </tr> </tbody> </table> Primary Care in Rochester and KassonFlu COVID VaccinePrimary Care in Rochester and KassonThe differences, similarities and treatments are explained.<img src="/-/media/ech-media/images/widgets/people/frostbite_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=F978BEABC6A6117F8A940134C1F4325C" alt="Frostbite_widget" width="100" height="65" DisableNVelocity="true" />Frostnip or bite, cold weather can hurt12/16/2024 12:00 AM<img src="/-/media/ech-media/images/widgets/people/frostbite_widget.jpg?h=205&iar=0&w=315&sc_lang=en&hash=816297DC1A3C5CDE69E4343CD0EFFD09" alt="Frostbite_widget" width="315" height="205" DisableNVelocity="true" />Like it or not, it's that time of year when the temperature drops. While it may be tempting to hibernate over the winter, we all know the importance of staying active for our overall health. But when you are out in frigid weather, you run the risk of injury from the cold. Cold injuries are caused by prolonged exposure to low temperatures. They may or may not involve the actual freezing of body tissues. The young and elderly are especially prone to these injuries. And drinking alcohol increases your risk. Two common cold-weather injuries are: <ul> <li>Frostnip, or chilblain While this injury is painful, there is little or no permanent damage. Frostnip is the stage before frostbite begins. It appears as red, swollen skin that's tender and hot to the touch. Your skin may also itch. These symptoms can worsen to an aching, prickling "pins and needles" sensation followed by numbness. Frostnip can develop in only a few hours if your skin is exposed to extreme cold.</li> <li>Frostbite This injury is much more serious and can cause long-term harm. It typically affects areas of your body, such as fingertips, earlobes, cheeks, chin and the tip of your nose. If an area of the body reaches 23 degrees Fahrenheit and that area stays that cold for an extended period, ice crystals form in the tissues. In other words, these tissues start to freeze. </li> </ul> There are four degrees of frostbite, and it may take three to four days to determine the degree: <ul> <li>First and second degree Signs and symptoms include blanching, where the skin turns white, temporary numbness, redness, and stinging and burning as the skin is warmed.</li> <li>Third and fourth degree These symptoms include swelling, blue-gray discoloration, deep burning pain as the area is warmed, blisters, and gangrenous scab formation within two weeks of injury. </li> </ul> How to treat cold-weather injuries <ul> <li>Get out of the cold.</li> <li>Remove any wet or tight clothing.</li> <li>Gently wash and dry the injured area.</li> <li>Elevate injured hands or feet.</li> <li>Slowly rewarm the injured areas in warm water (105-110 degrees Fahrenheit) for 20 to 30 minutes or until the skin flushes or turns pink.</li> <li>Cover injured areas with layers of loose, warm clothes or cloths.</li> <li>Protect the injured area if there's a risk of it freezing again.</li> <li>If you suspect frostbite, head to an urgent care facility or emergency department. </li> </ul> How to prevent cold-weather injuries <ul> <li>Plan to enjoy winter outdoor exercises and activities and minimize cold-weather injuries.</li> <li>Dress in layers to reduce the amount of exposed skin. Look for clothing that wicks dampness away from your skin and protects you from the wind.</li> <li>Heed windchill warnings, and head inside if you start developing frostnip symptoms. </li> </ul> Whatever the weather is this winter, stay active, healthy, warm and safe. Matthew Bernard, M.D., is a physician in Primary Care in Rochester and Kasson's Department of Family Medicine. He practices at Mayo Family Clinic Northwest in Rochester, Minnesota.Matthew Bernard, M.D.Primary Care in Rochester and KassonFrostbitePrimary Care in Rochester and KassonFor lasting well-being, build happiness from the inside out. <img src="/-/media/ech-media/images/widgets/people/asianfatherdaughterslide.jpg?h=65&iar=0&w=100&sc_lang=en&hash=73AAA5CDB4EA0F26F038D396B4DF8329" alt="AsianFatherDaughterSlide" width="100" height="65" DisableNVelocity="true" />Happiness: Beyond the fleeting feel-good moment10/28/2024 12:00 AM<img src="/-/media/ech-media/images/widgets/people/asianfatherdaughterslide.jpg?h=205&iar=0&w=315&sc_lang=en&hash=310FEBE57FAB7B88AAAB1F46A7C82F48" alt="AsianFatherDaughterSlide" width="315" height="205" DisableNVelocity="true" />Happiness. The quest for it is so ingrained in us that it’s even written into the Declaration of Independence: "…certain unalienable rights, that among these are life, liberty and the pursuit of happiness." But how do we achieve it? Happy in the moment Many of us can recognize what it’s like to feel happy—we’re filled with a sense of joy or pleasure about someone we’re with or what we’re doing. But we also know that happiness doesn’t last forever, no matter how much time we spend chasing it. Seeking what gives us meaning Though the feeling of happiness may not last forever, what does last is what we choose to do to give us a more complete, rich, and meaningful life. No one else can tell you what gives your life meaning—it’s unique and specific to you. And finding that meaning starts by building from the inside out, by asking yourself, "What are my values? What matters the most to me? What gives me a sense of purpose?" Take some quiet time to reflect on your values and the things you care about most. Perhaps jot them down on a sheet of paper or in a Notes app on your phone. These values can then serve as a compass that guides you, helping you move in the most meaningful directions. Once you've identified your values, you can check in with yourself and ask, "How consistently have I been engaging with my values recently? Are there areas where I would like to make some changes?" Life can be busy and challenging, and sometimes, we get distracted from our values. With our values in mind, however, we can start building goals and taking steps to live flexibly but consistently with the aspects of life that matter most. Once we’re aware of what we value, we can take action to build opportunities for happiness and meaning rather than wait for happiness to come by. Building inner meaning is a gradual process. For instance, if you value family, start by spending 15 minutes uninterrupted time with your family. If the outdoors and nature fulfill you, go to the park and relish your surroundings for 10 minutes a week. These simple and gradually increasing steps build opportunities for meaning and happiness. Take some time to consider some small steps you could take to connect with your values. Often people who are feeling unhappy can benefit from being consistent with matching what they value with their actions. Consider jotting down one or two small goals and when you plan to complete them. Remember, it can be helpful to start small with goals you’re confident you can achieve to help build momentum. Every feeling, including happiness, is fleeting, but if you can build consistent values-based activities into your life, that’s what will bring a deep-seated, lasting sense of purpose. Benefits of happiness and meaning Research shows us that happy people are healthier, live longer and have lower rates of heart disease, stroke and infection. Being positive makes us more likely to engage in healthy behaviors, such as eating well and regular exercise, which circle back and contribute to happiness. People who are deeply happy and have meaning in their lives tend to: <ul> <li>Have a network of social relationships. They want to be out and about in their neighborhoods, workplaces and even casual settings, such as coffee shops. They’re more comfortable and confident when with a group.</li> <li>Be more productive, cooperative and creative at work. They are better able to collaborate and contribute to reaching a common goal and are more apt to find the middle ground.</li> <li>Be good friends, neighbors and citizens. People with a positive mood see others more sympathetically and are more inclusive; they find ways to get along despite differences.</li> <li>Do good to feel good. Doing good can be volunteering, reaching across party lines, respecting cultural diversity, and helping neighbors they don’t know. The more we do it, the better we feel and experience greater happiness.</li> </ul> Happiness in the moment is always going to slip away. But when you know what gives your life the most meaning, happiness comes along for the ride. Kyle Schofield, Ph.D., is a clinical health psychology fellow in Primary Care in Rochester and Kasson's Division of Integrated Behavioral Health. <a rel="noopener" href="https://www.mayoclinic.org/biographies/roche-anne-i-ph-d-l-p/bio-20569110" target="_blank" title="Link opens in a new window">Anne Roche, Ph.D., L.P.</a>, and <a rel="noopener" href="https://communityhealth.mayoclinic.org/providers/craig-sawchuk-phdlp" target="_blank" title="Link opens in a new window">Craig Sawchuk, Ph.D., L.P.</a>, are clinical psychologists in Primary Care in Rochester and Kasson's Division of Integrated Behavioral Health.Kyle Schofield, Ph.D.; Anne Roche, Ph.D., L.P.; Craig Sawchuk, Ph.D., L.P.Primary Care in Rochester and KassonHappinessPrimary Care in Rochester and KassonWith the holidays nearing, great food is in abundance. Learn how to eat healthy during these family times. <img src="/-/media/ech-media/images/widgets/food/holidaymeal.jpg?h=65&iar=0&w=100&sc_lang=en&hash=B820110860B0B039DEC99AA3B7A6C2C9" alt="HolidayMeal" width="100" height="65" DisableNVelocity="true" />Set your sights on healthy holiday eating11/7/2024 12:00 AM<img src="/-/media/ech-media/images/widgets/food/holidaymeal.jpg?h=205&iar=0&w=315&sc_lang=en&hash=210337C6733E839C32B3266587C5AC82" alt="HolidayMeal" width="315" height="205" DisableNVelocity="true" />Let’s face it – our social media feeds have plenty of suggestions when it comes to feeding ourselves. Some of the information served up on platforms like Instagram and TikTok is good and tasty. However, although these suggestions may be appetizing, they may not always be good for us, especially when it comes to holiday eating. If you remember these five tried-and-true recommendations, you'll be well on your way to a healthy holiday season. <ul> <li>Eat mindfully. </li> <li>Choose carefully. </li> <li>Exercise is key. </li> <li>Drink alcohol in moderation. </li> <li>Stay accountable. </li> </ul> Before the holiday season hits full swing, consider visiting these reputable websites for guidance on eating well during the holidays (and beyond) – and take social media suggestions with a grain of salt. <ul> <li>Find holiday cooking and eating tips on the <a rel="noopener" href="https://www.nhlbi.nih.gov/health/educational/wecan/news-events/matte7.htm" target="_blank" title="Link opens in a new window">National Heart, Lung, and Blood Institute website</a> to maintain a healthy weight. </li> <li>Learn how to maintain a healthy holiday diet on the <a rel="noopener" href="https://www.nutrition.gov/healthy-holidays" target="_blank" title="Link opens in a new window">Nutrition.gov website</a>. </li> <li>Holiday-proof your diabetes management with this plan from the <a rel="noopener" href="https://www.cdc.gov/diabetes/healthy-eating/5-healthy-eating-tips-holidays.html" target="_blank" title="Link opens in a new window">Centers for Disease Control and Prevention website</a>. </li> <li>Control your holiday food budget with these tips from the <a rel="noopener" href="https://extension.umn.edu/save-money-food/holiday-food-budget" target="_blank" title="Link opens in a new window">University of Minnesota</a>. </li> <li>Learn how to make healthy food choices during the holidays in this <a rel="noopener" href="https://newsnetwork.mayoclinic.org/discussion/mayo-clinic-minute-how-to-make-healthy-holiday-food-choices/" target="_blank" title="Link opens in a new window">Mayo Clinic Minute</a>. </li> </ul> Michaeleen Burroughs, MS, RDN, LD, has worked in Primary Care in Rochester and Kasson for 28 years. She helps Mayo Family Clinics - Northwest, Southeast, Northeast, and Kasson patients. Her areas of interest are diabetes and child and adult weight management.Michaeleen Burroughs, M.S., RDN, LDPrimary Care in Rochester and KassonHealthy Holiday EatingPrimary Care in Rochester and KassonFind out how to cope with these common symptoms of menopause. <img src="/-/media/ech-media/images/widgets/people/ech_menopause_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=FCE52C853940F61A69E63BB4DAC013CB" alt="ECH_Menopause_widget" width="100" height="65" DisableNVelocity="true" />Did I just have a hot flash?11/11/2024 12:00 AM<img src="/-/media/ech-media/images/widgets/people/ech_menopause_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=6EF2CF870477E8E60710CE918A7072F1" alt="ECH_Menopause_widget" width="300" height="195" DisableNVelocity="true" />Are you feeling the heat in more than one way? Hot flashes are a common symptom of the menopausal transition for many patients, but they don't have to be a reason for sweating any time of the year. Hot flashes — also called vasomotor symptoms, hot flushes or night sweats — are experienced by up to 85% of women with varying degrees as they move through the perimenopausal transition. This happens when women stop having monthly menstrual bleeding cycles. They can occur both day and night and disrupt daily life for many. We are not entirely sure why they happen. Still, research suggests this change is partially related to a decline in hormone levels and a change in hormone fluctuations that every woman experiences. This change leads to waves of the following symptoms: <ul> <li> Inappropriate dilation of blood vessels of the skin.</li> <li>Increased perspiration.</li> <li>Measurable changes in the body surface temperature. </li> </ul> These symptoms are most notable along the face, neck and chest and can last anywhere from a minute or two to more than five minutes at a time for some. They can be worse for women with a higher body mass index (BMI), those who smoke, or people who are of African American or Hispanic heritage. Several non-medication options can help: <ul> <li>Staying out of the heat in favor of a cool room or environment.</li> <li>Using a fan, stand in a breeze in lightweight cotton clothing to allow air to move over the skin and reduce surface temperature.</li> <li>Dress in layers.</li> <li>Avoid warm beverages and spicy foods.</li> <li>Avoid alcohol, caffeine and tobacco products.</li> <li>Keep up with regular exercise. </li> </ul> If these measures don't help, there are both hormonal and non-hormonal medication options that you can talk to your healthcare clinician about if you are under the age of 60 and within 10 years of your last menstrual period. There is much controversy regarding the benefits and potential harms of over-the-counter supplements such as soy isoflavones, black cohosh, evening primrose oil and others that claim to help with menopausal symptoms. Talking to your clinician about these supplements before starting them is best. Remember that over-the-counter medications, even if labeled as natural, can interact poorly with your prescription medications, cause unwanted side effects or exacerbate other health concerns. They can make the symptoms worse in some patients, too. For more information, visit these trusted resource websites. <ul> <li><a rel="noopener" href="https://www.mayoclinic.org/diseases-conditions/hot-flashes/symptoms-causes/syc-20352790" target="_blank" title="Link opens in a new window">Hot flashes</a> (mayoclinic.org).</li> <li><a rel="noopener" href="https://www.menopause.org/" target="_blank" title="Link opens in a new window">The North American Menopause Society</a> (NAMS). </li> </ul> You don't need to suffer through hot flashes any longer. Talk to your healthcare clinician today. <a href="/providers/jenna-johnson-cnp">Jenna Johnson, APRN, C.N.P., D.N.P.</a>, is a primary care nurse practitioner interested in Women's Health. She has dual certifications in Adult and Women's Health. She provides primary care through Community Internal Medicine, Geriatrics and Palliative Care and helps staff the Primary Care in Rochester Gynecology Clinic.Jenna Johnson, APRN, C.N.P., D.N.P.Primary Care in Rochester and KassonHot FlashesPrimary Care in Rochester and KassonWith winter on the way, these tips can help you stay safe enjoying the ice. <img src="/-/media/ech-media/images/widgets/activities/frozenlakeicebreaking.jpg?h=65&iar=0&w=100&sc_lang=en&hash=C318D46ADD2F7012C6200CA7E11F40F2" alt="FrozenLakeIceBreaking" width="100" height="65" DisableNVelocity="true" />What to do when "Breaking the Ice"12/9/2024 12:00 AM<img src="/-/media/ech-media/images/widgets/activities/frozenlakeicebreaking.jpg?h=205&iar=0&w=315&sc_lang=en&hash=82F4A31958848AF25F4F51B0FA2F90FD" alt="FrozenLakeIceBreaking" width="315" height="205" DisableNVelocity="true" />As winter nears, many of you will be embarking upon adventures in this Land of 10,000 Lakes. As a primary care physician, I have recommendations to prepare you when "breaking the ice." Ice fishing Start by using an auger, chisel or drill to break the ice near your anticipated place of play. Then use a tape measure to calculate the ice thickness. Below are general guidelines of how much weight ice can hold in relation to its thickness. <ul> <li>< 4 inches = STAY OFF the ice.</li> <li>4 inches = Safe to be on foot.</li> <li>5–7 inches = Safe for snowmobile travel.</li> <li>8–12 inches = Safe for car travel.</li> <li>12–15 inches = Safe for truck travel. </li> </ul> When traveling on white ice — or snow ice — double the thickness guidelines above. White ice is only about half as strong as clear ice. Vehicle Safety <ul> <li>Cars, Trucks and SUVs should be parked 50 feet away from each other. </li> <li>Move vehicles every two hours to avoid sinking.</li> <li>If your vehicle breaks through the ice, the side windows are the best option for escape.</li> <li>Engine front vehicles tend to sink at a steep angle and end upside down. </li> </ul> What should you do if you fall through the ice? <ul> <li>Keep your clothes on, as this can trap air and help you float.</li> <li>Face the direction in which you entered, as this ice is the strongest.</li> <li>Stabilize yourself by placing your hands and arms on unbroken surfaces.</li> <li>Kick your feet and once horizontal use your arm strength to propel yourself out of the water.</li> <li>Lie flat on the ice and roll away from the hole. </li> </ul> What should you do if a friend falls through the ice? <ul> <li>Shout out to your friend that help is on the way — then dial 911.</li> <li>Extend an object to your friend, such as a rope or a cable.</li> <li>Stabilize yourself and provide counterforce while the other person attempts to pull himself or herself out of the water.</li> <li>If your friend starts to pull you in, release your grip and restart.</li> <li>If the above methods don't work, have your friend tie the rope around his or her waist until additional help arrives.</li> <li>Remember — ice is never 100% Safe </li> </ul> For more information and guidance on ice safety, visit the <a rel="noopener" href="https://www.dnr.state.mn.us/safety/ice/index.html" target="_blank" title="Link opens in a new window">Minnesota Department of Natural Resources website</a>. <a href="/providers/jacob-billings-do">Jacob Billings, D.O.</a>, is a resident in the Department of Family Medicine in Rochester. He provides full spectrum patient care at Mayo Family Clinic Kasson.Jacob Billings, D.O.Primary Care in Rochester and KassonIce SafetyPrimary Care in Rochester and KassonIn most cases you should keep taking your blood thinner. <img src="/-/media/ech-media/images/widgets/people/kneepain.jpg?h=65&iar=0&w=100&sc_lang=en&hash=F88BCB39AA9CF187DD411BC28EA3E7E8" alt="KneePain" width="100" height="65" DisableNVelocity="true" />Need a joint injection? What about your blood thinner medication?9/12/2024 12:00 AM<img src="/-/media/ech-media/images/widgets/people/kneepain.jpg?h=205&iar=0&w=315&sc_lang=en&hash=FE0623241599B92AB1793EE113E7BC5C" alt="KneePain" width="315" height="205" DisableNVelocity="true" />Anticoagulants are commonly referred to as "blood thinners" and are commonly used to treat and prevent blood clots and stroke. However, they can increase the risk of bruising and bleeding. Common blood thinning medications include: <ul> <li>Warfarin (Coumadin)</li> <li>Direct oral anticoagulants <ul> <li>Dabigatran (Pradaxa)</li> <li>Rivaroxaban (Xarelto)</li> <li>Apixaban (Eliquis)</li> <li>Edoxaban (Lixiana)</li> </ul> </li> <li>Anti-platelet medications <ul> <li>Aspirin</li> <li>Clopidogrel (Plavix)</li> <li>Ticagrelor (Brilinta) </li> </ul> </li> </ul> Joint injections can be an important treatment for many painful musculoskeletal conditions such as osteoarthritis, rheumatoid arthritis, trigger finger, gout, pseudogout, bursitis and tendinitis. If you have been referred for a joint injection or aspiration, you may have questions about the safety of having these procedures while on blood thinners. However, there are also major risks of stopping blood thinners, including recurrent blood clots, stroke and death. You should not stop these medications without talking with your clinician. The major bleeding risk of a joint aspiration/injection is bleeding into the joint, also known as a hemarthrosis. This risk is very low at less than 1 in 1000 injections. As long as your INR, a measurement used to determine how long it takes for your blood to clot, is in a therapeutic range while taking warfarin, or Coumadin, there is little, if any, increased risk of bleeding into the joint with a joint injection or aspiration. Similarly, taking direct oral anticoagulants and anti-platelet medications will not significantly increase your risk of bleeding into non-spine joints following one of these procedures. These recommendations do not apply to injections into the spine. In summary, if you are on a blood thinning medication and need to undergo a non-spine joint injection or aspiration, you may have some extra bruising, but the risk of a major bleeding complication is minimal, and you should continue your medications. If you have questions, it is always best to contact your healthcare team. <a href="/providers/terin-sytsma-md">Terin Sytsma, M.D.</a>, is a general internist in the Division of Community Internal Medicine, Geriatrics and Palliative Care. She completed her medical degree at Mayo Clinic Alix School of Medicine and her residency in internal medicine at Mayo Clinic in Rochester, Minnesota. Her interests include office-based procedures and musculoskeletal medicine.Terin Sytsma, M.D.Primary Care in Rochester and KassonJoint InjectionPrimary Care in Rochester and KassonThis disorder is more than a bad day. Help is available. <img src="/-/media/ech-media/images/widgets/teens/sadteensittingonbed_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=6D036777C5CC444E155AD53ED66324A8" alt="SadTeenSittingOnBed_widget" width="100" height="65" DisableNVelocity="true" />Seasonal affective disorder in children and teens11/25/2024 12:00 AM<img src="/-/media/ech-media/images/widgets/teens/sadteensittingonbed_widget.jpg?h=205&iar=0&w=315&sc_lang=en&hash=22871C28E90917A332E9811E5AB3B375" alt="SadTeenSittingOnBed_widget" width="315" height="205" DisableNVelocity="true" />What is seasonal affective disorder (SAD)? SAD is a type of depression that only happens during a certain time of the year. Kids and teens may become more depressed in the fall and winter due to shorter days and less sunlight. SAD typically resolves once the days become longer with more sunlight. It's essential to note that SAD is more than just a bad day here or there. It is a pattern of changes that lasts for weeks. Who does it affect? Seasonal affective disorder can affect kids and teenagers as well as adults. Why does it happen? <ul> <li>The cause of SAD is not entirely clear, but we think it is related to less exposure to sunlight.</li> <li>Sunlight affects the brain's two chemicals that influence mood: serotonin and melatonin. When it's sunny, your brain makes more serotonin, and this helps increase feelings of happiness. When it's dark (less sunlight), your brain produces more melatonin, making you feel sleepier with less energy.</li> <li>Shorter days with more darkness lead to less serotonin and more melatonin. This change makes depression more likely to happen. </li> </ul> What symptoms may you notice in your child or teen if they are experiencing SAD? <ul> <li>They may seem more sad or irritable even without a clear cause.</li> <li>They may lose interest in things they typically enjoy.</li> <li>They may seem more tired and sleep more than usual.</li> <li>They may have more trouble concentrating.</li> <li>They may have changes in eating habits with or without weight changes.</li> <li>They may engage in self-harm behaviors.</li> <li>They may have thoughts of or attempt suicide. </li> </ul> How is SAD diagnosed? This diagnosis will require a visit with your primary care clinician. They will diagnose the problem by asking questions and completing a physical exam. At this visit, your clinician can also ensure that symptoms are not due to something else. How is SAD treated? <ul> <li>Get more light exposure by spending more time outside during the daylight hours. This can be done by taking a daily walk or other exercise outside, which can be tricky in Minnesota due to the colder temperatures. Some fun outdoor activities in the winter can include skiing (downhill or cross-country), snowshoeing or ice skating.</li> <li>Light therapy with phototherapy. Your clinician may recommend purchasing a special light box for your child or teenager to sit in front of for about 45 minutes daily. Ask your clinician for more specifics on what light box to use and how to use it.</li> <li>Talk therapy. Your clinician may recommend a referral for treatment to help kids and teens work through negative thoughts and feelings that can happen with depression.</li> <li>Medicine. Your clinician may prescribe an antidepressant medication, which can help balance the chemicals in the brain that contribute to depression, such as serotonin, as discussed above. </li> </ul> What can parents do to help manage SAD? <ul> <li>Encourage your child to get plenty of exercise and exercise outside when able.</li> <li>Try to spend quality time with your child.</li> <li>Be patient with your child because symptoms often can take time to improve.</li> <li>Help organize homework and involve teachers if your child needs extra time or support with assignments.</li> <li>Encourage a good sleep cycle with routine bedtime and morning wake-up times. </li> </ul> What if your child needs more urgent help? If you are worried about your child, do not hesitate to use these helplines right away: <ul> <li><a rel="noopener" href="https://988lifeline.org/" target="_blank" title="Link opens in a new window">National Suicide Prevention Hotline</a>: 800-273-TALK (8255).</li> <li><a rel="noopener" href="https://www.thehopeline.com/" target="_blank" title="Link opens in a new window">24-hour National Suicide Crisis Hotline</a>: 800- SUICIDE (784-2433).</li> <li><a rel="noopener" href="https://www.thehopeline.com/" target="_blank" title="Link opens in a new window">Hopeline</a> (with a trained volunteer): 800-442-HOPE (4673).</li> <li><a rel="noopener" href="https://www.thehopeline.com/" target="_blank" title="Link opens in a new window">Hopeline</a> (teen to teen counseling): 877- 968-8591.</li> <li><a rel="noopener" href="https://www.samhsa.gov/find-help/" target="_blank" title="Link opens in a new window">Substance Abuse and Mental Health Services Administration (SAMHSA) helpline</a>: 800-662-HELP (4357). </li> </ul> <a href="/providers/chandler-kessel-md">Chandler Yost, M.D.</a>, is completing her third year of pediatric residency at Mayo Clinic in Rochester, Minnesota. She has special interests in pediatric mental health and preventive medicine and plans to provide primary care services in underserved areas following her residency.Chandler Yost, M.D.Primary Care in Rochester and KassonKids Seasonal Affective DisorderPrimary Care in Rochester and KassonGenitourinary syndrome of menopause (GSM) is a common effect of menopause that no one tells you about. <img src="/-/media/ech-media/images/widgets/people/blackwomanstress_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=09D53ECA5562FDF1EF52D1060CFA1FB2" alt="BlackWomanStress_widget" width="100" height="65" DisableNVelocity="true" />GSM: An unexpected 'surprise' of menopause10/17/2024 12:00 AM<img src="/-/media/ech-media/images/widgets/people/blackwomanstress_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=AED6CD2BD6B169AC926125883AB35EC4" alt="BlackWomanStress_widget" width="300" height="195" DisableNVelocity="true" />The transition to menopause can bring many expected changes, from the end of monthly bleeding to shifts in weight distribution to changes in sleep patterns. But it can also bring a few surprises that many women wish they had known more about. One of these changes is genitourinary syndrome of menopause (GSM). This change is likely related to declining estrogen levels and can lead to: <ul> <li> Shortening and thinning of the vagina/vaginal tissues.</li> <li>Decline in our natural lubrication.</li> <li>Loss of elasticity to the vaginal tissue.</li> <li>An increase in vaginal pH.</li> <li>Reduction in the normal vaginal flora with disruption to the vaginal flora/fauna balance. </li> </ul> Symptoms of GSM For many women, this means a vagina that isn't happy and doesn't feel the same as it used to. It's often experienced as: <ul> <li>Burning and dryness in the tissues of the vagina and vulva (external vagina).</li> <li>Increased vaginal discharge.</li> <li>Vaginal tissues that become easily irritated with intercourse.</li> <li>Increased pain, discomfort and bleeding with sex.</li> <li>Increased number of vaginal infections.</li> <li>Urinary changes, including recurrent urinary tract infections, increased urinary urgency and the need to use the restroom more often at night. </li> </ul> Who's at risk Those at higher risk of developing GSM are women who: <ul> <li>Have had their ovaries surgically removed.</li> <li>Never had a vaginal childbirth.</li> <li>Aren't sexually active.</li> <li>Don't exercise.</li> <li>Have an increased intake of alcohol.</li> <li>Smoke. </li> </ul> GSM affects more than 50% of women, yet studies show that less than 25% of them bring it up to their primary care clinician — and even fewer receive treatment for it. That's a lot of women who are suffering unnecessarily. What helps relieve GSM What can help? The first line of treatment for mild symptoms includes using vaginal moisturizers routinely (two to three days a week, every week) and/or a water-based vaginal lubricant with intercourse. These products can be found over the counter in the pharmacy section. For many women, these treatments are all they need. Vaginal estrogen: Another option For more moderate or persistent symptoms, vaginal estrogen treatment is recommended. Although this is a hormone, the effect on the body is primarily in the vaginal/vulvar tissues; many specialists don't feel vaginal estrogen is a system hormone at levels that bring significant risks. Most women can use it without concern. There are several delivery methods for vaginal estrogen therapy, including: <ul> <li>Vaginal cream (Estrace or Premarin creams).</li> <li>Vaginal tablet (Vagifem, Yuvafem) placed into the vagina two to three times a week.</li> <li>Insertion of a vaginal ring (Estring), which is left in the vagina for up to 90 days. </li> </ul> Choosing the type of vaginal estrogen depends on several factors. Your primary care clinician can help determine which one is best for you. Most women find significant improvement in as few as two to four weeks. Vaginal estrogen therapy is often needed indefinitely for ongoing management of GSM. If this therapy isn't effective or not an option for you, there are other treatments, including non-hormonal medications and laser therapy, which are less common. You may be referred to a gynecologist for these options. Not just menopausal women Although GSM is most often related to menopause, there's a small percentage of women who may experience it any time estrogen levels have declined due to multiple causes, including medication side effects, pregnancy or breastfeeding, or surgical changes affecting hormone levels. So, even if you haven't started the transition to menopause, talk with your primary care clinician if you're experiencing symptoms. <a href="/providers/jenna-johnson-cnp">Jenna Johnson, APRN, C.N.P., D.N.P.</a>, is a primary care nurse practitioner with a particular interest in Women's Health and has dual certifications in both Adult and Women's Health. She provides primary care through Community Internal Medicine, Geriatrics and Palliative Care and helps staff the Primary Care in Rochester Gynecology Clinic.Jenna Johnson, APRN, C.N.P., D.N.P.Primary Care in Rochester and KassonMenopause TransitionPrimary Care in Rochester and KassonOral health is important throughout the life span. <img src="/-/media/ech-media/images/widgets/kids/ech_halloween_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=BDA1C6A9569589B49579B5127E8043ED" alt="ECH_halloween_widget" width="100" height="65" DisableNVelocity="true" />Trick or treat and take care of your teeth10/24/2024 12:00 AM<img src="/-/media/ech-media/images/widgets/kids/ech_halloween_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=3CA599B1ECD01205C269972685F7679E" alt="ECH_halloween_widget" width="300" height="195" DisableNVelocity="true" />As Halloween — along with its candy and other sugary treats — approaches, it's important to reflect on the importance of oral health. Kids Sugar left on the teeth feeds the bacteria that lead to dental cavities and gum disease. For children, cavities can cause pain, infections, and complications that result in missed school days and missed work for parents. Starting with the first tooth, parents can help their children by brushing their teeth twice a day with fluoridated toothpaste. Once teeth start touching incorporate flossing once daily can also help remove those sugar bugs. For children under 3, use just a smear of fluoridated toothpaste the size of a grain of rice. For children three and older, increase the amount to a pea size. Young children may need assistance brushing their teeth until around age 8 when their dexterity allows them to adequately cover all their teeth using a toothbrush. Smartphone apps such as Toothsavers, Disney Magic Timer, and Tiny Dentist can encourage children to brush their teeth. Other steps to promote dental health in kids: <ul> <li>Ensure your child visits a pediatric dentist around one year of age or once teeth emerge.</li> <li>If you have well water, call your county and ask about water testing to check the fluoride content of your drinking water. Fluoride can naturally occur in well water. If the fluoride concentration is less than 0.7 parts per million, ask your primary care clinician about receiving fluoride supplements. Fluoride also can be applied to your child's teeth during well-child exams. This is recommended twice to four times yearly for all children under 5.</li> <li>Brush your child's teeth twice a day. If possible, brush after any sugary treats.</li> <li>Limit or avoid sticky candies, such as fruit snacks, that can adhere to teeth. These types of candies promote cavities by sticking to teeth.</li> <li>Encourage water between meals and avoid sugary drinks like soda and juice. Developing good oral care in childhood leads to good habits throughout the life span. </li> </ul> Pregnancy Pearly whites are important during pregnancy, too. While dental care is not often considered when considering pregnancy, good dental care before and during pregnancy is important. Pregnancy hormones can increase the chances of periodontal disease or inflammation of the tissues and structures that support the teeth. Inflammation can cause infections, leading to dental decay, tooth loss and bone infection if left untreated. Periodontal disease in mothers has been associated with low birth weights for babies and preeclampsia. It is safe to receive dental care during all trimesters of pregnancy. Good dental care during this time is critical to prevent periodontal disease, tooth pain and loss. If you are pregnant or considering pregnancy and do not have a dentist, it is best to establish one as soon as possible. Adults Unfortunately, the risk for periodontal disease increases with age. While you can't control your age, you can take measures to reduce your risk of periodontal disease. Poor dental care can lead to pain, infections and nutritional difficulties later in life. Periodontal disease is associated with worsening diabetic blood sugar control and heart disease. Dental hygiene for all ages The mouth is home to billions of bacteria that thrive on sugar. Like other parts of the body, bacteria need to be kept in balance to prevent dental disease. The mouth has some natural mechanisms to maintain this balance, including saliva production, which neutralizes the acid produced by the bacteria and helps clean food particles from teeth. Medical conditions and medications that cause dry mouth and reduce saliva production can increase a person's risk for tooth decay and periodontal disease. Strategies to treat dry mouth include: <ul> <li>Take frequent sips of water throughout the day and stay well-hydrated.</li> <li>Chew sugar-free gum.</li> <li>Use over-the-counter artificial saliva products. </li> </ul> Keys to prevent dental difficulties include: <ul> <li>Brushing teeth twice daily and flossing once daily.</li> <li>Treating dry mouth.</li> <li>Adhering to routine dental cleanings.</li> <li>Avoiding frequent snacking.</li> <li>Avoiding sugar-sweetened beverages, instead choosing water to stay hydrated.</li> <li>Brushing your teeth, or at a minimum, rinsing your mouth with water if you indulge in a sticky, sweet treat.</li> <li>Avoiding all tobacco use — smoking, chewing and vaping. </li> </ul> Oral health is critical to overall health throughout the life span. Remember that adults can set an example for children by practicing good oral hygiene. Have a happy and tooth-friendly Halloween. <a href="/providers/kathryn-king-cnp">Katie King, APRN, C.N.P., M.S.N.</a>, is a family medicine nurse practitioner at Mayo Family Clinic Southeast in Rochester. She is interested in preventive care services and agrees with Ben Franklin that "an ounce of prevention is worth a pound of cure." Katie enjoys being outside with her family and forward motion, such as cycling, jogging, walking and hiking.Katie King, APRN, C.N.P., M.S.N.Primary Care in Rochester and KassonOral HygienePrimary Care in Rochester and KassonTurn this daily "chore" into time to talk with kids about food choices to support good health.<img src="/-/media/ech-media/images/widgets/people/ech_packinglunch_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=3F8D212D2EF3351255C98D6A9BBBD7BB" alt="ECH_packinglunch_widget" width="100" height="65" DisableNVelocity="true" />Packing lunches together promotes parent-kid conversations9/19/2024 12:00 AM<img src="/-/media/ech-media/images/widgets/people/ech_packinglunch_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=C9E90B554FE661A541533EB564410921" alt="ECH_packinglunch_widget" width="300" height="195" DisableNVelocity="true" />Families face the dreaded chore of packing lunches every weeknight in homes nationwide. But as Mary Poppins says, "In every task that must be done, there's an element of fun." In this case, it can be a fun time for parents and kids to talk as they gather food to build healthy lunches. The conversations can be about anything, but this is a prime time to talk with your kids about making healthy food choices while packing lunches they'll enjoy. (You can pack yours for work, too!) To get started on your family lunch-packing project: <ul> <li>Make sure you have good lunch-carrying supplies: A good-quality lunch box or bento box, water bottle, thermal beverage container, some cool packs and reusable containers. Keep a variety of zipper food storage bags—both sandwich and snack size—to pack kid-sized portions of pretzels, dry cereal, dried fruits or nuts.</li> <li>Make a plan for lunches based on what you've got on hand, what leftovers could be re-imagined into sandwiches, salads or something hot for a chilly day, and what you need from the store.</li> <li>Have kids come shopping with you to pick out food they like — and try new ones. Are they studying a particular country or doing a unit on health? These connections can help you work with new options, such as food from that country or from something they're learning. But there's no shortage of familiar ones to choose from: Ready-to-pack cut fruits and veggies, dried fruits and unsalted nuts, pre-portioned cheese and single-serve yogurts or fruit cups, hummus and cracker cups, and tuna and chicken pouches.</li> <li>Clear a workplace on the kitchen counter or table and gather your ingredients. </li> </ul> As you assemble the lunches, try these talk topics: <ul> <li>Why are these good choices? Food is fuel; it powers their bodies — both brains and muscles — throughout the day and helps them grow and improve their school and sports performance.</li> <li>Food likes and dislikes, and why. Is it taste, texture, color or just too "yucky"? Why do they like what they like?</li> <li>How to build a healthy lunch. One typically contains three to five food groups — fruits, vegetables, protein, grains and dairy. A granola bar and grapes might be a good start for a packed lunch — grain and fruit — but what needs to be added to make the lunch more complete?</li> <li>What do other kids bring in their lunches? Is there something they'd like to try?</li> </ul> But don't forget the fun: <ul> <li>Once sandwiches are made, let your child use cookie cutters to create fun, bite-sized portions.</li> <li>Use a crinkle cutter to cut fruits and veggies with zigzag edges.</li> <li>Think up themes for the week – colors, animals, ethnic cuisines, birthdays, holidays, Disney movies and more.</li> <li>As a random surprise, tuck a cheerful note, fun sticker, comic strip or fortune cookie into their lunch box. </li> </ul> Making this chore fun and sharing the responsibility with your kids has the potential to build more than healthy lunches. The start of the new school year is the perfect time to give family lunch packing a try! Michaeleen Burroughs, MS, RDN, LD, has worked in Primary Care in Rochester and Kasson in Family Medicine for 28 years. She helps Mayo Family Clinics - Northwest, Southeast, Northeast, and Kasson patients. Her areas of interest are diabetes and child and adult weight management.Michaeleen Burroughs, MS, RDN, LDPrimary Care in Rochester and KassonPacking LunchPrimary Care in Rochester and KassonFind out why your surgeon requests this evaluation before surgery.<img src="/-/media/ech-media/images/widgets/people/femalephysicianadultwoman.jpg?h=65&iar=0&w=100&sc_lang=en&hash=2E70AD675738C2610BF2D1D9AEDBE0F6" alt="FemalePhysicianAdultWoman" width="100" height="65" DisableNVelocity="true" />What is a preoperative evaluation?9/23/2024 12:00 AM<img src="/-/media/ech-media/images/widgets/people/femalephysicianadultwoman.jpg?h=205&iar=0&w=315&sc_lang=en&hash=36AD5BE5A6AE9F3BB2C6FD65D786F23B" alt="FemalePhysicianAdultWoman" width="315" height="205" DisableNVelocity="true" />A preoperative evaluation prior to surgery aims to identify specific factors about your health or the surgical procedure that may increase your risk for complications after surgery. For patients with many medical problems, this appointment can help the patient and the surgical team better understand the risks of the planned surgery. A careful preoperative evaluation can often identify opportunities to reduce specific risks with strategies unique to each patient's medical condition. Preoperative evaluation visits are often performed by anesthesiologists, family medicine doctors, internal medicine doctors or advanced practice providers. Only some patients will need a preoperative evaluation; it depends on their medical conditions and the risk of the proposed surgical procedure. The evaluations are usually done a few weeks before surgery but often are done the day before the planned surgery. During this evaluation, you will be asked direct questions regarding the following: <ul> <li>Your health conditions, how they are currently being managed and how well controlled they are.</li> <li>A detailed list of all medications with dosages, including supplements that you take (this includes medications that are injected or infused intermittently).</li> <li>Medication allergies.</li> <li>Functional abilities (e.g., taking care of yourself, exercise ability, etc.).</li> <li>Nutritional status.</li> <li>Prior surgeries and anesthesia.</li> <li>Prior complications related to anesthesia or surgery.</li> <li>Prior heart, respiratory, bruising or bleeding problems.</li> <li>Prior history of blood clots.</li> <li>Information about any medical device placed in your body (e.g., pacemaker, defibrillator, pain pump, etc.) or a medical device used regularly (e.g., CPAP, insulin pump, continuous glucose meter).</li> <li>Current use of alcohol, tobacco, nicotine or other substances.</li> <li>Review any recent laboratory testing, x-rays, heart/lung tests or outside medical records.</li> </ul> Your clinician will perform a detailed history and examination, discuss important risks and recommend which medications to hold or adjust before surgery. During this visit, you will have the opportunity to ask questions to understand the risk of potential complications and how best to prevent them, if possible. If your preoperative visit is with an anesthesiologist, you can discuss if there are different options for anesthesia. However, suppose you have specific questions about the surgical procedure itself (e.g., details about the surgical procedure itself, how long recovery is expected to take, how many days in the hospital, the plan for pain medications, etc.). In that case, it is best to discuss these directly with the surgeon or the surgical team. <a rel="noopener" href="https://www.mayoclinic.org/biographies/mauck-karen-f-m-d-m-s/bio-20053745" target="_blank" title="Link opens in a new window">Karen F. Mauck, M.D., M.S.</a>, is a physician in the Division of General Internal Medicine, Mayo Clinic in Rochester. She is chair of the Preoperative Evaluation Clinic in General Internal Medicine.Karen Mauck, M.D., M.S.Primary Care in Rochester and KassonPreoperative EvaluationPrimary Care in Rochester and KassonThe vaccination works; it's safe and everyone needs it. <img src="/-/media/ech-media/images/widgets/people/familyvaccinebandaid.jpg?h=65&iar=0&w=100&sc_lang=en&hash=48A31AAB7D0A2A57D80E14B0871FB36C" alt="FamilyVaccineBandAid" width="100" height="65" DisableNVelocity="true" />Prevent influenza in your family this season9/25/2024 12:00 AM<img src="/-/media/ech-media/images/widgets/people/familyvaccinebandaid.jpg?h=205&iar=0&w=315&sc_lang=en&hash=43EF7F9CB1418BC82CD3CFBF464FD70E" alt="FamilyVaccineBandAid" width="315" height="205" DisableNVelocity="true" />Everyone ages 6 months and older in your family is due for influenza (or flu) vaccination this season. Vaccination against the flu works. It's safe, and everyone needs it. Even in healthy young adults, the flu takes its toll. Healthy unvaccinated young adults average one more sick day every year and one more healthcare visit a year. Some years are worse than others. Flu often goes undiagnosed but still causes harm. Part of the harm is spreading it to others: Co-workers, family members and neighbors. Indeed, school-aged children are most likely to bring a new flu outbreak into the home, neighborhood or community. If your school-aged children missed the vaccine this year at school, they will still benefit if you catch them up now. The flu season in Minnesota lasts through May or June each year. Flu hits infants, toddlers and those 65 years and older the worst. You can protect infants by vaccinating the mother during pregnancy. However, infants need their own influenza vaccination starting at 6 months. For the first season's vaccination, they need two doses. Children 9 and older only need one dose, even if they've never had the vaccine. For those 65 years and older, Mayo Clinic recommends the high-dose vaccine. Mayo Clinic also recommends this high-dose vaccine for those who have had a solid organ transplant on immunosuppressive medication who are 18 years and older. Schedule your influenza vaccination appointment at our <a href="/featured-stories/flu-covid-vaccine">Primary Care Vaccination Clinic</a>. Mayo Clinic staff members should plan to receive their flu and COVID vaccinations at one of the many on-campus walk-in clinics if possible. Take time to get your flu vaccine this season, and make sure your family members do, too. <a href="/providers/robert-jacobson-md">Robert M. Jacobson, M.D.</a>, is the medical director of the Primary Care Immunization Program in Southeast Minnesota. He is a physician in Community Pediatric and Adolescent Medicine at Mayo Clinic in Rochester and practices in the Baldwin building.Robert Jacobson, M.D.Primary Care in Rochester and KassonPrevent InfluenzaPrimary Care in Rochester and KassonFind out who is most at risk and who needs a vaccination. <img src="/-/media/ech-media/images/widgets/kids/asiangirlblowingnose.jpg?h=65&iar=0&w=100&sc_lang=en&hash=234EFFA9A8987DBC665B39FD2F7DD8B7" alt="AsianGirlBlowingNose" width="100" height="65" DisableNVelocity="true" />Prevent hospitalization from RSV this season9/11/2024 12:00 AM<img src="/-/media/ech-media/images/widgets/kids/asiangirlblowingnose.jpg?h=205&iar=0&w=315&sc_lang=en&hash=60BAD843D3D6922F0051176E9B355F3A" alt="AsianGirlBlowingNose" width="315" height="205" DisableNVelocity="true" />RSV stands for respiratory syncytial virus. It's the most common cause of hospitalization in children under 5 years old in the U.S. And older at-risk adults hospitalized for RSV have worse outcomes than older adults hospitalized for flu or COVID. Every family should consider their loved ones at risk and act this season. All adults 75 years and older are at risk, and they should get a dose of the RSV vaccine if they have not already. The best time to get the vaccine is September or October before the next RSV season starts for our region in November. Other adults at risk should all get one dose of the vaccine if they have not already. Risks include: <ul> <li>Lung disease.</li> <li>Heart and blood vessel diseases.</li> <li>Moderate or severe immune compromise.</li> <li>Diabetes mellitus with end-organ damage.</li> <li>Neurologic or neuromuscular conditions causing impaired airway clearance or respiratory muscle weakness.</li> <li>Advanced chronic kidney disease.</li> <li>Liver disorders.</li> <li>Blood disorders.</li> <li>Severe obesity.</li> <li>Frailty.</li> <li>Residence in a nursing home or other long-term care facility.</li> <li>Other chronic medical conditions that a clinician determines would increase the risk of severe disease due to respiratory infection. </li> </ul> Pregnant individuals during the months of September through January who are 32 to 36 weeks gestation should get the RSV maternal vaccine (Abryvso) if they have not already in a previous pregnancy. Babies born who did not benefit from maternal vaccination should get a dose of RSV immunoglobulin called nirsevimab (Beyfortus) between the months of October and March. All infants less than 8 months old during these months who did not get a birth dose should get one dose for this season during October through March. Older infants 9 through 19 months of age at risk for RSV hospitalization should get the immunoglobulin, too. Risks include: Infants born to immunocompromised pregnant people. Infants born to pregnant people who have medical conditions associated with reduced transplacental antibody transfer. Infants who have undergone cardiopulmonary bypass or extracorporeal membrane oxygenation, leading to loss of maternal antibodies. Infants with substantially increased risk for severe RSV disease. If you’re not sure if you or your family members should receive the RSV vaccine this season, reach out to your primary care clinician. <a href="/providers/robert-jacobson-md">Robert M. Jacobson, M.D.</a>, is the medical director of the Primary Care Immunization Program in Southeast Minnesota. He is a physician in Community Pediatric and Adolescent Medicine at Mayo Clinic in Rochester and practices in the Baldwin building.Robert Jacobson, M.D.Primary Care in Rochester and KassonPrevent RSVPrimary Care in Rochester and KassonGet your vaccine to prevent the annoyance. <img src="/-/media/ech-media/images/widgets/people/multigenerationalfamilyvaccinebandaid.jpg?h=65&iar=0&w=100&sc_lang=en&hash=C7403EF97D7386D948BD3271B2024241" alt="MultiGenerationalFamilyVaccineBandaid" width="100" height="65" DisableNVelocity="true" />Protect your family against 'annoying' COVID-1910/2/2024 12:00 AM<img src="/-/media/ech-media/images/widgets/people/multigenerationalfamilyvaccinebandaid.jpg?h=205&iar=0&w=315&sc_lang=en&hash=4911633BE7C4C8D379F52F23171B23F3" alt="MultiGenerationalFamilyVaccineBandaid" width="315" height="205" DisableNVelocity="true" />While families may sometimes disagree on the best way to treat an illness, there's one thing we can all agree on: COVID-19 is annoying. It caused a pandemic, and it did not go away when it ended. Suddenly, we had vaccines against the disease. Some had questions, some argued — were the vaccines rushed? Were they safe? Do they work? Over time, we found out the truth. These vaccines had gone through all the rigors of testing—more than some drugs we use to treat diseases, including COVID. These vaccines are safe, and they work. They are not perfect, but they reduce disease. They also reduce complications, hospitalizations and deaths. One annoying thing about COVID is that the virus evolves, like the flu. Every season, we will need the new seasonal COVID vaccine. That's the case for infants (aged 6 months and older), children, adults and the elderly. Younger children, immunocompromised persons, and adults 65 years and older will need more than one dose. Unlike the flu, the COVID season isn't that seasonal. New strains of the COVID virus kept showing up all summer. The updated vaccines become available in mid-September, and everyone should plan to get at least one dose. Protect your family against the annoyances that COVID brings, including severe disease. Schedule your COVID vaccination appointment at our <a href="/featured-stories/flu-covid-vaccine">Primary Care Vaccination Clinic</a>. Mayo Clinic staff members should plan to receive their flu and COVID vaccinations at one of the many on-campus walk-in clinics if possible.  <a href="/providers/robert-jacobson-md">Robert M. Jacobson, M.D.</a>, is the medical director of the Primary Care Immunization Program in Southeast Minnesota. He is a physician in Community Pediatric and Adolescent Medicine at Mayo Clinic in Rochester and practices in the Baldwin building.Robert Jacobson, M.D.Primary Care in Rochester and KassonProtect Against COVIDPrimary Care in Rochester and KassonEveryone is at risk for rabies. Find out how to reduce your risk of this fatal disease. <img src="/-/media/ech-media/images/widgets/people/ech_rabies_01_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=2FF7549A6C8C6D59DD8D8E0BE95E4069" alt="ECH_Rabies_01_widget" width="100" height="65" DisableNVelocity="true" />What you need to know about rabies9/9/2024 12:00 AM<img src="/-/media/ech-media/images/widgets/people/ech_rabies_01_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=6D9599DFFC1CD14CC2AE59AF08BCFFD6" alt="ECH_Rabies_01_widget" width="300" height="195" DisableNVelocity="true" />September is Rabies Awareness Month, but are you aware this disease is a yearlong problem for all of us? Once a patient has signs and symptoms of rabies, it is too late to treat. The illness is 100% fatal. This is why we take rabies prevention so seriously. Owners must vaccinate their cats, dogs, ferrets and horses against rabies. Farmers and ranchers should vaccinate their sheep and cattle when feasible as well. However, animal vaccination does not eliminate the risk for humans. First, animal vaccines are not 100% effective. Second, wild animals put us at risk, too. Skunks and bats are the primary wild animals in Minnesota that carry rabies. Cats, dogs, horses and cattle can also become infected when bitten by skunks or bats. Petting a stray cat or dog puts you at risk for rabies if you get bit — no matter how deep. Do not approach a strange cat or dog — no matter how cute. Do not put yourself at risk for a bite, even if the stray gets tangled up with your pet. If the biting animal cannot be tested or observed for 10 days, you must get the rabies prevention series. This measure involves rabies antibody or immunoglobulin injected directly into the bite wound. This also involves several doses of rabies vaccine. If the animal can be assessed and is negative, you can skip the treatment and be reassured you were not exposed. Unfortunately, capturing a stray is difficult, and the testing requires a brain sample, which requires the animal to be put to death. Waking up in a room with a bat means you might have been bitten. Since bats have incredibly small teeth, their bites are invisible and won't wake you. You won't find a wound and probably didn't feel a bite. If you find a child in the room with a bat, you must presume the child was bitten. It does not matter if the child is awake or asleep. The same goes for a drunk adult who was in a room with a bat. Bats, when healthy, do not stay in a room with a human. A bat in a room with a human is likely ill, and it could be rabies. If you can't capture the bat to have its brain tested, you need to start the rabies series. A bite from a neighbor's cat, dog or ferret is also a risk, even the case if your neighbor can document that the pet is up to date on rabies vaccines. The vaccine is not 100% effective. The pet still needs 10 days of observation to ensure it remains alive and healthy. If not, you will need to start the vaccination series. Call your care team if you or a loved one might have been exposed. It's an emergency. <a href="/providers/robert-jacobson-md">Robert M. Jacobson, M.D.</a>, is the medical director of the Primary Care Immunization Program in Rochester and Kasson. He is a Community Pediatric and Adolescent Medicine physician at Mayo Clinic in Rochester.Robert M. Jacobson, M.D.Primary Care in Rochester and KassonRabies 2024Primary Care in Rochester and KassonShorter days and fewer hours of sunlight can affect your mood and well-being.<img src="/-/media/ech-media/images/widgets/people/ech_sad_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=38BAAA647B731C8AED0E7E63A47023C4" alt="ECH_SAD_widget" width="100" height="65" DisableNVelocity="true" />Getting ahead of seasonal affective disorder11/18/2024 12:00 AM<img src="/-/media/ech-media/images/widgets/people/ech_sad_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=F91E2B0D3E9F664F8569520AB3494150" alt="ECH_SAD_widget" width="300" height="195" DisableNVelocity="true" />Warm summer breezes are slowly transforming into cooler temperatures at night. The leaves are just starting to change colors. The sun rises a little later in the morning and sets a bit earlier in the evening. This can be a time of year when people who tend to struggle with seasonal depressive patterns, also known as seasonal affective disorder (SAD), start to get concerned about changes in their mood and function that arrive later in autumn and early winter. Those who live in northern states are no strangers to the "winter blues," which is a milder version of seasonal depression. About 15% of the population may struggle with winter blues. Major depression with a seasonal pattern is more severe and impairing than the winter blues, however. Studies have shown that nearly 10% of people in New Hampshire have been diagnosed with seasonal affective disorder, but it affects only about 1% in Florida, the Sunshine State. Depression with seasonal patterns tends to be more common in women, young adults and those who live in northern latitudes. It has also been found to run in families. Symptoms typically start during the fall and winter and reliably go away during the spring and summer. Many symptoms feel like the need to hibernate. Common seasonal affective disorder symptoms include: Sleeping more but not sleeping well. <ul> <li>Feeling dragged out and unmotivated, with low energy.</li> <li>Heaviness in limbs.</li> <li>Craving junk or comfort food.</li> <li>Gaining weight.</li> <li>Losing interest in activities you once enjoyed.</li> <li>Not being able to focus.</li> <li>Avoiding social activities. </li> </ul> While many experience these symptoms to some degree, when they become disabling or make it difficult for you to function, you should contact your care team. If you already suffer from depression, seasonal patterns can worsen your symptoms. While there's no exact cause of seasonal affective disorder, researchers have found it may be linked to these factors: <ul> <li>Your biological clock (circadian rhythm) The reduced level of sunlight in the fall and winter may cause winter-onset depressive symptoms. This decrease in sunlight may disrupt your body's internal clock and lead to feelings of depression.</li> <li>Serotonin levels A drop in serotonin, a brain chemical that affects mood, might play a role in seasonal depressive patterns. Reduced sunlight can reduce serotonin, and that reduction may trigger depression.</li> <li>Melatonin levels The change in season can disrupt the balance of a body's level of melatonin, which plays a role in regulating sleep patterns and mood. </li> </ul> Although it may be several more weeks until your seasonal depressive symptoms normally start to appear, taking action now will help you get a running start on developing healthy habits. Whether it's the winter blues or seasonal depression, here are some things you can try to lift your mood: <ul> <li>Open your shades to let in the sunlight.</li> <li>Head outdoors on sunny days.</li> <li>Include physical activity in your daily routine.</li> <li>Adjust your diet to include foods that provide energy.</li> <li>Plan to stay connected regularly with friends, family and other social supports. </li> </ul> You also can try light therapy. During light therapy, you sit or work near a box that emits bright light mimicking natural outdoor light. The boxes are relatively inexpensive, and they can be bought without a prescription. Some insurance companies cover the cost. They're small, thin and lightweight, and they can be carried when you travel. Many patients find light therapy to be as effective as antidepressants, without the side effects. Choose a light box that emits 10,000 lux, is about one square foot in size and emits low ultraviolet light. Some light boxes emit off-white light or blue light, but there is no advantage to one color of light over the other. Here are some tips for using a lightbox correctly: <ul> <li>Start using the lightbox within two weeks of the usual time each year that your mood starts to decline.</li> <li>Set it at an angle to the left or right, at eye level or higher, and at about an arm's length away. Do not stare directly into the light.</li> <li>Keep your eyes open while using it, and feel free to perform other activities like reading or eating breakfast.</li> <li>Start light therapy for 20 to 30 minutes each day within the first hour of waking up in the morning. </li> </ul> Keep using it until the days lengthen and you begin to feel better, which is usually in the early spring to summer. Remember that consistent use is key. Studies also have shown that cognitive behavioral therapy, a skills-based treatment, can effectively treat seasonal depressive symptoms. As part of this therapy, people learn ways that can offset the likelihood of experiencing seasonal depressive symptoms in the future. Mayo Clinic has developed a series of free-to-use, online skill-building modules that can help people learn to cope with negative thoughts and avoidance behaviors they can access here: <ul> <li><a rel="noopener" href="https://mccmscontent.mayo.edu/IBH/EMHMT/content/index.html#/" target="_blank" title="Link opens in a new window">Managing Negative Thinking</a>.</li> <li><a rel="noopener" href="https://mccmscontent.mayo.edu/IBH/EMHBA/content/index.html#/" target="_blank" title="Link opens in a new window">Behavioral Activation</a>.</li> </ul> Some people also may benefit from antidepressants. Research has shown that starting a medication several weeks before the usual onset of seasonal affective disorder symptoms tends to be more helpful than starting a medication once it has already started. Talk to your healthcare team regarding the best options for managing your seasonal depression. Also, learn more about <a rel="noopener" href="https://www.mayoclinic.org/diseases-conditions/seasonal-affective-disorder/symptoms-causes/syc-20364651" target="_blank" title="Link opens in a new window">seasonal affective disorder</a> and how you can brighten your winter mood. Kyle Schofield, Ph.D., is a clinical health psychology fellow in Primary Care in Rochester and Kasson's Division of Integrated Behavioral Health. <a rel="noopener" href="https://www.mayoclinic.org/biographies/roche-anne-i-ph-d-l-p/bio-20569110" target="_blank" title="Link opens in a new window">Anne Roche, Ph.D., L.P.</a>, and <a rel="noopener" href="https://communityhealth.mayoclinic.org/providers/craig-sawchuk-phdlp" target="_blank" title="Link opens in a new window">Craig Sawchuk, Ph.D., L.P.</a>, are clinical psychologists in Primary Care in Rochester and Kasson's Division of Integrated Behavioral Health.Kyle Schofield, Ph.D.; Anne Roche, Ph.D., L.P.; Craig Sawchuk, Ph.D., L.P.Primary Care in Rochester and KassonSeasonal Affective DisorderPrimary Care in Rochester and KassonAsk your clinician about signing up for the next session. <img src="/-/media/ech-media/images/widgets/elderly/ech_seniorvitalitygroup_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=6CE74C44036825FF593CE8F199F73EEB" alt="ECH_SeniorVitalityGroup_widget" width="100" height="65" DisableNVelocity="true" />Senior Vitality Group: Connecting, enjoying, discovering11/14/2024 12:00 AM<img src="/-/media/ech-media/images/widgets/elderly/ech_seniorvitalitygroup_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=6D4A99C1A7B8448529E4BBE03CD93948" alt="ECH_SeniorVitalityGroup_widget" width="300" height="195" DisableNVelocity="true" />Aging can take a toll on the body, mind and spirit. Health issues, loss of loved ones, isolation and unexpected challenges can lead people away from their values and into depression and anxiety. However, the Senior Vitality Group is an opportunity to shift your focus back toward living from a place of heart and meaning through eight one-hour sessions. The series seeks to address these issues and enhance connection and aliveness that lasts beyond the series. The Senior Vitality Group is designed especially for those 60 and older who receive their healthcare through Primary Care in Rochester and Kasson. The content of the one-hour sessions is based on proven cognitive behavioral therapy techniques ranging from scheduled worry and flexible thinking to mindfulness and Tai Chi movements. You need a referral from your primary care clinician to attend. Sessions are planned throughout the rest of 2024 and into 2025. The Senior Vitality Group meets on Thursdays at 3:30 p.m., and topics include: Week 1: Quality of Life: Aging 101, holistic living, vitality, and legacy concept. Week 2: Exploring Social Support Systems and Education. Week 3: Exploring Elder Fraud, Scams, and Advanced Directives. Week 4: Eco Map, Cognitive Health and Dementia. Week 5: Caregiver Coping and Mental Health. Week 6: Physical Health. Week 7: Emotional Wellness. Week 8: Spirituality and Resilience: Faith, generativity, finding meaning transcendence. Through these sessions, seniors experience an increased connection with themselves and others. They reflect on a reduction in fear and an openness to adventure, appreciate being more informed, and often feel energized to take charge of life rather than deny the challenges of aging. Sessions also offer seniors someone besides their adult children to discuss unique issues. As a result, some have joined <a rel="noopener" href="http://125livemn.org/" target="_blank" title="Link opens in a new window">125 Live</a> to explore senior activities further. Others have participated in various other growth opportunities in the community through Rochester Community and Technical College and <a rel="noopener" href="https://www.elder-network.org/" target="_blank" title="Link opens in a new window">Elder Network</a> for ongoing social support. If you're interested, you can contact your primary care team. <a href="/providers/chad-ellis-licsw">Chad Ellis, L.I.C.S.W., M.S.W.</a>, is a clinical social worker/therapist in Integrated Behavioral Health (IBH). He has worked in psychiatry and behavioral health at Mayo Clinic for eight years, doing individual and group therapy. He is based at Mayo Family Clinic Northeast. <a href="/providers/kileen-smyth-licswmsw">Kileen Smyth, L.I.C.S.W., M.S.W.</a>, is a clinical social worker/therapist in Integrated Behavioral Health (IBH). She has worked in psychiatry and behavioral health at Mayo Clinic for 27 years, doing individual and group therapy. She is based at Mayo Family Clinic Northwest. They enjoy facilitating the senior vitality group as well as cognitive behavioral therapy (CBT) group for anxiety and depression.Chad Ellis, L.I.C.S.W., M.S.W.; Kileen Smyth, L.I.C.S.W., M.S.W.Primary Care in Rochester and KassonSenior VitalityPrimary Care in Rochester and KassonThese three words can take a toll on your body. Learn how to be safe. <img src="/-/media/ech-media/images/widgets/activities/shovelingsnow.jpg?h=65&iar=0&w=100&sc_lang=en&hash=8B98447BA289280D88A7711B94CC447C" alt="ShovelingSnow" width="100" height="65" DisableNVelocity="true" />Snow, ice and shovels12/30/2024 12:00 AM<img src="/-/media/ech-media/images/widgets/activities/shovelingsnow.jpg?h=205&iar=0&w=315&sc_lang=en&hash=408B5C7A04C7E1B6F39C1E4A737EAF02" alt="ShovelingSnow" width="315" height="205" DisableNVelocity="true" />For most people, the thought of shoveling snow makes them shiver — and not just from the cold. Picking up that shovel brings thoughts of back pain, falls — and more. These tips can help keep you safe from snow shoveling injuries. Be heart conscious If you are physically inactive or have a history of heart issues, be sure to talk to your primary care clinician before shoveling. Don't smoke or eat while shoveling or drink caffeine before shoveling as it may place extra stress on your heart. Dress warmly Wear several layers of clothing. If you start getting overheated, just remove a layer at a time until you are comfortable. Stay hydrated Make sure you are drinking adequate amounts of fluids. Men should drink approximately 15 cups and women 11 cups per day. Do warm-up stretches Stretching your arm and leg muscles before shoveling is crucial. Warm muscles are less likely to get injured. Take your time Make sure to take breaks and pace yourself. Protect your back Be sure to lift with your legs bent, feet hip-width apart and keep the shovel close to your body. Use a small shovel or fill a larger shovel only half full — don't pick up too much at one time. Fresh is best The freshly fallen snow is lighter than that which has started melting. Watch for ice You my find patches of ice when shoveling. Be sure to watch for these to decrease the chance of slipping and falling. Listen to your body This is the most important snow shoveling tip. If your body tells you "something's not right" — listen! Take a break or stop entirely. Call 911 for emergencies David Rushlow, M.D., is chair of the Department of Family Medicine in Rochester, Minn. He has been practicing as an outpatient physician at Mayo Clinic for over 27 years and enjoys caring for patients of all ages. He previously served as a faculty member for the Mayo Clinic Family Medicine Residency Program in La Crosse, Wisc., for 14 years.David Rushlow, M.D.Primary Care in Rochester and KassonShovelingPrimary Care in Rochester and KassonLearn more about this delicious bread option. <img src="/-/media/ech-media/images/widgets/food/sourdoughbread.jpg?h=65&iar=0&w=100&sc_lang=en&hash=15C6FA085DB5247DAFCF6676F7D31BFF" alt="SourdoughBread" width="100" height="65" DisableNVelocity="true" />Sourdough bread: Get familiar with this fermented food10/21/2024 12:00 AM<img src="/-/media/ech-media/images/widgets/food/sourdoughbread.jpg?h=205&iar=0&w=315&sc_lang=en&hash=1346A87034976A5A75297B70005D0FE2" alt="SourdoughBread" width="315" height="205" DisableNVelocity="true" />Bread is a food staple in many cultures. A good, toasted slice is the perfect vessel for loading on other nutritious foods to create a meal — any time of day. Sourdough bread is a versatile variety that not only has a desirable taste and texture but also has many scientifically proven health benefits. Compared to bread that uses traditional dry yeast, sourdough bread is created using a starter that undergoes a fermentation process involving healthy bacteria and naturally occurring yeasts. The fermentation process allows the bread to rise, gives it certain prebiotic and probiotic properties, and contributes to its distinctive "sour" flavor. Three proven health benefits of sourdough bread Supports a healthy gut microbiome. Sourdough bread contains more beneficial nutrients than other types of bread due to the fermentation process. Fermentation creates probiotics, or healthy bacteria, that can aid in digestion. Sourdough is a good source of prebiotics and fiber, which is the substance that feeds the good bacteria in your gut. Choosing a whole wheat version has more fiber and will further increase the benefits to your gut. Easily digested. Sourdough fermentation decreases the amount of gluten and FODMAP carbohydrates in the bread. This makes digestion easier and has proven beneficial for those with digestive disorders such as irritable bowel syndrome. Supports better blood sugar control. Sourdough bread has a lower glycemic index than white bread, so it doesn't increase blood sugar levels as quickly. This is true because the fermentation process makes starch in the bread less available for digestion and absorption into the bloodstream. Topping ideas for sourdough bread <ul> <li>Small curd cottage cheese, thinly sliced pear, a drizzle of honey, and sprinkle with cinnamon.</li> <li>Nut butter, sliced banana and cinnamon.</li> <li>Smashed avocado, soft-boiled eggs and pesto.</li> <li>Pizza sauce, grilled chicken pieces, fresh mozzarella and basil leaves. </li> </ul> This tasty and trending food has many health advantages when planning meals. Give it a try! Isabella Wiggins, MS, is a dietetic intern at Mayo Clinic in Rochester. She previously attended the University of Minnesota — Twin Cities, where she received her Bachelor of Science and Master of Science in Nutrition. Her areas of interest are diabetes, weight management, nutrition support and preventive care through nutrition.Isabella Wiggins, M.S.Primary Care in Rochester and KassonSourdough Bread BenefitsPrimary Care in Rochester and KassonStress can be both your friend and your enemy.<img src="/-/media/ech-media/images/widgets/randomimages/ech_ultimatefrenemy_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=8621D297E2D00EAD2CDF68BB6DC186F4" alt="ECH_UltimateFrenemy_widget" width="100" height="65" DisableNVelocity="true" />Stress: A potential frenemy12/2/2024 12:00 AM<img src="/-/media/ech-media/images/widgets/randomimages/ech_ultimatefrenemy_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=17FA0568164D28972B3267F712C2B983" alt="ECH_UltimateFrenemy_widget" width="300" height="195" DisableNVelocity="true" />Stress is our body's response to things around us, including good and bad changes. This reaction can be both physical and emotional. Stress is individualized; what triggers stress in you may not bother someone else. Everyone experiences stress as they learn to navigate life. We understand what we can add to our plate when we have too much to manage and how to set boundaries for ourselves and others. Cultivating balance is a key component of stress management. Good vs. bad stress Stress is a natural part of life; it can be helpful. Stress can motivate us to achieve goals, help us stay focused and give us the energy to “get stuff done.” For example, if we didn't feel stressed, we wouldn't worry about being late to work or school or finishing a project on time. Positive stress includes changes in our lives that fill us with excitement, such as the first day of school, learning a new hobby, going on vacation, having a child and meeting new people. Bad stress, also known as "distress," weighs on us, brings our mood down, drains our energy and diminishes our view of ourselves and others. It can be cunning and seep into many areas of our life. This kind of stress may feel burdensome. Examples of negative stress include abrupt or unforeseen life setbacks such as losing a job, failing a class, breaking up/divorcing or the death of a loved one. Sometimes, people can turn these difficulties into opportunities, but they are tough at the start. Stress comes from what happens around us or to us, as well as our reactions to what is happening or what we think is happening to us. Anxious or ruminative thoughts are often heightened during this time. Brain research has revealed that negative thoughts trigger stress, and our brains are drawn to negativity. That's why fears/phobias, overthinking, perfectionism and unrealistic or irrational expectations can stress us out. Signs of stress Physical signs of stress range from headaches to stomachaches, chest pain to fatigue and difficulty sleeping. Sleep issues can include trouble falling and staying asleep, oversleeping, waking up and being unable to fall back asleep. Stress in children may show itself in different ways than adults. Sleep issues may relate to anxiety, while being irritable may be a sign of depression or stress. Emotionally, stress exhibits itself as: <ul> <li>Irritability.</li> <li>Lack of enjoyment or motivation.</li> <li>Crying easily and more often than usual or when angry.</li> <li>Trouble concentrating and focusing.</li> <li>Worrying or feeling anxious.</li> </ul> Kids and stress Kids experience stress, too. But it may be harder for them to handle it because they don't have the life lessons and skills learned by adults. Educating kids on managing stress is vital for developing positive mental health. Helping your child cope with stress can be difficult, and it's tempting to take on their challenges and help them feel better faster. However, learning to manage stress in a healthy way is an important lesson and one they'll need throughout their lives. A few tips to help your kids manage stress include: <ul> <li>Model healthy ways to manage stress; they learn from watching you.</li> <li>Voice your feelings about work, family, etc. ("I felt frustrated today when my boss sprung a new assignment on me") and demonstrate a healthy way to manage it ("I think I'll go for a run to get it out of my system").</li> <li>Ask your kids for specifics about their day to avoid the "How was your day?" "Fine." cycle. Use open-ended prompts like, "Tell me about something difficult that happened today."</li> <li>Be careful about accidentally invalidating your child's distress. It can be tempting to respond to your child's concern by problem-solving or pointing out why it's "not so bad." Instead, listen empathically and allow your child to have negative emotions. </li> </ul> Raising kids can be the most rewarding and challenging thing we do. Being a parent is a second job on top of our daily routines and commitments, which can be overwhelming. As a parent or caregiver, you must take care of yourself to be the "best you" for your loved ones, so don't forget about your own stress management. Make time for yourself. Take a break by exercising, walking, reading, socializing with friends or practicing mindfulness. Use your support system. Reach out for professional help. You don't have to do this alone! Now that you know more about your frenemy, watch for a follow-up story on tips for coping with stress. Nikki Rose, L.I.C.S.W., M.S.W., is a clinical social worker serving the Mayo Clinic Center for Safe and Healthy Children and Adolescents. <a href="/providers/kileen-smyth-licswmsw">Kileen Smyth, L.I.C.S.W., M.S.W.</a>, is a clinical social worker at Mayo Family Clinic Northwest. She works with Primary Care's Division of Integrated Behavioral Health (IBH).Nikki Rose, L.I.C.S.W., M.S.W.; Kileen Smyth, L.I.C.S.W., M.S.W.Primary Care in Rochester and KassonStress FrenemyPrimary Care in Rochester and KassonThis common condition is treatable but not normal. <img src="/-/media/ech-media/images/widgets/people/ech_urineleaking_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=D595686C32452B93ADD12A4C3DB205E5" alt="ECH_urineleaking_widget" width="100" height="65" DisableNVelocity="true" />FAQ: Is urine 'leaking' typical for women?9/26/2024 12:00 AM<img src="/-/media/ech-media/images/widgets/people/ech_urineleaking_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=6FAC70AC10A62CD8C97B27C3424EDEDF" alt="ECH_urineleaking_widget" width="300" height="195" DisableNVelocity="true" />Urine "leaking" or incontinence isn't normal, but it is common — and treatable. Urine incontinence can adversely affect your physical, social and psychological well-being and even your quality of life at home and work. Answers to these frequently asked questions about this condition will help dispel some myths, and if you experience urine leakage, I encourage you to talk it over with your clinician. Q: How many women experience urine incontinence? A: More than you may think! As many as 60% of American women have reported urinary incontinence during their reproductive years, and incontinence gets more common with age — up to 75% of women over 65 report involuntary leakage. Q: Isn't it just a normal result of childbirth and aging? A: Childbirth and aging can play a role, but urine leaking isn't a given for women. Several factors can cause incontinence. Each cause makes your symptoms more severe and the treatment more complex. There are two main types: stress and urge incontinence. If you have both, it's called mixed incontinence. Q: How is urinary incontinence evaluated? A: First, your healthcare professional will take a thorough history, including an inventory of your symptoms and consideration of any other health conditions that may be causing the incontinence. Next, they will perform a physical exam, which will include evaluation of the pelvic floor and reproductive organs. Testing should include analysis of the urine and ruling out infection. Specific imaging of pelvic organs and bladder function testing may also be done. Q: What is stress incontinence and what causes it? A: This is the leaking brought on by physical activities such as coughing, laughing, sneezing, jumping or even walking. Increased firing of abdominal muscles from these actions exerts stress or pressure on your bladder and bladder neck. If your incontinence mechanisms are weakened, this increased stress causes leakage, typically spurts or drops of urine. Unfortunately, women affected by stress incontinence tend to stop doing their favorite sports or recreational activities and adopt a less active lifestyle. Q: How is this type of incontinence treated? A: If you have stress incontinence, there are several options for treating it: <ul> <li>Pelvic floor muscle training, or Kegel exercises, strengthen your pelvic floor muscles so they work more effectively and efficiently. You should see results within six weeks to six months. The use of mobile apps, weighted vaginal cones, or supervised pelvic floor physical therapy can augment training.</li> <li>Treatment for conditions that may contribute to incontinence. Obesity, chronic cough, constipation, diabetes, limited mobility and genitourinary symptoms of menopause all can contribute if not addressed or treated.</li> <li>Intravaginal pessary. A pessary is a device made out of silicone; it's fitted to your vagina and inserted by a clinician in the clinic. Depending on your condition and what is most comfortable, different types, shapes and sizes of pessaries are used for other pelvic floor problems. A ring pessary has a knob that exerts external pressure on your urethra to overcome the pressure caused by daily activities. The effect of a pessary is immediate — and reversible once the device is removed. </li> <li>Surgery. When other options fail, surgery can be a solution. The most common procedure is the mid-urethral sling. A synthetic mesh replaces the damaged fibromuscular sling that supports the midsegment of the urethra and reestablishes the continence mechanism. This procedure has a success rate of 80% to 90%; complications related to the mesh are reported at 3%. Other possible complications of surgery include groin pain and trouble urinating. A mid-urethral sling is considered minor surgery, and you'll probably be sent home the same day with some limitations on your activity. These options are safe, but there are risks. There's so much confusing information about mesh and slings, so talking with your healthcare clinician is essential. If you're interested, consult an experienced surgeon who does many of these procedures. </li> </ul> A less invasive option for some cases is an injection of bulking agents into the internal sphincter of the bladder, but this is less effective. Q: What is urge incontinence (overactive bladder), and what causes it? A: Have you ever had to "go" so bad, even when your bladder isn't full, that you can't hold it, and when you start to urinate, you can't stop it? That's urge incontinence and women who have it say it's more distressing than stress incontinence because it's unpredictable and restricts their lifestyle more. You may find yourself mapping out where toilets are located and limiting outings and social activities because you don't want to be embarrassed. Urge incontinence is usually caused by involuntary bladder contractions or "spasms," creating the strong urge to go to the bathroom and producing a larger volume of urine leakage. This can be a common condition as you get older, and most of the time, there's no underlying condition causing it. Risk factors for this condition can include neuropathy caused by diabetes or multiple sclerosis, menopausal symptoms or some types of brain injury that alter the bladder's inhibitory pathways. Q: How is it treated? A: As with stress incontinence, the first lines of therapy are pelvic floor muscle training and treatment of conditions contributing to the problem. In addition, your healthcare team can teach and reinforce modifications for voiding, including: <ul> <li>Fluid management.</li> <li>Scheduled voiding.</li> <li>Bladder training to gradually increase the time between voiding.</li> <li>Double voiding (urinate, wait a couple of minutes, then urinate again).</li> <li>Avoiding bladder irritants, such as caffeine (coffee, tea, chocolate, certain medications, artificial sweeteners like aspartame and saccharin), alcoholic beverages, carbonated beverages (including sparkling water), chili pepper, and citrus fruits and juices (grapefruits, lemons, limes, oranges, tangerines, kiwi, Vitamin C supplements).</li> <li>Self-monitoring with a bladder/voiding diary. </li> </ul> Unlike stress incontinence, medications can be very effective in treating urinary urgency, frequency and urge incontinence. First-line options are medications that relax the muscles of your bladder. The most common side effects include dry mouth, constipation and low blood pressure. Recently, Botox (yes, the wrinkle-fixing drug) injections have been used in patients who don't respond to or tolerate the medicines. Injections provide reasonable improvement for about six months. Possible side effects include temporary urine retention. Surgery is used for this type of incontinence only in very rare cases. Q: If I'm experiencing leakage, should I talk it over with my clinician? A: Absolutely! Only 45% of women who experience weekly episodes of urine leakage talk with their providers about it. Some find it too embarrassing to discuss, while others may think it's normal. You can find relief from this condition and resume your active, engaged lifestyle. If you are experiencing blood in the urine, pain or sudden onset of incontinence, you should seek help immediately. <a href="/providers/jennifer-horn-md">Jennifer Horn, M.D.</a>, is a family physician in Primary Care in Rochester and Kasson's Department of Family Medicine. She completed her medical degree at Mayo Clinic Alix School of Medicine and her residency in Family Medicine at Mayo Clinic in Rochester. Her interests include population health, clinical operations and holistic wellness for patients and employees.Jennifer Horn, M.D.Primary Care in Rochester and KassonUrine IncontinencePrimary Care in Rochester and KassonThese tips can help you achieve your weight-loss goals. <img src="/-/media/ech-media/images/widgets/randomimages/scale_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=4949805C6DA1B4696A5167EAC8C32292" alt="Scale_widget" width="100" height="65" DisableNVelocity="true" />Making your weight-loss resolution stick12/19/2024 12:00 AM<img src="/-/media/ech-media/images/widgets/randomimages/scale_widget.jpg?h=205&iar=0&w=315&sc_lang=en&hash=03F6E85FA7174CD40A2030AD045DEF3F" alt="Scale_widget" width="315" height="205" DisableNVelocity="true" />As the Earth completes another trip around the sun, many people reflect on the previous year's weight-loss resolutions that didn't work out as planned. You have undoubtedly seen an explosion of weight-loss medication advertisements over the last year. While these medicines can potentially be helpful, they need to be used in conjunction with healthy lifestyle changes. Here are some tips to make 2025 the year your weight-loss resolutions stick! Start with a diet to lose weight. Weight loss is 20% in exercise and 80% in the kitchen. You will get far more weight loss by focusing on diet to start. Think small! Aim to lose about three to five pounds per month. Rapid weight loss is usually a sign that you're doing something that will be hard to keep up. Don't go on a "diet," instead make a "lifestyle change" by focusing on small things you can sustain for the rest of your life. Remember: Small changes over a long period yield big results. Rethink your drink. Calories are experts at sneaking into your diet without you even noticing, especially in beverages. Reducing or eliminating sugary drinks and alcohol can make a HUGE difference. Consider these simple substitutions: diet soda instead of regular soda, skim milk instead of whole milk for your coffee, flavored water instead of fruit juice, etc. Avoid portion pitfalls. Oversized portions derail the best weight-loss plans. Give these quick fixes a try: <ul> <li>At restaurants, put half of your meal in a to-go box as soon as it comes to the table.</li> <li>At home, keep serving dishes away from the dining table to discourage seconds and thirds.</li> <li>With snacking, put your snack in a bowl or container rather than sit and munch with the whole package at hand.</li> <li>Spoil your dinner! A healthy snack before dinner that leads to eating less at your meal is A-OK! </li> </ul> Ease into exercise. Exercise is key to a healthy life, but if you're not doing much exercise to start, going from zero to 60 is a recipe for crash and burn. Start low and go slow. Start with 10 minutes of exercise per week. Add 10 minutes weekly and slowly build up to 30 minutes five days a week. How do you know if you're exercising right? If you're breathing hard enough that it would be challenging to have a conversation with someone, then you're doing it right! Put a dietitian in your pocket. Have a smartphone or tablet device? Use it to work for you! Knowing which foods are good and bad is only part of the struggle. MyFitnessPal is a fantastic, free app that helps you set weight-loss goals and track your calories. Most important: Don't focus on weight too much! Weight is only one piece of the health puzzle! We tend to focus on weight as it is the easiest to see and measure, but being healthy is much more than your weight. The quality of the food you eat, the exercise you get and the unhealthy choices you avoid are just as important! Remember that your healthcare clinician is there for you. Don't hesitate to ask for guidance and talk about available tools to lose weight and be healthy. Make 2025 the year your weight-loss resolutions stick so you have many more trips around the sun. <a href="/providers/luke-hafdahl-md">Luke Hafdahl, M.D.</a>, is a Community Internal Medicine, Geriatrics and Palliative Care physician. He has a particular interest in medical education.Luke Hafdahl, M.D.Primary Care in Rochester and KassonWeight Loss ResolutionPrimary Care in Rochester and KassonTake proper precautions during cold-weather activities. <img src="/-/media/ech-media/images/widgets/activities/ech_winter_safety_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=7E25AC9054AD17C0D256D127B2E5A967" alt="ECH_winter_safety_widget" width="100" height="65" DisableNVelocity="true" />Outdoor winter fun: Keeping kids safe12/12/2024 12:00 AM<img src="/-/media/ech-media/images/widgets/activities/ech_winter_safety_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=6C85AA41522FD4C72E95BAFB32837617" alt="ECH_winter_safety_widget" width="300" height="195" DisableNVelocity="true" />Winter is here, whether we like it or not. While some may grumble and hibernate for the winter, many people will head outdoors for fun in the snow and cold. The winter season offers many activities that are fun for the entire family to enjoy. These cold-weather activities can be dangerous, but you can reduce your risk of injury if you and your family take the proper safety precautions. Here are some tips: Wear protection Wearing an appropriately sized helmet can reduce your risk of a serious head injury when playing on snow and ice. Helmets are strongly encouraged during many winter sports, especially if you are sledding, skiing, snowboarding, ice skating and snowmobiling. Apply sunscreen, lip balm, and wear sunglasses or goggles, to keep your skin, lips and eyes safe from the wind and sun. Even in the winter, your skin and eyes can be damaged by the sun, especially with the sun reflecting off the snow. Know the terrain When participating in outdoor activities, be on the lookout for trees, people and other obstacles. Avoid sledding on hills near roads, parking lots, ponds or other obstacles on the sledding route. Find a sledding hill with a clear finish area without trees or other obstacles in the way. If you like to ice skate outdoors, you should do so at skating rinks, if possible, rather than ponds or other bodies of water. If you ice skate over a body of water, make sure the ice is thick enough to skate on. If you like to ski, pick a skiing hill that is appropriate for your skill level. Stay on designated skiing trails and courses. Phone a friend Your child should never do any winter activities alone. Young children should always be supervised by an adult while doing outdoor winter activities. Older kids and teens should always have someone with them in case of injury, especially in the harsh, cold elements. Plus, it’s more fun with a friend! Learn from the pros Lessons are strongly encouraged for beginner skiers and snowboarders. Be sure your child follows the instructions of their guide, instructor or coach to safely participate in outdoor winter activities. If you live in Minnesota, snowmobilers are required by law to take a snowmobile safety training course before operating a snowmobile. If you live elsewhere, you should familiarize yourself with your state's snowmobile regulations before your child rides on or operates a snowmobile. Stay warm To stay warm, wear layers, including: <ul> <li>Base layer: This layer should be a breathable, moisture-wicking base.</li> <li>Insulating layer: You should have at least one insulating layer between your base and top layers.</li> <li>Top layer: Your top layer should be waterproof and windproof. </li> </ul> Try to cover up as much of your child's skin as possible to prevent cold injury, such as frostbite. Make sure clothing is replaced if it gets too wet for the child. Wet gear causes a rapid loss of body heat and can lead to frostbite and hypothermia. Also, take frequent breaks to go inside to warm up. Don't forget to drink water before, during and after outdoor winter activities. It is easy to forget to drink fluids during winter sports, but it's just as important to stay hydrated during the winter as it is during hot weather. Staying well-hydrated will help maintain good circulation, and help your child stay warm and active. Recognize hypothermia and frostbite Hypothermia is a life-threatening condition that happens when someone's core body temperature gets too low. Due to a variety of reasons, children are more prone to hypothermia than adults. Suspect hypothermia if you notice: <ul> <li>Slurred speech.</li> <li>Uncontrollable shivering.</li> <li>Confusion.</li> <li>Stumbling or clumsiness </li> </ul> Seek emergency care if you suspect hypothermia. Frostbite is a cold injury to the skin, most commonly on extremities and exposed areas of skin, such as ears, nose, chin, hands and feet. Monitor your child for signs of frostbite. Skin numbness or stinging, or a tingling sensation, can be early signs of frostbite. If frostbite is suspected, warm the skin up slowly in warm — not hot — water. If skin numbness doesn't go away — or if the skin appears hard, waxy, white or grayish-yellow in appearance, with a lack of sensation — seek emergency care for frostbite. Watch closely for signs of hypothermia and frostbite in children who cannot communicate easily, such as young children or children with communication disabilities. Seek care when concerned It's important for your child to stay healthy and active this winter season. Participating in outdoor winter activities is a fun way for the whole family to stay active. Despite your best efforts to keep your kids safe this winter season, they still may end up with an injury or ailment. If so, contact your healthcare provider promptly to ensure your child gets an appropriate evaluation and any treatment that they may need. Stay warm, stay safe, and have fun this winter! <a href="/providers/luke-radel-md">Luke Radel, M.D.</a>, practices in Community Pediatric and Adolescent Medicine in Rochester, Minnesota. He is board-certified in pediatrics and sports medicine. Dr. Radel is the volunteer team physician at John Marshall High School in Rochester and has provided medical coverage for many winter sporting activities. He has experience treating youth, collegiate and professional athletes.Luke Radel, M.D.Primary Care in Rochester and KassonWinter SportsPrimary Care in Rochester and Kasson<img src="/-/media/ech-media/images/widgets/people/uri_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=08E8B686372E07E4C572C50DE280175C" alt="URI_widget" width="100" height="65" DisableNVelocity="true" />Prepare for this year's upper respiratory infection season10/17/2024 12:00 AM<img src="/-/media/ech-media/images/widgets/people/uri_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=F347820C49206B1F09BE366B63660154" alt="URI_widget" width="300" height="195" DisableNVelocity="true" />Respiratory illnesses are a common occurrence in the fall and winter, with seasonal cases of COVID-19, influenza, strep throat and respiratory syncytial virus (RSV) likely increasing over the next few months. Here are a few tips and reminders to guide you through this year’s upper respiratory infection season. Mayo Clinic’s guidelines for the testing and treatment of upper respiratory infections are informed by expertise and best practices from Mayo’s Department of Infectious Diseases and the Centers for Disease Control and Prevention. For most people, respiratory illnesses can be treated at home. Mayo recommends clinic-based testing and treatment only for those at high risk for severe illness, including people who are 65 or older, immunocompromised, pregnant or have other complex health conditions.    If you have respiratory symptoms and aren’t high-risk, you probably don’t need to make an appointment with your clinician. Getting plenty of rest, drinking fluids and using over-the-counter medications can help you feel better and aid recovery.  Use home antigen tests to test for COVID-19. If you have COVID-19 symptoms or have been exposed to COVID-19, home antigen tests are the fastest, most convenient and least expensive way to get tested. These inexpensive tests are widely available through commercial pharmacies and big-box grocery stores. You can also order <a rel="noopener" href="https://covidtests.gov/" target="_blank" title="Link opens in new window">free home antigen tests</a> through the U.S. Department of Health and Human Services. Tests for other infections such as influenza are recommended only for high-risk patients or those who meet certain criteria. For most people, testing for influenza or other infections will not change your treatment plan. Report a positive result to your clinician only if you’re interested in treatment. You only need to report your COVID-19 home test results to your primary care clinician if you’re interested in receiving treatment. You can self-report a positive test result through the COVID-19 home antigen attestation questionnaire on the patient portal. If you test positive for COVID-19, you don’t always need oral antiviral treatment (Paxlovid). Unless you’re at high risk for complications, you likely won’t benefit from oral antiviral treatment with Paxlovid. If you’re low risk, this medication does not shorten the amount of time you’ll experience symptoms or reduce your risk of hospitalization. Taking Paxlovid can make low-risk patients feel worse. Researchers don’t know if Paxlovid reduces the risk of long COVID. Paxlovid is no longer provided to patients by the government, which means there is a cost for this treatment. Make sure you check your insurance coverage to understand how much you’ll be expected to pay for Paxlovid. Use Mayo Clinic’s digital tools for quick and convenient upper respiratory symptom assessment and care. Remember that Mayo Clinic has a variety of digital tools to help assess your upper respiratory symptoms and determine the best mode of care. Tools like the Primary Care Nurse Triage Line are available any time, including when clinics are closed, and follow Mayo Clinic protocols and expertise. In general, Check Symptoms in the patient portal is the fastest and most convenient way to assess your upper respiratory infection symptoms. Patients can also use Express Care Online for symptom assessment and care recommendations during the day and in the evening. these resources can provide care recommendations and help determine if you need a visit with a primary care clinician. Prevention is the best protection against upper respiratory infections. Following simple prevention guidelines can go a long way in protecting you and your family members from illness. Make sure you wash your hands, avoid prolonged contact with sick individuals and <a rel="noopener" href="https://communityhealth.mayoclinic.org/featured-stories/flu-covid-vaccine" target="_blank" title="Link opens in new window">stay current on your recommended vaccines</a>, especially for influenza and COVID-19. If you do become ill, help protect others by staying home until your symptoms improve and you have been fever-free without medication for 24 hours. For the next five days, take added precautions, like keeping your distance from others and wearing a high-quality, well-fitting mask if contact with people is unavoidable. <a href="/providers/sidna-tulledge-scheitel-md" style="color: #003da5;">Sidna Tulledge-Scheitel, M.D., M.P.H.</a>, is a physician in Community Internal Medicine, Geriatrics and Palliative Care in Rochester. She is also the medical director for Mayo Clinic’s Midwest Virtual Care Team, a group of clinicians who manage upper respiratory infection testing and treatment protocols for patients in Rochester and across Mayo Clinic Health System.Sidna Tulledge-Scheitel, M.D., M.P.H.Primary Care in Rochester and KassonURI Season 2024Primary Care in Rochester and KassonFind out what options are available for your arthritis relief. <img src="/-/media/ech-media/images/widgets/people/kneepain.jpg?h=65&iar=0&w=100&sc_lang=en&hash=F88BCB39AA9CF187DD411BC28EA3E7E8" alt="KneePain" width="100" height="65" DisableNVelocity="true" />Arthritis and the role of cortisone injections1/30/2025 12:00 AM<img src="/-/media/ech-media/images/widgets/people/kneepain.jpg?h=205&iar=0&w=315&sc_lang=en&hash=FE0623241599B92AB1793EE113E7BC5C" alt="KneePain" width="315" height="205" DisableNVelocity="true" />Arthritis is a common condition that affects millions of people worldwide. It can cause pain, stiffness and reduced mobility, affecting daily life and overall well-being. Let's explore what arthritis is, the range of therapies available and how corticosteroid injections can help manage this condition. What is arthritis? Arthritis is a term used to describe inflammation of the joints, leading to symptoms such as pain, swelling, stiffness and decreased range of motion. There are many types of arthritis, but two of the most common are: <ul> <li>Osteoarthritis (OA): Often called “wear-and-tear” arthritis, OA occurs when the protective cartilage that cushions the ends of bones wears down over time.</li> <li>Rheumatoid Arthritis (RA): This is an autoimmune condition where the body's immune system attacks the lining of the joints, causing inflammation and damage. </li> </ul> Other causes of arthritis include gout, lupus, psoriatic arthritis and infections that affect the joints. Treatment options for arthritis The goal of arthritis treatment is to reduce pain, improve joint function and enhance quality of life. Treatment options vary depending on the type and severity of arthritis and may include: Lifestyle modifications: <ul> <li style="margin-left: 40px;">Regular exercise to strengthen muscles around the joints and improve flexibility.</li> <li style="margin-left: 40px;">Weight management to reduce stress on the joints.</li> <li style="margin-left: 40px;">Balanced diets rich in anti-inflammatory foods.</li> </ul> Medications: <ul> <li style="margin-left: 40px;">Pain relievers, such as acetaminophen or NSAIDs.</li> <li style="margin-left: 40px;">Disease-modifying antirheumatic drugs (DMARDs) for autoimmune types of arthritis.</li> <li style="margin-left: 40px;">Biologic agents for more severe cases of inflammatory arthritis.</li> </ul> Physical and occupational therapy: <ul> <li style="margin-left: 40px;">Techniques to improve strength and mobility and reduce strain on the joints.</li> <li style="margin-left: 40px;">Assistive devices to make daily activities easier.</li> </ul> Interventional procedures: <ul> <li style="margin-left: 40px;">Joint injections, such as corticosteroid injections, to reduce inflammation.</li> <li style="margin-left: 40px;">In advanced cases, joint replacement surgery may be necessary. </li> </ul> The Role of corticosteroid injections, aka “cortisone shots” Corticosteroid injections are a powerful treatment option for arthritis-related joint inflammation. These injections deliver corticosteroids directly into the affected joint, providing rapid relief from pain and swelling. Here are some key points about this treatment: How they work: Corticosteroids mimic hormones naturally produced by the body to reduce inflammation. When injected, they target the inflamed joint, calming the immune response and alleviating symptoms. Effectiveness: Many patients experience significant relief within days of the injection, and the effects can last weeks to months, depending on the person and the severity of the condition. When to consider them: <ul> <li style="margin-left: 40px;">When arthritis symptoms are moderate to severe and not adequately controlled by other treatments.</li> <li style="margin-left: 40px;">As a temporary solution to manage flares or before physical therapy.</li> </ul> What joints can be injected? <ul> <li style="margin-left: 40px;">Common joints that can be injected in primary care or orthopedics include shoulder, thumb and wrist joints, hips, knees, ankles, and big toes (especially in the case of gout).</li> <li style="margin-left: 40px;">Other joints may require more specialized care.</li> </ul> Limitations: While effective, corticosteroid injections are not a cure and should not be used too frequently. Overusing these injections can lead to potential side effects, such as elevation of blood sugar and blood pressure and, in some cases, premature thinning of joint cartilage. As a collaborative approach to arthritis management at Mayo Clinic, we take a personalized approach to arthritis care. Our team works with you to develop a comprehensive treatment plan that addresses your unique needs and goals. If you think corticosteroid injections might be right for you, we're here to guide you through the decision-making process and ensure the best possible outcomes. Arthritis doesn't have to define your life. With the right combination of therapies and support, you can regain mobility, reduce pain and improve your quality of life. <a href="/featured-stories/arthritis-relief">David Brennan, M.D.</a>, is a primary care physician in the Division of Community Internal Medicine, Geriatrics and Palliative Care in Rochester, Minnesota. He focuses on prevention and treatment of a wide variety of common diseases.David Brennan, M.D.Primary Care in Rochester and KassonArthritis ReliefPrimary Care in Rochester and KassonTreating diabetes requires balancing many factors, including blood glucose levels. <img src="/-/media/ech-media/images/widgets/diabetes/ech_diabetes3_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=64A0E76A992EF0AD575F8A0ED5B14A7F" alt="ECH_diabetes3_widget" width="100" height="65" DisableNVelocity="true" />Managing blood glucose: Finding the right balance1/9/2025 12:00 AM<img src="/-/media/ech-media/images/widgets/diabetes/ech_diabetes3_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=6AC3CDB8F29CE6687EE118B4FC4A0F95" alt="ECH_diabetes3_widget" width="300" height="195" DisableNVelocity="true" />Managing diabetes means finding a good balance in different parts of life. This includes balancing the disease with other health issues and keeping mental and physical health in line with life's other demands. It also means considering the benefits and risks of treatment and lowering blood sugar. Diabetes is recognized by elevated blood glucose levels caused by: <ul> <li>Your body is not making enough insulin, using it well, or both (type 2).</li> <li>Your pancreas is not producing insulin (type 1). </li> </ul> Diabetes complications The concern around poorly controlled blood sugar levels is that it affects almost every part of your body. Diabetes: <ul> <li>Is the 8th leading cause of death in the U.S.</li> <li>Is the leading cause of new cases of blindness among adults.</li> <li>Is the leading cause of chronic kidney disease (CKD).</li> <li>Can increase the risk of needing lower limb amputation.</li> <li>Significantly increases the risk of heart disease and strokes.</li> <li>Can damage nerves, causing numbness and pain in your feet and legs as well as unstable blood pressure and pulse. It can also affect digestion.</li> <li>Can affect your teeth and gums, which could lead to tooth loss.</li> <li>Can increase the risk of depression. </li> </ul> Measuring glucose control Controlling blood sugar levels is the key to reducing the risk of these complications. There are two ways to measure glucose control: <ul> <li>Blood glucose monitoring: <ul> <li>Self-monitoring of blood glucose (SMBG): This means using a blood sugar meter to check your blood sugar levels at different times during the day, depending on your diabetic program. You do this by pricking your finger and putting a small drop of blood on a test strip.</li> </ul> </li> <li>Continuous glucose monitoring (CGM): <ul> <li>This system uses a small sensor under the skin to measure blood sugar levels all day and night. It gives real-time data and shows trends.</li> </ul> </li> <li>Hemoglobin A1c (HbA1c) test: <ul> <li>This blood test measures the average glucose level during the past 2-3 months. It provides a longer-term view of blood sugar control and is usually done in a healthcare setting. </li> </ul> </li> </ul> HbA1c and blood glucose goals Blood sugar goals and treatment should be personalized because every person is different. To prevent serious complications from diabetes, it is important to aim for goals that are right for you. The American Diabetes Association provides general goals appropriate for most people but stresses the importance of individualizing these goals based on discussions with your healthcare clinician. More stringent goals of an A1c of 7% or less may be recommended if they can be achieved safely with an acceptable burden of therapy. Less stringent goals, an A1c up to 8%, may be recommended if the risks and burdens outweigh the potential benefits. Working with your healthcare clinician to determine your A1c and glucose goals is essential. Hyperglycemia (high blood sugar) Blood sugar levels above 180 mg/dL are considered high, corresponding to a HbA1c of 8%. These levels may indicate the need for changes to your diabetes program. It is crucial to discuss high blood sugar levels with your healthcare clinician and how you should treat them when and if they occur. Symptoms of high sugar can include: <ul> <li>No symptoms.</li> <li>Increased thirst.</li> <li>Frequent urination.</li> <li>Blurred vision.</li> <li>Feeling weak or unusually tired.</li> <li>Confusion.</li> <li>Loss of consciousness.</li> <li>Nausea and vomiting</li> </ul> Hypoglycemia (low blood sugar) Trying to lower blood sugar too much can lead to levels that are too low, something referred to as hypoglycemia. Blood sugar levels under 70 mg/dL are considered low. Blood sugars at this level can be harmful and should be treated promptly, including assessing why it occurs and identifying steps to prevent it from happening again. Symptoms of low sugar can include: <ul> <li>No symptoms.</li> <li>Feeling shaky, nervous or anxious.</li> <li>Sweating, chills and clamminess.</li> <li>Irritability or impatience.</li> <li>Confusion.</li> <li>Fast heartbeat.</li> <li>Feeling lightheaded or dizzy.</li> <li>Hunger.</li> <li>Nausea.</li> <li>Feeling sleepy.</li> <li>Feeling weak or having no energy.</li> <li>Vision changes.</li> <li>Tingling or numbness in lips, tongue or cheeks.</li> <li>Seizures. </li> </ul> Finding the right balance Balance changes over time, so what worked for you before might not work now. That's why talking with your healthcare team about your goals, preferences and concerns is very important. Together, you can find a diabetes treatment plan that is right for you. Elizabeth Miles, APRN, CNP, is a family nurse practitioner in the Department of Endocrinology, Diabetes, Metabolism, and Nutrition. She specializes in managing type 1 and type 2 diabetes and has over 15 years of experience in endocrinology. Elizabeth is an Instructor in Medicine and Associate Program Director for the Mayo Clinic School of Health Sciences Nurse Practitioner Program.Elizabeth Miles, APRN, C.N.P.Primary Care in Rochester and KassonBlood GlucosePrimary Care in Rochester and KassonUnfortunately, there isn't a magic pill for brain health.<img src="/-/media/ech-media/images/widgets/elderly/ech_caregiver_stress_01_widget.jpg?h=65&iar=0&w=100&hash=5EA68E0BDAB984B76E1564A96472EF8C" alt="ECH_Caregiver_Stress_01_widget" width="100" height="65" DisableNVelocity="true" />Are supplements good for brain health?1/27/2025 12:00 AM<img src="/-/media/ech-media/images/widgets/elderly/ech_caregiver_stress_01_widget.jpg?h=195&iar=0&w=300&hash=8B5430B510532665498CB9AC2463DEFE" alt="ECH_Caregiver_Stress_01_widget" width="300" height="195" DisableNVelocity="true" />Healthcare clinicians are often asked about brain or memory supplements, as there are countless products with excellent and effective marketing that claim to increase memory, concentration and learning. Unfortunately, there isn’t yet a magic pill for brain health, and it may be more worthwhile to spend your money elsewhere. Ingredients of these supplements can vary and include a wide range of vitamins, botanical herbs, medicinal mushrooms and even jellyfish. Many of these products are not FDA-approved or regulated for purity of ingredients or other added substances. To date, no large clinical trials or high-quality evidence suggest any product marketed as such is beneficial. Some may even pose serious health risks, including side effects and interactions with your medications. Speaking with your healthcare clinician before initiating any of these supplements would be wise. Instead, consider focusing on proven strategies to promote healthy aging and memory, including physical and cognitive exercise, optimal sleep, social connectedness and healthy eating. If you or your loved ones have concerns, speak with your healthcare clinician for further evaluation. Sara Shu, D.O., is a board-certified family medicine physician and geriatrician-in-training in Community Internal Medicine, Geriatrics and Palliative Care at Mayo Clinic in Rochester.Sara Shu, D.O.Primary Care in Rochester and KassonBrain Health SupplementsPrimary Care in Rochester and KassonThis common screening for adults is equally important in children. <img src="/-/media/ech-media/images/widgets/kids/blooddrawchild.jpg?h=65&iar=0&w=100&sc_lang=en&hash=CE2CB0EA505FB9A73050F7D35C9EE63F" alt="BloodDrawChild" width="100" height="65" DisableNVelocity="true" />Cholesterol screening in children: Why it's important1/13/2025 12:00 AM<img src="/-/media/ech-media/images/widgets/kids/blooddrawchild.jpg?h=205&iar=0&w=315&sc_lang=en&hash=1664A47A705052B4A3AF68AF768D4D41" alt="BloodDrawChild" width="315" height="205" DisableNVelocity="true" />What is cholesterol? Cholesterol is a waxy, fat-like substance found in every body cell. It plays many important roles, including producing hormones, vitamin D and bile acids that help digest foods. The body gets cholesterol from two sources: the liver and the foods we eat. There are different types of cholesterol. Low-density lipoprotein (LDL) cholesterol is often called the "bad" cholesterol, as high levels can result in cholesterol deposits on the walls of arteries leading to plaque formation. On the other hand, high-density lipoprotein (HDL) cholesterol is known as the "good" cholesterol because it helps remove excess cholesterol from the arteries. Why does it matter? Hypercholesterolemia, or high cholesterol, occurs when too much cholesterol is in the blood. If cholesterol levels are high, plaque build-up can narrow arteries in the heart and brain, leading to an increased risk of heart attack and stroke over time. Studies have shown that this process of plaque build-up, also known as atherosclerosis, can begin in children. What causes high cholesterol? Genetics: Inherited conditions can cause high cholesterol levels, even in children. Some of these conditions can be relatively common, such as familial hypercholesterolemia, which is found in about 1 in 250 people. Diet: Certain foods, mainly those high in saturated or trans fats, can increase cholesterol levels. Weight: Being overweight or having obesity can lead to increased cholesterol levels. Other underlying health conditions: Certain health conditions, such as diabetes, hypothyroidism, and kidney or liver disease can contribute to high cholesterol levels. Why is it important to check cholesterol levels in children? Hypercholesterolemia often does not show any symptoms until it leads to serious health problems, such as heart attack or stroke. Therefore, early detection and management through screening can help prevent those issues from developing. The American Academy of Pediatrics recommends cholesterol screening for ALL children between ages 9 and 11 and again between ages 17 and 21. If your child has certain risk factors, such as a family history of high cholesterol or early heart disease, then screening may be recommended sooner, between ages 2 and 8. Cholesterol screening is done by a blood test measuring different cholesterol types. How is high cholesterol managed in children? <ul> <li>Well-balanced diet: Encourage a diet rich in fruits, vegetables, whole grains, lean proteins and healthy fats. Mono- and polyunsaturated fats, found in avocados, salmon, olive or canola oil, nuts and seeds, should be favored, while saturated and trans fats, present in red meat, full-fat dairy products, fried foods and margarine, should be limited. Meeting with a nutritionist is advised if any dietary changes are recommended.</li> <li>Regular physical activity: Aim for at least 60 minutes of moderate to vigorous physical activity daily.</li> <li>Limit screen time: Non-academic screen time should be limited to 1-2 hours per day.</li> <li>Avoid smoking or smoke exposure.</li> <li>Medications: Sometimes, medication may be prescribed to help lower cholesterol levels. Talk to your child's primary care clinician for more information. </li> </ul> Leslie Saba, M.B., B.Ch., B.A.O., is a Pediatric and Adolescent Medicine resident in Rochester, Minnesota. After residency, she will complete her fellowship in Pediatric Endocrinology at Mayo Clinic.Leslie Saba, M.B., B.Ch., B.A.O.Primary Care in Rochester and KassonCholesterol Screen ChildrenPrimary Care in Rochester and KassonEmbrace play, pleasure and laughter in everyday activities.<img src="/-/media/ech-media/images/widgets/kids/ech_cardboard_box_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=5C5345E83A1B120524F98B155FF1959E" alt="ECH_cardboard_box_widget" width="100" height="65" DisableNVelocity="true" />Find the fun in your day1/23/2025 12:00 AM<img src="/-/media/ech-media/images/widgets/kids/ech_cardboard_box_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=7F8BC0FC12D1A42D681762F0A7CE36F4" alt="ECH_cardboard_box_widget" width="300" height="195" DisableNVelocity="true" />Remember when a cardboard box was more than just a box? It was a rocket ship you could use to fly to the moon or a boat to travel across the ocean. Children have an amazing ability to live in the present. Worries, fears and doubts don't inhibit their confidence and creativity. They embrace the situation and find it fun. As adults, we don't always have time to have big fun moments, so try to embrace play, pleasure and laughter in everyday activities. Seek out laughter in your life. Watch a funny video your friend posted on social media or tell jokes with friends or family — encourage and get involved in situations that induce laughter and lightheartedness. The fun will start to find you. Learn to laugh at yourself. Sometimes, life doesn't go as planned — you send a text message, and auto-correct puts a wrong word in. Look for the humor in the randomness and irony of life. Allow yourself to have a good chuckle, pick yourself up and move on with life. People who laugh at themselves are more cheerful, optimistic and resilient. Enjoy the little things. Don't have time for lunch, so you grab a chocolate candy bar? Sit for just five minutes and enjoy the flavor. Give yourself "unwind" time by taking 5- to 10-minute breaks from life. Be spontaneous. Not everything needs to be planned. Take advantage of the spur-of-the-moment getaway, last-minute family gathering or party. Seek out and try new things. Jump out of your comfort zone and try something new — that salsa dance class your co-worker invited you to might be just the thing to relax you! Look for ways to make work fun. Let's face it, many of us spend more time at work than we do at home (awake) and with our families. Bond with your co-workers, even if you work remotely! Set up a once-weekly coffee club — 15 minutes max, and no work talk is allowed; decorate your workspace to brighten your day, or create a cookie club where a different person brings cookies for the group each week. Take a break and do a quick lap around the block with a team member. Switch up your routine. Drive a different route to work. Jump off the bus six blocks from your destination and spend time looking at the scenery. Practice mindfulness. Spend two minutes each morning noticing your breathing. Focus on the things around you—sights, smells, tastes, feelings, etc. Add this tactic throughout your day to give yourself those quick breaks. Change your mindset. Do you feel like everything goes wrong? Is it always your fault? Are you bored with your job? Try to look at the positive things you have in life. Change your thinking from "the glass is half empty" to "the glass is half full." Block out time to play. Choose something you consider "pure fun" and schedule it into your week. Bring others with you to join the fun—or ask to attend their planned events.Primary Care in Rochester and KassonFind FunPrimary Care in Rochester and KassonThese screening tests allow for early identification and treatment.<img src="/-/media/ech-media/images/widgets/kids/doctorbaby.jpg?h=65&iar=0&w=100&sc_lang=en&hash=FDA124AA3C0EB1388DF8EFF36744D29B" alt="DoctorBaby" width="100" height="65" DisableNVelocity="true" />Why are lead and anemia screening important for children? 1/20/2025 12:00 AM<img src="/-/media/ech-media/images/widgets/kids/doctorbaby.jpg?h=205&iar=0&w=315&sc_lang=en&hash=B5F17B7A0DC4C454618545F1F0617E82" alt="DoctorBaby" width="315" height="205" DisableNVelocity="true" />Have you ever wondered why your child's primary care clinician recommends lab testing for lead or anemia screening if your child appears healthy? Lead and anemia screening during early childhood allows for early identification and treatment before the risk of poor health outcomes. A child poisoned by lead may not look or act sick and their symptoms may be quite vague. This can lead to lead poisoning, which could be mistaken for other illnesses or can go unrecognized. Similarly, the infant or child with mild anemia does not display obvious clinical signs or symptoms. The risk of exposure to lead and iron deficiency anemia peaks around 12 to 24 months and can extend up to 36 months of age. The American Academy of Pediatrics (AAP) recommends that all infants be screened for anemia at 12 months of age. Additional screening is recommended for any child with risk factors for anemia (feeding problems, prematurity, poor growth, inadequate dietary iron intake). Other risk factors during early childhood include excessive cow's milk, chronic conditions, lead exposure and obesity. As of 2022, Minnesota Public Health has recommended that all children receive a lead blood test at 12 months of age with a second lead test at 24 months of age. There is no safe lead level for children. Low levels of exposure can contribute to behavioral problems, learning difficulties (lower IQ scores, academic underachievement) and slowed growth and development. As blood levels increase symptoms may include abdominal pain, loss of appetite, constipation, irritability, headaches, encephalopathy, seizures and even death. What you need to know <ul> <li>Every child should be evaluated at 12 and 24 months of age, sometimes later depending on environmental factors.</li> <li>The only way to screen for lead exposure and anemia is with a blood test.</li> <li>In the state of Minnesota, the Women, Infant and Child program does not evaluate your child's lead level. Please arrange to have this done with your child's healthcare clinician.</li> <li>Lead exposure increases in your child's environment at 6 months of age and peaks at 2 years due to increasing mobility and developmental behaviors, such as increased hand-to-mouth activities.</li> <li>How to prevent iron deficiency: <ul> <li>If your baby is formula-fed, iron-fortified formula will provide your infant with the recommended amounts.</li> <li>If your baby receives breastmilk, start an iron supplement. You can talk to your child's healthcare clinician about when to start this (typically at 4 to 6 months of age).</li> <li>Limit cow's milk consumption to approximately 20 ounces per day for children 1 to 5 years of age.</li> <li>Offer iron-rich foods such as red meat, fish, beans, spinach, iron-fortified baby cereal, pureed meats and pureed beans. </li> </ul> </li> </ul> <a href="/featured-stories/lead-anemia-children">Meghan Deyo, APRN, C.N.P., M.S.</a>, is a pediatric nurse practitioner in Primary Care in Rochester and Kasson's Division of Community and Pediatric and Adolescent Medicine. She has worked in pediatrics since 2011.Meghan Deyo, APRN, C.N.P., M.S.Primary Care in Rochester and KassonLead Anemia ChildrenPrimary Care in Rochester and KassonKnow where to go for worsening upper respiratory symptoms this winter. Care options for upper respiratory infection symptoms12/23/2024 12:00 AM<img src="/-/media/ech-media/images/widgets/people/uri_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=F347820C49206B1F09BE366B63660154" alt="URI_widget" width="300" height="195" DisableNVelocity="true" />As the holiday season brings gatherings with friends and family, it also brings a rise in upper respiratory infections. Cases of influenza and respiratory syncytial virus (RSV) are on the rise in our area, with other conditions like COVID-19 and strep throat likely not far behind. Now is a good time to familiarize yourself with Mayo Clinic care options for upper respiratory infection conditions and tips for symptom management. Remember that for most people, respiratory illnesses can be treated at home. Mayo recommends clinic-based testing and treatment only for those at high risk for severe illness, including people who are 65 or older, immunocompromised, pregnant or have other complex health conditions. If you have respiratory symptoms and aren’t high-risk, you probably don’t need to make an appointment with your clinician. Getting plenty of rest, drinking fluids and using over-the-counter medications can help you feel better and aid recovery.  Consider Mayo Clinic Express Care options for convenient clinician visits. <a rel="noopener" href="https://communityhealth.mayoclinic.org/express-care-overview#EC" target="_blank" title="Link opens in a new window">Mayo Clinic Express Care</a> offers convenient walk-in and virtual video visit care for more than 25 common health concerns, including upper respiratory infections. Care is available for patients 18 months through 75 years old unless otherwise noted. Scheduled appointments are available via your Patient Portal for face-to-face or virtual video visits. Drop-in visits are available on a first-come, first-serve basis (sign up on arrival). Learn more about the Mayo Clinic Express Care <a href="/locations/express-care-north">North</a> and <a href="/locations/express-care-south">South</a> locations. Prevention is the best protection against upper respiratory infections. Following simple prevention guidelines can go a long way in protecting you and your family members from illness. Make sure you wash your hands and avoid prolonged contact with sick individuals. If you do become ill, help protect others by staying home until your symptoms improve and you have been fever-free without medication for 24 hours. For the next five days, take added precautions, like keeping your distance from others and wearing a high-quality, well-fitting mask if contact with people is unavoidable.Primary Care in Rochester and KassonURI Care OptionsPrimary Care in Rochester and KassonHow much water you need depends on several factors.<img src="/-/media/ech-media/images/widgets/beverages/waterglass.jpg?h=65&iar=0&w=100&sc_lang=en&hash=A5CD260C312DC6309F10E3DE2561AF99" alt="WaterGlass" width="100" height="65" DisableNVelocity="true" />Water is essential to good health1/16/2025 12:00 AM<img src="/-/media/ech-media/images/widgets/beverages/waterglass.jpg?h=205&iar=0&w=315&sc_lang=en&hash=87BB947B184D54F091A029AB360CE8B9" alt="WaterGlass" width="315" height="205" DisableNVelocity="true" />Water makes up between 50% and 70% of your body weight. It's essential for every cell, tissue and organ in your body. Water removes waste through urination, perspiration and bowel movements. It's also a component of the lubrication and cushioning of your joints and helps to regulate your temperature. How much water you need depends on several factors: <ul> <li>Environment: You may need more water at higher altitudes or in hot or humid weather.</li> <li>Exercise: If you sweat, you need to replace the water. Sometimes, you may need to include rehydration fluids to add the salt you lose with excessive perspiration back into your body — especially in hot weather.</li> <li>Illness: Vomiting or diarrhea increases the loss of water.</li> <li>Pregnancy and breastfeeding: You may need additional fluids.</li> <li>Medications: If you take a diuretic, you may need to manage your fluid intake under the supervision of your healthcare team. </li> </ul> Without enough water, you can become dehydrated. Symptoms of dehydration can include feeling dizzy or lightheaded, tired, fatigued or having a headache. You can avoid dehydration by drinking water — and water from the faucet is just fine. Other fluids such as milk, juice and herbal teas can replace some of your water intake. And yes, even coffee and soda, but be careful of sugar-based drinks as they add calories. You can infuse water with flavor using herbs, fruits and vegetables. Don’t forget that some fruits, like watermelon, are almost all water. So, how do you know if you are drinking enough? If your urine is light yellow or clear and you don’t feel thirsty, you are likely drinking enough. If you have questions, consulting your healthcare team is always a good idea. You can also drink too much water. This can lead to problems with the levels of sodium in your blood, and that is dangerous. Excessive thirst can also be a symptom of diabetes. So, if you have a thirst that cannot be quenched, pay attention and contact your healthcare team. <a href="/providers/denise-dupras-md">Denise Dupras, M.D., Ph.D.</a>, is a general internist in the Division of Community Internal Medicine, Geriatrics and Palliative Care. She completed her medical and doctoral degrees at Mayo Clinic Alix School of Medicine and her residency in internal medicine at Mayo Clinic in Rochester. Her interests include medical education and LGBTI medicine.Denise Dupras, M.D., Ph.D.Primary Care in Rochester and KassonWater IntakePrimary Care in Rochester and KassonThese key practices can help manage stress in your daily life.&nbsp;<img src="/-/media/ech-media/images/widgets/randomimages/ech_stressfrenemy_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=0C09191987573A83DCB252DFD5C6C795" alt="ECH_StressFrenemy_widget" width="100" height="65" DisableNVelocity="true" />Dealing with stress2/13/2023 4:30 AM<img src="/-/media/ech-media/images/widgets/randomimages/ech_stressfrenemy_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=4A9DD3E633A61F943A3C54CC9815A379" alt="ECH_StressFrenemy_widget" width="300" height="195" DisableNVelocity="true" />As defined by the World Health Organization, stress is any type of change that causes physical, emotional or psychological strain. To simplify, stress is any change that causes strain. Change refers to anything altered or modified from the norm. Recently, the COVID-19 pandemic introduced significant change into everyday life. From social distancing, masking policies and mandated isolation, people experienced major alterations to their daily norm. Unsurprisingly, more Americans stated they were more stressed after the pandemic started than before.   Strain refers to the body's response to a perceived threat, or in this case, change. The body is largely regulated by the autonomic nervous system (ANS). The ANS has a sympathetic and a parasympathetic component. The parasympathetic component is active when the body is at rest, and it is known as the "rest and digest" response. The sympathetic component is activated when the body perceives an acute threat. It is known as the "fight or flight" response. While this sympathetic response was evolutionarily beneficial for escaping an imminent threat, such as being chased by a lion, this same system is activated in response to daily stimuli we perceive as threats, such as change, someone cutting us off in traffic or an impending deadline.   Importantly, this highlights stress is a response, not a disease. When activated for short amounts of time, the sympathetic response increases alertness and focus, allowing us to overcome the perceived threat. However, when activated for long periods of time, the stress response can have harmful effects on the body, resulting in high blood pressure, gastrointestinal distress, insomnia and anxiety disorders. Having a toolkit to manage the stress response is key to maintaining long-term health.   Key practices to help manage stress in your daily life include:   Maintain a routine <ul style="list-style-type: disc;"> <li>Change is one of the primary drivers of stress. Maintaining a daily routine can help control the stress response. </li> <li><a rel="noopener" href="https://anxietycoach.mayoclinic.org/family-stress/managing-routines-and-schedules/" target="_blank">Managing Routines and Schedules - Mayo Clinic Anxiety Coach</a>.</li> </ul> Quality Sleep <ul style="list-style-type: disc;"> <li>The Centers for Disease Control and Prevention recommends adults need seven or more hours of sleep per night. Sleep helps establish a healthy stress response. </li> <li><a rel="noopener" href="https://www.sleepfoundation.org/sleep-habits" target="_blank">Healthy Sleep Habits: The Ultimate Sleep Improvement Plan | Sleep Foundation</a>.</li> <li><a rel="noopener" href="https://www.cdc.gov/sleep/about/" target="_blank">Tips for Better Sleep | CDC</a>.</li> <li><a rel="noopener" href="https://www.mayoclinic.org/healthy-lifestyle/adult-health/in-depth/sleep/art-20048379" target="_blank">Sleep tips: 6 steps to better sleep - Mayo Clinic</a>.</li> </ul> Exercise <ul> <li><a rel="noopener" href="https://www.mayoclinic.org/healthy-lifestyle/fitness/in-depth/exercise-intensity/art-20046887" target="_blank">Exercise intensity: How to measure it - Mayo Clinic</a>.</li> </ul> <a href="https://www.mayoclinic.org/healthy-lifestyle/fitness/in-depth/exercise-intensity/art-20046887" target="_blank"></a>Positive social connection <ul> <li>Spend time with others either in person or on the phone. </li> <li><a rel="noopener" href="https://newsnetwork.mayoclinic.org/discussion/mayo-clinic-minute-the-benefits-of-being-socially-connected/" target="_blank">Mayo Clinic Minute: The benefits of being socially connected - Mayo Clinic News Network</a>.</li> </ul> <a href="https://newsnetwork.mayoclinic.org/discussion/mayo-clinic-minute-the-benefits-of-being-socially-connected/" target="_blank"></a>Eat a healthy, well-balanced diet. <ul> <li><a rel="noopener" href="https://diet.mayoclinic.org/us/" target="_blank">The Mayo Clinic Diet</a>.</li> </ul> <a href="https://diet.mayoclinic.org/us/" target="_blank"></a>Meditation <ul> <li><a rel="noopener" href="https://www.mayoclinic.org/tests-procedures/meditation/about/pac-20385120" target="_blank">Meditation - Mayo Clinic</a>.</li> </ul> <a href="https://www.mayoclinic.org/tests-procedures/meditation/about/pac-20385120" target="_blank"></a>Breathing exercises <ul> <li><a rel="noopener" href="https://www.mayo.edu/research/labs/mindful-breathing/videos" target="_blank">Videos - Mindful Breathing: Roberto P. Benzo - Mayo Clinic Research</a>.</li> </ul> <a href="https://www.mayo.edu/research/labs/mindful-breathing/videos" target="_blank"></a>Spend time in nature <ul> <li><a rel="noopener" href="https://newsnetwork.mayoclinic.org/discussion/mayo-clinic-minute-prescribing-nature-for-mental-physical-health/" target="_blank">Mayo Clinic Minute: Prescribing nature for mental, physical health - Mayo Clinic News Network</a>.</li> </ul> While there are many healthy ways to manage stress, there are also many unhealthy ways. Use of alcohol, tobacco and other recreational drugs are not effective solutions for managing stress and promoting health. If you are reliant upon any of these substances for stress relief, please seek professional support. Additionally, stress typically resolves once the "threat" is resolved. If you feel symptoms of stress persist without an identifiable trigger, please consider reaching out to your health care clinician. If you find yourself overwhelmed by your symptoms and feel you might harm yourself, please call or text the Suicide and Crisis Lifeline at 988.   Brent Gawey, M.D., M.S., is a resident in the Internal Medicine program at Mayo Clinic in Rochester, Minnesota. He has a strong passion for realizing health equity through the application of evidence-based lifestyle and preventive medicine interventions. Brent Gawey, M.D., M.S.Primary Care in Rochester and KassonDealing StressPrimary Care in Rochester and KassonLearn about signs, symptoms and how to reduce your risk.&nbsp;<img src="/-/media/ech-media/images/widgets/people/chestpain.jpg?h=65&iar=0&w=100&sc_lang=en&hash=A6380CF35BBDA705CE831C0061CC287D" alt="ChestPain" width="100" height="65" DisableNVelocity="true" />Heart failure: What does it mean?2/23/2023 4:30 AM<img src="/-/media/ech-media/images/widgets/people/chestpain.jpg?h=205&iar=0&w=315&sc_lang=en&hash=FC2E3697A016CF842458275F7178D849" alt="ChestPain" width="315" height="205" DisableNVelocity="true" />Heart failure is a chronic condition causing the heart to not be able to pump enough blood to meet the body's blood and oxygen needs. Through this process, the body and heart try to offset the heart's inability to meet those needs by increasing the heart's size, increasing the heart's muscle amount and beating faster — trying to increase the amount of blood the heart is pumping out. The body also tries to offset the reduction by narrowing the blood vessels to keep blood pressure up in normal range, pumping blood to crucial organs, including the heart and brain, and diverting it from less important organs, such as the kidneys, which causes damage to the kidneys over time. Sign and symptoms of heart failure <ul style="list-style-type: disc;"> <li>Shortness of breath with activity or when lying flat</li> <li>Increased and unusual fatigue</li> <li>Swelling in the legs, ankles and feet</li> <li>Rapid weight gain due to fluid in the legs, ankles and feet</li> <li>Decreased appetite</li> <li>Decreased ability to exercise due to fatigue and shortness of breath</li> <li>Feelings of rapid or irregular heartbeats</li> <li>Chest pain, if the heart failure is due to a heart attack</li> </ul> How to reduce your risk <ul style="list-style-type: disc;"> <li>Be active with regular exercise. It is recommended that you do at least 30 minutes of moderate intensity exercise daily.</li> <li>Maintain a healthy weight. Heart-healthy foods include lean proteins, fruits, vegetables and good fats — like avocados, olive oil and fish. Reduce the amount of saturated and trans fats, sodium and sugar.</li> <li>Stop smoking, vaping or using recreational drugs.</li> <li>Have regular checkups with your clinician to catch and treat medical conditions in the early stages. </li> <li>If you have high blood pressure, diabetes, sleep apnea, thyroid, lung or kidney disease, treating them and keeping them under control is critical. Work closely with your health care team and follow their recommendations.</li> </ul> <a href="https://communityhealth.mayoclinic.org/providers/angela-luckhardt-aprncnpms">Angela Luckhardt, APRN, C.N.P.</a>, is a nurse practitioner in Community and Internal Medicine, Geriatrics and Palliative Care. Her interest in heart failure came from working 11 years as an end-stage heart failure clinician. Working with end-stage patients raised her interest in preventive medicine in hopes of helping individuals live a healthier, happier, more active lifestyle.Angela Luckhardt, APRN, C.N.P.Primary Care in Rochester and KassonHeart FailurePrimary Care in Rochester and KassonKnow what to watch for and how to respond.&nbsp;<img src="/-/media/ech-media/images/widgets/teens/ech_eating_disorder.jpg?h=65&iar=0&w=100&sc_lang=en&hash=34E74731547A0CEDBD51422C2C30D99B" alt="ECH_Eating_Disorder" width="100" height="65" DisableNVelocity="true" />Identifying eating disorders2/27/2023 4:30 AM<img src="/-/media/ech-media/images/widgets/teens/ech_eating_disorder.jpg?h=195&iar=0&w=300&sc_lang=en&hash=F284D5C0760E98EF1D56E75687EA72C3" alt="ECH_Eating_Disorder" width="300" height="195" DisableNVelocity="true" />As many as 3%–13% of children or adolescents will have an eating disorder by the time they reach adulthood. Further, 30% of boys and 55% of girls report at least one risky eating behavior, such as fasting, significantly restricting their diet or smoking for weight control, during adolescence.  Eating disorders are dangerous psychological disorders, and they are associated with one of the highest rates of death. Therefore, it is important for caregivers to be aware of eating issues in children and be prepared to intervene quickly. This is frequently difficult, as eating disorders often are characterized by secrecy, shame and denial of the illness's severity.  So what's a caregiver to do? Here are some red flags that should prompt concern:  <ul style="list-style-type: disc;"> <li style="color: #131313;">Physical changes  Physical changes associated with an eating disorder are often hard to spot in a growing child. By the time changes in weight or other physical signs become obvious, the eating disorder is often already extremely serious. Weight loss, and irregular or missed menstrual cycles, are cause for concern, as is failure to achieve expected height and weight milestones. Contrary to widespread belief, however, eating disorders are not always characterized by overall weight loss. Despite common misperceptions, those with eating disorders, including anorexia, do not always appear emaciated and cannot usually be identified by eyeballing their shape or weight. Often these children present at an average — or even higher — weight, but they still meet criteria for a deadly eating disorder. For these children, the effects of an eating disorder will only be seen in changes to developmental trends and evident through their personal growth chart, like the type your health care team keeps. </li> <li style="color: #131313;">Dieting  Studies have found that teenagers who are considered serious dieters have a 1 in 5 chance of developing an eating disorder, compared to the 1 in 500 chance for those who do not diet. Even exposure to caregivers' attempts to diet can increase a child's risk of an eating disorder, so work to eliminate dieting from your home and be alert for any dieting behaviors in your child. </li> <li style="color: #131313;">Social withdrawal  Eating disorders are unusual in that sick children are often able to maintain high levels of achievement in school and activities. At the same time, however, children and adolescents with eating disorders often become isolated from friends and family. If your child seems more withdrawn, more reluctant or worried about socializing, or if he or she appears depressed or anxious — and this is a departure from normal — intervention is likely needed. </li> </ul> If you suspect that your child might be developing an eating disorder, the best thing to do is act. Early intervention is associated with the best outcome, so it is better to overreact if you notice any red flags. Treat an eating disorder like you would any other life-threatening illness and seek an evaluation immediately. You also should be prepared to play a role in treatment. Family involvement is often a crucial component of successful child or adolescent eating disorder treatment.  If you have concerns, you're encouraged to schedule an appointment with your primary care clinician and discuss what you are seeing in your child. Integrated Behavioral Health also can be a helpful resource to assess for the presence of an eating disorder and make a referral to the correct type of care.  Other resources for caregivers include the <a rel="noopener" href="https://www.nationaleatingdisorders.org/" target="_blank">National Eating Disorders Association website</a>, <a rel="noopener" href="https://www.feast-ed.org/" target="_blank">Families Empowered and Supporting Treatment for Eating Disorders parent group</a>, as well as these parent manuals: <ul style="list-style-type: disc;"> <li style="color: #131313;">"Help Your Teenager Beat an Eating Disorder" by James Lock and Daniel Le Grange</li> <li style="color: #131313;">"I'm, Like, So Fat" by Dianne Neumark-Sztainer</li> </ul> Primary Care in Rochester and Kasson's Integrated Community Specialties Eating Disorders program specializes in identifying and treating child and adolescent eating disorders in primary care patients. This program is staffed by health care professionals from the Department of Psychology and the Division of Community Pediatric and Adolescent Medicine at Mayo Clinic, including:  <ul style="list-style-type: disc;"> <li style="color: #131313;"><a href="https://www.mayoclinic.org/biographies/lebow-jocelyn-r-ph-d-l-p/bio-20230204" target="_BLANKǗ">Jocelyn Lebow, Ph.D.</a>, a child and adolescent psychologist in the Division of Integrated Behavioral Health, which is part of Primary Care in Rochester and Kasson. </li> <li style="color: #131313;"><a href="https://communityhealth.mayoclinic.org/providers/marcie-billings-md/" target="_BLANKǗ">Marcie Billings, M.D.</a>, chair of the Division of Community Pediatric and Adolescent Medicine, which is part of Primary Care in Rochester and Kasson. Her primary area of practice is adolescent medicine. </li> <li style="color: #131313;"><a href="https://communityhealth.mayoclinic.org/providers/paige-partain-md" target="_BLANKǗ">Paige Partain, M.D.</a>, a pediatrician in the Division of Community Pediatric and Adolescent Medicine, which is part of Primary Care in Rochester and Kasson, at Mayo Family Clinic Northeast in Rochester. Her areas of interest include preventive medicine and pediatric behavioral health, particularly attention-deficit/hyperactivity disorder, depression, anxiety and eating disorders. </li> <li style="color: #131313;"><a href="http://communityhealth.mayoclinic.org/providers/angela-mattke-md" target="_BLANKǗ">Angela Mattke, M.D.</a>, a pediatrician in the Division of Community Pediatric and Adolescent Medicine, which is part of Primary Care in Rochester and Kasson. She also hosts Mayo Clinic's "<a href="https://www.facebook.com/search/top/?q=%40askthemayomom" target="_BLANKǗ">#AskTheMayoMom</a>" interactive Facebook Live show, where she discusses and answers audience questions about common pediatric health topics. You can follow her on Twitter at <a href="https://twitter.com/DrAngelaMattke" target="_BLANKǗ">@DrAngelaMattke</a>. For more information about pediatric health topics, follow <a href="https://twitter.com/search?q=mayoclinickids&src=typd" target="_BLANKǗ">@mayoclinickids</a> on Twitter.</li> </ul>Jocelyn Lebow, Ph.D., Marcie Billings, M.D., Paige Partain, M.D., Angela Mattke, M.D.Primary Care in Rochester and KassonIdentify Eating DisordersPrimary Care in Rochester and KassonYour role is more important than you think for a mother's breastfeeding success.&nbsp;<img src="/-/media/ech-media/images/widgets/people/breastfeedingcouple.jpg?h=65&iar=0&w=100&sc_lang=en&hash=87369A53676C889BE5CD5047D0F77AE9" alt="BreastfeedingCouple" width="100" height="65" DisableNVelocity="true" />A partner's role in breastfeeding2/9/2023 4:30 AM<img src="/-/media/ech-media/images/widgets/people/breastfeedingcouple.jpg?h=205&iar=0&w=315&sc_lang=en&hash=95B66ACAC28E2E26057788D9B6BBE4FC" alt="BreastfeedingCouple" width="315" height="205" DisableNVelocity="true" />They make it look so effortless, the breastfeeding moms we see, as if it comes so naturally. While the source may be natural, breastfeeding is a learned skill, especially for new mothers and their babies. Currently, the American Academy of Pediatrics recommends exclusive breastfeeding for the first six months of a child's life and continuing for as long as is mutually desired for the mother and baby. For breastfeeding to be successful and continue for the recommended duration, women need adequate support. A father's/partner's support is one of the most important factors for a mother's breastfeeding success. This impact starts even before the baby is born, and a partner can influence whether a mother chooses to breastfeed. In one study, when fathers were given a two-hour presentation on how to support breastfeeding, the mother was 1.8 times more likely to try breastfeeding. Partners also have a strong influence on how long their baby is breastfed. In a review of eight studies that took place around the globe, research shows that breastfeeding education and promotion for fathers, both before and after birth, improved breastfeeding rates at 6 months and lessened the occurrence of breastfeeding-related problems. While a father/partner may not physically be able to breastfeed their baby, there are many ways in which they can support mothers by boosting their confidence and helping to overcome obstacles. Learn breastfeeding basics before baby arrives One of the best things a partner can do is learn about the benefits of breastfeeding and how to breastfeed. To do this, there are face-to-face or online breastfeeding classes available through the community, your local hospital or WIC (nutrition program for women, infants and children). There are also books about breastfeeding. By learning about breastfeeding ahead of time, a partner can help the mother remember breastfeeding information, such as strategies for positioning, latching and managing breastfeeding challenges. Be involved in conversations about breastfeeding in the hospital and at your infant's appointments after discharge Discuss your breastfeeding plans and goals prior to your baby's due date so that you are on the same page about what successful breastfeeding will look like. Get to know the hospital's breastfeeding practices to ensure that they align with your goals. At the time of delivery, advocate for skin-to-skin time soon after birth, if this is safe for mother and baby per their health care team. If the mother is having trouble with breastfeeding, ask the hospital staff or your clinician for help. There are lactation specialists available that can assist with any challenges that may come up. Offer a helping hand Once mom has gotten comfortable, bring the baby over to her when it is time to nurse. You also can help to position the baby or breast to establish a good latch. Bring glasses of water, heating pads, fresh nursing pads, lanolin cream or anything else the mother may need while nursing. Many babies fall asleep at the breast, especially prior to switching to the second breast. Partners can change baby's diaper prior to switching to the other breast to help stimulate and wake the baby so they are ready to finish nursing. It can be difficult for anyone to wake up in the middle of the night, so it also may be helpful for you to help wake up the mother in the middle of the night when the baby is cueing to eat. Some mothers also will choose to pump, and, in this case, it can be helpful to assist with cleaning breast pump parts and bottles. After baby is done feeding, help by putting the baby back to sleep. Be mom's and baby's caretaker Mothers often find it difficult to complete simple tasks, such as showering, fixing a meal or using the restroom. When mom needs alone time, take time to comfort, snuggle, bond and even do skin-to-skin with baby. Ensure that nutritious foods are available that take minimal preparation and ensure mom is eating enough. Offer encouragement/company Parenting can be a thankless job. And especially during the period after delivering a baby, many mothers need a little extra encouragement. Provide moral support and let her know you think she's doing a great job. Be an advocate for mother and support her as she feeds your baby in public, and proudly keep her company. Breastfeeding is a family affair and requires teamwork. Together, you can optimize your chances for a successful and rewarding breastfeeding experience. Noelle Torrance, M.D., is a resident in Pediatric and Adolescent Medicine at Mayo Clinic. Dr. Torrance developed an interest in breastfeeding education when she spent a month with lactation specialists during medical school. Noelle Torrance, M.D.Primary Care in Rochester and KassonPartner Role BreastfeedingPrimary Care in Rochester and KassonBreathing high levels of radon over time can lead to lung cancer.&nbsp;<img src="/-/media/ech-media/images/widgets/randomimages/radon.jpg?h=65&iar=0&w=100&sc_lang=en&hash=9E426F26C8D75DA6D38AEB1220E54A31" alt="Radon" width="100" height="65" DisableNVelocity="true" />Radon: The odorless, invisible threat2/16/2023 4:30 AMRadon is an odorless, invisible radioactive gas. It's naturally released from rocks, soil and water — and it can get trapped inside your home, office or school. There's no known safe level of radon. Unfortunately, there are no symptoms of radon exposure as there are with carbon monoxide poisoning. What makes radon so dangerous? Breathing high levels over time can lead to lung cancer. In fact, radon is a Class A carcinogen. It's the No. 1 cause of lung cancer in nonsmokers and the second-leading cause of lung cancer overall. Nationwide, 21,000 people die from radon-caused lung cancer each year. Smoking and secondhand smoke, combined with exposure to high radon levels, increase your risk of lung cancer. If you or your family are experiencing breathing issues, consult with a pulmonologist. Radon can be found in any home — old or new — and typically enters through cracks in the foundation caused by natural settling and windows. Radon levels often are higher in lower levels and basements. Across the U.S., 1 in 15 homes have elevated radon levels, and levels are higher in the Midwest. For Minnesota homes, the average radon level is about 4.5 picocuries per liter of air (pCi/L) compared to 1.3 pCi/L nationwide. Test your nest for radon There's a simple solution to this close-to-home health hazard: Test your nest. That's what the Environmental Protection Agency (EPA) urges all homeowners to do, especially those in high-radon areas. Testing is the only way to determine the radon level in your home. You can find radon testing kits at hardware or other home maintenance stores. They run about $20 or less, and are easy to use. It typically takes two to seven days for results. Since there's no safe level of radon, you should always aim for the lowest level. The EPA recommends 4 pCi/L or less. If your home tests higher than 4 pCi/L, then you'll need to have a professional fix the radon issue, which includes installing venting equipment. The equipment looks like a big tube that reaches below the foundation of your home and vents radon up and out of the house. Unfortunately, the system can be expensive, but you may be able to apply for assistance from your state. Once the mitigation system has been installed, your home should be tested again to make sure the fix is effective. Even if your home passes the first test, you should retest every two years. Also, radon testing is not required when selling a home. So, as a buyer, you should insist on it. If levels are high, you can negotiate costs with the seller. Learn more about radon, testing and abatement: <ul style="list-style-type: disc;"> <li style="color: #0d0d0d; background: white;"><a rel="noopener noreferrer" rel="noopener noreferrer" href="https://www.epa.gov/radon" target="_blank" title="Opens in a new window.">Radon information from the EPA</a></li> <li style="color: #0d0d0d; background: white;"><a rel="noopener noreferrer" rel="noopener noreferrer" href="https://www.epa.gov/radon/find-radon-test-kit-or-measurement-and-mitigation-professional" target="_blank" title="Opens in a new window.">How to find testing kits and abatement professionals</a></li> <li style="color: #0d0d0d; background: white;"><a rel="noopener noreferrer" rel="noopener noreferrer" href="https://www.epa.gov/radon/epa-map-radon-zones-and-supplemental-information#datainfo" target="_blank" title="Opens in a new window.">State assistance programs</a></li> <li style="color: #0d0d0d; background: white;"><a rel="noopener noreferrer" rel="noopener noreferrer" href="https://www.epa.gov/radon/radon-resources-home-buyers-and-sellers" target="_blank" title="Opens in a new window.">Home buyers and sellers guide</a></li> <li style="color: #0d0d0d; background: white;"><a rel="noopener noreferrer" rel="noopener noreferrer" href="https://www.epa.gov/radon/radon-hotlines-and-information-resources#hotlines" target="_blank" title="Opens in a new window.">Radon hotlines</a></li> </ul> <a href="https://www.mayoclinichealthsystem.org/providers/elizabeth-morton-pac" target="_self" title="Opens in same window.">Elizabeth Morton, P.A.-C., </a>is a physician assistant in Pulmonology in Mankato, Minnesota.Elizabeth Morton, P.A.-C.Primary Care in Rochester and KassonRadonPrimary Care in Rochester and KassonIncorporating even small amounts of physical activity can significantly improve symptoms.&nbsp;<img src="/-/media/ech-media/images/widgets/activities/armbandstretch.jpg?h=65&iar=0&w=100&sc_lang=en&hash=EE1840DEE1FCA743B33EECD74CCE818E" alt="ArmBandStretch" width="100" height="65" DisableNVelocity="true" />Can exercise help rheumatoid arthritis?2/20/2023 4:30 AM<img src="/-/media/ech-media/images/widgets/activities/armbandstretch.jpg?h=205&iar=0&w=315&sc_lang=en&hash=3A3F14723480AD3D46F1F4F61415BF19" alt="ArmBandStretch" width="315" height="205" DisableNVelocity="true" />When struggling with rheumatoid arthritis symptoms, like joint pain and fatigue, staying physically active can feel difficult to achieve. However, studies have shown that incorporating even small amounts of physical activity into your day can significantly improve rheumatoid arthritis symptoms and quality of life. Research suggests that physical activity in rheumatoid arthritis can: <ul style="margin-top: 0in; list-style-type: disc;"> <li style="margin-bottom: 0in; border: none;">Improve overall fitness, day-to-day functioning, strength and fatigue.</li> <li style="margin-bottom: 0in; border: none;">Reduce the risk of cardiovascular disease, which is more common in rheumatoid arthritis patients than the general population.</li> <li style="margin-bottom: 0in; border: none;">Reverse the body composition changes that can occur in rheumatoid arthritis, including breakdown of muscle and buildup of visceral, or abdominal fat.</li> <li style="margin-bottom: 0in; border: none;">Slow the progression of joint destruction in both small and large joints.  </li> <li style="border: none;">Reduce hospitalizations and lengths of hospital stays for rheumatoid arthritis flares. </li> </ul> Is exercise safe for people with rheumatoid arthritis? Studies have not shown evidence of worsening joint damage from low-to-moderate intensity physical activity. However, it is important to listen to your body, especially during flares. Adjust the intensity of your workouts accordingly. If you find that one particular activity causes you discomfort (for example, walking), try replacing it with another activity that puts less pressure on the joints (for example, swimming). If you have any doubts, it's best to contact your clinician before starting an exercise regimen. What kinds of exercise should I do? Research has included looking at several types of exercise, including aerobic, strength training, stretching and balance exercises. Ultimately, any kind of movement was found to be beneficial. You may want to include a variety of exercises into your day or choose exercises specific to your symptoms. For example, if you struggle with pain in the joints of your hands, you may choose to spend time on gentle hand stretches and exercises. These have been shown to help preserve the finger joints and dexterity over time. Low-impact aerobic exercises include walking, cycling, swimming and dancing. These activities carry a broad range of benefits for your heart, lungs and muscle health. They also can help you sleep better and improve day-to-day functioning. Strengthening exercises help maintain the muscles around the joints, while protecting against the bone loss that can happen with inactivity or use of corticosteroids, a medication type frequently used in rheumatoid arthritis. These exercises rely on using some form of resistance, like a handheld weight, resistance band or a weight machine. Aim for an activity that challenges your muscles but does not worsen joint pain. Stretching, or range-of-motion exercises, can help maintain flexibility and function in joints affected by rheumatoid arthritis. These are particularly helpful for stiff joints and can usually be done on a daily basis. The goal of these exercises is to gently allow your joints to move through their entire range of motion. How much exercise should I do? Any amount of physical activity is better than no physical activity. While the World Health Organization generally recommends that adults 18–64 get 150 minutes of moderate intensity exercise each week, amounts less than this can still provide health benefits. If fatigue is a problem, exercises can be done in multiple 5- or 10-minute intervals for similar health benefits as longer sessions. In fact, simply incorporating more movement into activities you already do (for example, dancing while preparing a meal) can add up over time and improve your overall health. In all cases, it's important to start slow and listen to your body as you explore new movements. Discussing your questions and concerns on a regular basis with your arthritis care team, including your primary clinician or rheumatologist, will help. Physical and occupational therapists also can help suggest customized exercises that will be safe and effective for your specific needs. With their guidance, you can build a more active lifestyle and enjoy all the health benefits that come with it.Primary Care in Rochester and KassonRheumatoid Arthritis ExercisePrimary Care in Rochester and KassonWhile they may not admit it, many people have fears ranging from clowns to lakes to otters to everything in general.&nbsp;<img src="/-/media/ech-media/images/widgets/randomimages/ech_phobias_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=B261A161DFC40A7AFE3236A98BAC3CBB" alt="ECH_phobias_widget" width="100" height="65" DisableNVelocity="true" />Strange fears? There's help for you2/6/2023 4:30 AM<img src="/-/media/ech-media/images/widgets/randomimages/ech_phobias_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=87D10AFC4010B9F1334CCF9FEEFFCE98" alt="ECH_phobias_widget" width="300" height="195" DisableNVelocity="true" />Specific phobias are an excessive and intense fear of certain situations or objects to the point where they cause significant disruption in your life. Understandably, the prospect of experiencing extreme anxiety and panic often leads you to avoid these triggers. While phobias are one of the most common mental health conditions — affecting an estimated 12% of the population — less than 10% seek treatment. The "Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition" classifies specific phobias across five subtypes: <ul> <li>Animals, such as snakes, spiders and dogs. </li> <li>Situations, including driving, flying and public speaking. </li> <li>Natural environment, such as thunderstorms, heights and the dark. </li> <li>Blood, injection and injury, including blood draws, needles and wounds. </li> <li>Other, and this is where things get weird. </li> </ul> According to basic learning models, having a bad experience with almost anything can result in developing a phobia. About half of people report a direct, negative experience that led to the onset of their phobia. Naming a phobia involves combining the prefix of a Greek or Latin term for a specific object or situation with the Greek suffix "phobos," which means "to fear." Here are several of phobias in the "other" category from <a rel="noopener noreferrer" href="http://www.phobialist.com/" target="_blank">The Phobia List</a>: <ul> <li>Alektorophobia (fear of chickens) It's not nice to call somebody chicken for having a phobia, but doing so in this case might be OK because you are just calling it for what it is. </li> <li>Megalophobia (fear of large things) and microphobia (fear of small things) Thank goodness, there is no fear of medium things. </li> <li>Porphyrophobia (fear of the color purple) and basileophobia (fear of royalty) This is not a good combination for Prince fans. </li> <li>Nyctohylophobia (fear of dark, wooded areas) paired with nebulaphobia (fear of fog) paired with either novercaphobia (fear of your stepmother) or vitricophobia (fear of your stepfather) or coulrophobia (fear of clowns) That is a premise for a really bad movie. </li> <li>Zemmiphobia (fear of the great mole rat) Have you seen a great mole rat? Having a phobic reaction in this case seems really adaptive. </li> <li>Hypengyophobia (fear of assuming responsibility) Come to think of it, that could come in handy from time to time. </li> <li>Chronophobia (fear of time) and chronomentrophobia (fear of clocks) Honestly, it's about time you started dealing with this phobia. </li> <li>Geliophobia (fear of laughter) For people with this condition, laughter truly is the best medicine. However, for pharmacophobics (fear of medicine), this can turn into a serious condition.</li> <li>Telephonophobia (fear of telephones) If you have difficulty with this phobia, call your health care professional. Or if you struggle with technophobia (fear of technology) or cyberphobia (fear of computers), it may be best to book an appointment online. </li> </ul> Thankfully, phobias are among the most treatable mental health conditions, with success rates often reaching close to 90%, which is great, even for those with euphobia (fear of good news). Exposure therapy, which involves predictable, controllable and repetitive exposures to phobic triggers is an effective and durable treatment approach. Some phobias — even long-standing, strange fears — can be treated in as little as a single session of prolonged exposure. So for all those isolophobics (fear of being alone) out there, you're not alone — phobias are common, treatable conditions. Anne Roche, Ph.D., and Sydney Kelpin, Ph.D., M.S., are clinical health psychology fellows in Primary Care in Rochester and Kasson's Division of Integrated Behavioral Health at Mayo Clinic. <a href="https://www.mayoclinic.org/biographies/sawchuk-craig-n-ph-d-l-p/bio-20085911">Craig Sawchuk, Ph.D., L.P.</a>, is a clinical psychologist in Primary Care in Rochester and Kasson's Division of Integrated Behavioral Health. He is the co-chair of the Division of Integrated Behavioral Health and co-chair of Clinical Practice with the Department of Psychiatry and Psychology at Mayo Clinic.Anne Roche, Ph.D.,Sydney Kelpin, Ph.D., M.S., Craig Sawchuk, Ph.D., L.P.Primary Care in Rochester and KassonStrangeFearsPrimary Care in Rochester and KassonThat new diet you heard about may be more harmful than beneficial.&nbsp;<img src="/-/media/ech-media/images/widgets/randomimages/ridiculousdangerous.jpg?h=65&iar=0&w=100&sc_lang=en&hash=AC50F14619DE680059D8A4D383876655" alt="RidiculousDangerous" width="100" height="65" DisableNVelocity="true" />TikTok diets: From the ridiculous to the dangerous2/2/2023 4:30 AM<img src="/-/media/ech-media/images/widgets/randomimages/ridiculousdangerous.jpg?h=205&iar=0&w=315&sc_lang=en&hash=8C5CB350746093B3F8BA8B03C4E3ECA7" alt="RidiculousDangerous" width="315" height="205" DisableNVelocity="true" />If you've been paying any attention to social media, you know that TikTok has blown up within the last few years. The video sharing app has become a social space for many to share their everyday lives, including meal planning, recipes and even diet trends. But how sustainable are these diets? Are they helpful or harmful? We've seen our fair share of nutrition misinformation on the social platform, so here's what you need to know about TikTok diet trends: Lemon water <ul> <li>The Trend: We'll start with lemon water — this trend consists of adding lemon juice to water and drinking it first thing in the morning on an empty stomach. The health claims, according to some videos on TikTok, are that it boosts metabolism and increases weight loss. </li> <li>The Truth: Four main ways to increase metabolism include adding muscle mass to your body via weight training, eating protein at every meal, not skipping meals and getting enough sleep each night. Drinking water each morning is great for hydration, and lemon juice provides plenty of vitamin C. But there is no scientific evidence that lemon water will result in weight loss. </li> <li>Helpful or Harmful: There's nothing wrong with adding lemon juice to your morning glass of water. However, it's not a secret weight-loss drink. </li> </ul> Ketogenic diet <ul> <li>The Trend: The ketogenic diet is the highest trending diet on TikTok, with over 10 billion hashtags. The high-fat, very low-carb diet has been popular for years, claiming to aid in weight loss by entering a state of ketosis, forcing the body to burn fat instead of carbohydrates for energy. </li> <li>The Truth: Mayo Clinic aided in the development of the ketogenic diet in the 1920s as a treatment for children with epilepsy — it was never intended for long-term weight loss. Research has shown that ketogenic diets are no better than other diets when it comes to weight loss, as it all comes down to being in a caloric deficit. </li> <li>Helpful or Harmful: The ketogenic diet is poor in overall quality because it leaves out entire healthy food groups, including fruits, whole grains and dairy. If weight loss is the goal, there are better methods, such as the <a rel="noopener noreferrer" href="https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/mediterranean-diet/art-20047801" target="_blank">Mediterranean diet</a>, paired with a caloric deficit for healthy and sustainable weight management. </li> </ul> Carnivore diet <ul> <li>The Trend: While we've seen plenty of low-carb diets become popular throughout the years, this newer zero-carb, all-meat diet may be the most extreme yet. Anything that isn't meat, poultry and fish, or derived from one of the three, is not allowed in the carnivore diet, with health claims ranging from weight loss to anti-inflammatory effects to increased testosterone levels. </li> <li>The Truth: Not only is this diet not sustainable, but there's also no scientific evidence supporting any such claims. It's important to note that most scientifically proven anti-inflammatory diets tend to be plant-based. Animal products also can contain higher amounts of saturated fat, which we want to limit for heart health. </li> <li>Helpful or Harmful: This diet could potentially be harmful, especially if done long term. Such high amounts of protein can put stress on the kidneys. You're better off eating a well-rounded diet with lean protein sources, along with a balance of all food groups. </li> </ul> Dry scooping pre-workout <ul> <li>The Trend: This popular trend among gymgoers promotes consuming pre-workout powder without mixing it with water prior to exercise with hopes of improved performance. </li> <li>The Truth: A 2018 study found that some may experience improved performance surrounding pre-workout supplement intake because it can act as an ergogenic aid. However, there is no evidence that taking pre-workout powder without liquid improves performance, and it may suppress such benefits due to lack of hydration. When searching the trend on TikTok, a disclaimer appears warning users that this online challenge may be harmful and encourages users to protect their well-being. </li> <li>Helpful or Harmful: It's most likely harmful. Not only could dry scooping be a choking hazard because the body is not intended to swallow powder, but this dangerous trend has been linked to numerous health risks, including heart attacks. It's recommended to consume pre-workout supplements according to the package directions. </li> </ul> The bottom line is to be mindful of where you receive your nutrition information. If you have nutrition questions, we encourage you to ask your health care clinician to connect you with a registered dietitian.  Elisa Iglesia is a dietetic intern at Mayo Clinic. She earned her bachelor's degree in Nutrition and Kinesiology from Miami University and her master's degree from Columbia University in Clinical Nutrition and Exercise Physiology. Elisa IglesiaPrimary Care in Rochester and KassonTikTok DietsPrimary Care in Rochester and KassonBleeding disorders can be inherited or acquired.&nbsp;<img src="/-/media/ech-media/images/widgets/randomimages/bleedingthroughbandage.jpg?h=65&iar=0&w=100&sc_lang=en&hash=7844C2052A6FC73DC3FBD03274EE565E" alt="BleedingThroughBandage" width="100" height="65" DisableNVelocity="true" />What is a bleeding disorder?3/23/2023 4:30 AM<img src="/-/media/ech-media/images/widgets/randomimages/bleedingthroughbandage.jpg?h=205&iar=0&w=315&sc_lang=en&hash=7DA328487F0665B0E51E4D2A4A010298" alt="BleedingThroughBandage" width="315" height="205" DisableNVelocity="true" />A bleeding disorder affects your body's ability to control bleeding. According to the Centers for Disease Control and Prevention (CDC) there are 3 million people affected by bleeding disorders. Von Willebrand disease and hemophilia are the most common bleeding disorders. However, both are considered rare. What causes a bleeding disorder? Bleeding disorders are inherited or acquired, though they can be related to platelet abnormalities. Inherited bleeding disorders are passed genetically from parents. Inherited bleeding disorders include von Willebrand disease, hemophilia A (factor VIII deficiency) or B (factor IX deficiency), deficiency of factors II, V, VII, X, XI or XIII (deficiency of factor XII prolongs partial thromboplastin time, it is not associated with excessive or unusual bleeding), dysfibrinogenemia, hypofibrinogenemia, afibrinogenemia, Alpha-2 antiplasmin deficiency and plasminogen activator inhibitor (PAI 1) deficiency. Acquired conditions include vitamin K deficiency, liver disease, disseminated intravascular coagulation, massive transfusions, acquired coagulation factor inhibitors, acquired coagulation factor deficiency and acquired von Willebrand's syndrome. Platelet abnormalities also may be inherited or acquired. Inherited platelet abnormalities include Bernard-Soulier syndrome, Glanzmann's thrombasthenia, gray platelet syndrome and dense granule deficiency. Certain medications and medical conditions can contribute to platelet abnormalities. How can I prevent a bleeding disorder? While some bleeding disorders are the result of genetic mutations, prevention may not be possible without genetic testing. Genetic mutations are passed down to offspring. Developing an acquired bleeding disorder may be reduced by eating a healthy diet, exercising regularly, maintaining healthy weight and seeing your primary care clinician regularly for chronic disease prevention and treatment. What are the signs and symptoms of a bleeding disorder? Many people who have bleeding disorders reports symptoms that can include: <ul> <li>Easy, excessive bruising.</li> <li>Recurrent and prolonged epistaxis.</li> <li>Prolonged bleeding from minor surgeries, cuts or lacerations, or blood draws.</li> <li>Prolonged bleeding after decidual tooth loss, extractions or dental work.</li> <li>Heavy menstruation (soaking feminine napkins or tampons every two hours).</li> </ul> What should I do if I am worried about having a bleeding disorder? If you are worried you or a family member may be impacted by a bleeding disorder, the best thing to do is set up an appointment to review your concerns with your primary care clinician. Initial steps to evaluate people with concerns for bleeding disorders begins with sharing your personal and family history with your primary care clinician, having a complete physical examination and blood testing. For those with elevated risk factors, your clinician may refer you to a hematologist for further evaluation. Knowing the signs and symptoms of bleeding disorders can help you connect with your primary care clinician early to begin the necessary evaluation to look for potential underlying bleeding disorders. Once a bleeding disorder is identified, treatment plans can be created under the guidance of a hematologist. Education is key in helping ensure those with bleeding disorders are safely cared for. In the event you or a loved one has a known bleeding disorder, ensure they are wearing the disorder-specific medical alert bracelet. <a href="https://communityhealth.mayoclinic.org/providers/jessica-richardson-aprncnpmsn" style="font-style: italic;">Jessica Richardson, APRN, C.N.P., M.S.N.</a>, is a nurse practitioner at Mayo Family Clinic Northeast in Rochester. She spends her free time enjoying a variety of activities with her family and friends. She also fills her time volunteering at the Salvation Army Good Samaritan Clinic and as a ski patroller at Welch Village. Jessica Richardson, APRN, C.N.P., M.S.N.Primary Care in Rochester and KassonBleeding DisorderPrimary Care in Rochester and KassonWhile some discomfort is normal, severe pain may be caused by endometriosis.<img src="/-/media/ech-media/images/widgets/people/womanholdingstomach.jpg?h=65&iar=0&w=100&sc_lang=en&hash=F39F1B2C63BBCEFED8496986FDEE95AD" alt="WomanHoldingStomach" width="100" height="65" DisableNVelocity="true" />Menstrual period pain: Is this normal?3/27/2023 4:30 AM<img src="/-/media/ech-media/images/widgets/people/womanholdingstomach.jpg?h=205&iar=0&w=315&sc_lang=en&hash=DE51199540350B516817CC402B13404F" alt="WomanHoldingStomach" width="315" height="205" DisableNVelocity="true" />Endometriosis is a chronic condition where endometrial tissue, or the tissue that lines your uterus, grows outside of the uterus. This endometrial tissue can be found in multiple locations, including the tissue lining the pelvic cavity; ovaries; bowel; bladder; ureters; or extrapelvic structures, such as the lungs, diaphragm or belly button. Risk factors known to be correlated with endometriosis include: <ul> <li>Genetics.</li> <li>Exposure to diethylstilbestrol, which was a synthetic hormone given to pregnant women between 1940 and 1971 to prevent pregnancy complications.</li> <li>Starting your period at an early age.</li> <li>A short menstrual cycle.</li> <li>Heavy menstrual periods.</li> <li>Low body mass index.</li> <li>Decreased number of pregnancies.</li> </ul> What are the symptoms of endometriosis? The presentation of endometriosis varies from person to person. Endometriosis can be asymptomatic or cause nonspecific symptoms that are often cyclical with menstruation, such as pelvic pain, painful periods, pain with intercourse, pain with bowel movements or urination, or heavy menstrual bleeding. Endometriosis also can cause fatigue, insomnia, diarrhea, constipation, bloating, nausea and infertility. And it can affect your physical, mental, sexual and social health. How is endometriosis diagnosed? Although symptoms of endometriosis usually begin in adolescence, diagnosis often is delayed for several reasons. Endometriosis is a difficult diagnosis to make, as the diagnosis is generally confirmed through surgical visualization, often by laparoscopic surgery. Due to associated risks, surgery often is delayed until the severity of symptoms warrants increased risk and other conditions have been excluded. Imaging, with ultrasound or MRI, can be performed, but this requires a trained specialist. Also, sensitivity and specificity vary. How is endometriosis treated? Various endometriosis treatment options are available. Treatment depends on your symptoms and whether you want to become pregnant. Treatment can include pain medications, such as nonsteroidal anti-inflammatory drugs, acetaminophen and hormone therapy. Hormonal therapies can include traditional contraceptives (oral and nonoral), gonadotropin-releasing hormone agonists and antagonists, progestin therapy, and aromatase inhibitors. The oral contraceptive pill often is used as the first-line treatment in women who want to get pregnant immediately. Surgical intervention often is considered when women have failed pain and hormonal treatment options. The goal of conservative surgery is to destruct or remove excess endometrial tissue and adhesions, but success varies and does not ensure improved symptoms. Definitive surgery, such as a hysterectomy, is common with endometriosis. But it is not an option for women who want to get pregnant in the future, and it comes with additional risks. Reproductive assistance may be required in women who want to get pregnant. Since endometriosis may cause more than just physical symptoms, anti-anxiety medications, antidepressants, pelvic physical therapy, sexual therapy, pain education, mindfulness strategies, cognitive behavioral therapy, trigger point injections, acupuncture, botulinum toxin and dietary changes also may be beneficial. <a href="https://communityhealth.mayoclinic.org/providers/danielle-olaughlin-pac/">Danielle O'Laughlin, P.A.-C., M.S.</a>, is a physician assistant in Primary Care in Rochester and Kasson's Division of Community Internal Medicine, Geriatrics and Palliative Care. She is the team lead of the Primary Care Gynecology Clinic and the Clinical Skills co-director of the Mayo Clinic Physician Assistant Program. Danielle O'Laughlin, P.A.-C., M.S.Primary Care in Rochester and KassonEndometriosisPrimary Care in Rochester and KassonUse these tips to find one that best fits your needs.&nbsp;<img src="/-/media/ech-media/images/widgets/food/mealkit.jpg?h=65&iar=0&w=100&sc_lang=en&hash=C6AFFF93F63F629FAFFAED116C2D67C2" alt="MealKit" width="100" height="65" DisableNVelocity="true" />Meal kits: Which one is best?3/2/2023 4:30 AM<img src="/-/media/ech-media/images/widgets/food/mealkit.jpg?h=205&iar=0&w=315&sc_lang=en&hash=F72742BA90287BB7B540441745972F5F" alt="MealKit" width="315" height="205" DisableNVelocity="true" />Meal kit delivery services have catchy names — with everything from home to fresh to aprons to carrots. But what does a meal kit delivery service have to offer? And is it right for you? If you have ever struggled with deciding what to eat for dinner, a meal kit delivery service might be right for you. Meal kit delivery services can take the guesswork out of your busy day. The kits are partially prepped and portioned, with food ingredients and recipes that allow people to easily prepare home-cooked meals. The recipes tend to offer step-by-step instructions to guide the cook. For those who lack time to prepare food, some meal kit delivery services offer prepared meals that only require reheating.  Why use them? <ul> <li>Saves time. Precut and portioned food items make cooking simple and fast. Everything you need for each meal is delivered direct to you. This sames time from grocery shopping. </li> <li>Reduces food waste. Fresh produce often gets thrown out. The kit's prepared ingredients reduce food waste in the kitchen. </li> <li>Complies with dietary needs. Some companies provide items for those looking to avoid allergens or other items not appropriate for you. </li> <li>Simplifies meal planning. Preselected meals take away the guesswork in the kitchen.</li> <li>Helps provide a balanced diet. Choosing meals that offer at least three food groups from <a rel="noopener noreferrer" href="https://www.myplate.gov/" target="_blank">MyPlate</a> helps achieve a balanced diet. Select from various food groups to obtain nutrients for good health. </li> <li>Develop culinary skills. Cooking at home will improve your culinary skills. Even the novice chef can feel confident preparing healthy options. </li> <li>Customizable. Customize your meal items as you please to develop a delicious meal that meets health goals. For example, choose ground turkey over ground beef. </li> </ul> How to customize meal kits to achieve a healthy diet. <ul> <li>Use <a rel="noopener noreferrer" href="https://www.myplate.gov/" target="_blank">MyPlate</a> when selecting your meal. Choose at least three of the five food groups.</li> <li>Choose lean protein. Best choices include low-fat meats, low-fat dairy, beans, legumes, nuts and seeds.</li> <li>Choose a variety of colors. Colorful foods provide a wide variety of nutrients, including fiber, vitamins and minerals — all important for good health. </li> <li>Choose whole grains. Whole grains offer increased fiber. </li> </ul> Stop stressing about what you are going to have for dinner and try meal kit delivery services. Save time, eat healthier and enjoy delicious customizable dinners. To choose which meal kit delivery service is right for you, check out the <a rel="noopener noreferrer" href="https://mcforms.mayo.edu/mc1100-mc1199/mc1110-78.pdf" target="_blank">Rochester/Midwest Meal and Ingredient Delivery Options and More brochure</a>.  Tony Gagliardi is a Mayo Clinic dietetic intern. He earned his bachelor's degree in science dietetics at the University of Wisconsin. Tony GagliardiPrimary Care in Rochester and KassonMeal KitsPrimary Care in Rochester and KassonThese tips can help reduce the effects of motion sickness when traveling.<img src="/-/media/ech-media/images/widgets/people/motionsicknessplane.jpg?h=65&iar=0&w=100&sc_lang=en&hash=4265AE3D66757A013E962FE27FAC3669" alt="MotionSicknessPlane" width="100" height="65" DisableNVelocity="true" />Does traveling make you sick?3/13/2023 4:30 AM<img src="/-/media/ech-media/images/widgets/people/motionsicknessplane.jpg?h=205&iar=0&w=315&sc_lang=en&hash=7138B49214AA58281193CBA903335EFF" alt="MotionSicknessPlane" width="315" height="205" DisableNVelocity="true" />With summer approaching, travel is something many people are looking forward to. However, one thing that can make traveling less enjoyable is travel-related motion sickness.  Motion sickness causes nausea, dizziness, vomiting, belching, increased saliva, feeling warm or sweating. It happens to people when traveling by boat, car or with most any type of motion.  To decrease your motion sickness risk when traveling, consider these tips: <ul> <li>When on a ship, stay in a cabin in the front or middle, near the water level.  </li> <li>If traveling by airplane, sit in a row over the wing and direct the air vent to your face.</li> <li>While on a train ride, sit facing forward near the front and next to a window.</li> <li>During a car ride, be the driver or sit in the front passenger's seat. However, children should remain in age-appropriate seats and restraints at all times. Be sure to follow state laws for the location you are in.</li> </ul> Also consider these recommendations to decrease the possibility of motion sickness: <ul> <li>Keep your eyes on the outside while in motion.</li> <li>If possible, lie on your back to ease motion sickness.</li> <li>Avoid reading, watching a movie or looking at things close to you.</li> </ul> There are also over-the-counter medicines that can help prevent and treat motion sickness. These include dimenhydrinate (Dramamine), meclizine (Antivert) and diphenhydramine (Benadryl). Other treatments for motion sickness include ginger and acupressure. If your motion sickness is severe, your primary care clinician may prescribe a scopolamine patch.  Find more information about <a rel="noopener noreferrer" rel="noopener noreferrer" href="https://www.mayoclinic.org/first-aid/first-aid-motion-sickness/basics/art-20056697" target="_blank">motion sickness and tips to treat it</a> on the Mayo Clinic website.  <a href="https://communityhealth.mayoclinic.org/providers/nicole-borkovskiy-cnp">Nicole Borkovskiy, APRN, C.N.P.</a>, is a nurse practitioner in Family Medicine at Mayo Clinic Express Care in Rochester, Minnesota, where she leads the Express Care Guideline Committee. The committee reviews up-to-date guidelines and research articles to ensure the best care is provided to patients. She enjoys traveling, being outside, going for walks and spending time with her family.Nicole Borkovskiy, APRN, C.N.P.Primary Care in Rochester and KassonMotion SicknessPrimary Care in Rochester and KassonThese tips may help you get that much needed night of sleep.<img src="/-/media/ech-media/images/widgets/kids/babycrib.jpg?h=65&iar=0&w=100&sc_lang=en&hash=FC65CFFEFF77E8702192571A5C21528B" alt="BabyCrib" width="100" height="65" DisableNVelocity="true" />Tips for a restful night with a new baby3/16/2023 3:30 AM<img src="/-/media/ech-media/images/widgets/kids/babycrib.jpg?h=205&iar=0&w=315&sc_lang=en&hash=42D1286FE85B0743D07027F4F95F64D2" alt="BabyCrib" width="315" height="205" DisableNVelocity="true" />Tending to your baby 24/7 can be exhausting. Developing just a few skills can be beneficial to ensure adequate rest for everyone in the household to thrive and survive.  At birth and for the first several months, babies have no perception of daylight/darkness. Adults tend to function better when they sleep in the darkness and are mostly awake and active in the daytime. As new parents or caregivers, setting the schedule and getting enough sleep is going to be up to you. The key is to get your baby to sleep when you need to sleep. While a nap in the daytime when baby is napping can be helpful, the majority of sleep should happen at night for adults and babies.  Babies need their own sleep space For the first few months, putting a crib or bassinet in proximity to where parents or caregivers sleep can help reduce disruption. However, this needs to be reevaluated as the baby gets older. Many families have a bassinet or crib in the parents' room when they bring their baby home. During the daytime or when parents or caregivers are awake, it's important to have babies sleep in their own room if the long-term plan is for the baby to be sleeping there.  Babies make a lot of noise when they sleep Sometimes this normal baby noise disrupts parents and caregivers and leads to sleep deprivation and disruption for the adult. Moving the baby farther from the parent's bedroom might be appropriate. Some parents or caregivers need to have babies sleep in their own room with a baby monitor to allow everyone to get adequate rest. These monitors allow parents to hear and see what is going on without the baby being aware that they are there, which can have advantages. Babies like their parents and caregivers. Sometimes they cry and carry on simply because they want to see you. Before responding to the noises by picking the baby up, verify that they are really awake and need something. Allow your baby the opportunity to try to self-soothe and go back to sleep. Teaching babies to fall asleep in their own bed is very important While there is nothing more rewarding than holding a sleeping baby, they do need to learn to sleep in their own bed. Ideally, when babies are well fed, have a clean diaper, are sleepy but are not yet asleep, place them in their crib or bassinet and allow them to fall asleep on their own. In allowing a baby to fall asleep in their own bed, you reinforce that they can go to sleep without you. This is the first independence skill a baby needs to learn for the family survival. This allows babies to know that if they wake up and do not have a need, they can simply go back to sleep when there isn't another need for a caregiver response.  Pacifiers can help with self-soothing and can aid infants in falling asleep In the middle of the night as baby is stirring, a caregiver can help assist the infant by simply replacing a pacifier without other touch to see if this alone is enough to allow baby to fall back to sleep. If caregivers hold the baby until they are asleep and then transfer back to bed, the baby never learns to go to sleep alone. Instead, they cry then are picked up and put back to sleep. The longer this process goes on and the older the child, the longer and harder this will be to stop. Most infants by 6 months should have a six to eight hour sleep stretch.  All humans seem to do better with a schedule or routine Keeping the same routine trains the adult and baby to optimize sleep. Most people get restorative sleep as the first sleep after getting into bed for the night. By 2 months old, infants will start to have a longer sleep stretch, typically about four to six hours. Matching this longer stretch for baby with parent sleep optimizes the restorative sleep for the adults in the home. Most of the time this stretch happens as the first sleep of the night. This might require parents to have an earlier bedtime. Sharing or alternating the night responsibilities between caregivers allows all of the caregivers to have enough rest to function the next day, especially in the first weeks to months of the baby's life when the number of sleep disruptions is highest.  When responding to infant needs in the nighttime/darkness, keep the lighting low Learn to work in the dark with indirect light. Diaper, feed, back to bed — as efficiently as possible. Avoid loud noises and a lot of talking. Keep the TV, mobile devices and screens off, as this light is disruptive to you and to baby. Change the baby's diaper before feeding and/or in the middle of the feed. After burping your baby and before the baby is soundly sleeping again, put your baby back in bed, pop a pacifier in baby's mouth and allow your child to fall asleep in their bed alone. Avoid staying up and playing or socializing with your baby during the night hours when you would be sleeping.  Keeping comfortable is important People do not like to be too cold or too hot. Your baby's room temperature should be comfortable. Cover babies with the same number of layers as you are comfortable sleeping with. Swaddle babies for as long as they seem comfortable with it. Somewhere around 2 months, babies are typically done with the swaddling process, and usually by 4 months, they will start to roll over. There are sleep sacks or strap-on blankets that can be used to avoid layering on piles of blankets. These strap-on or sleep sacks are a natural progression from a swaddling blanket. Keeping your baby cool also has an advantage at decreasing the incidence of SIDS, or sudden infant death syndrome. Strap-on blanketing is better than regular blankets until about age 1. Laying babies on their backs to sleep is recommended to decrease SIDS As soon as your baby is rolling over, your job remains in putting them in bed lying on their back to sleep. If your baby rolls onto their stomach you should not worry about this or try to prop or position them to keep them from rolling. Keep the baby's crib boring — no toys or stuffed animals.  <a href="https://communityhealth.mayoclinic.org/providers/marcia-obrien-md/">Marcia O'Brien, M.D.</a>, is a physician in the Department of Family Medicine at Mayo Family Clinic Northeast in Rochester. She practices the full spectrum of family medicine, including hospital medicine, newborn nursery and obstetrics care.  Marcia O'Brien, M.D.Primary Care in Rochester and KassonSleeping Baby TipsPrimary Care in Rochester and KassonTuberculosis is caused by bacteria in the lungs, but it can impact other parts of the body.<img src="/-/media/ech-media/images/widgets/people/handtochest.jpg?h=65&iar=0&w=100&sc_lang=en&hash=5BD3F9017B187576D66283FFFF7A581E" alt="HandToChest" width="100" height="65" DisableNVelocity="true" />Should I worry about tuberculosis?3/30/2023 4:30 AM<img src="/-/media/ech-media/images/widgets/people/handtochest.jpg?h=205&iar=0&w=315&sc_lang=en&hash=CD47389AB37A634635C52924C18F7363" alt="HandToChest" width="315" height="205" DisableNVelocity="true" />March 24 is World Tuberculosis Day. It's a day to remember the discovery of the bacteria that cause tuberculosis, or TB, and increase awareness of the impact of tuberculosis in the world. What is tuberculosis? Tuberculosis is a health condition caused by a bacterium called Mycobacterium tuberculosis. Typically, the bacteria impact the lungs, but they can impact other parts of the body, such as the spine, brain and kidney. There are two types of TB conditions, latent tuberculosis infection and active tuberculosis, or TB disease. Not everyone who has tuberculosis bacteria becomes ill. <ul> <li>Latent TB: The bacteria are inactive and "hide" in the body. In this situation, people are not sick because the bacteria are inactive, but people can develop symptoms in the future if the bacteria become active. In latent TB, the bacteria cannot spread to other people.</li> <li>Active TB: The bacteria are active in the body. People often have symptoms of tuberculosis and can spread the bacteria to others. TB is spread to others when the bacteria move into the air from an infected person through tiny droplets. If someone has active TB disease, they can spread the germs by coughing, speaking, singing and sneezing.</li> </ul> What are symptoms of tuberculosis? Those with tuberculosis disease often have symptoms. General symptoms of tuberculosis include weight loss, decreased appetite, fever, night sweats, weakness and feeling tired. If the bacteria are in the lungs, it often causes coughing that can last for at least several weeks, coughing up blood or phlegm, and chest pain. If the bacteria are in other places of the body, the symptoms depend on where the bacteria have affected. Who needs testing for tuberculosis? If you have symptoms of TB, you should see your health care clinician to help determine if you should be tested for TB. The Centers for Disease Control and Prevention (CDC) also recommends testing for latent TB in people that are at higher risk for this condition. This includes people that are around someone with TB, have travelled to or are from countries with high rates of TB (such as Latin America, Asia and Africa), have AIDS/HIV, use IV drugs, work in health care and treat people with a higher risk of TB, work or live in a setting where TB is more common (such as prisons or nursing homes), or children who are around adults at risk of TB. If you are at higher risk for latent TB, your health care clinician will help you determine how often you should be tested. How is TB testing done? There are two main tests for tuberculosis, a skin test and a blood test. In the skin test, a small amount of a liquid called tuberculin is injected just under the skin in your forearm. After 48 to 72 hours, your arm will be checked by health care staff to determine if there is a reaction. If there is a hard bump at the injection site, it is possible that person has TB bacteria in their body. The size of the bump is used to determine if the test is positive. The blood test requires a blood draw and can generally be used for anyone 2 and older. Some people born outside of the U.S. have received the bacilli Calmette-Guerin (BCG) vaccine. The BCG vaccine is used in countries with high prevalence of TB and is given at birth. The BCG vaccine can make people have a false positive TB skin test, which means people can test positive, but they do not have the TB bacteria in their body. If a patient has had the BCG vaccination in the past, health care clinicians will typically order the blood test method when testing for TB. What if you test positive? When people test positive for TB, it means they have the TB bacteria in their body. Their health care clinician will order additional testing, such as a chest X-ray, to help determine if the person has TB disease (active infection) or latent TB (hidden infection). People with TB disease will be treated with a combination of medications for six to 12 months. It's important that people with TB disease take all recommended medications so the bacteria does not become resistant. Since latent TB can turn into active TB, those with latent TB also are treated so they do not become sick. <a href="https://communityhealth.mayoclinic.org/providers/jillian-lynaugh-cnpdnprn">Jillian Lynaugh, APRN, C.N.P., D.N.P.</a>, is a primary care pediatric nurse practitioner in Primary Care in Rochester and Kasson's Division of Community Pediatric and Adolescent Medicine. She practices at Mayo Family Clinic Northwest in Rochester. She spent several years working overseas in health and nutrition project management in conflict and disaster areas and continues to have a passion for global health and refugee care. <a href="https://communityhealth.mayoclinic.org/providers/julie-hanson-md">Julie L. Hanson, M.D.</a>, is a pediatrician in Primary Care in Rochester and Kasson's Division of Community Pediatric and Adolescent Medicine. She practices at Mayo Family Clinic Northwest in Rochester. She has a particular interest in refugee and global health and has received her Certificate of Knowledge in Clinical Tropical Medicine and Traveler’s Health (CTropMed). Jillian Lynaugh, APRN, C.N.P., D.N.P., and Julie L. Hanson, M.D.Primary Care in Rochester and KassonTuberculosisPrimary Care in Rochester and KassonThese tips can help find the support you need.<img src="/-/media/ech-media/images/widgets/people/alcoholawareness.jpg?h=65&iar=0&w=100&sc_lang=en&hash=9FBCDF35D8E8B1C6C893BB821F5233BF" alt="AlcoholAwareness" width="100" height="65" DisableNVelocity="true" />Is alcohol use a concern for you?4/24/2023 4:30 AM<img src="/-/media/ech-media/images/widgets/people/alcoholawareness.jpg?h=205&iar=0&w=315&sc_lang=en&hash=858FB3AE43E17BCD0FF2DB2C66987706" alt="AlcoholAwareness" width="315" height="205" DisableNVelocity="true" />From religious rituals to frat parties, alcohol consumption has played a role in human cultures throughout time. Alcohol use — in moderation — has often been viewed as a normal aspect of adult life. However, it is becoming increasingly popular and important for individuals to consider reducing alcohol consumption for potential benefits to their physical and mental health. For example, trends like <a rel="noopener" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4684010/" target="_blank">Dry January</a> have become more and more common, even among individuals who do not view their alcohol use to be problematic.   If cutting back on drinking is a goal for you, consider experimenting with these tips and strategies to get you started: <ul> <li> Track your alcohol use. Anytime you want to make a change, it's helpful to know your baseline. When it comes to alcohol, it can be useful to start regularly keeping track of the days you drink and the number of drinks you have per day (in general, one standard drink equals 12 ounces of beer or 5 ounces of wine). You might use a calendar, paper form or app. As you start to see patterns, you'll also be able to identify opportunities for cutting back. Continuing to track alcohol use over time can help you to see the progress you're making, which can feel good. </li> <li> Alter your environment. You may find yourself drinking simply out of habit or based on the situation you're in. Consider making changes to your environment or activities that might help with consuming less alcohol. For example, you might try removing alcohol from the home. If it's not easily accessible, you're less likely to grab it. Similarly, perhaps you're more likely to have a drink if you go out to a sports bar or when you're with certain friends. Consider going to a different type of restaurant or hanging out with a different group occasionally. </li> <li> Consider what alcohol provides. Different people drink alcohol for different reasons, and even the same individual might drink for different reasons at different times. This may sound strange, but it can be helpful to reflect on what alcohol provides for you. Is it a way to relax and de-stress? Is it a way to connect with friends? Once you identify the purpose(s) of alcohol use, you can begin to identify alternate activities that might serve a similar function. You might experiment with new leisure and social activities, such as taking a bath, playing a board game or going for a walk. Explore what seems to fit best for you. </li> <li> Reflect on your motivations and have compassion for yourself. Let's face it, changing behavior can be really hard. To maintain motivation, consider reflecting on your reasons for wanting to make this change in the first place. Ask yourself questions like, "Why is it important to me to cut back?" or "Six months from now, if I've reached my goal, what will be better in my life?" This can help you remind yourself of your values and how cutting back fits in. Finally, show yourself some compassion. It's OK if this is challenging. No one is perfect, and setbacks are a normal part of the process. Focus on one step at a time and treat yourself with kindness. </li> </ul> Lastly, how might you know if alcohol use is becoming more problematic? Some common signs might include: <ul> <li> Regularly drinking larger amounts of alcohol than intended. </li> <li> Needing to drink more to experience a similar effect. </li> <li> Significant difficulty cutting back. </li> <li> Craving alcohol. </li> <li> Spending a lot of time acquiring, using or recovering from alcohol. </li> <li> Problems at work, school or in relationships due to alcohol. </li> <li> Giving up other important activities because of alcohol use. </li> <li> Continuing to use alcohol even with the knowledge that it may be significantly damaging your physical or emotional health. </li> </ul> If you're concerned that alcohol use has become a problem for you or a loved one, help is available. Depending on your level of concern, you may consider some of these options: <ul> <li> Reach out to your primary care clinician. Talk with them about your concerns and the resources and support that may be available to you. </li> <li> Alcoholics Anonymous (AA) meetings are groups that may be helpful in supporting recovery. Visit <a rel="noopener" href="https://www.aa.org/find-aa" target="_blank" title="Link opens in a new window">their website</a> to explore meetings available in your area. Meetings are available in person and online. </li> <li> Chemical dependency treatment programs are a higher level of care that might be the best fit for some people. <a rel="noopener" href="https://www.mayoclinic.org/departments-centers/psychiatry/addiction-services/overview" target="_blank">Mayo Clinic's Addiction Services</a> provide a variety of treatment options; consider seeking out a consultation. You also can explore other options through the <a rel="noopener" href="https://findtreatment.gov/" target="_blank">Substance Abuse and Mental Health Services Administration website</a>. </li> </ul> Alisson Lass, Ph.D., and Anne Roche, Ph.D., are clinical health psychology fellows in Primary Care in Rochester and Kasson's Division of Integrated Behavioral Health. <a rel="noopener" href="https://communityhealth.mayoclinic.org/providers/craig-sawchuk-phdlp" target="_blank">Craig Sawchuk, Ph.D., L.P.</a>, is a clinical psychologist in Primary Care in Rochester and Kasson's Division of Behavioral Health. He is co-chair of the Division of Integrated Behavioral Health and co-chair of Clinical Practice within the Department of Psychiatry and Psychology at Mayo Clinic.Alisson Lass, Ph.D.; Anne Roche, Ph.D.; Craig Sawchuk, Ph.D., L.P.Primary Care in Rochester and KassonAlcohol ConcernPrimary Care in Rochester and KassonIf your child has an electronic device, they may have access to pornographic material.&nbsp;<img src="/-/media/ech-media/images/widgets/kids/screentime.jpg?h=65&iar=0&w=100&sc_lang=en&hash=509D5E4267B45CC81DC2B7C7D4103AAF" alt="ScreenTime" width="100" height="65" DisableNVelocity="true" />Is your child at risk for engaging in pornography?4/17/2023 4:30 AM<img src="/-/media/ech-media/images/widgets/kids/screentime.jpg?h=205&iar=0&w=315&sc_lang=en&hash=506C341C4D3A01A5DD31B40162C27594" alt="ScreenTime" width="315" height="205" DisableNVelocity="true" />Children are getting cellphones at younger ages. These aren't usually flip phones as their older relatives might have. They tend to get a smartphone or tablet that gives them access to the internet at their fingertips, and quite possibly access to some material you may have overlooked as a parent. The likely age that a child is first exposed to pornography is in the tween years, but many are even earlier. There are many concerns with viewing pornography. Pornography is widely available for free online, and it's often violent, degrading and extreme. This may influence the viewer to pressure their partners into porn-style sex or have unrealistic expectations in a relationship when the partner does not react as the actors did in the viewed pornography. Another concern is the development of problematic sexual behaviors, where they may abuse a sibling, relative or another available person as a form of sexual experimentation. The best way to prevent problems is with education and communication with your child. Online safety tips for you and your children <ul style="list-style-type: disc;"> <li>Monitor your child's activity on computers and mobile devices. Become familiar with options for monitoring anything with online access. Check your child's search history periodically — you are not spying. It's your responsibility as your child's caregiver to protect them. Remember that these tools are not perfect and could be outsmarted.</li> <li>Consider having a home base for electronics at night so they are not in your child's room.</li> <li>Teach your child to use social media with caution and choose their screen name carefully. Don't share your full name, school name or any part of your address, including the city or state. Teach your kids to be thoughtful about sharing their location, whether through a direct message/chat or in the device settings for the device or application being used. Parents should also make sure their kids' privacy settings are set to "Friends" only.</li> <li>Use extreme caution when communicating with people you don't know in real life, such as through school, sports or clubs. Don't post or send pictures to people you don't know. Don't meet them in person.</li> <li>Photos and videos last forever. Sending or receiving explicit images of a minor is considered child pornography and may result in legal consequences. Sending pictures or videos also could result in exploitation attempts where a person threatens to distribute the images to family and friends unless a certain sum of money is received.</li> </ul> Discussions to have with your children                                                                                  <ul> <li>Start talking about sexuality early and often. Use proper names for body parts. Let your child know that there are areas of the body that are private. Teach your child that they can ask questions anytime. If we don't talk to our children about sexuality, someone else will.</li> <li>Remind your child that they should speak to two trusted adults when they see something that concerns them or have experienced any touch that makes them feel uncomfortable.</li> <li>Emphasize healthy relationships and consent. Consent is making an active choice to agree. If someone tries to convince another person to do something sexual, even if they have done it with that person before, he or she has the right to say "no." Agreeing because you feel pressured to do something sexual is coercion — not consent.</li> </ul> When to reach out for help <ul style="list-style-type: disc;"> <li>Change in mood, like depression or anxiety.</li> <li>Grades dropping.</li> <li>Isolating themselves or wanting to spend more time alone.</li> <li>Loss of interest in previous activities.</li> <li>Not taking care of themselves.</li> <li>Suicidal ideation or self-harm.</li> </ul> Reach out to your child's primary care team, mental health professional, school or a program, such as <a href="https://www.mayoclinic.org/departments-centers/childrens-center/child-family-advocacy-center/overview">Mayo Center for Safe and Healthy Children and Adolescents</a>, if you have concerns.   Shawna Wollbrink, R.N., is a registered nurse who works in the Mayo Clinic Center for Safe and Healthy Children and Adolescents. She has been with Mayo Clinic for more than 25 years. Prior to her role with the child abuse team, she worked as a registered nurse in pediatrics in the hospital and primary care settings.Shawna Wollbrink, R.N.Primary Care in Rochester and KassonChild PornographyPrimary Care in Rochester and KassonA diet to support Mother Earth?<img src="/-/media/ech-media/images/widgets/food/farmersmarket.jpg?h=65&iar=0&w=100&sc_lang=en&hash=972213D0E2F124E2EB2B1B947F29E952" alt="FarmersMarket" width="100" height="65" DisableNVelocity="true" />Climate-friendly eating4/6/2023 4:30 AM<img src="/-/media/ech-media/images/widgets/food/farmersmarket.jpg?h=205&iar=0&w=315&sc_lang=en&hash=89F03B87D577BA7047763ABE7D626378" alt="FarmersMarket" width="315" height="205" DisableNVelocity="true" />A climate-friendly diet, or climatarian diet, is a healthy, climate-friendly, nature-friendly diet. The priority of the diet is to reduce the effects of climate change and improve the health of our planet. A climatarian diet does not require one to adhere to strict food guidelines. Rather, it focuses on eating foods that don't contribute to environmental harm, making it easy to follow, even with a busy lifestyle. With the increasing awareness of the negative impact that human activities have on the planet, people are looking for ways to reduce their carbon footprint and live a more sustainable lifestyle. Regardless of what your current diet might look like, there are a number of ways for you to begin your journey toward climate-friendly eating. What does a climate-friendly diet look like? Decreasing the consumption of animal products and increasing the intake of plant-based foods is essential for achieving a sustainable food system. In doing so, we can ensure that the nutritional needs of the population are met without transgressing planetary boundaries. How to achieve a more climate-friendly diet <ul> <li>Eat a variety of foods. Try incorporating a wider variety of foods into your diet. Perhaps start with a family challenge to try a new food two to three times per month. </li> <li>Increase your intake of plant-based foods. By consuming more foods derived from plants, you help reduce your carbon footprint, while improving the quality of your diet. Consider eating plant-based or vegetarian meals at least one day per week. </li> <li>Eat smaller portions of meat, dairy and other animal-based foods. Decreasing, with no need to avoid altogether, your consumption of animal products, particularly red meat and dairy, is one of the most impactful ways to lower the environmental impact of your diet. </li> <li>Aim for seasonal and locally sourced foods when possible. Eating produce that is in season helps reduce the energy and resources needed for storage and transportation. Look for farmers markets or consider joining a community-supported agriculture program to get fresh, locally grown produce.</li> <li> Eat less processed and packaged foods. Highly processed foods come with a lot of unnecessary packaging, which contributes to waste and pollution. Opt for whole, unprocessed foods whenever possible to minimize your consumption of packaged meals and snacks. </li> <li>Reduce your food waste. To reduce food waste, plan your meals in advance. Only purchase what you need and make use of your leftovers. Composting repurposes food scraps to create rich soil for gardening. </li> </ul> Eating a climate-friendly diet protects the environment and your health. Consider the above ideas and choose one to start working on being kind to Mother Earth. Genevieve (Gen) Geenen is a Mayo Clinic dietetic intern at Mayo Clinic in Rochester, Minnesota. She received her bachelor's degree in Nutrition and Dietetics from Arizona State University (ASU) and is currently completing her master's degree in Nutritional Science from ASU.Genevieve (Gen) GeenenPrimary Care in Rochester and KassonClimate Friendly EatingPrimary Care in Rochester and KassonIrritable bowel syndrome, or IBH, is a chronic gastrointestinal (GI) disease that affects your small and large intestine.&nbsp;<img src="/-/media/ech-media/images/widgets/people/stomachpain_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=718646FDB083693D1C8F8B4E08283876" alt="StomachPain_widget" width="100" height="65" DisableNVelocity="true" />What is irritable bowel syndrome?4/13/2023 4:30 AM<img src="/-/media/ech-media/images/widgets/people/stomachpain_widget.jpg?h=205&iar=0&w=315&sc_lang=en&hash=A662AAF96F11F0F54C5E8775FA2CFC87" alt="StomachPain_widget" width="315" height="205" DisableNVelocity="true" />Irritable bowel syndrome, or IBS, is a chronic gastrointestinal (GI) disease that affects your small and large intestine. What causes IBS? The exact cause of IBS is not known. It is likely a mix of problems with muscle contractions in the gut, higher pain response to gas or stool in your digestive system, and changes in the gut microbiome. Certain foods, drinks and stress can make your symptoms worse. It also can be triggered after diarrhea caused by bacteria or a virus. What are the symptoms? Recurrent abdominal pain that is usually one or more times per week, with two or more of the following: <ul> <li>Change in the frequency of bowel movements.</li> <li>Change in bowel movement appearance.</li> <li>Change in abdominal pain, either improvement or worsening, after a bowel movement.</li> </ul> You also may feel bloated. You may have primarily diarrhea, primarily constipation or a mix of the two, which can change over time. Who gets IBS? IBS is common and affects 1 in 20 people. It is more common in people younger than 50 and people with a family history of IBS. While more common in women, men can have IBS as well. Those with anxiety, depression or other mental health issues are at higher risk. How is IBS diagnosed? If your primary symptom is diarrhea, you may be tested for celiac disease and have stool and blood tests to look for inflammation. If your primary symptom is constipation that is hard to treat, you may need to be tested for pelvic floor dysfunction. You do not routinely need food allergy testing, stool testing for infection or a colonoscopy. It is important that your colon cancer screening be up to date. How is IBS treated? While there is no cure for IBS, symptoms can be controlled with: <ul> <li>Diet: Avoiding or eliminating foods that trigger symptoms. Eat foods high in soluble fibers (e.g., oat bran, beans, barley).</li> <li>Medications: <ul> <li>Over-the-counter medications (OTC) may be helpful to manage constipation — including stool softeners, bulk-forming laxatives or with the addition of stimulant laxatives. Loperamide may be used for managing diarrhea .</li> <li>If OTC medications don't work, your primary care clinician may prescribe other medications for constipation (e.g., lubiprostone, linaclotide) or diarrhea (e.g., eluxadoline, rifaximin) which can help symptoms.</li> </ul> </li> <li>Other options: Peppermint oil, probiotics, exercise, stress reduction and gut-directed psychotherapy have been found to help some people.</li> </ul> Are people with IBS at higher risk for cancer? No, having IBS does not place you at higher risk of colon cancer than the rest of the general population. Inform your primary care clinician if you experience fevers, unexplained weight loss, blood in the stool, iron deficiency, diarrhea at night, or significant abdominal pain or nausea with vomiting. This may indicate a more serious condition. Stacey Rolak, M.D., M.P.H.., is a resident physician in internal medicine at Mayo Clinic in Rochester, Minnesota. She earned her medical degree at the University of Wisconsin School of Medicine and Public Health and her Master of Public Health from George Washington University. She is interested in patient education and preventive care. Stacey Rolak, M.D., M.P.H.Primary Care in Rochester and KassonIrritable Bowel SyndromePrimary Care in Rochester and KassonYoga is an excellent way to reconnect with your mind and body.&nbsp;<img src="/-/media/ech-media/images/widgets/activities/yoga.jpg?h=65&iar=0&w=100&sc_lang=en&hash=2162410B594AF33AFEAE0BDB805E01DA" alt="Yoga" width="100" height="65" DisableNVelocity="true" />Improve your mind-body connection with yoga4/10/2023 4:30 AM<img src="/-/media/ech-media/images/widgets/activities/yoga.jpg?h=205&iar=0&w=315&sc_lang=en&hash=8DE9378792E5A92033535ABF4A8DFF3E" alt="Yoga" width="315" height="205" DisableNVelocity="true" />As a society, we spend more time on our phones or electronic devices than at any other time in history. This sedentary lifestyle is taking an enormous toll on our physical health and mental well-being. Therefore, we must find activities that allow us to disconnect from the digital world and reconnect with our minds and body. Practicing yoga is an excellent way to make this mind-body connection. The health benefits of yoga are numerous, yet many people are unfamiliar with yoga practice and how practicing yoga helps to improve your health.   What is yoga?   In the most straightforward definition, yoga is a lifestyle practice that improves your mind-body connection through various postures and poses while focusing on your breathing (pranayama). There are many types of yoga practices one can explore:   <ul style="margin-top: 0in; list-style-type: disc;"> <li style="margin-bottom: 0in;">A vinyasa flow is the most popular type of yoga, focusing on the breath (pranayama) to calm the mind and focus on physical movement. </li> <li style="margin-bottom: 0in;">Yin yoga practice focuses on holding your poses for up to five minutes to find a deep stretch, releasing stress and attachment, and concentrating on breathing (pranayama). </li> <li style="margin-bottom: 0in;">Many other variations of yoga practice are also available today. </li> </ul> As a yoga instructor, I guide my students through a series of movements to help each student improve strength, flexibility, balance and endurance. Classes typically last 45-60 minutes, but also can be as short as 20 minutes. Students should plan to attend a class at least three to four times weekly to maintain their strength, balance, flexibility and endurance.       One major advantage yoga has over other forms of exercise is that nearly everyone can participate in yoga practice. It does not matter if you are young or old, if you are overweight or out of shape, you can participate in yoga. Even if you are in excellent health, you still can benefit from practicing yoga. The key ingredient of the practice is always a mind-body connection made through poses and breathing, leading to improved strength, flexibility, balance and endurance. Additionally, the gentle movement and meditation of yoga can help to improve your mental health.   I would encourage anyone who has not previously attended a yoga class to give it a try. You can check the <a rel="noopener noreferrer" href="https://www.yogaalliance.org/" target="_blank">Yoga Alliance website</a> to find a list of certified yoga instructors in your area. Be sure to consult with your health care professional before starting any exercise routine to ensure that you do not have any health issues preventing you from participating in a yoga class.   Marisa Kadlec, lead group fitness instructor and RYT 200 yoga instructor, Dan Abraham Healthy Living Center, Mayo Clinic in Rochester, Minnesota.Marisa KadlecPrimary Care in Rochester and KassonYoga MonthPrimary Care in Rochester and KassonFind tips to consider when determining if driving is still right for you or a family member.&nbsp;<img src="/-/media/ech-media/images/widgets/elderly/olderdriver.jpg?h=65&iar=0&w=100&sc_lang=en&hash=6B87A62BCAB4BD31DAFA07A84A62BBE2" alt="OlderDriver" width="100" height="65" DisableNVelocity="true" />Keys to healthy aging and driving5/4/2023 4:30 AM<img src="/-/media/ech-media/images/widgets/elderly/olderdriver.jpg?h=205&iar=0&w=315&sc_lang=en&hash=1D522A40DB40690C498E0DFC741BC37C" alt="OlderDriver" width="315" height="205" DisableNVelocity="true" />As we age, we're faced with numerous big decisions. Where should I live? What activities bring me the most joy? How will I spend my time in retirement? A big question that many older adults consider is when to retire from driving. Aging and medical conditions impact driving fitness With age, all of us will experience physiologic changes that impact our ability to drive. For example, our ability to react quickly decreases as does our ability to divide our attention between multiple activities. Additionally, medical conditions can affect your ability to drive safely. Common conditions like peripheral neuropathy, sleep apnea, cognitive impairment and vision impairment can all impact our driving fitness. Warning signs You might be concerned about a family member or friend's ability to safely operate a motor vehicle. Worrisome signs include driving too fast or too slow, getting lost in familiar areas, struggling with turning left or having difficulty parking. Additional red flags include car accidents, traffic violations and near misses. Who can help me decide? Still, getting older doesn't mean that you automatically have to give up driving. Most older adults are very capable of safe driving. For many of us, driving allows us to stay actively independent and mobile in our communities. Unfortunately, sometimes it can be difficult to know when it's time to consider driving retirement. Thankfully, there are members of the health care team that can help make this difficult decision. While it might seem strange to talk to your clinician about driving safety, your primary care team knows you well and can have an honest discussion with you about your medical conditions and how these might impact your ability to stay safe on the road. Here are some keys for older adults to consider <ul> <li><a href="https://www.nhtsa.gov/older-drivers/driving-safely-while-aging-gracefully#driving-safely-while-aging-gracefully-self-assessment">Perform a self-assessment</a> with your loved ones. </li> <li><a href="https://s0.hfdstatic.com/sites/the_hartford/files/cmme-crossroads.pdf">Encourage open dialogue</a> with your loved ones about driving safety. </li> <li>Talk to your primary care clinician about how your health conditions might impact driving safety. </li> <li>Ask your primary care team if working with a driving rehabilitation expert might be useful. </li> <li>Learn about transportation alternatives in your community. Your local <a href="https://semaaa.org/">Area Agency on Aging</a> can help you find these resources. </li> <li>Consider your driving legacy. We all want to end our driving career on a safe note, not after an accident. Plan for driving retirement on your own terms. </li> </ul> <a href="https://communityhealth.mayoclinic.org/providers/ericka-tung-md">Ericka Tung, M.D., M.P.H.</a>, is a physician specializing in Internal Medicine and Geriatrics. She practices in the Division of Community Internal Medicine, Geriatrics and Palliative Care where she also leads the Geriatric Medicine Fellowship. She is passionate about healthy aging throughout the life course.Ericka Tung, M.D., M.P.H.Primary Care in Rochester and KassonAging and DrivingPrimary Care in Rochester and KassonEnsure your asthma is well managed this spring.&nbsp;<img src="/-/media/ech-media/images/widgets/people/asthma.jpg?h=65&iar=0&w=100&sc_lang=en&hash=99DCA696C72C3C5EB1B59D5178691249" alt="Asthma" width="100" height="65" DisableNVelocity="true" />Spring into action to control your asthma5/8/2023 4:30 AM<img src="/-/media/ech-media/images/widgets/people/asthma.jpg?h=205&iar=0&w=315&sc_lang=en&hash=04330FF4A54B0C7E4E03423E80137911" alt="Asthma" width="315" height="205" DisableNVelocity="true" />One of the effects of the COVID-19 pandemic was a disruption in health care appointments for general medical care. Lockdowns, social distancing measures and fear of exposure to the virus resulted in fewer medical visits for routine follow-up, including common chronic diseases like asthma. The risk of poorly controlled asthma increases with a decrease in timely and appropriate medical care for adults and children with asthma. Since spring is a peak season for asthma and allergy sufferers, it is an important time to review aspects of good asthma control. According to the Centers for Disease Control (CDC), one in 13 people in the United States have asthma. As of 2021, the CDC reported: <ul> <li>More than 25 million Americans have asthma and 4.2 million are under the age of 18. </li> <li>Boys are more likely to have asthma than girls, but women are more likely to have asthma than men. </li> <li>There are more than 1.2 million emergency room visits for asthma every year. </li> <li>Asthma is the second-leading cause of hospital stays in children younger than 15. </li> <li>Ten Americans die from asthma each day. </li> <li>Adults are six times more likely than children to die from asthma. </li> </ul> Determining if your asthma is under good control involves monitoring symptoms and the ability to engage in regular activities. No matter the severity level, these factors indicate that asthma is well controlled. <ul> <li>Minimal or no troublesome symptoms, such as coughing or shortness of breath. </li> <li>Participation in normal activities (e.g., exercise, playing sports, attending school or work, etc.). </li> <li>Sleeping through the night. </li> <li>Minimal or no need for quick-relief medicines — less than twice a week during the day or twice a month at night. </li> <li>Maintenance of best lung function, as measured by spirometry tests. </li> <li>One or fewer asthma attacks per year that result in an emergency room visit or hospitalization. </li> <li>Use of oral corticosteroids once or less per year. </li> </ul> Poorly controlled or uncontrolled asthma can develop suddenly or come on slowly. These factors are indicators that asthma isn't being controlled: <ul> <li>Symptoms, such as frequent coughing, wheezing, chest tightness or shortness of breath, start to occur more often or become more severe. </li> <li>Symptoms occur at night, causing sleep disruption. </li> <li>Limiting or stopping activities due to asthma symptoms. </li> <li>Missing school or work because of asthma symptoms. </li> <li>Asthma medicines don't seem to work anymore. </li> <li>Using a quick-relief inhaler more than two times a week. </li> <li>Having to go to the emergency room or see a health care clinician because of an asthma attack. </li> </ul> It is important to communicate regularly with your health care clinician and follow recommendations for monitoring and managing asthma. Patients with asthma should have a minimum of one visit with their health care clinician each year to assess asthma control and adjust treatment as needed. They should also have annual screening of lung function with pulmonary function testing, primarily spirometry. Patients may need more frequent visits with their health care clinician, more frequent spirometry or pulmonary function testing, and/or more medication adjustments during periods of poor asthma control. Just like the changing of the seasons, asthma may change over time, and it's important to stay ahead of it. Regular visits with your health care clinician provide an opportunity to monitor your asthma control, address any concerns or questions you may have and work together to optimize your treatment plan. Taking control of your asthma is important to maintain your current level of activity and overall well-being. Don't hesitate to schedule a follow-up visit to ensure that your asthma is well controlled. <a href="https://communityhealth.mayoclinic.org/providers/joy-fladagermuth-cnp/">Joy Fladager Muth, APRN, C.N.P.</a>, is a pediatric nurse practitioner in the Division of Community Pediatric and Adolescent Medicine. She is one of eight pediatric clinicians serving as Integrated Community Specialists. In this role, Joy provides expert asthma care and consulting services for primary care pediatric patients with asthma, in collaboration with Mayo's Pediatric Pulmonology and Pediatric Allergy specialty clinicians.Joy Fladager-Muth, APRN, C.N.P.Primary Care in Rochester and KassonAsthma ControlPrimary Care in Rochester and KassonPatients and visitors to the Baldwin Building should plan ahead and follow traffic signage.<img src="/-/media/ech-media/images/widgets/randomimages/roadconstruction.jpg?h=65&iar=0&w=100&sc_lang=en&hash=59F37740618693F1977EC7C09DED4DB4" alt="RoadConstruction" width="100" height="65" DisableNVelocity="true" />Road construction around Baldwin Building begins May 14/25/2023 4:30 AM<img src="/-/media/ech-media/images/widgets/randomimages/roadconstruction.jpg?h=205&iar=0&w=315&sc_lang=en&hash=02C429C60804005B96DC923C42DD3A00" alt="RoadConstruction" width="315" height="205" DisableNVelocity="true" />Beginning May 1, road construction surrounding the Baldwin Building clinics will change traffic and pedestrian patterns for patients and visitors. These planned improvements will connect the walking subway from the Kellen Building (located to the south of Baldwin), to the subway between the Baldwin and Harwick Buildings (the Harwick is located to the east of Baldwin).  Construction will happen in two phases and is expected to last about six months.  During phase 1, traffic on the east side of Baldwin on 4th Avenue Southwest will be converted to a two-way flow instead of a one-way flow. There will be no pedestrian crossing Between the Baldwin and Kellen Buildings to the Harwick Courtyard.  During phase 2, which will immediately follow phase 1, traffic will be routed to the right out of the Baldwin Building to the south. A temporary paved road will replace the sidewalk to accommodate traffic flow. Pedestrians will be routed to a new temporary sidewalk.  Please plan for your visit to the Baldwin Building clinics and follow all posted traffic and pedestrian signage for directions. Primary Care in Rochester and KassonConstruction Baldwin BuildingPrimary Care in Rochester and KassonThe health benefits extend beyond digestive health. Find easy ways to add fiber to your diet.&nbsp;<img src="/-/media/ech-media/images/widgets/food/fiberrichfoods.jpg?h=65&iar=0&w=100&sc_lang=en&hash=E39AF3538C5734FA84F2C16759ADE2D8" alt="FiberRichFoods" width="100" height="65" DisableNVelocity="true" />Filling the fiber gap5/1/2023 4:30 AM<img src="/-/media/ech-media/images/widgets/food/fiberrichfoods.jpg?h=205&iar=0&w=315&sc_lang=en&hash=94E3E325B2520129EE533E3C60276408" alt="FiberRichFoods" width="315" height="205" DisableNVelocity="true" />Dietary fiber has made a name for itself for its role in relieving constipation. But did you know its benefits extend beyond digestive health? Other benefits include better gut health, lower cholesterol, bowel regularity and healthy weight control. There are easy ways to add fiber to your diet.  What is dietary fiber? Dietary fiber includes the parts of plant foods that the body is unable to digest or absorb. How much fiber do you need? The American adult's average fiber intake is 15 grams per day — about half of the recommended dietary intake, making it a nutrient of concern. It's important to find ways to fill the fiber gap. <ul> <li>Daily fiber goal for women: 21 g for age 50 and older, 25 g for those under 50.</li> <li>Daily fiber goal for men: 30 g for age 50 and older, 38 g for those under 50. </li> </ul> Benefits of fiber The benefits of fiber depend on the type of fiber – soluble or insoluble. Choose a variety of fiber-rich foods to reap the benefits of both types. Most plant foods contain both types of fiber. <ul> <li>Soluble fiber: lowers LDL cholesterol levels, helps control blood glucose and increases healthy gut bacteria. </li> <li>Benefits of insoluble fiber: prevents constipation and promotes bowel regularity. </li> <li>Both fiber types: helps with feeling full by filling the stomach while providing few calories, which promotes a healthy weight; may play a role in preventing colorectal cancer and colorectal conditions like hemorrhoids and diverticulitis. </li> <li>Choose plants to increase dietary fiber: fiber is found exclusively in plant-based foods like fruits, vegetables, whole grains, beans, nuts and seeds; animal-based foods like meat, poultry, fish, eggs and dairy contain no dietary fiber. </li> </ul> Easy ways to add dietary fiber at each meal Breakfast <ul> <li>Use whole-wheat bread for peanut butter toast. </li> <li>Add bell pepper, mushrooms or spinach to scrambled eggs. </li> <li>Top oatmeal with a sliced banana. </li> <li>Choose a whole orange over orange juice. </li> </ul> Lunch <ul> <li>Make sandwiches with whole-wheat bread and add sliced tomatoes, lettuce or spinach. </li> <li>Pack a cup of fresh mixed fruit like melon, pineapple and blueberries. </li> <li>Have a baked potato or sweet potato with skin. </li> </ul> Dinner <ul> <li>Include plant-based proteins like beans, chickpeas, lentils and edamame in soups, stews, stir-fries and side dishes. </li> <li>Choose whole-wheat pasta and whole grains such as quinoa, bulgur or barley. </li> <li>Season and roast a tray of vegetables like onions, potatoes, bell peppers and chickpeas.</li> </ul> Snacks <ul> <li>Grab a banana, apple, or orange. </li> <li>Add berries to your yogurt. </li> <li>Have a handful of nuts or seeds, such as almonds or sunflower seeds. </li> <li>Try vegetables such as carrots, red bell pepper or celery with hummus. </li> </ul> Tips <ul> <li>Check the Nutrition Facts panel. Dietary fiber of at least 3 grams per serving is considered high fiber. </li> <li>Increase fluid intake while increasing fiber intake. If your body is not used to large amounts of fiber, constipation can occur without adequate hydration. </li> <li>If you have recently had a bowel obstruction or have a gastrointestinal condition that causes narrowing of the bowel, ask your doctor or a registered dietitian before adding more fiber. </li> </ul> Small changes lead to big results Dietary fiber has many benefits, from digestive health to heart health. Remember, small changes are the most effective. Try adding one fiber-rich food each day and increase gradually – the benefits will add up! Meredith Bonde, BS, is a dietetic intern at Mayo Clinic. She completed her bachelor's degree in health sciences at the University of Minnesota-Rochester and a second major in Nutrition at the University of Minnesota-Twin Cities. She is working on her master's degree in nutrition at the University of Minnesota-Twin Cities with an interest in how culinary skills training can create more effective dietitians.Meredith Bonde, BSPrimary Care in Rochester and KassonFiberPrimary Care in Rochester and KassonRecommendations for healthy blood pressure numbers have changed.&nbsp;<img src="/-/media/ech-media/images/widgets/people/ech_knowyournumbers_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=F9AFA00C2C51E5B3F3802A571130AE89" alt="ECH_KnowYourNumbers_widget" width="100" height="65" DisableNVelocity="true" />Blood pressure: It's about the numbers5/18/2023 4:30 AM<img src="/-/media/ech-media/images/widgets/people/ech_knowyournumbers_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=D0EA3D07152F5CAB98CAF953459F63F1" alt="ECH_KnowYourNumbers_widget" width="300" height="195" DisableNVelocity="true" />Blood pressure is all about the numbers. And those numbers have changed. Until recently, blood pressure was considered high with a reading of 140/80 or above. But research has led to new guidelines, which now identify 130/80 as high blood pressure and healthy blood pressure as 120/80. One result of these guidelines is that more people are being diagnosed as having high blood pressure, allowing their health care teams to intervene sooner. So what does this mean for you? First, what do these numbers represent? <ul> <li>Systolic pressure. This is the higher number, which is the phase of the heartbeat when the heart muscle contracts and pumps blood from the chambers into the arteries. </li> <li>Diastolic pressure. The lower number is when the heart muscle relaxes and allows the chambers to fill with blood. </li> </ul> Both are important. High blood pressure can lead to cardiovascular disease, which puts you at risk for a heart attack or stroke. Unfortunately, most people don't know if they have high blood pressure, since there are few symptoms; that's why it's called the silent disease. The best way to find out if your blood pressure is high is to be screened.  Screening for high blood pressure Most people should start having their blood pressure checked at age 40, and every three to five years after that, if they're healthy. Typically, adults have their blood pressure checked whenever they come to the clinic, which helps you and you care team stay on top of your numbers.  However, if your body mass index (BMI) is over 25, you are African American, or have previously been found to have high blood pressure (above 130/80), you should be checked every year.  If you're found to have high blood pressure (130/80 or higher) in the office,you should have your blood pressure confirmed with readings at home. You will also need to continue to monitor your blood pressure regularly by taking your blood pressure when you're away from the clinic. This is a chronic disease that needs to be managed by regular monitoring and annual visits to your provider.  Managing your condition The first course of action for managing high blood pressure is making lifestyle changes, either instead of, or in addition to, starting on medication. Losing weight, even just 10 pounds, can have a major impact. The <a rel="noopener noreferrer" rel="noopener noreferrer" href="https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/dash-diet/art-20048456" target="_blank">DASH diet</a>, with its emphasis on fruits and vegetables, is one of the most effective approaches for stopping high blood pressure. Increasing exercise and decreasing alcohol consumption helps, too.  Treatment with medication depends on the stage at which your blood pressure was diagnosed.  <ul> <li>Stage 1 (130-139/80-89). Medications are given based on other risk factors, such as heart or kidney disease or diabetes. For many, lifestyle changes may be enough. </li> <li>Stage 2 (140/90). Medication is recommended for nearly everyone. These fall into four categories: diuretics (chlorthalidone, hydrochlorothiazide); ACE inhibitors (lisinopril); ARBs (losartan); and calcium channel blockers (amlodipine). Studies have shown all are equally effective in reducing blood pressure. At Stage 2, two drugs may be prescribed. </li> </ul> If you're on medications, it's really important to take them as prescribed; definitely don't stop without consulting your care team. Also, you'll need periodic blood tests to check your levels of electrolytes, which are the balance of salts in your body. Along with these steps, it's vital to monitor your blood pressure at home, which is the best way to determine the effectiveness of your treatment.  One side effect of treating high blood pressure is that you can develop low blood pressure. This condition can cause dizziness, lightheadedness and increase the risk of falls. This potential side effect is why it's important to monitor your blood pressure, take your medication as prescribed, and contact your clinician with any side effects that you experience.  Blood pressure is all about the numbers. But if you keep the numbers in line with healthy guidelines, you greatly reduce the chance of heart attack or stroke.  <a href="https://communityhealth.mayoclinic.org/providers/jason-post-md">Jason Post, M.D.,</a> is an internal medicine physician in the Division of Community Internal Medicine, Geriatrics and Palliative Care and practices in the Baldwin Building clinic in Rochester. His interests include hypertension, medical education, competency-based assessment, point-of-care ultrasound and office-based procedures. Jason Post, M.D.Primary Care in Rochester and KassonBlood PressurePrimary Care in Rochester and KassonCataracts are a potentially reversible cause of vision loss.<img src="/-/media/ech-media/images/widgets/medicalimages/ech_cataracts_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=9E84B7321DC6398671C645F2D59E0F50" alt="ECH_Cataracts_widget" width="100" height="65" DisableNVelocity="true" />What you need to know about cataracts6/5/2023 4:30 AM<img src="/-/media/ech-media/images/widgets/medicalimages/ech_cataracts_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=63091FC346A73822344509F0123BCA3C" alt="ECH_Cataracts_widget" width="300" height="195" DisableNVelocity="true" />Cataracts affect more than 24.4 million Americans by the time they reach age 40 and older. By age 75, approximately half of all Americans have cataracts. They're responsible for about 12% of cases of blindness in the U.S., but they're also treatable.  With chances of developing cataracts high, here's what you need to know about what they are, what causes them and how they're treated: <img alt="CataractEyeLens" src="/-/media/ech-media/images/widgets/medicalimages/cataracteyelens.jpg?h=132&w=289&sc_lang=en&hash=BCA4740262DB5EBE185C83047CE569DA" style="height: 132px; width: 289px; float: right;" />What is a cataract? A cataract is clouding of the lens, the part of your eye that focuses light.  What causes a cataract? This clouding is mainly driven by the effects of aging. That's why most cataracts appear in patients 60 and older. A cataract also can develop from direct trauma to the eye and sometimes as an effect of prolonged systemic steroid use. Factors that can play a role in age degeneration of the lens include smoking, drinking alcohol, diabetes and exposure to sunlight.  What are the symptoms of cataracts?  Symptoms often but not always appear in both eyes, usually as blurry vision. Some patients complain of everything looking slightly brown in color. Another common symptom is difficulty driving at night. Many people say that headlights seem to have a glare or halo, and it's hard to read street signs. Symptoms are often progressive but not associated with pain.  How are cataracts diagnosed? Cataracts are easily diagnosed by direct inspection of your eye without using any special equipment. Your primary care clinician can make this diagnosis. However, your clinician will almost always send you to an ophthalmologist for a comprehensive eye exam. The ophthalmologist will determine your treatment and make sure no other eye problems need to be addressed.  How are cataracts treated? The main treatment for cataracts is surgery. The procedure is simple with minimal risks. It consists of removing the cloudy lens and replacing it with an artificial one.  Your ophthalmologist most likely will operate on one eye and then operate on the other at a different time. The surgery rarely causes pain or infection.  Not all cataracts need to be removed, and the decision is based on the degree of vision loss being caused and whether you want to undergo surgery. When cataracts are severe enough, surgery can greatly improve vision.  Can cataracts be prevented? No known therapy prevents cataracts. However, a healthy diet rich in fruits and vegetables, along with smoking cessation, can slow the normal aging process of the eye lens. Protecting your eyes from sunlight with sunglasses or a hat also can help.  <a href="https://communityhealth.mayoclinic.org/providers/daniel-sanchez-pellecer-md">Daniel Sanchez Pellecer, M.D.</a>, is a physician in the Division of Community Internal Medicine, Geriatrics and Palliative Care at Mayo Clinic in Rochester. His interests align with delivery systems of high-quality and compassionate primary care for older adults with a special focus on palliative care. He is board-certified in internal medicine, geriatrics and palliative care. Daniel Sanchez Pellecer, M.D.Primary Care in Rochester and KassonCataractsPrimary Care in Rochester and KassonFind answers about fibromyalgia, its symptoms and more.<img src="/-/media/ech-media/images/widgets/medicalimages/ech_fibromyalgia_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=B65C72346AB8584095F56E248B695E78" alt="ECH_Fibromyalgia_widget" width="100" height="65" DisableNVelocity="true" />When everything hurts: Fibromyalgia explained5/25/2023 4:30 AM<img src="/-/media/ech-media/images/widgets/medicalimages/ech_fibromyalgia_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=CE0D829269E472D260CD6461051B83D4" alt="ECH_Fibromyalgia_widget" width="300" height="195" DisableNVelocity="true" />Fibromyalgia is a common illness that is characterized by chronic, widespread pain. It also is often accompanied by other symptoms such as fatigue, sleep problems, mood disturbances and cognitive complaints. Approximately 2-8% of the general population is affected by fibromyalgia, and symptoms can range in severity from being a nuisance to causing severe limitations in function. Despite it being relatively common, fibromyalgia remains poorly understood by many.  What is fibromyalgia? The exact cause of fibromyalgia is unclear. Most physicians believe it is a disorder of pain processing and regulation where the body is more sensitive to pain stimuli than would normally be expected. Fibromyalgia often coexists with other acute or chronic pain conditions, including trauma, osteoarthritis, rheumatoid arthritis and chronic back pain. Mood disorders or stress may also trigger fibromyalgia symptoms. It can develop at any age and affects people of all backgrounds.  What are the symptoms? The primary symptom of fibromyalgia is chronic, widespread pain that lasts more than three months without another cause, but there are many other potential symptoms. Common symptoms include: <ul> <li>Widespread musculoskeletal (usually aching) pain for more than 3 months.</li> <li>Fatigue/sleep disruptions.</li> <li>"Brain fog/fibro fog" or problems with memory, attention or concentration.</li> <li>Depression.</li> <li>Other body symptoms: headaches, jaw pain, abdominal pain/bloating, nausea, diarrhea, dizziness, numbness or tingling.</li> </ul> What are the risk factors? There are both modifiable and unmodifiable risk factors for fibromyalgia: <ul> <li>Unmodifiable risk factors: <ul> <li>Genetics/family history.</li> <li>Female gender.</li> <li>Psychiatric disorders such as depression, anxiety, post-traumatic stress disorder and obsessive-compulsive disorder.</li> <li>Other coexisting painful or inflammatory conditions.</li> </ul> </li> <li>Modifiable risk factors: <ul> <li>Physical inactivity.</li> <li>Overweight/obesity.</li> <li>Poor sleep habits.</li> </ul> </li> </ul> How is fibromyalgia diagnosed? Fibromyalgia is a clinical diagnosis, meaning it requires a thorough history and physical exam and can be diagnosed without lab tests or imaging. Your clinician may do limited lab workup and/or imaging to rule out other causes of fibromyalgia-like symptoms. He or she may also consider a sleep study if sleep apnea or other sleep disorders as suspected.  What is the treatment? Fibromyalgia is a chronic disease with no cure, but it can be managed. Treatment focuses on improving function and quality of life and managing symptoms. No single treatment will resolve all symptoms related to fibromyalgia, so a combination of treatments is often needed. Non-medication therapies are the mainstay of treatment. It is also important to treat coexisting conditions such as sleep apnea or depression.  Regular physical activity, including aerobic exercise, is very important in the treatment of fibromyalgia. Options for low-impact aerobic exercise include walking, biking, swimming and water aerobics. Other forms of exercise therapy may include strength training, tai chi or yoga. General guidelines recommend that healthy adults should get 150 minutes of moderate-intensity exercise per week: that's 30 minutes, 5 days per week. People with fibromyalgia should gradually build up their exercise tolerance to avoid an increase in symptoms.  Other potential treatment options include: <ul> <li>Stress management, cognitive behavioral therapy and mindfulness techniques. Mayo offers online modules for these treatments. </li> <li>Maintaining good sleep habits.</li> <li>Balanced diet and weight reduction.</li> <li>Manual therapies (acupuncture, chiropractics, massage, etc.).</li> <li>Medications also have a role in treatment: <ul> <li>Your clinician may recommend medications such as duloxetine, gabapentin, pregabalin or amitriptyline. Over-the-counter pain medications may also be helpful. </li> <li>Narcotic medications have not been shown to be helpful, may worsen pain and carry addiction risks. </li> <li>Medical cannabis has not been shown to be effective. </li> </ul> </li> </ul> Bottom line Fibromyalgia is a common condition characterized by widespread musculoskeletal pain for more than three months. Treatment focuses on improving function and quality of life and incorporates both medications and non-medication therapies.  <a href="https://communityhealth.mayoclinic.org/providers/terin-sytsma-md/">Terin Sytsma. M.D.</a>, is a physician in the Division of Community Internal Medicine, Geriatrics and Palliative Care. She has a particular interest in musculoskeletal medicine, office-based procedures, and medical education. Terin Sytsma, M.D.Primary Care in Rochester and KassonFibromyalgiaPrimary Care in Rochester and KassonFind tips to decrease the amount of food you waste.&nbsp;<img src="/-/media/ech-media/images/widgets/food/foodwaste.jpg?h=65&iar=0&w=100&sc_lang=en&hash=07ED8AD85E4AFB21DCA3E20CFCD230FC" alt="FoodWaste" width="100" height="65" DisableNVelocity="true" />Are you 'waste wary' with food?6/1/2023 4:30 AM<img src="/-/media/ech-media/images/widgets/food/foodwaste.jpg?h=205&iar=0&w=315&sc_lang=en&hash=EB820493C55DCC0D56E826C39737D2EE" alt="FoodWaste" width="315" height="205" DisableNVelocity="true" />Are you wary of routinely throwing away food? Being "waste wary" is important because food waste is not only harmful to our wallets, but it also harms the environment. Making small, thoughtful changes to our habits can help reduce food waste.  Consider these tips to start reducing food waste: Create a grocery list. Menu plan and use that plan to create your list. Not only will you buy less, but you will also save some money, too.  Build leftovers into the menu. Whether at a restaurant or at home, this is a wonderful way to avoid throwing out extra food. You can reheat leftovers as an extra meal or even add them to another recipe to create a new meal.  Explore ways to use your extra food items. Do you throw out the heel of your bread loaves? There are many ways they can be used. Check out some recipes online. Examples include grating them into breadcrumbs, using them to soften baked goods or brown sugar, using them as a thickener or making a bread pizza out of them. Consider ways to use foods "past their prime." Just because a fruit or vegetable does not look "normal" does not mean that it's inedible. They will taste the same. Instead of throwing overripe fruit away, add them to smoothies.  Incorporate a way to compost. Composting food items lost in the back of the refrigerator is another way to repurpose foods to reduce waste. Look at your city government website to find out more about composting or look into tips on how to <a rel="noopener noreferrer" rel="noopener noreferrer" href="https://www.nrdc.org/stories/composting-101" target="_blank">compost</a> at home.  Be storage savvy. Storing food correctly can maximize freshness. Learn better ways to keep your food fresh longer through the <a rel="noopener noreferrer" rel="noopener noreferrer" href="https://savethefood.com/storage" target="_blank">food storage guide</a> and <a rel="noopener noreferrer" rel="noopener noreferrer" href="https://www.foodsafety.gov/keep-food-safe/foodkeeper-app" target="_blank">FoodKeeper App</a>.  Rethink "best if used by." These phrases indicate when a food item will be at its best quality. It's not necessary to automatically throw out items that are past their date. Look for changes in smell, color and texture to decide if food is fit for the menu or the compost bin.  It may be overwhelming to start all of these tips to limit your food waste at once. Try adding one or two into your routine to start. Think of what will work best with your daily routines, and soon you'll be making use of your food "waste." Kelly Hastings is a dietetic intern at Mayo Clinic in Rochester, Minnesota. She received her undergraduate degree at Gustavus Adolphus College and completed her graduate degree at the University of Michigan. Kelly HastingsPrimary Care in Rochester and KassonFood WastePrimary Care in Rochester and KassonThese tips can help you learn more about Lyme disease and help you enjoy time in the outdoors this upcoming season.&nbsp;<img src="/-/media/ech-media/images/widgets/randomimages/lymediseasetick.jpg?h=65&iar=0&w=100&sc_lang=en&hash=EF52DE945D8FE49E48BF30A38927582E" alt="LymeDiseaseTick" width="100" height="65" DisableNVelocity="true" />That's not a mole, that's a tick!5/15/2023 4:30 AM<img src="/-/media/ech-media/images/widgets/randomimages/lymediseasetick.jpg?h=205&iar=0&w=315&sc_lang=en&hash=701EA87478B4D3F81854C88AA8A16777" alt="LymeDiseaseTick" width="315" height="205" DisableNVelocity="true" />Tick bites tend to happen when it's least expected. It's important to know that some tick bites can cause an illness called Lyme disease. In the U.S., bites from infected blacklegged deer ticks are the most common type of tick bite to cause this illness. However, when evaluating patients for Lyme disease, clinicians consider several things: Where in the U.S. did the bite occur? The chances of your tick bite causing Lyme disease depends on where in the U.S. the bite occurred. Not all ticks are infected with the bacterium that causes Lyme disease. To help you understand if your tick bite has a high chance of carrying the disease-causing bacteria, check out the <a rel="noopener" href="https://www.cdc.gov/lyme/about/" target="_blank">Center for Disease Control and Prevention's information on Lyme disease</a>. Their map will show you which states have a high incidence of the disease. If your tick bite occurs in one of these high-incidence states, you have a higher risk of developing Lyme disease. How long was the tick attached to your body? If an infected tick is attached to your body for 36 or more hours, it could put you at a higher risk of developing Lyme disease. However, if the tick is attached to your body for less than 36 hours, you have a lower chance of developing the disease. What are the symptoms of Lyme disease? If an infected tick is not removed early enough, Lyme disease can develop. The symptoms of Lyme disease are broad, and they can change depending on how long an infected tick was attached. If infected for three to 30 days: <ul> <li>You may notice a gradually expanding target-like rash at the site of the tick bite. This symptom occurs in most but not all patients. </li> <li>Flu-like symptoms also can occur, including a new headache, fever, chills, swollen lymph nodes, fatigue, muscle aches or joint aches.</li> </ul> If left untreated, more significant symptoms can develop: <ul> <li>More target-like rashes on your body. </li> <li>Severe joint pain that can move to different joints. </li> <li>Inflammation of the heart that can cause palpitations or chest pain. </li> <li>Inflammation of the covering of your brain and spinal cord that can cause a stiff neck, headache and fever. </li> <li>Weakness of the muscles on one side of your face, which is caused by a condition known as Bell's Palsy.</li> </ul> <img height="242" alt="LymeDiseaseRash1" width="800" src="/-/media/ech-media/images/widgets/randomimages/lymediseaserash1.jpg?sc_lang=en&hash=57297D15EB25D765975F60EA0612F899" /> How is Lyme disease diagnosed? If you think you have Lyme disease, your health care clinician should evaluate you. Sometimes the disease can be diagnosed based on your history and physical examination alone. Blood tests can help diagnose Lyme disease as well. If blood tests are performed too soon, the results can sometimes be falsely negative. If a patient has a history and physical examination suggestive of possible Lyme disease and tests negative, they should be retested in two to four weeks. How is Lyme disease treated? If you are concerned about a recent tick bite, try to visit your health care clinician within 72 hours of the tick bite to see if you would benefit from preventive antibiotic treatment. If you see your health care clinician after 72 hours of a tick bite, you could be treated with a longer course of antibiotics if your clinician feels you would benefit from treatment for Lyme disease. How can you prevent a tick bite? If you spend time in wooded or grassy areas, take extra precautions to avoid a tick bite with these preventive measures: <ul> <li>Wear bright-colored, long-sleeved shirts, with long pants tucked into your socks. Wear closed-toe shoes. These measures help prevent ticks from attaching to your skin. </li> <li>To stay cool and protected from the sun ― and from ticks ― wear sun-protective clothing. </li> <li>Apply permethrin to your clothing or purchase pretreated permethrin clothing. Do not apply permethrin directly to your skin. If you use permethrin clothing or gear, be sure to follow the product packaging labels for directions and precautions. </li> <li>Apply an Environmental Protection Agency-registered insect repellent containing DEET or picaridin to your skin to help repel ticks. Be sure to follow package instructions. </li> <li>Carefully inspect your body, clothes, pets and children after spending time outdoors. </li> <li>Shower with a washcloth as soon as you come indoors for the day. This is a good time to inspect your entire body for signs of ticks. Pay close attention to your armpits, groin, behind your knees and in your hair. </li> <li>Place dry clothing in your dryer on high heat after you come indoors for at least 10 minutes to help try to kill ticks that may be on your clothing. This practice may reduce your exposure to ticks brought into your home. If clothes are wet or damp, longer times in the dryer are needed. </li> <li>If you identify a tick on your body, have it removed as soon as possible. You can try removal on your own with tweezers. Be sure to grasp the tick as close to the mouth as possible. Carefully pull away from your body and dispose of it in isopropyl alcohol to kill it. Place the tick in a bag and bring it to your health care clinician for it to be examined. Be sure to clean the bite area with soap and water after removal. If you do not feel comfortable removing the tick, make an appointment with your health care clinician for assistance. </li> <li>If you remove a tick from your body – or if you think you have encountered a tick bite ― call your medical clinician.</li> </ul> <a href="https://communityhealth.mayoclinic.org/providers/joshua-luciew-pac">Joshua Luciew, MPAS, P.A.-C.</a>, is a physician assistant in the Department of Family Medicine at Mayo Clinic in Rochester. He enjoys wilderness medicine and practices at Mayo Family Clinic Southeast.Joshua Luciew, MPAS, P.A.-C.Primary Care in Rochester and KassonLyme DiseasePrimary Care in Rochester and KassonA few proven treatments can help slow or even restore hair in areas of baldness.&nbsp;<img src="/-/media/ech-media/images/widgets/people/malebaldness.jpg?h=65&iar=0&w=100&sc_lang=en&hash=227FEF99871FBFF51615226EED03EF0D" alt="MaleBaldness" width="100" height="65" DisableNVelocity="true" />What can you do about male pattern hair loss?6/8/2023 4:30 AM<img src="/-/media/ech-media/images/widgets/people/malebaldness.jpg?h=205&iar=0&w=315&sc_lang=en&hash=BE1B7254D94A795F9F59C01220078E3A" alt="MaleBaldness" width="315" height="205" DisableNVelocity="true" />Androgenic alopecia, also known as male pattern baldness, affects roughly half of men. Given its commonness, this condition shouldn't be thought of as abnormal. However, if you carry the right combination of genes and an average male level of testosterone resulting in significant hair loss, you may be wondering if there's anything you can do about your receding hairline or balding patch. If your male pattern baldness doesn't bother you, don't worry about it. There's nothing wrong with allowing your body to change with age, and your hair loss will not negatively affect your physical well-being. If you prefer to take steps to slow hair loss or even restore hair in areas of baldness, let your primary care clinician know. A few proven treatments can help, but your clinician may not initiate the conversation unless they know this is a concern of yours. Here are some options: <ul> <li>Finasteride. This once-daily pill is commonly known as Propecia. Its effects are most pronounced if continued for several years. After discontinuation, hair loss can return quickly. The main side effects are reduced sexual function or libido.</li> <li>Minoxidil. This topical scalp treatment comes in a few different forms and often needs to be used twice daily for several months followed by indefinite treatment. Side effects are uncommon, but as with finasteride, discontinuation results in continued hair loss.</li> <li>Surgery. Hair transplantation involves harvesting hair follicles from the portion of your scalp with thicker hair and moving them to the balding areas. This surgery is often performed in combination with finasteride or minoxidil use.</li> </ul> Other treatments with less evidence for benefit include light therapy, platelet-rich plasma injections, and other medications and vitamins. At the end of the day, if you are wondering about taking steps to address your male pattern hair loss, ask your primary care clinician if any of these options would be a good fit for you. <a href="https://communityhealth.mayoclinic.org/providers/david-brennan-md/">David Brennan, M.D.</a>, is a primary care physician in the Division of Community Internal Medicine, Geriatrics and Palliative Care in Rochester, Minnesota. He focuses on prevention and treatment of a wide variety of common diseases. David Brennan, M.D.Primary Care in Rochester and KassonMale Pattern Hair LossPrimary Care in Rochester and KassonOne in five children will suffer from a serious mental health condition.&nbsp;<img src="/-/media/ech-media/images/widgets/kids/ech_youngboywindow_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=69E195E19A4E645F3D2D39FD0FACCEA8" alt="ECH_YoungBoyWindow_widget" width="100" height="65" DisableNVelocity="true" />Encouraging psychological wellness in children6/26/2023 4:30 AM<img src="/-/media/ech-media/images/widgets/kids/ech_youngboywindow_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=5472435767AE99545075DB0B58FE8FF3" alt="ECH_YoungBoyWindow_widget" width="300" height="195" DisableNVelocity="true" />It's inevitable that our children will face disappointment, rejection and challenges. These situations and feelings will be opportunities for growth, especially if we can help our children develop resiliency. Building resilience in children means increasing their ability to respond positively and adapt when faced with adversity, tragedy, challenges or stressors.  When we try to solve our children's problems, we deprive them of opportunities for independence and slow their development of self-efficacy. It sends the message that we don't think they can handle the problem. However, if we support our children and push them to try new things, be uncomfortable and meet new people, they may just learn how much they are truly capable of. Through our good intentions to prevent pain for our children, we may actually be preventing their growth.  Children and adolescents often have intense or confusing emotions. They don't always know how to express themselves. Parents may be left wondering if they should be concerned. There are several signs to watch for in children and adolescents that may indicate they are struggling and need additional support. These include the following changes in behavior:  <ul> <li>Unusually and excessively sad, irritable or upset. </li> <li>Sudden changes to sleep or appetite.</li> <li>Persistent low energy.</li> <li>Loss of focus and concentration.</li> <li>Loss of interest in enjoyable activities.</li> <li>Excessive and disproportionate worry or fear.</li> <li>Difficulties separating from caregivers.</li> </ul> If you are concerned for your child's psychological wellness or have noticed these symptoms for more than a few days, please talk to your child's primary care clinician. Strategies for building resiliency and psychological wellness in children and adolescents include:  <ul> <li>Helping children build a social support network of people — young and old — who are supportive, caring and competent.</li> <li>Empowering children to make their own choices and giving them appropriate responsibilities for their developmental age. </li> <li>Setting an example for the behaviors you want your children to demonstrate. </li> <li>Promoting realistic goal setting based on your child's own interests and aspirations. </li> <li>Modeling and encouraging how to manage mistakes. </li> <li>Encouraging expression of all emotions and validating those emotions without fixing the problem. </li> <li>Praising effort, not performance. </li> <li>Promoting exercise, good sleep and a balanced diet.</li> <li>Making failure a part of trying and succeeding. </li> <li>Encouraging facing fears and trying new things. </li> </ul> <a href="https://communityhealth.mayoclinic.org/providers/hannah-mulholland-licswmsw">Hannah Mulholland, L.I.C.S.W., M.S.W.</a>, is a clinical social worker serving children and adolescents in Primary Care in Rochester and Kasson's Division of Integrated Behavioral Medicine. Hannah Mulholland, L.I.C.S.W., M.S.W.Primary Care in Rochester and KassonMental Wellness ChildrenPrimary Care in Rochester and KassonThere are many evidence-based treatments for migraine, and the list of options continues to grow.&nbsp;<img src="/-/media/ech-media/images/widgets/people/headache.jpg?h=65&iar=0&w=100&sc_lang=en&hash=8F90D3F4C846C5AC7032F61772E02DA9" alt="Headache" width="100" height="65" DisableNVelocity="true" />Help! I have a migraine6/12/2023 4:30 AM<img src="/-/media/ech-media/images/widgets/people/headache.jpg?h=205&iar=0&w=315&sc_lang=en&hash=AC5BECF76DFB518F61B9CA8D503AA736" alt="Headache" width="315" height="205" DisableNVelocity="true" />Migraine is one of the most common and debilitating conditions we care for in primary care. Thousands of office visits per year are focused on evaluating and treating migraine headaches. Their impact on quality of life, function, work and leisure activities can be tremendous. Suffering from a migraine is not like a broken bone that heals predictably over time but instead can be unpredictable, frequent and just as disabling. A migraine is a biological disease that probably has genetic underpinnings. Migraine patients face a lot of unnecessary stigmas. A migraine is not due to a lack of resiliency or ability to manage stress or emotion. The migraine patients we care for every day are very resilient and are usually trying to live busy, active lives. Migraine headaches are typically experienced as throbbing, pounding headaches that are often worse on one side. Migraines are usually accompanied by sensitivity to light, sound, smell and motion, as well as nausea. The pain usually goes on for more than four hours and can last days. Thankfully, there are many evidence-based treatments for migraine, and the list of options continues to grow. Most treatments can be provided by your primary care team, although some may require consultation with a neurologist. In primary care, we are working hard to improve migraine care and make it more convenient and affordable for our patients. All clinicians at Mayo Clinic may order the migraine e-learning module for their patients. This is a self-paced online learning module full of helpful content from Mayo headache experts. You will need access to the Mayo Clinic patient portal to access the module. If you do not have a portal account, you can <a href="https://onlineservices.mayoclinic.org/content/staticpatient/showpage/patientonline">sign up here</a>. Ask your primary care team for an order. Keep in mind that when you see your primary care clinician, they have access to telephone or electronic advice from neurologists in the Integrated Community Specialty (ICS) clinic where the full range of migraine treatments may be prescribed. Formal face-to-face consults are available in ICS as well as the headache subspecialty clinic. If your condition leads to an ICS visit, we will develop an individualized migraine care plan. We have learned from patients that they want a plan as well as the ability to contact us via portal or telephone as they progress along the plan. The ICS team can help you follow your treatment plan until you are stable and satisfied. Your primary care team can then help continue with the long-term care plan. Within ICS we have developed a way for you to use the Mayo app on your smartphone to assess and monitor your migraine. This approach is called the Migraine Interactive Care Plan. The data you share about your headaches goes into your chart and can replace other headache trackers you may be using. We don't actively monitor the data, but if you are not well, we can use your information to justify the next step in a care plan. You can also see and track your own progress with additional education that is delivered through the app. This helps ease communication with your care team. We hope to begin offering this interactive care plan in primary care in late 2023. <a rel="noopener noreferrer" href="https://www.mayoclinic.org/biographies/young-nathan-p-d-o/bio-20055108" target="_blank">Nathan Young, D.O.</a>, is a community neurologist with a special interest in migraine care. He sees patients in the Integrated Community Specialties practice that supports Rochester-based primary care teams. He is also the chair of Community Neurology for the Mayo Clinic Health System.Nathan Young, D.O.Primary Care in Rochester and KassonMigrainePrimary Care in Rochester and KassonSuspect a problem? See your care team or a dentist for an exam.&nbsp;<img src="/-/media/ech-media/images/widgets/people/soremouth.jpg?h=65&iar=0&w=100&sc_lang=en&hash=EAB55F36184AA58417CBFFBDEE7F944D" alt="SoreMouth" width="100" height="65" DisableNVelocity="true" />Know the symptoms of oral cancer6/22/2023 4:30 AM<img src="/-/media/ech-media/images/widgets/people/soremouth.jpg?h=205&iar=0&w=315&sc_lang=en&hash=49B496D93384487501B377EBDC9E0587" alt="SoreMouth" width="315" height="205" DisableNVelocity="true" />According to the American Cancer Society, an estimated 54,540 people will be diagnosed with oral cavity or oropharyngeal cancer in 2023 in the United States, and 11,580 people will die from the disease. Most cases of oral cancer are linked to cigarette smoking, heavy alcohol use and the human papillomavirus. Tobacco use plus alcohol poses a much greater risk than using either substance alone. Smokeless tobacco, a form of tobacco placed into the mouth and not burned, also can significantly increase the risk for oral cancer.  A variety of symptoms may indicate oral cancer including:  <ul> <li>Lump, sore or white or red patch in the mouth, lip or throat.</li> <li>Feeling like something is caught in the throat.</li> <li>Difficulty chewing, swallowing or moving the tongue.</li> <li>Numbness in the tongue or other areas of the mouth.</li> <li>Jaw swelling.</li> <li>Ear pain.</li> </ul> These symptoms are not always cancer, but it's important to have them checked out early because cancer caught earlier is easier to treat. A person who has these symptoms for more than two weeks should see a dentist or clinician for an oral examination.  If you are at high risk for oral cancer, you should have frequent checks with an oral health professional or medical clinic provider.  One way to lower your chance for oral cancer is to quit tobacco use completely. Effective treatments for helping you stop smoking include nicotine replacement therapy (gum, patch, lozenge, inhaler, nasal spray), as well as two prescription medications, varenicline and bupropion. For quitting the use of smokeless tobacco, nicotine replacement therapy (lozenge) and varenicline have proven effective.  <a rel="noopener noreferrer" href="http://communityhealth.mayoclinic.org/providers/jon-ebbert-md" target="_blank">Jon Ebbert, MD</a>, is a physician in the Division of Community Internal Medicine, Geriatrics and Palliative Care in Rochester, Minnesota. He is the medical director of <a rel="noopener noreferrer" href="http://www.mayoclinic.org/departments-centers/nicotine-dependence-center/minnesota/overview" target="_blank">Mayo Clinic's Nicotine Dependence Center</a> and chair of Community Internal Medicine's Division of Telehealth, where he provides virtual visit care across Southeast Minnesota. Jon Ebbert, M.D.Primary Care in Rochester and KassonOral CancerPrimary Care in Rochester and KassonOver-the-counter aids can help you sleep better, but which one's right for you?<img src="/-/media/ech-media/images/widgets/medications/ech_otcsafety_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=2D0DF10F070FA0FE28C1A97D155DCF1E" alt="ECH_OTCsafety_widget" width="100" height="65" DisableNVelocity="true" />Aids for getting a good night's sleep5/11/2023 4:30 AM<img src="/-/media/ech-media/images/widgets/medications/ech_otcsafety_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=29475A3DC6C9A4584FE255AFDD669627" alt="ECH_OTCsafety_widget" width="300" height="195" DisableNVelocity="true" />Getting a good night's sleep is a challenge for a lot of Americans. According to the Centers for Disease Control and Prevention (CDC), about one in three adults report not getting enough sleep at night. An estimated 50-70 million Americans have some type of sleeping disorder. Not getting enough sleep can be linked to many chronic conditions such as heart disease and obesity. The American Academy of Sleep Medicine and the Sleep Research Society recommend adults sleep at least seven hours each night. To help achieve that healthy goal, 10 to 12 percent of adults use over-the-counter (OTC) sleep aids, according to the U.S. Department of Health and Human Services (HHS). Catching ZZZs can be more difficult for seniors The quality of sleep decreases as we age. People over 60 years or older are at higher risk for insomnia; sleep duration may shorten, and sleep latency (the time it takes to fall asleep) may increase. Sleep is often interrupted by a variety of factors, including medications, sleep-interrupting trips to the bathroom and high incidence of depression. Getting back to sleep then becomes the problem. Consequently, we often see seniors seeking medications to combat trouble sleeping. Using OTC sleep medicines is quite common in patients who have been regularly taking prescribed medications to treat insomnia. Nearly all sleep-promoting medicines, whether prescribed or OTC, have an especially high potential for side effects. Generally, it's best to avoid or limit use as much as possible. Talk with your doctor or pharmacist before starting any over-the-counter medications or supplements to review any potential interactions with your other medications and potential adverse effects. As a pharmacist, I ask patients, "What medication do you take if you can't sleep?" followed by, "Does it help?" I hear many different answers to these questions, so here's a look at what's available over the counter: OTC options to help for a better night's sleep Diphenhydramine or doxylamine These are first-generation antihistamines. Other common names are Unisom or ZzzQuil. These antihistamines are also added with some formulations of pain medications, such as acetaminophen or ibuprofen with the addition of "P.M." or "nighttime" in the name. Approval of these products has been grandfathered in, and they haven't been subjected to required safety and efficacy testing for sleep by the FDA. They also take longer to clear from our bodies the older we get. We have good evidence that first-generation antihistamines cause sleepiness, but they come with frequent side effects, especially for seniors. That's because they work by chemically interrupting specific signaling mechanisms in the brain, which already are more disrupted by the aging process. Some side effects include: <ul> <li>Confusion. </li> <li>Morning grogginess. </li> <li>Falling.</li> <li>Slowed reaction times. </li> <li>Short-term learning and memory impairment. </li> <li>Possibility of strokes and longer-term memory impairment. </li> </ul> Melatonin This is a hormone that has some evidence for improving our sleep cycle. We know that when day/night sleep patterns are disrupted, like in people who work night shifts, melatonin can promote drowsiness. Herbal supplements Most OTC herbals are classified as supplements, so they are not FDA regulated for standards of potency and benefit. They're usually referred to as "natural" and purportedly safe. They may enhance sleep, but there's no strong evidence showing real benefit. Herbal supplements also have possible side effects, including impaired motor functions, restlessness, agitation and others. Magnesium This mineral has been promoted to improve sleep quality, but there aren't enough clinical studies to recommend it as an effective sleep aid. Valerian Root Valerian root is an herbal remedy, which has shown to modestly improve sleep quality in various studies but may take several weeks to see benefit. The herbal remedy does not seem to improve sleep duration or insomnia severity. Theanine An amino acid, theanine is promoted to enhance sleep quality, but once again, there aren't enough clinical studies to endorse it as effective for sleep. Ashwagandha Also known as “Indian Winter Cherry” or Indian Ginseng,” research has shown this herb may modestly improve sleep in patients with insomnia or non-restorative sleep. Summary The combination of OTC or prescription sleep aids and alcohol/other substances that affect brain function have the potential to increase the risk of serious side effects or life-threatening sedation. So if you're having trouble sleeping, ask your provider or pharmacist, "What do you think would be safe for me to take with my other medicines?" Often, the answer is not medication or supplements but instead to improve your sleep habits. Check out these helpful sleep tips from the <a rel="noopener noreferrer" href="https://www.thensf.org/sleep-tips/" target="_blank">National Sleep Foundation</a>. Andrea Aguayo, PharmD, RPh, is a first year community-based resident rotating through various outpatient departments at Mayo Clinic in Arizona. She plans to continue her residency training at Mayo Clinic Health System in Eau Claire, Wisconsin. She is devoted to the patients she encounters daily in the clinic and enjoys working with the providers to find the best therapy and answering medication-related questions.Andrea Aguayo, Pharm.D., R.Ph.Primary Care in Rochester and KassonOver The Counter Sleep MedicationsPrimary Care in Rochester and KassonTips to stay healthy with water activities this summer.<img src="/-/media/ech-media/images/widgets/kids/waterpark.jpg?h=65&iar=0&w=100&sc_lang=en&hash=CE464014E5CFB255C178E6BE109147EC" alt="Waterpark" width="100" height="65" DisableNVelocity="true" />Make a healthy splash at pools, waterparks6/19/2023 3:30 AM<img src="/-/media/ech-media/images/widgets/kids/waterpark.jpg?h=205&iar=0&w=315&sc_lang=en&hash=D1B80A3DA40FBF3AF49F8BB3900D8A76" alt="Waterpark" width="315" height="205" DisableNVelocity="true" />Swimming is a great way for kids and adults to be physically active in the summer. But splashing and swimming at waterparks, public pools, lakes or even home pools can pose a health risk if you swallow contaminated water.  Isn't the water disinfected to kill germs and make it safe, you might ask? Water treatments such as chlorine don't kill germs instantly. Some germs such as cryptosporidium can live in properly treated water for days. Swimming-related illness can occur if you swallow, have contact with or breathe in mist from contaminated water. Although diarrhea is the most common swimming-related illness, other illness such as skin rashes, ear pain, cough/congestion and eye pain can also occur. It's important to rinse off after swimming and dry your ears. While pool and water play area operators work hard to keep the water as safe as possible, taking these important measures can reduce your risk of illness.  DO: <ul> <li>Stay out of the water if you've have diarrhea in the past two weeks. </li> <li>Take kids on bathroom breaks and check diapers every hour. Remember that swim diapers and swim pants are NOT leakproof.  </li> <li>Rinse off for one minute before you enter the water play area. </li> <li>Wash your hands — preferably with soap — before eating, especially if you have been playing in or touching the sand. </li> </ul> DON'T: <ul> <li>Drink the water. </li> <li>Sit on the water jets. </li> </ul> If you plan to soak in a hot tub, it's good to follow these additional guidelines:  <ul> <li>Don't let children less than five years of age use hot tubs. </li> <li>Don't drink alcohol before entering the hot tub or during hot tub use. </li> <li>If pregnant, consult a physician before hot tub use, particularly in the first trimester. </li> <li>A well-chlorinated hot tub has little odor. A strong chemical smell indicates a maintenance problem. </li> </ul> Check out the Centers for Disease Control's (CDC) <a rel="noopener" href="https://www.cdc.gov/healthy-swimming/prevention/" target="_blank">Healthy Swimming webpages</a> for more information. Taking a few precautions can make your summer swimming adventures fun and healthy! <a href="https://communityhealth.mayoclinic.org/providers/tessa-hessedal-aprncnp">Tessa Hessedal, APRN, C.N.P.</a>, is a certified nurse practitioner in the Department of Family Medicine at Mayo Clinic Express Care in Rochester, Minnesota. She serves on the guideline committee reviewing up-to-date evidence to ensure the best care is provided to patients. She enjoys mentoring students, traveling and spending time with family and friends. Tessa Hessedal, APRN, C.N.P.Primary Care in Rochester and KassonPools Water ParksPrimary Care in Rochester and KassonStrengthening your social resilience can enhance your happiness and add meaning to life.&nbsp;<img src="/-/media/ech-media/images/widgets/elderly/ech_seniorvitalitygroup_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=6CE74C44036825FF593CE8F199F73EEB" alt="ECH_SeniorVitalityGroup_widget" width="100" height="65" DisableNVelocity="true" />Cultivating social resilience6/29/2023 4:30 AM<img src="/-/media/ech-media/images/widgets/elderly/ech_seniorvitalitygroup_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=6D4A99C1A7B8448529E4BBE03CD93948" alt="ECH_SeniorVitalityGroup_widget" width="300" height="195" DisableNVelocity="true" />What are we finding as we tiptoe out of COVID-19 mask restraints? Each other. Rediscovering the smile of a colleague or person on the street can be priceless. As we reopen the curtain to each other's faces, dare to take a second look at people. On May 2, the U.S. surgeon general reported on an ailment linked to increased heart attacks, depression, diabetes and dementia that affects people no matter where they live: loneliness. He identified "loneliness and isolation" as the new pandemic. How timely for all of us to think about and act on solutions. Cultivating social resilience can minimize many mental health challenges, and it's especially helpful in the midst of transition. How to cultivate social resilience: Set an intention to reach out in some way to up to five people a day. Do it via phone, text, email or in person. Observe rather than judge. Be open to new thoughts, feelings and people. Cultivate self-compassion. You may find yourself extending it to others. Investigate opportunities to volunteer, learn, grow, or play and follow through on doing one of them. Accept people as they are. Allow yourself to learn something from everything. Listen attentively. Let your fears go. Deliberately take in the good for 10–20 seconds at a time. Restore friendships — dare to reach out to someone you have been missing and spend some quality time. Embrace imperfection. Recognize when “perfection” is more of a shield and limits authentic connection. Set a goal each day to express gratitude to someone. Investigate ideas and ask someone about their hobbies or interests. Limit your electronics. Dare to talk to someone on the park-and-ride, in your neighborhood or in your family. Intentionally live from a place of heart and meaning. Energize openness, be curious, get to know people around you and help where you can. Nurture a connection with nature, walk in parks with others, join a bike group, eat outdoors and watch the stars. Connect with someone you treasure at least once a week. YES — harness the power of your "micro yes" — the smallest possible thing you can do without triggering an overwhelming feeling. Keep doing it and build your social resiliency. Here are some online resources you may find helpful: <ul style="margin-top: 0in; list-style-type: disc;"> <li><a rel="noopener noreferrer" href="https://www.resilientoption.com/" target="_blank" title="Opens in new browser window">Resilient Option</a>.</li> <li>ACT Coach from the U.S. Department of Veterans Affairs (available on the <a rel="noopener noreferrer" href="https://apps.apple.com/us/app/act-coach/id804247934" target="_blank" title="Opens in new browser window">Apple App Store</a> and <a rel="noopener noreferrer" href="https://play.google.com/store/search?q=act%20coach&c=apps" target="_blank" title="Opens in new browser window">Google Play</a>).</li> <li>Mindfulness Coach from the U.S. Department of Veterans Affairs (available on the <a rel="noopener noreferrer" href="https://apps.apple.com/us/app/mindfulness-coach/id804284729" target="_blank" title="Opens in new browser window">Apple App Store</a> and <a rel="noopener noreferrer" href="https://play.google.com/store/search?q=mindfulness%20coach&c=apps" target="_blank" title="Opens in new browser window">Google Play</a>).</li> </ul> Strengthening your social resilience can enhance your happiness and add meaning to life. <a href="https://communityhealth.mayoclinic.org/providers/kileen-smyth-licswmsw">Kileen Smyth, L.I.C.S.W., M.S.W.</a>, is a clinical social worker and therapist for Integrated Behavioral Health at Mayo Family Clinic Northwest. She provides individual and group therapy for patients dealing with anxiety, panic, obsessive-compulsive disorder, depression, insomnia and an array of other family and life transition challenges. She also facilitates group supervision, helps educate colleagues and enjoys the opportunity to network with mental health colleagues throughout the Rochester community. Kileen Smyth, L.I.C.S.W., M.S.W.Primary Care in Rochester and KassonSocial ResiliencePrimary Care in Rochester and KassonLifestyle changes can help prevent stroke, and quick action can ensure good outcomes.<img src="/-/media/ech-media/images/widgets/medicalimages/stroke.jpg?h=65&iar=0&w=100&sc_lang=en&hash=C1980AF17A22D06B8805792E91D14E6F" alt="Stroke" width="100" height="65" DisableNVelocity="true" />What you need to know about strokes5/22/2023 4:30 AM<img src="/-/media/ech-media/images/widgets/medicalimages/stroke.jpg?h=205&iar=0&w=315&sc_lang=en&hash=BAFDC172126AF4260FA4649873313489" alt="Stroke" width="315" height="205" DisableNVelocity="true" />Because stroke is one of the leading causes of disability and death, it's important to prevent, identify and treat strokes quickly to ensure good outcomes.  What is a stroke? A stroke occurs when the blood supply to the brain is blocked — known as an ischemic stroke — or bleeding occurs in the brain — known as a hemorrhagic stroke.  What are modifiable stroke risk factors? Risk factors that can be controlled include diabetes, high blood pressure, high cholesterol, smoking, alcohol consumption, sleep apnea, heart disease, obesity and a sedentary lifestyle.  Can strokes be prevented? You can take steps to prevent a stroke by changing your lifestyle — such as losing weight, exercising regularly and seeking treatment for the risk factors mentioned above.  What are stroke symptoms? Stroke symptoms happen quickly, and they include difficulty speaking; vision loss; dizziness; difficulty walking; and weakness or numbness in the face, arm or leg.  If you suspect someone is having a stroke, act FAST.  This acronym stands for: <ul> <li>Facial droop: Ask them to smile and see if their face droops on one side. </li> <li>Arm weakness: Ask them to lift their arms and see if one drifts down. </li> <li>Speech difficulty: Ask them to repeat a phrase and note any slurred speech or odd words. </li> <li>Time: Note the time of the first symptom. Every second counts, so call 911 at once. </li> </ul> Watch this Mayo Clinic Q&A podcast featuring <a rel="noopener noreferrer" href="https://www.mayoclinic.org/biographies/brown-robert-d-jr-m-d-m-p-h/bio-20053204" target="_blank">Dr. Robert Brown, Jr.</a>, chair of Mayo Clinic's Division of Stroke and Cerebrovascular Diseases as he discusses knowing the warning signs of stroke: <iframe width="560" height="315" src="https://www.youtube.com/embed/uz_DGdiHT5w" title="YouTube video player" frameborder="0" allow="accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture"></iframe> How are strokes treated? A stroke is a medical emergency. It's important to seek medical evaluation and treatment as soon as symptoms start to reduce brain damage and disability.  Some patients with ischemic strokes are eligible for time-sensitive treatments like clot-busting medication or minimally invasive procedures to remove the clot. In hemorrhagic strokes, surgery can repair the bleeding blood vessel.  A multidisciplinary team is needed to provide stroke care, recovery and rehabilitation. This team includes physicians; advanced practice providers and nurses; and physical, speech and occupational therapists.  Preventing stroke through lifestyle changes and promptly treating a stroke when it occurs can lower the chances of disability.  <a rel="noopener noreferrer" href="https://www.mayoclinic.org/biographies/nasr-deena-m-d-o/bio-20447797" target="_blank">Deena Nasr, D.O.</a>, is a neurologist in the Division of Cerebrovascular Neurology. She practices in the stroke clinic, Mayo Clinic Hospital — Rochester, Saint Marys Campus, and telestroke practice based out of Rochester. Her interests include cerebrovascular malformations and ischemic stroke management and prevention.Deena Nasr, D.O.Primary Care in Rochester and KassonStrokePrimary Care in Rochester and KassonThese tips can help keep your family safe this summer.&nbsp;<img src="/-/media/ech-media/images/widgets/kids/family-on-beach.jpg?h=65&iar=0&w=100&sc_lang=en&hash=8838039BDD9A94C553D6DC5D88AAD0CE" alt="Family On Beach" width="100" height="65" DisableNVelocity="true" />Make fun and safe summer memories6/15/2023 4:30 AM<img src="/-/media/ech-media/images/widgets/kids/family-on-beach.jpg?h=205&iar=0&w=315&sc_lang=en&hash=B297700482D042D4663A9D546E212AF5" alt="Family On Beach" width="315" height="205" DisableNVelocity="true" />Summer brings an atmosphere of fun and relaxation that's meant to be enjoyed with family and friends. Summer activities often develop into a positive core of experiences that lasts a lifetime. Follow the tips below to make sure the summer memories your child makes are fun and safe.  Beat the heat: Prevent heat exhaustion Children under the age of four are at increased risk of contracting heat exhaustion. To prevent heat exhaustion, avoid scheduling activities during the hottest part of the day. In addition, it's important to stay hydrated, preferably by drinking water or a flavored electrolyte drink. On extremely hot days, offer frequent water breaks to children. Children under the age of six months should only be given breastmilk or formula and should be monitored closely for heat exhaustion.  Spark joy, not burns, this Fourth of July Fireworks bring wonder and awe to a child's world. The safest way to enjoy fireworks is to enjoy a professional fireworks show. If you decide to do a home firework display, do not allow children to light or hold fireworks.  While sparklers may seem like a safer way to enjoy fireworks, they are the leading cause of firework-related injuries. Sparklers should not be given to children seven years of age or younger. Children who are given sparklers must be closely supervised by an adult.  Avoid insect-borne disease Spending time outdoors is a hallmark activity of the summer, and insects are more than willing to enjoy the outdoors with you. Prevent insect bites by applying a bug spray with 10%–30% DEET. Choose the lowest percent of DEET needed (10% DEET lasts for 45 minutes and 30% DEET lasts for five hours). Do not apply bug spray to children who are two months of age or younger.  An alternative insect repellant includes products that contain the oil of lemon eucalyptus and can be applied to children over the age of three. These products contain 10%–30% oil of the eucalyptus and should be EPA registered.  Have your child wear long-sleeved shirts and pants when walking in wooded or long grass areas where ticks like to live.  Lawnmower safety Each year, over 9,000 children sustain lawnmower-related injuries, with 38% of these children sustaining an amputation injury. To prevent injuries, keep children away from the lawn when you are mowing, preferably indoors or at another location. Never let a child ride as a passenger on a lawnmower.  Children 12 years of age and older may operate a push lawnmower, while children 16 years of age and older may operate a riding lawnmower. Teach your child how to safely operate the lawnmower. Require your child to wear appropriate closed-toe shoes and protective eyewear while mowing. In addition, debris should be cleared from the lawn prior to mowing to prevent injury from projectile objects.  Bike and scooter head injury prevention All children and adults should wear a helmet while riding a motorcycle, bicycle or scooter. The helmet should fit properly and meet <a rel="noopener noreferrer" rel="noopener noreferrer" href="https://www.cpsc.gov/safety-education/safety-guides/sports-fitness-and-recreation-bicycles/which-helmet-which-activity" target="_blank">Consumer Product Safety Commission</a> standards.  Water safety Drowning is the leading cause of death in children between one and four years of age. Closely supervise your child around open bodies of water (e.g., kiddie pools, bathtubs, raised pools, lakes, etc.). Children should always wear a properly fitting <a rel="noopener noreferrer" rel="noopener noreferrer" href="https://www.dco.uscg.mil/CG-ENG-4/PFDSel/" target="_blank">Coast Guard-approved life jacket</a> when they are near an open body of water or while riding a watercraft. Enrolling your child in formal swim lessons will teach them how to swim as well as appropriate water safety.  If you have a home pool, make sure your pool is surrounded by a fence that is at least four feet high and is separate from the house. The gate to the fence should be self-closing and self-latching. The latch needs to be out of reach of children. Pool alarms and door alarms may also be utilized. You may also purchase a pool cover that prevents children from falling under the cover.  Sunburn Preventing sunburn in children protects them against skin cancer in adulthood. Limit sun exposure by seeking a shady spot. If seeking shade is not possible, prevent sunburn by applying sunscreen 15 minutes before going outside, regardless of whether the weather is sunny or cloudy. Choose a sunscreen that is broad-spectrum, water-resistant and has an SPF, or sun protection factor, of at least 30. Reapply sunscreen every two hours or sooner if your child is swimming or sweating. you may also have your child wear sun-protective clothing, swim gear, a hat and sunglasses.  For children under six months of age, avoiding sun exposure is the safest way to prevent sunburn. avoiding sun exposure may include seeking shade, using an umbrella, wearing light clothing that covers the legs and arms, wearing hats and sunglasses, or using a stroller canopy. If it's not possible to avoid sun exposure, children under six months of age may have sunscreen of at least SPF-15 applied to their skin. A small amount of sunscreen will not hurt your infant.  <a href="https://communityhealth.mayoclinic.org/providers/chelsea-willson-aprncnpdnp/">Chelsea Willson, APRN, C.N.P., D.N.P.</a>, is a pediatric nurse practitioner in Primary Care in Rochester and Kasson's Division of Community Pediatric and Adolescent Medicine (CPAM) at Mayo Clinic in Rochester. Chelsea Willson, APRN, C.N.P., D.N.P.Primary Care in Rochester and KassonSummer SafetyPrimary Care in Rochester and KassonIncoming traffic to the Baldwin Building will be required to enter the parking ramp.&nbsp;<img src="/-/media/ech-media/images/locations/baldwin.jpg?h=65&iar=0&w=100&sc_lang=en&hash=D111A7A05825057A4A3EB16016795DD7" alt="Baldwin Building" width="100" height="65" DisableNVelocity="true" />Construction to impact Baldwin Building June 86/6/2023 10:35 AM<img src="/-/media/ech-media/images/locations/baldwin.jpg?h=195&iar=0&w=300&sc_lang=en&hash=96BD94AA58F0ABE7DC3CCAE680B9FCB7" alt="Baldwin Building" width="300" height="195" DisableNVelocity="true" />Beginning the afternoon of June 8, 4th Street SW in front of the Baldwin Building will be closed to all through traffic to remove and reroute city water lines.  All car traffic will be required to enter and exit the Baldwin patient parking ramp.  Traffic flow is expected to return to normal by early Friday morning, June 9. Primary Care in Rochester and KassonBaldwin Road ConstructionPrimary Care in Rochester and KassonIt's all over social media, but what is the keto diet?&nbsp;<img src="/-/media/ech-media/images/widgets/food/ketodietfoods.jpg?h=65&iar=0&w=100&sc_lang=en&hash=552569B481BD6B29F19B88601566D5E1" alt="KetoDietFoods" width="100" height="65" DisableNVelocity="true" />Keto Diet: Is it right for you?7/6/2023 4:30 AM<img src="/-/media/ech-media/images/widgets/food/ketodietfoods.jpg?h=205&iar=0&w=315&sc_lang=en&hash=25FEDC72721E08B7F94072E24607F01E" alt="KetoDietFoods" width="315" height="205" DisableNVelocity="true" />It's on social media. Your friends say you have to try it. Foods are marketed as "keto-friendly." Its popularity comes from the claim that it can help you lose weight in a short time. But what is the keto diet — and is it right for you? What is the keto diet? The ketogenic (keto) diet is a high-fat, moderate protein, low-carbohydrate diet. Normally, the body uses carbohydrates as its primary source of energy, but the keto diet restricts carbohydrates to 50 grams per day or less. A more typical intake of carbohydrates is 150-250 grams, or three to five times as much. With the reduced carbohydrate intake, the body is forced to use fat as its primary source of fuel instead of glucose from carbohydrates. This process puts the body in a state of ketosis, meaning the blood has a high level of ketones — thus the name "keto" diet.  Keto diet and weight loss Studies have found that individuals on a keto diet report less hunger and desire to eat. However, the keto diet can be hard to follow long-term due to its restrictive nature. Once individuals return to their original eating patterns, they tend to regain the weight they had lost.  Is the keto diet right for you? Although it is possible to lose weight on a ketogenic diet, it's important to consider other factors before making a drastic change to dietary patterns.  <ul> <li>Individuals may experience "keto flu" (headache, fatigue, grogginess or other flu-like symptoms) while the body transitions into ketosis. </li> <li>People on this diet have an increased risk of constipation, nutrient deficiencies, heart disease and other chronic diseases. </li> <li>Since the keto diet is quite restrictive, many people find it hard to dine out with others. </li> <li>Following this diet requires a lot of time, planning and preparation. </li> <li>A keto diet is not recommended for individuals with certain medical conditions such as diabetes, heart disease, or thyroid or gall bladder conditions. </li> </ul> Reduction vs. restriction A better choice when thinking about weight management would be to reduce the type of carbohydrates you eat rather than following the strict restriction of the keto diet. The priority should be to reduce simple carbohydrates and include more complex carbohydrates. Complex carbohydrates are high in nutrients and fiber that increase fullness, which can help with weight control. Some healthy swaps include:  <ul> <li>Plain yogurt with fruit instead of flavored yogurt. </li> <li>Zucchini noodles instead of linguine or spaghetti noodles. </li> <li>Riced cauliflower instead of white rice. </li> </ul> The bottom line The keto diet is quite restrictive and hard to sustain long-term, making it not the best choice for lifelong weight management. The best diet for weight management is one that can be maintained long-term. If the goal is to lose weight, having a healthy eating pattern along with a calorie deficit and increased physical activity can help individuals manage their weight in a healthy and sustainable way.  Don't restrict carbohydrates — rather, reduce them by choosing more complex carbs. This approach may be more sustainable. Instead of asking if the keto diet is right for you, ask if you can eat this way for the rest of your life and if it's the best choice for your long-term good health.  Carly Olin is a Dietetic Intern at Mayo Clinic. She earned her bachelor's degree in Family and Consumer Science — Dietetics from Minnesota State University, Mankato. Carly OlinPrimary Care in Rochester and KassonKeto DietPrimary Care in Rochester and KassonA parents' guide to keeping kids safe at home.&nbsp;<img src="/-/media/ech-media/images/widgets/kids/babyswallowingtoy.jpg?h=65&iar=0&w=100&sc_lang=en&hash=E20C7B3799B156A7DDD2466203D9D162" alt="BabySwallowingToy" width="100" height="65" DisableNVelocity="true" />You swallowed what? 7/17/2023 4:30 AM<img src="/-/media/ech-media/images/widgets/kids/babyswallowingtoy.jpg?h=205&iar=0&w=315&sc_lang=en&hash=CED2756DC6F80FAC7B4E8C89F54820BC" alt="BabySwallowingToy" width="315" height="205" DisableNVelocity="true" />Anyone who has spent time with small children has noticed they explore their world with all their senses. While this sensory curiosity helps them learn their environment, it also puts them at risk of injury or infection when everyday items end up lodged in dangerous places like mouths, ears and noses. Think only the children in your life do this? It's such a common practice that a museum at Boston Children's Hospital displays items removed from kids' throats, nostrils and ears dating back to 1918. Here's a guide for parents to know what to do when kids do weird things with everyday items and how to keep children safe at home: When kids lodge items in ears and noses Toddlers and preschoolers sometimes stick household items into their noses or ears when no one is watching. Symptoms of something stuck include nasal discharge from one nostril that may be foul smelling or complaints of ear pain or difficulty hearing. Don't try to pull the object out yourself. Block the other nostril with your finger and have the child "blow." If the object doesn't come out, the child should be seen by a health care professional. If you suspect the object is a button battery, paired disc magnet or superabsorbent polymer — also called a hydrogel and found in household items like diapers, hot-and-cold packs and watch-it-grow toys — the child should be seen immediately for an examination and removal of the material. Foreign objects that remain in place for a long time can cause infection or damage to the ear or nose. When kids swallow, inhale or choke on foreign items Kids 6 months to 3 years old are most at risk of choking or inhaling foreign objects. The most dangerous of these items include: <ul> <li>Button batteries and magnets.</li> <li>Long objects, such as toothbrushes or spoons. </li> <li>Superabsorbent polymers or hydrogels. </li> <li>Lead-containing objects, including fishing sinkers, air rifle pellets and lead-based paint. </li> <li>Sharp objects. </li> </ul> The most common items infants inhale are small pieces of food, such as nuts, seeds or popcorn. In older children, the most common are nonfood items, such as jewelry, paperclips, pins and pen caps. At any age, toy balloons and similar objects are the most fatal if inhaled. Children who inhale or swallow any of these items should be seen by a health care professional who can remove the item and provide treatment if necessary. Symptoms that kids have swallowed or inhaled a foreign object include trouble swallowing food, pain in the neck or chest, drooling, coughing, breathing trouble or noisy breathing. Children who suddenly begin drooling excessively, have difficulty breathing, are making high-pitched breathing noises, or coughing and wheezing should be taken to the Emergency Department. When kids chew or lick jewelry or paint Some jewelry can contain harmful chemicals, such as cadmium and lead. With children under 6, be careful when buying or letting them play with jewelry. <a rel="noopener noreferrer" rel="noopener noreferrer" href="https://www.mayoclinic.org/diseases-conditions/lead-poisoning/symptoms-causes/syc-20354717" target="_blank" title="Opens in new browser window">Lead-based paints</a> were banned in residential homes in 1978. In homes built before then, lead-based paint can be found on surfaces, including windows and sills, doors and door frames, stairs, railings, banisters and porches. Children should be discouraged from chewing on or licking these surfaces. If a home has chipping, peeling or cracking lead-based paint, this damage requires immediate attention. When kids eat dirt or grass Kids occasionally eat dirt or grass. A small amount in an otherwise healthy child isn't necessarily dangerous. Keep kids away from dirt and grass treated with chemicals or that have come in contact with animal feces. If your child consistently eats dirt or nonfood items, such as paper, paint or hair, the child should be evaluated by a primary care clinician. This behavior can be a sign of underlying health conditions or nutrient deficiencies. When kids stick things in electrical outlets Kids don't just stick weird objects in their mouths, ears and noses. They also like to stick objects into things around the house. The most dangerous are electric outlets, and the most common things stuck into them are metallic objects, including hairpins, keys, paperclips, utensils and small toy parts. Metallic objects inserted into an outlet can shock the child. If you suspect your child has been electrocuted, seek medical care immediately because not all electric shock injuries are visible. All homes built or renovated after 2008 should have tamper-resistant receptacles. These outlets contain an internal shutter that blocks foreign objects. However, older homes may not have them. Consider upgrading the outlets in your home. Another option is installing outlet plates or covers that small children can't remove and are large enough so they're not a choking hazard. How to keep kids safe at home Keep objects like spare button batteries, jewelry, coins and magnets out of reach of young children. When cleaning the house, do a final search at child level for objects that might have fallen under furniture and evaded the broom or vacuum. If you've got kids in a range of ages, keep in mind that toys appropriate for older children may contain small parts, such as Legos, board game pieces, action figure or doll accessories, that are a choking hazard to younger ones. Educate older siblings about keeping small toy parts away from young children. Create cleanup routines that round up these small toy pieces, and supervise young children around choking hazards. And finally, it's a good idea for anyone in your household caring for the kids to be certified in <a rel="noopener noreferrer" rel="noopener noreferrer" href="https://www.mayoclinic.org/first-aid/first-aid-cpr/basics/art-20056600" target="_blank" title="Opens in new browser window">CPR</a> and choking first aid. <a rel="noopener noreferrer" rel="noopener noreferrer" href="https://www.mayoclinichealthsystem.org/providers/jessie-wilburn-pac-ms" target="_blank" title="Opens in new browser window">Jessie Wilburn, P.A.-C., M.S.</a>, is a physician assistant in Emergency Medicine in Albert Lea, Austin and Red Wing, Minnesota.Jessie Wilburn, P.A.-C., M.D.Primary Care in Rochester and KassonKids Swallowing ThingsPrimary Care in Rochester and KassonIt's important to share your information for personalized healthcare recommendations.&nbsp;<img src="/-/media/ech-media/images/widgets/lgbtqi/ech_lgbt_01_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=1CE67B73FA0193817040129CF7A037BD" alt="ECH_LGBT_01_widget" width="100" height="65" DisableNVelocity="true" />LGBTQIA+ patients: How 'telling' can improve your care7/24/2023 4:30 AM<img src="/-/media/ech-media/images/widgets/lgbtqi/ech_lgbt_01_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=E155F0C3FE10201BCFCA415BC3CC82F9" alt="ECH_LGBT_01_widget" width="300" height="195" DisableNVelocity="true" />We learned that a policy of "don't ask, don't tell" doesn't work — particularly when it comes to giving our LGBTQIA+ patients the most appropriate healthcare. The fear of stigma, discrimination, negative reactions and even denial of care can keep patients from revealing their sexual orientation or gender identity to their healthcare team. Here are three reasons how "telling" — and making sure it's part of your electronic health record — can help support LGBTQI patients' health.  #1: Minimizes barriers to healthcare Asking questions about gender identity and sexual orientation can help minimize barriers between patients and their care teams, letting patients know they're seen, heard and respected, while keeping the information confidential. By sharing with your care team, our staff can use preferred names, pronouns and other language to respectfully communicate with you. Collecting information about gender identity and sexual orientation and documenting it in your electronic health record can reduce stress when seen by other clinicians.  These questions also may make non-LGBT-identified individuals feel more comfortable discussing issues of sexual, gender or reproductive health.  #2: Provides a basis for delivering the most appropriate care Knowing a patient's self-identification helps providers and care teams identify the risk factors and provide personalized recommendations for screening, prevention and treatment of medical conditions. Healthcare clinicians may not consider medical conditions related to your anatomy due to assumptions based on appearance. For example: <ul> <li>Rates of cervical cancer are higher among cisgender lesbian and bisexual women compared to cisgender heterosexual women. By informing you of these statistics, your clinician can highlight the importance of cervical cancer screening. </li> <li>In transgender women who undergo gender-affirmation surgery, the prostate is kept intact. Without this information, your clinician may not discuss screening for prostate cancer. </li> <li>If a patient was assigned male at birth but identifies as female, it's helpful to know if they've been seen by a gender specialist of if they've undergone gender-affirming surgery or hormone therapy, which may create a risk factor for certain conditions.. </li> </ul> #3: Encourages comprehensive care, fosters patient-care team relationship The role of the care team is to provide patient-centered care founded on scientific evidence, clinical expertise, availability of resources and equity. With the knowledge of a patient's gender identity and sexual orientation, your care team can make referrals and coordinate resources tailored to you.  By self-identifying to their care team, LGBTQIA+ patients feel more affirmed and understood by their care team, which may strengthen their engagement with a treatment plan.  <a href="/providers/matthew-heinrich-mdmba">Matthew Heinrich, M.D.</a>, is a physician in the Department of Medicine Primary Care Clinic located in the Baldwin building in Rochester, Minnesota. He earned his medical degree at Texas Tech University Health Sciences Center School of Medicine in Lubbock, Texas. His interests include primary care, evidence-based medicine and care of LGBTQIA+ patients. <a href="/featured-stories/lgbtqi-telling">Denise Dupras, M.D., Ph.D.</a>, is a physician in Community Internal Medicine, Geriatrics and Palliative Care at Mayo Clinic in Rochester. She earned her medical and doctoral degrees at Mayo Clinic Alix School of Medicine and completed her residency in internal medicine at Mayo Clinic in Rochester. Her interests include medical education, evidence-based medicine and care of LGBTQIA+ patients.Matthew Heinrich, M.D., and Denise Dupras, M.D., Ph.D.Primary Care in Rochester and KassonLGBTQI TellingPrimary Care in Rochester and KassonThe new center makes it convenient for our community to donate blood for others in need.&nbsp;<img src="/-/media/ech-media/images/widgets/blooddonation/nw_blooddonation.jpg?h=65&iar=0&w=100&sc_lang=en&hash=FD24A5AEC542C654F78208A3EF1685FE" alt="NW_BloodDonation" width="100" height="65" DisableNVelocity="true" />Blood Donor Center opens in Northwest Rochester7/10/2023 4:30 AM<img src="/-/media/ech-media/images/widgets/blooddonation/nw_blooddonation.jpg?h=205&iar=0&w=315&sc_lang=en&hash=FD3FAD6732ADB198D55D7A860F37C626" alt="NW_BloodDonation" width="315" height="205" DisableNVelocity="true" />The Mayo Clinic Blood Donor Program has opened a brand-new blood donation center in the 41st Street Professional Building in northwest Rochester. "The Mayo Clinic Blood Donor Program is thrilled to be opening a new blood donation site in northwest Rochester to make it easier for members of our community to come in to donate blood for others in need," says <a rel="noopener noreferrer" rel="noopener noreferrer" href="https://www.mayoclinic.org/biographies/juskewitch-justin-e-m-d-ph-d/bio-20504176" target="_blank" title="Opens in new browser window">Justin Juskewitch, M.D., Ph.D.</a>, Transfusion Medicine. Community members can call to schedule their blood donation appointments at the Northwest Blood Donor Center. The new collection site currently has 5 donor chairs to collect whole blood with the intention to expand to platelets and double red collections in the future. The Northwest Blood Donor Center will help to provide the approximately 50,000 transfused blood products that patients at Mayo Clinic Rochester require each year. "Blood donation remains the most common way in which neighbors can help save lives,"says Dr. Juskewitch. "It takes an entire community to help provide the amount of blood that some of our neighbors need because of illness, surgery, or accidents." To schedule your blood donation appointment at the Northwest Blood Donor Center or one of the other Mayo Clinic Blood Donor Center locations, call <a href="tel:5072844475" title="Opens in new browser window">507-284-4475</a>. Be sure to watch for more information by visiting the <a rel="noopener noreferrer" rel="noopener noreferrer" href="https://connect.mayoclinic.org/page/blood-donor-program/" target="_blank" title="Opens in new browser window">Blood Donor Program blog</a>, the <a rel="noopener noreferrer" rel="noopener noreferrer" href="http://http://www.mayoclinic.org/donateblood" target="_blank" title="Opens in new browser window">Minnesota Blood Donor Program website</a> or our <a rel="noopener noreferrer" rel="noopener noreferrer" href="https://www.facebook.com/blooddonorcentermc?ref=br_tf" target="_blank" title="Opens in new browser window">Facebook page</a>. Here's where and when you can donate: <ul> <li> Hilton Building, First floor, downtown Weekdays from 6 a.m. to 4:30 p.m.; until 7 p.m. every second Thursday of the month.</li> <li>Joseph Building M-86, Saint Marys Campus Weekdays from 8 a.m. to 3 p.m. </li> <li>Northwest Blood Donation Center Weekdays from 8 a.m. to 4 p.m.</li> </ul>Primary Care in Rochester and KassonNew Blood Donor CenterPrimary Care in Rochester and KassonPicky eaters may have this disorder if it's impacting their ability to grow.&nbsp;<img src="/-/media/ech-media/images/widgets/kids/pickyeater_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=A5055CAB73B82D2EACFD9470F90D1E49" alt="PickyEater_widget" width="100" height="65" DisableNVelocity="true" />What is Avoidant Restrictive Food Intake Disorder?8/3/2023 4:30 AM<img src="/-/media/ech-media/images/widgets/kids/pickyeater_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=C55695C7FA108A7A6D90F886F0F30D41" alt="PickyEater_widget" width="300" height="195" DisableNVelocity="true" />Is your child experiencing extreme picky eating that is impacting the ability to grow? Do you wonder if it's just a phase or if it can indicate something more serious? Your child may have an eating disorder called Avoidant Restrictive Food Intake Disorder, or ARFID.  What is ARFID? Symptoms include: <ul> <li>Extreme picky eating and a general lack of interest in eating that progressively worsens over time. </li> <li>Avoiding certain textures, smells or colors of foods. </li> <li>Eating a limited variety of preferred foods. </li> <li>Weight loss that causes delayed development and growth — however, in some instances the child may be at a normal weight. </li> <li>Fears of vomiting or choking on certain foods. </li> <li>Gastrointestinal symptoms such as upset stomach or feeling full. </li> </ul> ARFID is more common in children and young adolescents. It can also develop in late adolescence and adulthood as well. A child with picky eating tendencies typically will outgrow this habit by a certain age; however, a child with ARFID tends to get pickier over time.  ARFID is diagnosed by the symptoms present. If your child does have ARFID, the disorder requires proper treatment with a team who specializes in eating disorders. This approach includes a clinician, a psychotherapist and a dietitian who can help come up with strategies for healthy eating patterns.  How can parents help? Be supportive and encourage positive attitudes about eating healthy and nutritious foods.  Consider these tips to support healthy eating for kids and families: <ul> <li>Be a role model. Serve and eat a variety of foods. </li> <li>Schedule regular meals and snacks. </li> <li>Share meals together as a family. </li> <li>Encourage your child to try new foods but don't pressure them. If they refuse it, keep offering, as it can take up to 10 times for your child's taste buds to accept a new food. </li> <li>Get creative. Prepare foods that are arranged in fun and colorful shapes. Kids love finger foods. Cut foods into solid bite-sized pieces to prevent choking. </li> <li>Introduce foods with a similar color and texture. If your child likes pumpkin pie, try doing mashed sweet potatoes and then mashed carrots. </li> <li>Involve children in meal prepping with assigned tasks such as sifting, counting ingredients or stirring. They'll be more interested in trying new foods they've helped prepare. </li> <li>Reward positive eating behaviors with an activity, such as going for a walk, a bike ride or extra time outside playing. </li> </ul> Having a child with ARFID can be challenging for both the parents and the child. If you think your child may have ARFID, reach out to your healthcare provider. Treating the condition early on and getting the support of your care team is the best way to successfully treat and promote healthy growth and development.  Jessica Nelson is a clinical dietetics intern at Mayo Clinic in Rochester. She received her Bachelor of Science in Nutrition and Dietetics from New York University. Jessica NelsonPrimary Care in Rochester and KassonARFIDPrimary Care in Rochester and KassonThis guide can help you manage fall allergy symptoms.&nbsp;<img src="/-/media/ech-media/images/widgets/asthmaallergies/fallallergies.jpg?h=65&iar=0&w=100&sc_lang=en&hash=4375217DA33A734F66AC2E697BFCAC20" alt="FallAllergies" width="100" height="65" DisableNVelocity="true" />How to manage fall allergies8/28/2023 4:30 AM<img src="/-/media/ech-media/images/widgets/asthmaallergies/fallallergies.jpg?h=205&iar=0&w=315&sc_lang=en&hash=6DA22AA6F40E98573B6605C47DFD5ABF" alt="FallAllergies" width="315" height="205" DisableNVelocity="true" />As fall approaches, we look forward to outdoor activities such as apple picking, pumpkin patches and hay rides. The leaves begin to change colors and drop to the ground, but with the weather change, you may notice you're not feeling your best. Seasonal allergies can make you feel miserable, but this guide is here to help you manage your fall allergies.  What causes fall allergies? Many people suffering from seasonal allergies have sneezing, itchy and watery eyes, runny nose, coughing or congestion symptoms. It's common for those who suffer from spring or summer allergies to also have fall allergies. Common triggers of fall allergies include:  <ul> <li>Ragweed: Ragweed is considered the most common trigger of fall allergies. Ragweed pollen season starts in August and can last into October. Even if you don't live in an area where ragweed is prevalent, the pollen can travel hundreds of miles to your area, causing your symptoms. </li> <li>Molds: They like to grow in damp, cool areas of the house. In the fall, piles of damp leaves are also an ideal place for mold to grow. </li> <li>Dust mites: These tiny bugs live in house dust. As we spend more time indoors in colder weather, we are exposed to more dust mites, which can worsen fall allergies. </li> </ul> How can I treat my allergies? There are several medications that can help manage your allergies.  <ul> <li>Oral antihistamines are daily pills that can help relieve your symptoms and are available over the counter. Examples include cetirizine (Zyrtec), fexofenadine (Allegra) and loratadine (Claritin). </li> <li>Corticosteroid nasal sprays can be used once a day in each nostril to help relieve nasal symptoms such as sneezing and congestion. They are available over the counter and examples include fluticasone propionate (Flonase), budesonide (Rhinocort) and triamcinolone (Nasacort). </li> <li>Cromolyn nasal spray can also prevent allergy symptoms if used before you are exposed to the allergen. This over-the-counter therapy can be used several times a day as needed. </li> <li>Allergy shots are another option that can be prescribed by a clinician if over-the-counter options are not controlling your symptoms. these can help your body become desensitized to allergens. Speak to your healthcare clinician about whether this option would be the right choice for you. </li> </ul> Other tips to manage symptoms <ul> <li>Wear a mask while doing outdoor chores. </li> <li>Check the pollen count on a local weather report and try to stay inside at times when the pollen is at its peak. In the fall, ragweed pollen levels are often highest in the morning. </li> <li>Keep your home and car windows closed to avoid allergens from entering inside. </li> <li>When indoors, vacuum often and use a high-efficiency air filter to catch any allergens that may have made their way inside. </li> </ul> Nisha Patel, M.D., is a resident physician in internal medicine at Mayo Clinic in Rochester, Minnesota. She earned her medical degree at The Ohio State University College of Medicine. She is interested in Allergy & Immunology, focusing on allergic diseases and women's health. Nisha Patel, M.D.Primary Care in Rochester and KassonFall AllergiesPrimary Care in Rochester and KassonFind answers to common questions about kids and concussions.&nbsp;<img src="/-/media/ech-media/images/widgets/activities/football.jpg?h=65&iar=0&w=100&sc_lang=en&hash=809018F086F03EC14878F6C3B47FE629" alt="Football" width="100" height="65" DisableNVelocity="true" />Fall sports safety: Kids and concussions8/7/2023 4:30 AM<img src="/-/media/ech-media/images/widgets/activities/football.jpg?h=205&iar=0&w=315&sc_lang=en&hash=F795D40917EC12EE23483473125E5B6B" alt="Football" width="315" height="205" DisableNVelocity="true" />The end of summer break is rapidly approaching, which means many kids are preparing to start the fall sports season. Unfortunately, some kids will experience injuries throughout the season. One injury that many people are concerned about is a concussion. Many people have heard of concussions from the news, social media, friends and many other sources. Here are some key points about concussions to clarify any questions or concerns that you may have:  What is a concussion? A concussion is a traumatic brain injury caused by a direct blow to the head, neck or body that causes the brain to shake inside the skull and results in temporary disruption in brain function. This injury results in a variety of different signs and symptoms that may present immediately or evolve over minutes to hours.  What are the signs and symptoms of a concussion? With concussions, there are no abnormalities seen in standard head imaging studies such as a CT or MRI, so clinicians rely on recognizing certain signs and symptoms to diagnose a concussion. These signs and symptoms include: <ul> <li>Headaches.</li> <li>Neck pain.</li> <li>Light or noise sensitivity.</li> <li>Dizziness.</li> <li>"Don't feel right."</li> <li>Difficulty concentrating or remembering.</li> <li>Nausea or vomiting.</li> <li>Trouble falling asleep.</li> </ul> If you or your child's coach suspect your child has a concussion, he or she should be removed from the sport or activity immediately. A medical provider ― either on the sidelines by an athletic trainer or at your child's clinic ― should evaluate your child promptly. The following symptoms should prompt a more immediate evaluation in the Emergency Department: <ul> <li>Severe head or neck pain, especially if it's worsening.</li> <li>Loss of consciousness greater than one minute.</li> <li>Excessive sleepiness or difficulty arousing.</li> <li>Seizure.</li> <li>Vision loss.</li> <li>Slurred speech.</li> <li>Recurrent vomiting.</li> <li>Numbness, tingling or weakness in an arm or leg.</li> </ul> Can a concussion be treated? Thankfully with proper attention and treatment, most concussions resolve within days, but some may be prolonged. Concussion treatments include: <ul> <li>Rest: The initial treatment for a concussion is a period of rest for the first one to two days after the injury. Your child should avoid any major cognitive or physical activities during this period. While resting, try to avoid things that worsen the symptoms, such as excessive screen time, bright lights or noise. Don't take medications such as aspirin or other anti-inflammatories, opioids or sedatives until cleared to do so by a medical provider.</li> <li>School: In general, school attendance is safe and encouraged as soon as possible, even if it means taking several breaks or attending half days. In some severe cases, your child may need to take a day or two off of school to rest at home. When returning to school, your child may require some academic accommodations, such as frequent breaks; extended time on assignments and homework; test taking in a quiet environment; and avoiding loud noises, such as band, choir or shop class.</li> <li>Physical activity: Physical activity has been shown to be safe and effective in concussion recovery. After the initial few days of rest, your child should begin some low-impact aerobic activity, such as brisk walking or riding a stationary bike. These activities are safe to do, even if your child has mild symptoms as long as symptoms do not worsen. Once your child is symptom-free, he or she can start a return-to-play protocol that focuses on gradually increasing physical activity. Your child shouldn't fully return to his or her sport until cleared by a medical provider.</li> <li>Avoiding high-risk activities: While recovering from a concussion, it's important to avoid activities that place your child at risk for sustaining a repeat concussion. Your child should not drive a motor vehicle until cleared to do so.</li> <li>Taking care of your body: Throughout your child's recovery, it's important to get adequate restorative nighttime sleep, stay well-hydrated and eat healthy foods that fuel and heal the body. Some providers may recommend supplements, such as melatonin, fish oil, magnesium, riboflavin or turmeric.</li> </ul> Can concussions be prevented? Concussions can't be completely prevented, especially in contact and collision sports, but strategies for lowering concussion risk include: <ul> <li>Focusing on core and neck strengthening.</li> <li>Using proper technique and following the rules of the sport.</li> <li>Educating players, coaches and parents to recognize the signs and symptoms of concussions.</li> <li>Wearing appropriate equipment when required, such as mouthguards and helmets. Although the equipment doesn't necessarily prevent concussions, it's important to help protect the head and face from fractures and other severe head trauma. </li> <li>Removing an athlete from the sport when a concussion is suspected. "When in DOUBT, sit them OUT."</li> </ul> Some youth organizations may implement injury prevention strategies, such as rule changes that limit unnecessary or excessive contact. It's important that coaches and officials appropriately enforce these rules. Do concussions have long-term consequences? A lot of unknowns exist in the relationship between concussions and long-term brain health, and this is an active area of research. Many people fear concussions will lead to chronic traumatic encephalopathy, or CTE, which is a rare progressive degenerative brain disease diagnosed only by an autopsy. No current evidence says a concussion will definitively lead to long-term neurologic disease or impairment, and there is no evidence that describes how many concussions are too many. The best advice to follow is to reduce the amount of unnecessary head trauma your child experiences. If your child has a head injury, it's important that a medical provider recognizes and treats it appropriately. <a href="/providers/luke-radel-md">Luke Radel, M.D.</a>, practices in Primary Care in Rochester and Kasson's Division of Community Pediatric and Adolescent Medicine. He is board-certified in pediatrics and sports medicine. Dr. Radel is the volunteer team physician for Rochester John Marshall High School. He has experience treating youth, collegiate and professional athletes.Luke Radel, M.D.Primary Care in Rochester and KassonKids ConcussionsPrimary Care in Rochester and KassonMayo Clinic Diet teaches the foundations of habits and weight loss and is hopefully the last diet you'll ever need.&nbsp;<img src="/-/media/ech-media/images/widgets/food/mayodiet.jpg?h=65&iar=0&w=100&sc_lang=en&hash=7296A42659C5E7DC874D90BC31976E8B" alt="MayoDiet" width="100" height="65" DisableNVelocity="true" />The 'new' Mayo Clinic Diet8/24/2023 4:30 AM<img src="/-/media/ech-media/images/widgets/food/mayodiet.jpg?h=205&iar=0&w=315&sc_lang=en&hash=B9AD61356C399E3DC3CB4A0FDD017C32" alt="MayoDiet" width="315" height="205" DisableNVelocity="true" />It's funny how certain times of year inevitably spark discussions about weight loss. The advent of summer and the dawning of New Year's Day are two of those times that come to mind. That's when it becomes hard to ignore the abundance of methods, programs and even drugs promising to help us shed those extra pounds.  At Mayo Clinic Diet, we take a different approach when these discussions pop up. Instead of focusing on achieving our New Year's resolutions or obtaining a summer beach body, we aim at identifying genuine lifestyle changes that promote lasting, lifelong health.  The Mayo Clinic Diet is designed to help you achieve a healthier weight by adopting better habits. The program consists of two phases — "Lose It" and "Live It." The goal of each phase is to establish positive lifestyle habits — such as exercising regularly and eating fruits and vegetables, all while breaking negative habits — such as distracted eating and consuming too much sugar. Through this program, you can learn practical, realistic and scientifically backed ways to lose weight and maintain your progress all year long.  Best of all, our popular program features a brand-new platform that incorporates a user-friendly website and a convenient mobile app. When you become a member of the Mayo Clinic Diet, you gain access to a whole host of valuable resources. These include a 12-week course on healthy weight-loss principles, weekly meal plans with a handy grocery list, unlimited group coaching, two helpful eBooks, a private Facebook community, a food tracker, a barcode scanner and exclusive content from Mayo Clinic experts. Additionally, the program offers tailored content designed specifically for those with diabetes.  Ultimately, the Mayo Clinic Diet caters to those who desire program flexibility while also receiving guidance from the Mayo Clinic specialists you know you can trust. Visit our <a rel="noopener noreferrer" href="https://diet.mayoclinic.org/us/" target="_blank" title="Opens in new browser window">Mayo Clinic Diet website</a> for more information.  For a limited time only, newsletter subscribers can take advantage of a <a rel="noopener noreferrer" href="https://diet.mayoclinic.org/us/registration/?promotion=newsletter&utm_source=mayo&utm_medium=newsletter&utm_campaign=aboutthediet" target="_blank" title="Opens in new browser window">special membership offer</a> of only $19.99 a month — one of our most flexible offers. Proceeds are invested into furthering medical research and education at Mayo Clinic. Primary Care in Rochester and KassonMayo Clinic DietPrimary Care in Rochester and KassonThese frequently asked questions can provide updates on this new form of treatment.&nbsp;<img src="/-/media/ech-media/images/widgets/medications/ech_med_marijuana_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=2A70F599C4BC81B4323E4D4B0B9DADE3" alt="ECH_med_marijuana_widget" width="100" height="65" DisableNVelocity="true" />Learn the latest about medical marijuana8/31/2023 4:30 AM<img src="/-/media/ech-media/images/widgets/medications/ech_med_marijuana_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=EF07AF2B675C883FE6A54FF25D416B4E" alt="ECH_med_marijuana_widget" width="300" height="195" DisableNVelocity="true" />Although prescribing medical marijuana has been legal in Minnesota since July 2015, ask most people what they know about it and they typically answer, "Not much." The answers to these frequently asked questions should update you on this new form of treatment. Remember, medical marijuana is not legal in all states; this information pertains only to Minnesota.  What conditions can be treated with medical marijuana? In Minnesota, medical marijuana can be prescribed to treat: <ul> <li>Alzheimer's disease.</li> <li>Amyotrophic lateral sclerosis (ALS). </li> <li>Autism spectrum disorder (must meet DSM-5). </li> <li>Cancer.*</li> <li>Chronic motor or vocal tic disorder. </li> <li>Chronic pain. </li> <li>Glaucoma.</li> <li>HIV/AIDS.</li> <li>Inflammatory bowel disease, including Crohn's disease. </li> <li>Intractable pain (pain whose cause cannot be removed and, according to generally accepted medical practice, the full range of pain management modalities appropriate for this patient has been used without adequate results or with intolerable side effects). </li> <li>Irritable bowel syndrome (effective Aug. 1, 2023).</li> <li>Obsessive-compulsive disorder (effective Aug. 1, 2023). </li> <li>Obstructive Sleep Apnea (only trial if typical treatments like CPAP have failed). </li> <li>Post-traumatic stress disorder (PTSD). </li> <li>Seizures, including those characteristic of epilepsy. </li> <li>Severe and persistent muscle spasms, including those characteristic of multiple sclerosis (MS). </li> <li>Sickle cell disease. </li> <li>Terminal illness, with a probable life expectancy of less than one year.*</li> <li>Tourette syndrome. </li> </ul> *If your illness or its treatment produces one or more of the following: Severe or chronic pain, nausea or severe vomiting, cachexia or severe wasting. Are there side effects?  Short- and long-term effects include:  <ul> <li>Addiction, which occurs in about 10% of users who start smoking marijuana before age 25. </li> <li>Breathing problems for people who smoke marijuana. </li> <li>Dizziness. </li> <li>Impaired concentration and memory.</li> <li>Increased heart rate. </li> <li>Increased risk of heart attack or stroke. </li> <li>Mental illness in people with a tendency for it. </li> <li>Negative drug-to-drug interactions. </li> <li>Slower reaction times. </li> <li>Withdrawal symptoms (more likely with large doses of products with high THC content). </li> <li>Cannabinoid hyperemesis syndrome (nausea, severe vomiting and abdominal pain that repeats every week or every few weeks). </li> </ul> Does it work? While medical marijuana is still considered experimental, since becoming legal for medical use in 37 states and the District of Columbia, more studies are being conducted on its effectiveness. The evidence is still sparse due to issues of the legality of medical marijuana; it's legal at the state level but not at the federal level.  Studies support the role of cannabis/cannabinoids for pain, seizure disorders, appetite stimulation, muscle spasticity and treatment of nausea/vomiting. The biological activities of the cannabinoids suggest that they may be useful in the treatment of central nervous system disorders (such as neurodegenerative diseases, PTSD and addiction) or for the treatment of cancer. The data for those conditions is less robust. Most of the information on its effectiveness is from subjective patient reports of improvement or objective improvement in case studies. At this time, there isn't a wealth of good, randomized control trials.  What do I have to do to be treated with medical marijuana? Start by having a conversation with your healthcare clinician to determine if medical marijuana might be right for you. Your clinician will review all treatment options for your condition and provide recommendations on the best treatment options for you. If medical marijuana is the chosen treatment option, your clinician will certify that you have a qualifying condition with the Minnesota Department of Health (MDH). In order to do this, they will need your email address, which is how you will be contacted with instructions for you to register. You can find more details about the process on the <a rel="noopener" href="https://mn.gov/ocm/dmc/" target="_blank" title="Opens in new browser window">MDH website</a>. There's a $200 annual registration fee, although you may qualify for a reduced fee. Where will I get treatment? You'll need to go to one of fifteen <a rel="noopener" href="https://www.health.state.mn.us/people/cannabis/patients/locations.html" target="_blank" title="Opens in new browser window">Cannabis Patient Centers</a> in Minnesota; there's one in Rochester. At the center, a pharmacist will review your records and recommend a specific dosage and type of cannabis.  How much does medical marijuana cost? The cost for your prescription will vary based on the type, quantity and other factors. Currently, health insurance plans don't cover medical marijuana, so this will be an out-of-pocket expense for you.  Where can I learn more? These sites are good resources for information about medical marijuana:  <ul> <li><a rel="noopener" href="https://www.mayoclinic.org/healthy-lifestyle/consumer-health/in-depth/medical-marijuana/art-20137855?pg=1" target="_blank" title="Opens in new browser window">Mayo Clinic: Medical marijuana.</a></li> <li><a rel="noopener" href="https://www.health.state.mn.us/people/cannabis/index.html" target="_blank" title="Opens in new browser window">Minnesota Department of Health: Medical cannabis.</a></li> </ul> <a href="/providers/sonya-peters-pac">Sonya Peters, P.A.-C.</a>, is a physician assistant with Primary Care in Rochester and Kasson's Division of Community Internal Medicine, Geriatrics and Palliative Care at Mayo Family Clinic Northwest. Her areas of special interest are women's health and procedural medicine. Sonya Peters, P.A.-C.Primary Care in Rochester and KassonMedical Marijuana 2023Primary Care in Rochester and KassonUse these tips to determine if you or your loved ones could benefit from a Medical Alert system.&nbsp;<img src="/-/media/ech-media/images/widgets/medicalimages/medicalert_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=0855FE7211B8D9E05ACFE5C3AC835B00" alt="MedicAlert_widget" width="100" height="65" DisableNVelocity="true" />August is MedicAlert Awareness Month8/21/2023 4:30 AM<img src="/-/media/ech-media/images/widgets/medicalimages/medicalert_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=63B729B481C6BFD4DCF0EFFB94E2841C" alt="MedicAlert_widget" width="300" height="195" DisableNVelocity="true" />Do no harm. This first principle in medical practice is self-evident during everyday interactions between patients and their medical care team. But in the midst of a medical emergency, a lack of details of a person's medical history might be crucial — and even detrimental — to their recovery if not communicated at the time. Medical Alert Systems are designed to help during these critical situations.  What are Medical Alert Systems? Medical Alert Systems include IDs and devices.  <ul> <li>A MedicAlert ID is a piece of jewelry, like a bracelet or necklace, engraved with important information to alert emergency first responders of any life-threatening medical conditions a person might have. </li> <li>A MedicAlert Device is a small device that, upon activation, helps notify family members, friends, neighbors and emergency medical responders in the event of an emergency. </li> </ul> Why use a Medical Alert System? MedicAlert IDs help provide a quick recognition of any medical condition the person might have, such as heart disease, epilepsy, diabetes, certain allergies and use of insulin or blood thinners. They may also provide information on treatments the person has agreed (or not agreed) to receive and prevent treatment errors. Examples include patient's wishes on blood transfusions and Do Not Resuscitate orders.  MedicAlert Devices can be lifesaving if the person is in an accident or is alone and has a medical emergency. Activating the device, usually with the push of a button, will immediately alert the designated personnel to dispatch to the person's location — along with key information such as medical conditions, allergies and medications.  Who needs to use the Medical Alert Systems? Anyone with a medical condition that may involve a medical emergency (e.g., patients with diabetes, heart disease, seizures) is encouraged to wear a medical alert system. People with certain severe allergies should consider wearing a MedicAlert ID that lists those allergies. MedicAlert Devices are especially helpful for older adults or seniors who live alone should they suffer a fall at home or even simply need help. The MedicAlert Devices can also be used as a panic button.  If you or a loved one might benefit from wearing a MedicAlert, please discuss the option with your medical care team. Do not wait until you suffer an injury or illness before considering wearing one.  More advanced Medical Alert Systems are now available and include fall detection and GPS, among other features.  Although proven to be lifesaving devices, Medical Alert systems may not be covered by medical insurance. There are exceptions, however, so patients should contact their insurance company to confirm. Bottom line MedicAlert IDs and Devices are lifesaving, relatively cheap, easy to use, and provide ease of mind. Seniors may especially benefit from a medical alert device to help them maintain their independence while connecting them with the help they need upon any emergency.  <a href="/providers/tamim-rajjo-md">Tamim Rajjo M.D.</a>, is a family physician and a preventive medicine specialist. He has a particular interest in the management of obesity in the primary care setting. He holds a Master's degree in Public Health and serves as the medical director of Mayo Family Clinic Northeast in Rochester. Tamim Rajjo, M.D., M.P.H.Primary Care in Rochester and KassonMedicAlert Awareness 2023Primary Care in Rochester and KassonTake steps to reduce your risk of HIV infection.&nbsp;<img src="/-/media/ech-media/images/widgets/people/menwindowsill.jpg?h=65&iar=0&w=100&sc_lang=en&hash=A6D9F020CE5D2E46E8AF6F97314A2F51" alt="MenWindowsill" width="100" height="65" DisableNVelocity="true" />PrEP to end the HIV epidemic8/14/2023 4:30 AM<img src="/-/media/ech-media/images/widgets/people/menwindowsill.jpg?h=205&iar=0&w=315&sc_lang=en&hash=B0C22F62713F679B97A1853BA461991A" alt="MenWindowsill" width="315" height="205" DisableNVelocity="true" />In the 30 years since the human immunodeficiency virus (HIV) epidemic began, many treatment options have been developed that safely and effectively treat HIV. Today, people living with HIV have a normal life expectancy while on consistent treatment. Despite this achievement, the rate of new HIV infections has not improved, with nearly 40,000 people diagnosed each year in the U.S. With this in mind, pre-exposure prophylaxis, or PrEP, is now recommended for those at increased risk for HIV infection through sex or injection of recreational drugs. What is PrEP? Pre-exposure prophylaxis (PrEP) is a medicine taken to prevent infection with HIV. PrEP works by preventing HIV from replicating within the body in people who have not been previously exposed to HIV. For most patients, PrEP is a once-daily pill that must be taken consistently, though long-acting injections have also been developed. PrEP is highly effective when taken as prescribed, reducing the risk of getting HIV from sex by about 99%, or about 74% from injection drug use. Even with PrEP, condom use is still important to protect against other sexually transmitted infections. Who might be eligible for PrEP? PrEP is not for everyone but is recommended for those at elevated risk for HIV infection. This includes sexually active adults and adolescents with any of the following: <ul> <li>History of inconsistent or no condom use during sex.</li> <li>HIV-positive sexual partner.</li> <li>Sexually transmitted infection, such as gonorrhea, syphilis or chlamydia, in the past 6 months. </li> </ul> For people who inject drugs, PrEP is recommended for those who share injection equipment or who have an HIV-positive injecting partner. How can I start PrEP? If you think you are at increased risk for HIV, reach out to your local care team. If you and your care team agree that PrEP can reduce your risk for HIV, you will need to be seen for a general exam, blood testing for HIV and other sexually transmitted infections, and testing of your kidney function to ensure PrEP medications are safe for you. After starting PrEP, you must regularly follow up with your care team for monitoring tests. When used appropriately, PrEP is highly effective at preventing new HIV infections and continues to be a powerful tool to help end the HIV epidemic. Visit these websites for more information about HIV risks: <ul> <li><a rel="noopener noreferrer" href="https://hivrisk.cdc.gov/about-the-data/" target="_blank" title="Opens in new browser window">HIV Risk Reduction Tool</a> (Centers for Disease Control and Prevention).</li> <li><a rel="noopener noreferrer" href="https://hivrisk.cdc.gov/risk-estimator-tool/#-sb" target="_blank" title="Opens in new browser window">Estimate the HIV Risk</a> (Centers for Disease Control and Prevention. </li> </ul> <a href="/providers/matthew-heinrich-mdmba">Matthew Heinrich, M.D., M.B.A.</a>, is an internal medicine resident in the Department of Medicine Primary Care Clinic located in the Baldwin building in Rochester, Minnesota. He earned his medical degree at Texas Tech University Health Sciences Center School of Medicine in Lubbock, Texas. His interests include primary care, evidence-based medicine and care of LGBTQIA+ patients. <a href="/providers/denise-dupras-md">Denise Dupras, M.D., Ph.D.</a>, is a Community Internal Medicine, Geriatrics and Palliative Care physician at Mayo Clinic in Rochester. She earned her medical and doctoral degrees at Mayo Clinic Alix School of Medicine and completed her residency in internal medicine at Mayo Clinic in Rochester. Her interests include medical education, evidence-based medicine and care of LGBTQIA+ patients.Matthew Heinrich, M.D., M.B.A. and Denise Dupras, M.D., Ph.D.Primary Care in Rochester and KassonPrEP and HIVPrimary Care in Rochester and KassonMore than one in 10 people have high cholesterol, but most don't know much about it.&nbsp;<img src="/-/media/ech-media/images/widgets/randomimages/ech_obesityknowledge_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=66C3FB7F89FD369CC99F59B7F8BC879D" alt="ECH_ObesityKnowledge_widget" width="100" height="65" DisableNVelocity="true" />Debunking five myths about cholesterol9/28/2023 4:30 AM<img src="/-/media/ech-media/images/widgets/randomimages/ech_obesityknowledge_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=B45E8BA522A38E579EB2E8A634234693" alt="ECH_ObesityKnowledge_widget" width="300" height="195" DisableNVelocity="true" />High cholesterol is very common. In fact, more than one in 10 people in the United States will have high cholesterol. However, many don't even know they have high cholesterol or much about this condition. Here are five common myths about cholesterol and the truth behind each of them.  <h3>Myth 1: All types of cholesterol are the same.</h3> Truth 1: Cholesterol comes from two sources: dietary cholesterol (found in the food we eat) and blood cholesterol (naturally occurring, waxy, fat-like substance in our bodies). Blood cholesterol comes in two main types, low-density lipoprotein (LDL) and high-density lipoprotein (HDL).  <ul> <li>LDL is considered the "bad cholesterol" and can contribute to plaque build-up in our arteries. </li> <li>HDL is considered the "good cholesterol" because it helps rid our bodies of extra cholesterol. </li> </ul> When your clinician orders a lipid panel/profile, it measure four things:  <ul> <li>Total cholesterol. Best is less than 200 mg/dL; above this level is considered high. </li> <li>HDL (good). Best is 60 mg/dL or more. </li> <li>LDL (bad). Best is 100 mg/dL or less. If you have an LDL level over 199, you may be at risk for a syndrome called familial hypercholesterolemia, and it's important to talk with your healthcare clinician. </li> <li>Triglycerides (also bad). Best is 150 mg/dL or less. </li> </ul> <h3>Myth 2: Young and thin people don't have to worry about their cholesterol.</h3> Truth 2: While being older and/or overweight can contribute to high cholesterol, the truth is there are many different risk factors for high cholesterol. Even people who are young and thin should pay attention to their cholesterol levels. Risk factors include:  <ul> <li>Family history. Some forms of high cholesterol can be inherited. With familial hypercholesterolemia, people have greatly elevated cholesterol and are at a very high risk of heart attack. They may need their levels checked more often. </li> <li>Diabetes. Diabetes can lower good cholesterol and worsen bad cholesterol. </li> <li>Lack of physical activity or physical exercise. A sedentary lifestyle has been shown to affect your cholesterol, even if you're not overweight or obese. </li> <li>Older age. As we age, our cholesterol levels go up, especially in women. </li> </ul> <h3>Myth 3: How much you diet and exercise dictates what your cholesterol level will be. </h3> Truth 3: Diet and physical activity does affect your cholesterol level, but they're not the only factors. Family history can be very important. If family members have high cholesterol or heart attacks before age 60, you need to have your lipid levels checked and managed.  <h3>Myth 4: My lipid panel was high, so now my doctor will make me start a statin.</h3> Truth 4: The next step after your clinician orders a lipid panel is to assess your risk for heart attack and stroke. This assessment will help determine the best management strategy for you. Patients at high risk might need to start with medication AND lifestyle modifications, while patients at lower risk might start by modifying their lifestyle. Some of the lifestyle recommendations include: <ul> <li>Getting active. Small steps can lead to big progress. We recommend getting about 150 minutes of moderate-level physical activity each week. </li> <li>Eat healthy fats. Poly- or monounsaturated fats are best — including nut oils, olive oil and avocados. Try to avoid saturated or trans fats — such as butter, margarine, cheese and red meat. These all increase bad cholesterol. </li> <li>Stop smoking. Smoking can increase your risk of heart disease and stroke, so it's very important to quit. Your care team has many resources to help you. </li> </ul> For those who cannot tolerate a statin medication, there are other medications that can lower cholesterol, and it's worth a discussion with your clinician about what is the best option for you.  <h3>Myth 5: Everyone who takes a statin experiences muscle pain.</h3> Truth 5: Many patients are concerned about starting a statin due to fear that it might cause muscle pain or cramping. The truth is only about 2%-10% of patients experience muscle-related side effects, which range from muscle pain/aching to cramping. Of patients who had these side effects with one statin, 90% were able to tolerate an alternative statin medication with continued use.  If you're experiencing muscle symptoms while taking a statin, please talk with your clinician. Depending on the symptoms, they might suggest a "drug holiday" to see if the symptoms resolve, switching the statin or changing the dose. These medications are incredibly important for lowering your risk for heart disease and stroke, so it's necessary to evaluate and address your side effects.  <a href="/providers/allison-ducharme-smith-md">Allison Ducharme-Smith, M.D.</a>, is an internal medicine physician in the Division of Community Internal Medicine, Geriatrics and Palliative Care and practices at Mayo Family Clinic Northeast in Rochester. She is also the Medical Director of the Good Samaritan Free Health Clinic. Her interests include preventive medicine, women's health, chronic disease management and medical education. Allison Ducharme-Smith, M.D.Primary Care in Rochester and KassonCholesterol MythsPrimary Care in Rochester and KassonHere are some ways to make shared mealtimes happen.&nbsp;<img src="/-/media/ech-media/images/widgets/food/ech_family_dinner_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=BEC7EFEEE8A46F56BA91663D0D8224D1" alt="ECH_family_dinner_widget" width="100" height="65" DisableNVelocity="true" />Family mealtimes make a difference9/21/2023 4:30 AM<img src="/-/media/ech-media/images/widgets/food/ech_family_dinner_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=BD7475C9B747EB58F3CC839DAB4E0922" alt="ECH_family_dinner_widget" width="300" height="195" DisableNVelocity="true" />With summer a pleasant memory and the flurry of back-to-school over, families are settling into their school-year routines. One routine to make a priority this school year is family meals — together — because it does make a difference. Research shows that there are many ways that eating meals together as a family can impact children. Benefits include: <ul> <li>Better physical health: Family meals are associated with better fitness levels and less likelihood of developing an eating disorder or of being overweight.</li> <li>Healthier eating habits: Kids who eat more family meals also have more fruits and veggies, fewer sugary drinks and healthier portion sizes. Teens have better cardiovascular health.</li> <li>Improved communication: Routine communication at family meals can help the whole family — promoting language development for toddlers and supporting more closeness among family members.</li> <li>Higher academic achievement: Regular family dinners are associated with kids doing better in school.</li> <li>Better mental health: Regular family meals are associated with a lower risk of depression, anxiety and stress and can lead to greater resilience in kids.</li> </ul> Knowing these benefits can boost your family's efforts to make family meals happen. Scheduling regular family meals together isn't impossible. Here are some tips to make it easier: <ul> <li>Pick a meal, any meal. Mealtimes can be breakfast, lunch, dinner, weekend brunch or any intentional nighttime snack.</li> <li>Put them on the calendar. Mark the meals, days and times on everyone's calendar. Remember, just three a week makes a difference.</li> <li>Make your time together count. You do not have to spend hours at the table, but the time you do spend should be device- and TV-free.</li> <li>Keep it simple. The meal does not have to be "special," just healthy and well-balanced. If you need help, check out <a rel="noopener noreferrer" rel="noopener noreferrer" href="https://www.myplate.gov/" target="_blank" title="Opens in new browser window">myplate.gov</a>. Use your slow cooker so the main dish is ready when you get home.</li> <li>Make it easy. Pull out the paper plates and napkins to reduce clean up.</li> <li>Get the kids involved. Have them plan a meal, help cook, set the table or wash the dishes. Approaching the family meal as a team effort can help everyone feel important and lessen the load on parents/caregivers.</li> <li>Consider theme meals. Taco Tuesdays, breakfast for supper, soup night and more. A theme can add an element of fun to meals. Encourage and give opportunities to try dishes from other cultures or a new ingredient.</li> <li>Aim for pleasant and relaxed. Now is not the time to bring up hot topics or quiz the kids on their schoolwork. Instead, use the time to tune into family affairs. Ask everyone to tell about something good or unusual that happened that day, or something surprising they noticed. More ideas for mealtime conversation starters can be found at <a rel="noopener noreferrer" rel="noopener noreferrer" href="https://thefamilydinnerproject.org/conversation/" target="_blank" title="Opens in new browser window">Conversation - The Family Dinner Project</a>.</li> <li>Make it enjoyable. For ideas about games to play at the table that may spark conversation or bring on laughter, check out games by age on <a rel="noopener noreferrer" rel="noopener noreferrer" href="https://thefamilydinnerproject.org/fun/" target="_blank" title="Opens in new browser window">The Family Dinner Project</a> website.</li> </ul> Be a role model. Children learn from watching what foods you choose, your pace and mindfulness of eating. Parents' attitudes and approaches to mealtime will set the mood for the whole family. The benefits of eating as a family help your kids today, but also helps them establish skills and habits for a lifetime. Michaeleen Burroughs, M.S., RDN, LD, is a registered dietitian nutritionist in Primary Care in Rochester and Kasson. She guides patients and families toward healthy eating. Her areas of interest are diabetes and child and adult weight management.Michaeleen Burroughs, M.S., RDN, LDPrimary Care in Rochester and KassonFamily MealtimePrimary Care in Rochester and KassonIf you're a Medicare recipient, you can take advantage of Annual Wellness Visits.&nbsp;<img src="/-/media/ech-media/images/widgets/elderly/elderlyswimming.jpg?h=65&iar=0&w=100&sc_lang=en&hash=E6C6A932A64C996ABEAC7F4FA110390A" alt="ElderlySwimming" width="100" height="65" DisableNVelocity="true" />7 common questions about Medicare Annual Wellness Visits8/8/2023 4:30 AM<img src="/-/media/ech-media/images/widgets/elderly/elderlyswimming.jpg?h=205&iar=0&w=315&sc_lang=en&hash=00D793D3FC11DBAF8111F7E453633197" alt="ElderlySwimming" width="315" height="205" DisableNVelocity="true" />Medicare Annual Wellness Visits are a preventive health benefit available after having Medicare Part B coverage for at least one year. All Medicare Advantage Plans are required to offer Annual Wellness Visits for their members. A nurse or nurse practitioner reviews your health status and helps you plan for health and wellness needs. In most cases, the Annual Wellness Visit will be followed by a separate medical visit with your primary care clinician to close any healthcare gaps and address any problems identified during the visit. Here are answers to seven common questions about Annual Wellness Visits: Why are Annual Wellness Visits important? The Annual Wellness Visit allows you to review your health history and identify any current or potential health risks with a healthcare professional. The Annual Wellness Visit enables the nurse to focus on prevention and wellness while making sure you are up to date on recommended immunizations and health screenings like colonoscopies or mammograms. This allows your primary care clinician more time to focus on your medical concerns and needs at a separate physical exam. How often can I have an Annual Wellness Visit? During your second year of Medicare Part B coverage and every year after, you may have one Annual Wellness Visit per year. The visit must be at least 11 full months after your previous year's visit. Do I need to be 65 or older to have an Annual Wellness Visit? You do not need to be 65 years of age or older to qualify for an Annual Wellness Visit, as long as you've been on Medicare Part B for at least one year. How is an Annual Wellness Visit scheduled? If you are due for an Annual Wellness Visit, you may be prompted to self-schedule the visit in the<a rel="noopener noreferrer" href="https://onlineservices.mayoclinic.org/content/staticpatient/showpage/patientonline" target="_blank" title="Opens in new browser window"> patient portal</a>. You also may call your care team and ask to be scheduled for an Annual Wellness Visit. If your Annual Wellness Visit is with a nurse or nurse practitioner, it is recommended to schedule this visit before the visit with your primary care clinician. This allows your clinician the chance to address any concerns mentioned during your Annual Wellness Visit. How can I prepare for my Annual Wellness Visit? You may be asked to complete some questionnaires before arriving for your appointment. The questionnaires will be sent to your <a rel="noopener noreferrer" href="https://onlineservices.mayoclinic.org/content/staticpatient/showpage/patientonline" target="_blank" title="Opens in new browser window">patient portal account</a>. If you cannot access the questionnaires before the appointment, plan to arrive at your appointment early to complete them. It is helpful to come prepared to your Annual Wellness Visit with this information: <ul> <li>All prescription medications, vitamins and supplements you take, including how much and how often you take them. </li> <li>Additional medical records, including immunization records. </li> <li>Dates of your most recent preventive services, like a colonoscopy or mammogram, if completed by another healthcare facility. </li> <li>Family health history, with as much detail as possible. </li> <li>List of medical providers and suppliers who provide you care, equipment or services. </li> </ul> What can you expect during an Annual Wellness Visit? During the Annual Wellness Visit, you will meet with a nurse or nurse practitioner to: <ul> <li>Evaluate your fall risk.</li> <li>Measure your height, weight and blood pressure.</li> <li>Offer referrals to other health education or preventive services.</li> <li>Provide information related to voluntary advance care planning.</li> <li>Screen for cognitive impairments like dementia.</li> <li>Screen for depression.</li> <li>Update your medical and family history. </li> </ul> What is the cost of an Annual Wellness Visit? Medicare offers the Annual Wellness Visit at no cost for people who have Medicare Part B coverage for at least one year before the visit. If you are referred for other tests or services, they will be billed to your insurance. If you have a separate visit with your primary care professional following your Annual Wellness Visit, you or your insurance carrier will be responsible for the cost of that visit. Robert Stroebel, M.D., is a Community Internal Medicine, Geriatric and Palliative Care physician in Primary Care in Rochester and Kasson.Robert Stroebel, M.D.Primary Care in Rochester and KassonMedicare Annual Wellness VisitPrimary Care in Rochester and KassonSchedule your appointment today through the patient portal.&nbsp;<img src="/-/media/ech-media/images/widgets/people/womancouchcomputer.jpg?h=65&iar=0&w=100&sc_lang=en&hash=A376EFE3DC1D27E28730DFB9EC38DB76" alt="WomanCouchComputer" width="100" height="65" DisableNVelocity="true" />Primary Care Gynecology Clinic offers self-scheduling8/30/2023 4:30 AM<img src="/-/media/ech-media/images/widgets/people/womancouchcomputer.jpg?h=205&iar=0&w=315&sc_lang=en&hash=91C4498FACFB351D84818FF40B749010" alt="WomanCouchComputer" width="315" height="205" DisableNVelocity="true" />The Primary Care Gynecology Clinic, located on the sixth floor of the Baldwin building, now offers patients the opportunity to self-schedule appointments.  If you are 12 years of age or older and are due for a Pap smear, have vaginal concerns, require sexually transmitted infection testing or have questions about birth control management, schedule your appointment today through your patient portal or by calling your primary care clinician's appointment desk.  Our primary care nurse practitioners and physician assistants are available Monday through Friday from 8 a.m. to 5 p.m. (excluding holidays).  Self-scheduling allows you to schedule appointments on your own time and pick an appointment time that is convenient for you. Primary Care in Rochester and KassonPrimary Care Gynecology ClinicPrimary Care in Rochester and KassonFactors such as age, medical history and personal values may influence your choice.&nbsp;<img src="/-/media/ech-media/images/widgets/people/ech_prostatescreening_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=470E0D14ACC03267FED9E2189560CAB6" alt="ECH_ProstateScreening_widget" width="100" height="65" DisableNVelocity="true" />Prostate cancer screening: Not a straightforward decision9/7/2023 4:30 AM<img src="/-/media/ech-media/images/widgets/people/ech_prostatescreening_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=37BEA07B48E82DE5CC5CEFA52D0781E2" alt="ECH_ProstateScreening_widget" width="300" height="195" DisableNVelocity="true" />In some men, prostate cancer can be dangerous. However, most prostate cancers are slow-growing and will not cause any problems.  An autopsy study of men in their 70s who died from non-prostate cancer causes showed that 70% of these men had prostate cancer and were unaware of it. Unfortunately, determining whether a man has a slow-growing cancer that will not cause any problems or a dangerous cancer that should be treated early is difficult.  Until one of the dangerous cancers is in an advanced stage, there are usually no symptoms to indicate a man has the harmful type of cancer. Changes in urination, which are common with aging, are not a sign of prostate cancer, and these changes generally should not influence the decision to undergo prostate cancer screening.  Prostate-specific antigen, or PSA, blood testing is the only recommended test for prostate cancer screening. Men are screened with a PSA test for prostate cancer in the hopes of catching the small number of these bad cancers, which left untreated can shorten a man's life. However, this screening also catches many slow-growing cancers never destined to cause harm in addition to those fast-growing and dangerous cancers. Over the last 10 years, fewer men have been screened and fewer new cases of prostate cancer have been detected; however, the rates of prostate cancer death have remained stable.  <img height="367" alt="ProstateCancer" width="490" src="/-/media/ech-media/images/prostatecancer.jpg?sc_lang=en&hash=8F4739FE910AEA0F34D08897BE6B08B2" /> Why not screen everybody? Harm can arise from a simple blood test. A false positive — elevation but not due to prostate cancer — can cause significant anxiety, unnecessary prostate biopsies and repeat testing. Finding a slow-growing cancer that is never destined to hurt you can result in unhelpful treatment. Prostate cancer treatment can result in long-term urinary incontinence, erectile dysfunction and bowel difficulties. Because of the high rate of incidental slow-growing cancer, it's recommended that many men over 70 not receive PSA testing.  What should you do? If you're a man under 70, you should discuss screening benefits and risks with your primary care clinician. When to start screening may depend on ethnicity and family history. Your primary care clinician will discuss your preferences and values, and together you should decide whether PSA screening makes sense. There is no right or wrong answer. When deciding, be sure to discuss the potential benefits and harm with your healthcare clinician.  Many men experience harm from the screening, including:  <ul> <li>False positive results that require additional testing and possible prostate biopsy. </li> <li>Overdiagnosis, including finding a prostate cancer that would never harm you. </li> <li>Treatment complications, such as incontinence and erectile dysfunction. </li> </ul> You should also consider your values and preferences, as well as any risks for prostate cancer based on family history, race and ethnicity, or other medical conditions.  If you do decide to be screened and your PSA is elevated, a prostate biopsy is likely to be recommended. While a biopsy sometimes provides an answer, sometimes it doesn't. This cycle of testing, often without clear answers, can cause a lot of frustration and anxiety. Plus, the tests may cause complications or discomfort.  Shared decision making Patients should make the decision about prostate cancer screening based on the information and perspectives shared by their primary care clinician. This is called shared decision-making and there isn't one answer that is right for everyone. You should take the time to learn all you can about the risks and benefits. Together with your clinician, you can come to a decision that you're comfortable with.  Some sources for more information about prostate cancer and screening are the <a rel="noopener" href="https://www.cdc.gov/prostate-cancer/screening/get-screened.html?CDC_AAref_Val=https://www.cdc.gov/cancer/prostate/basic_info/get-screened.htm" target="_blank" title="Opens in new browser window">Centers for Disease Control and Prevention</a> and, of course, <a rel="noopener" href="http://www.mayoclinic.org/diseases-conditions/prostate-cancer/in-depth/prostate-cancer/art-20048087" target="_blank" title="Opens in new browser window">Mayo Clinic</a>.  <a href="/providers/john-matulis-do">John Matulis, III, D.O., M.P.H.</a>, is a physician in Community Internal Medicine, Geriatrics and Palliative Care in Rochester. In addition to general internal medicine, he's board-certified in preventive medicine and has an interest in quality improvement. John Matulis, III, D.O., M.P.H.Primary Care in Rochester and KassonProstate CancerPrimary Care in Rochester and KassonMoving more during your day can help you reap major health benefits.<img src="/-/media/ech-media/images/widgets/people/vacuumdance.jpg?h=65&iar=0&w=100&sc_lang=en&hash=EE814628DD57ECBF9FFA75D31C757C32" alt="VacuumDance" width="100" height="65" DisableNVelocity="true" />Sit less, move more11/6/2023 4:30 AM<img src="/-/media/ech-media/images/widgets/people/vacuumdance.jpg?h=205&iar=0&w=315&sc_lang=en&hash=0E6E75BA47F83D58A688F4CD51944415" alt="VacuumDance" width="315" height="205" DisableNVelocity="true" />Want one thing to focus on that can have big benefits to your health and wellness? Move more! Did you know: <ul> <li>On average, we sit seven to 15 hours per day.</li> <li>Sedentary jobs have increased by 83% since 1950.</li> <li>By the time kids reach high school, 63% are no longer physically active.</li> </ul> All this sitting isn't doing our health any good. Research suggests that excessive inactivity can be a risk factor for heart disease, stroke, diabetes and cancer. These risks can be reduced significantly if we get up and move. Adding activity can be easy and fun. Movement can be anything — sweeping the kitchen floor, taking the stairs, parking on the far side of the lot and walking, putting on some tunes and dancing in the living room, or just plain standing. Yes, even standing. One hour of standing in your day can increase blood flow and metabolism and improves focus and energy. As Dr. James Levine, a former Mayo Clinic endocrinologist and researcher who has studied the benefits of movement says, "Don't sit when you can stand, and don't stand when you can move." Every little bit helps and everything counts. That includes household chores and yard work. Instead of looking at these tasks as one more thing to do, consider them an opportunity to move. "Ah," you say, "I work out at the gym every morning." That's super — keep it up. There are amazing added benefits to moving throughout the day. This does not need to be complicated. Look at your day and ask, "What movement can I do for 10 minutes?" Work movement into your day, no matter where you are. Here are a few ideas to get you started: <ul> <li>Stand, rather than sit, in a meeting or at your child's soccer practice.</li> <li>Vacuum the living room.</li> <li>Go for a walk, taking a slightly hillier route to challenge yourself.</li> <li>Sweep the walk.</li> <li>Play with your kids: Shoot baskets, play catch, splash in the pool, go for a bike ride — it's limitless.</li> <li>March in place while you're doing the dishes.</li> <li>Do some lunges or squats by your desk.</li> </ul> Studies show that we move more when we have a buddy. So create a community of movers around you. Find someone who would like to go for a walk over lunch, stand at the back of the room with you, share gardening chores, or take a community belly-dancing or tai chi class. For every modern convenience we've added to our lives — whether it's a washing machine, riding lawnmower, grocery delivery service or TV remote control, the unfortunate consequence is that we've removed opportunities for consistent, informal movement from our daily lives. And now we're seeing the ramifications on our health. But those consequences can be reduced if we just get up and MOVE! Go for it! See some easy activities for adding movement into your work day: <iframe width="560" height="315" src="https://www.youtube.com/embed/OW-NbZtBka0?si=8mWA-uaVzk4-A8qA&enablejsapi=1&origin=https:%2F%2Fsncs.mayo.edu" title="Mayo Clinic Minute: Move more at work" frameborder="0" allow="accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share" id="ytVideoPlayer1"></iframe> Danielle Johnson, M.S., P.T., is a wellness physical therapist at the Mayo Clinic Healthy Living Program in Rochester, Minn. She specializes in combining physical therapy with whole-body wellness and integrating fundamental and natural movement patterns, as well as practical and playful movement, into daily experiences. Danielle Johnson, M.S., P.T.Primary Care in Rochester and KassonSit Less Move MorePrimary Care in Rochester and KassonAfter 18 blood and 41 platelet transfusions, Carter is celebrating his "re-birth."<img src="/-/media/ech-media/images/widgets/blooddonation/carter100523.jpg?h=65&iar=0&w=100&sc_lang=en&hash=6AF972CDC2DCD317EF398E47D70B2120" alt="Carter100523" width="100" height="65" DisableNVelocity="true" />Carter: A recipient story10/5/2023 4:30 AM<img src="/-/media/ech-media/images/widgets/blooddonation/carter100523.jpg?h=205&iar=0&w=315&sc_lang=en&hash=1246ED7841CA0076F636FD64769F07A4" alt="Carter100523" width="315" height="205" DisableNVelocity="true" />Carter was diagnosed with acute myeloid leukemia in October 2015 at the age of 7. "Carter is a fighter," Sergeant Chad Blanchette, Carter's father, said. "We are blessed that he never gave up and kept fighting." Carter received multiple rounds of chemotherapy, 18 blood transfusions and 41 platelet transfusions. He experienced a roller coaster of highs and lows as he fought his way into remission, through a relapse and then to his "re-birth." Through it all, Carter and his family persevered, held up not only by their family but also by friends, doctors, nurses, child life, clergy, co-workers and Carter's unrelenting spirit. "He never complained about a diagnosis and treatment. He took it in stride. He made adjustments and fought," said Sergeant Blanchette.  Blood products were a crucial part of Carter's care. Platelet transfusions gave him the boost he needed to keep fighting until a bone marrow donor was found. Carter's family urged others to sign up at <a rel="noopener noreferrer" rel="noopener noreferrer" href="https://bethematch.org/" target="_blank" title="Opens in new browser window">bethematch.org</a> to see if they were a match for Carter or any other family in need. Carter found a half match in his big sister Elena, who selflessly underwent her own procedure to help her little brother — to save his life.  In 2022, in honor of Carter's five-year "re-birthday," Sergeant Blanchette hosted a blood drive at the Rochester Police Department. "Since my fellow officers are in the lifesaving business, I couldn't think of a better way to show our community that we care about them than to begin hosting blood drives," said Sergeant Blanchette. "People really don't realize the impact of giving blood. It's such a small sacrifice on your part to help save someone's life.  To schedule your blood donation appointment at the Northwest Blood Donor Center or the Hilton Building Blood Donor Center, call the Mayo Clinic Blood Donor Center at <a href="tel:5072844475" title="Opens in new browser window">507-284-4475</a>. Be sure to watch for more information by visiting the <a rel="noopener noreferrer" rel="noopener noreferrer" href="https://connect.mayoclinic.org/page/blood-donor-program/" target="_blank" title="Opens in new browser window">Blood Donor Program blog</a> or the <a rel="noopener noreferrer" rel="noopener noreferrer" href="http://www.mayoclinic.org/donateblood" target="_blank" title="Opens in new browser window">Minnesota Blood Donor Program website</a> or <a rel="noopener noreferrer" rel="noopener noreferrer" href="https://www.facebook.com/blooddonorcentermc?ref=br_tf" target="_blank" title="Opens in new browser window">Facebook</a> page. Primary Care in Rochester and KassonBlood Donation CarterPrimary Care in Rochester and KassonBreast milk is a complete source of nutrition for your child.&nbsp;<img src="/-/media/ech-media/images/widgets/people/breastfeeding.jpg?h=65&iar=0&w=100&sc_lang=en&hash=71ECAAA03EE755A6BD7A5D6CB115D94B" alt="Breastfeeding" width="100" height="65" DisableNVelocity="true" />What are the benefits of breastfeeding?10/16/2023 4:30 AM<img src="/-/media/ech-media/images/widgets/people/breastfeeding.jpg?h=205&iar=0&w=315&sc_lang=en&hash=8EA43D66B0026E5301CD49A094799FA3" alt="Breastfeeding" width="315" height="205" DisableNVelocity="true" />Breast milk is the complete source of nutrition for the optimum growth of a child. Besides its nutritional benefits, it also protects the infant and mother against various diseases and conditions. The American Academy of Pediatrics (AAP) recommends exclusive breastfeeding for the first six months of life which means that the baby doesn't need any other food besides breast milk during this time. After that, breastfeeding should be continued, preferably for the first two years of life or more with other complementary foods. In general, breastfed babies have strong immune systems, get fewer illnesses and have improved dental and neurodevelopmental outcomes.  Benefits of breastfeeding Breastfed children have a decreased risk of the following conditions: <ul> <li>Ear infections, or otitis media. </li> <li>Diarrhea.</li> <li>Respiratory tract infections.</li> <li>Eczema, or atopic dermatitis. </li> <li>Asthma. </li> <li>SIDS.</li> <li>Necrotizing enterocolitis. </li> <li>Celiac disease. </li> <li>Crohn's disease and ulcerative colitis. </li> <li>Late-onset sepsis in preterm infants. </li> <li>Type 1 and Type 2 diabetes. </li> <li>Leukemia. </li> <li>Childhood overweight or obesity. </li> </ul> Maternal benefits of breastfeeding Breastfeeding helps a mother lose weight after pregnancy while creating a special emotional bond with her child. Breastfeeding mothers also have a decreased risk of the following conditions:  <ul> <li>Excessive menstrual blood loss. </li> <li>Breast, ovarian, endometrial and thyroid cancers. </li> <li>Hypertension. </li> <li>Type 2 diabetes. </li> <li>Rheumatoid arthritis. </li> </ul> Other benefits Breastfeeding is also a great benefit to the environment and society.  <ul> <li>Breastfeeding children are sick less often and their parents miss less work. </li> <li>It's climate-friendly, as it does not require energy for manufacturing or create waste or air pollution. </li> <li>There is no risk of contamination and breast milk is always available, at the right temperature and ready to feed, even in the case of emergencies, such as natural disasters. </li> </ul> Contraindications to breastfeeding There are only two true contraindications to breastfeeding:  <ul> <li>Infants with classic galactosemia, a rare genetic disorder that affects how the body breaks down sugar called galactose. </li> <li>Mothers in the U.S. who are infected with human immunodeficiency virus (HIV). </li> </ul> <a href="/providers/chetna-mangat-md">Chetna Mangat, M.D.</a>, is a physician in Primary Care in Rochester and Kasson's Division of Community Pediatric and Adolescent Medicine. She is board-certified in pediatrics, a board-certified lactation consultant and is a member of AAP's Section on Breastfeeding. Chetna Mangat, M.D.Primary Care in Rochester and KassonBreastfeeding BenefitsPrimary Care in Rochester and KassonFind out if chiropractic care is right for you.&nbsp;<img src="/-/media/ech-media/images/widgets/medicalimages/chiropractichealth.jpg?h=65&iar=0&w=100&sc_lang=en&hash=BC441C9A17FB236CE003AAE2A874B257" alt="ChiropracticHealth" width="100" height="65" DisableNVelocity="true" />What is chiropractic health?10/12/2023 4:30 AM<img src="/-/media/ech-media/images/widgets/medicalimages/chiropractichealth.jpg?h=205&iar=0&w=315&sc_lang=en&hash=C014B80252E0D2B5620D706D2AABE1B5" alt="ChiropracticHealth" width="315" height="205" DisableNVelocity="true" />Chiropractic healthcare was developed in 1895 as a method of optimizing neuromusculoskeletal health by using nonmedicinal, hands-on techniques. The word "chiropractic" combines two Greek words, χέρι and Πρακτική, and literally means "to practice by hand." Early chiropractors referred to these hands-on techniques as "adjustments." Chiropractors today continue to utilize spinal adjustments, also referred to as "spinal manipulation," to alleviate spine-related pain and improve spinal motion. What is a spinal adjustment? Although the specific way chiropractors adjust the spine varies from chiropractor to chiropractor and patient to patient, adjustments generally entail applying a controlled amount of force to specific joints in the neck or back and then either applying a quick, shallow thrust or oscillating the pressure until joint motion is restored and pain is relieved. Spinal adjustments are generally safe, although patients with certain conditions such as severe osteoporosis, spinal cancer, inflammatory arthritis and previous spinal fusion surgery should consider a different approach. What else do chiropractors do today? Chiropractors today are also trained to massage and stretch muscles and recommend exercise and nutritional approaches to managing spine pain. Should I see a chiropractor? Although early medical doctors were skeptical of the sweeping claims early chiropractors made regarding the holistic effects of spinal adjustments, research today supports the use of chiropractic adjustments for specific conditions. Chiropractic care is recommended by many medical doctors to treat back pain, neck pain and muscle tension-related problems. If you are considering chiropractic care, ask your doctor for a referral. Benjamin Holmes, D.C., Ph.D., is a chiropractor in Primary Care in Rochester and Kasson's Integrated Community Specialties and the Mayo Clinic Spine Center. He has extensive training in outpatient spinal therapeutics and specializes in care for mechanical back and neck pain as well as posture- and sport-related myofascial pain, synthesizing passive and active care techniques. As the first chiropractor at Mayo Clinic, Dr. Holmes has pioneered the integration of chiropractic care into the clinic's multispecialty spine program. Benjamin Holmes, D.C., Ph.D.Primary Care in Rochester and KassonChiropractic HealthPrimary Care in Rochester and KassonAsk your healthcare clinician these five questions before getting any tests, treatments or procedures.&nbsp;<img src="/-/media/ech-media/images/widgets/medicalimages/ech_choosingwisely_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=40A24B29E55DC44E42B7D590069D7B39" alt="ECH_ChoosingWisely_widget" width="100" height="65" DisableNVelocity="true" />'Choosing Wisely' for the best medical care10/23/2023 4:30 AM<img src="/-/media/ech-media/images/widgets/medicalimages/ech_choosingwisely_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=51C9A4CF3102851F0E11B4210BA261D5" alt="ECH_ChoosingWisely_widget" width="300" height="195" DisableNVelocity="true" />It's well known that healthcare has become more and more complex for patients and providers. Each visit may involve multiple decisions about tests and treatments. Which ones give you the benefits you need? What are the potential downsides? How do you know which ones may be unnecessary?  To help patients and clinicians answer these questions and more, the American Board of Internal Medicine Foundation, along with Consumer Reports, launched the Choosing Wisely campaign in 2012. The campaign was designed to encourage discussion and guide decision-making between patients and healthcare clinicians about medical care and how to avoid unnecessary and potentially harmful tests, treatments and procedures.  The <a rel="noopener noreferrer" href="http://www.choosingwisely.org/" target="_blank" title="Opens in new browser window">Choosing Wisely</a> website encourages all patients to ask their healthcare clinicians five questions before they get any test, treatment or procedure. <ol> <li>Do I really need this test or procedure?</li> <li>What are the risks of this test, treatment or procedure? Are there potential side effects or could the results be inaccurate?</li> <li>Are there simpler, safer options? For instance, will weight loss help my high blood sugar, blood pressure or cholesterol? </li> <li>What will happen if I don't do anything? Will my condition get worse — or possibly better — if I don't do anything today?</li> <li>How much will it cost? Are there less expensive tests, treatments or procedures that will provide the same information? Sometimes you may need to check your insurance for coverage. When you can, choose generic drugs over brand names. </li> </ol> More than 80 medical societies and specialties, including nurses, nurse-midwives, surgery, surgical specialties, pediatrics, chiropractors, genetics, physical therapy, internal medicine and others have participated in this healthcare initiative.  The recommendations of Choosing Wisely are an important way to talk with your healthcare clinician and make informed decisions about your healthcare. Give them a try.  <a href="/featured-stories/choosing-wisely">Denise Dupras, M.D., Ph.D.</a>, is a physician in Community Internal Medicine, Geriatrics and Palliative Care in Rochester, Minn. She received her medical and doctoral degrees at Mayo Clinic Alix School of Medicine and completed her residency in internal medicine at Mayo Clinic Rochester. Her interests include medical education, evidence-based medicine and care of LGBTQIA+ patients. Denise Dupras, M.D., Ph.D.Primary Care in Rochester and KassonChoosing WiselyPrimary Care in Rochester and KassonThe pharmacy drive-up kiosk reopened on May 20.<img src="/-/media/ech-media/images/widgets/buildings/neclinicpharmacy.jpg?h=65&iar=0&w=100&sc_lang=en&hash=F695CE934E9942D7EFB40A98719F1CB3" alt="NEClinicPharmacy" width="100" height="65" DisableNVelocity="true" />Mayo Family Clinic Northeast Pharmacy reopens drive-up kiosk5/22/2024 12:00 AM<img src="/-/media/ech-media/images/widgets/buildings/neclinicpharmacy.jpg?h=205&iar=0&w=315&sc_lang=en&hash=980BBAEFE4ABA3226362190C5F6517C0" alt="NEClinicPharmacy" width="315" height="205" DisableNVelocity="true" />The Mayo Family Clinic Northeast Pharmacy has recently upgraded its drive-up kiosk, located on the north side of the clinic's front entrance. Patients can once again take advantage of this convenient service for picking up prescription medications. How the drive-up kiosk works <ul> <li>Arrival: Patients simply pull up to the drive-up kiosk and press the call button to notify pharmacy staff of their arrival.</li> <li>Video Consultation: A two-way video communication system allows patients to consult with pharmacy staff.</li> <li>Prescription Pickup: Patients can send their prescriptions and credit card payment information through the pneumatic tube system. </li> </ul> While overall, pick-ups at the drive-up kiosk will be quick, patients who are picking up several prescriptions at once may experience a longer wait time if the individual medications cannot be sent together through the tube due to the size of the bottles and the tube. The drive-up will be open during the Northeast Clinic Pharmacy's regular business hours, Monday-Friday, 8 a.m. to 12:30 p.m. and 1–5 p.m.Primary Care in Rochester and KassonNE Pharmacy DriveupPrimary Care in Rochester and KassonTherapy during the preschool years helps show improvements in stuttering.<img src="/-/media/ech-media/images/widgets/kids/speechtherapy.jpg?h=65&iar=0&w=100&sc_lang=en&hash=2AF31DA48B3BBD66295A11A771CBBD6C" alt="SpeechTherapy" width="100" height="65" DisableNVelocity="true" />Stuttering in children10/19/2023 3:00 AM<img src="/-/media/ech-media/images/widgets/kids/speechtherapy.jpg?h=205&iar=0&w=315&sc_lang=en&hash=D1C816AED1F16662B41CEA0698AE4FBD" alt="SpeechTherapy" width="315" height="205" DisableNVelocity="true" />Stuttering is a speech disorder without a fully understood medical cause. It's characterized by the repetition of sounds, syllables or words resulting in hesitations and interruptions in speech. This often makes it challenging to communicate and frustrating for individuals who stutter. They know what they want to say but cannot get the words out fluently. These children can show signs of physical distress or even try to hide stuttering by avoiding speaking.  Stuttering happens most often in young children, ages 2 to 5, but a minority (25% of those who stutter as children) will continue into adulthood. Experts approximate that 5% of children will stutter as they learn a language, and stuttering is more common in boys and those with a family history.  The best advice for a caregiver with concerns about stuttering is to have the child evaluated by a speech-language pathologist (SLP). Several studies show improvement in stuttering if therapy and coaching are started by an SLP in the preschool years. Stuttering lasting more than 6 weeks is another indication for such a referral.  In addition, suggestions from <a rel="noopener noreferrer" href="https://www.stutteringhelp.org/" target="_blank" title="Opens in new browser window">The Stuttering Foundation</a> to help children with fluency and stuttering include allowing a child more time to speak, slowing down the pace, full listening without interruptions or corrections, simplifying your own words, resisting asking one question after another and building confidence with praise.  For more information, please visit <a rel="noopener noreferrer" href="https://www.stutteringhelp.org/" target="_blank" title="Opens in new browser window">The Stuttering Foundation's website</a>.  <a href="/providers/jessica-davis-md">Jessica M. Davis, M.D.</a>, is a physician in Community Pediatric and Adolescent Medicine and practices general pediatrics along with clinical care in the Integrated Community Specialties Pediatric Developmental Clinic. Her interests include expanding access to care for children with autism spectrum disorder and developmental delays and reducing bias and ableism — discrimination in favor of able-bodied people — in healthcare. Primary Care in Rochester and KassonStutteringPrimary Care in Rochester and KassonFour things you need to know about this year's upper respiratory infection season.&nbsp;<img src="/-/media/ech-media/images/widgets/people/familyuri.jpg?h=65&iar=0&w=100&sc_lang=en&hash=4FA6103CC8C54093DB5252DB5ED6172B" alt="FamilyURI" width="100" height="65" DisableNVelocity="true" />Upper respiratory infection season has arrived9/26/2023 4:30 AM<img src="/-/media/ech-media/images/widgets/people/familyuri.jpg?h=205&iar=0&w=315&sc_lang=en&hash=B118615EA84699C8B3C03F928F20A0FB" alt="FamilyURI" width="315" height="205" DisableNVelocity="true" />It’s that time of year: Cooler weather, changing leaves, and unfortunately an uptick in upper respiratory infections. Respiratory illnesses are a common occurrence in the fall and winter, with seasonal cases of influenza, strep throat and respiratory syncytial virus (RSV) likely increasing over the next few months. COVID-19 also remains active in our community, with many areas seeing a recent rise in cases. Below you’ll find a few reminders to guide you through this year’s upper respiratory infection season. For most people, respiratory illnesses can be treated at home. Mayo Clinic’s guidelines for the testing and treatment of upper respiratory infections, including COVID-19, are informed by expertise and best practices from Mayo’s Department of Infectious Diseases and the Centers for Disease Control and Prevention. We typically recommend clinic-based testing and treatment only for those at high risk for severe illness (age 65 or older, immunocompromised, pregnant, have other complex health conditions, etc.).    If you have respiratory symptoms and aren’t high-risk, you probably don’t need to get tested or make an appointment with your provider. Getting plenty of rest, drinking fluids and using over-the-counter medications can help you feel better and aid recovery.  Use home antigen tests to test for COVID-19. If you have COVID-19 symptoms or have been exposed to COVID-19, home antigen tests are the fastest, most convenient and least expensive way to get tested. Unlike PCR tests, antigen tests are widely available through commercial pharmacies and big-box grocery stores. They don’t require a clinic appointment, won’t get sent to the lab for results and can be used from the comfort of home. You can self-report a positive test result through the COVID-19 home antigen attestation questionnaire in the patient portal Tests for other infections, such as influenza and strep, are recommended only for high-risk patients or those who meet certain criteria. For most people, testing for influenza or other infections will not change your treatment plan. Prevention is the best protection against upper respiratory infections. Following simple prevention guidelines can go a long way in protecting you and your family members from illness. Make sure you wash your hands, avoid prolonged contact with sick individuals and stay current on your recommended vaccines, especially for influenza and COVID-19. If you do become ill, help protect others by staying home. Wear a high-quality, well-fitting mask if contact with other people is unavoidable, and follow isolation guidelines for returning to work or school. <a href="/providers/sidna-tulledge-scheitel-md">Sidna Tulledge-Scheitel, M.D., M.P.H.</a>, is a physician in Community Internal Medicine, Geriatrics and Palliative Care in Rochester. She is also the medical director for Mayo Clinic’s Midwest Virtual Care Team, a group of clinicians who manage upper respiratory infection testing and treatment protocols for patients in Rochester and across Mayo Clinic Health System. Sidna Tulledge-Scheitel, M.D., M.P.H.Primary Care in Rochester and KassonURI Season 2023Primary Care in Rochester and KassonBefore you agree to the role of caregiver, be honest with yourself and your loved ones about your resources and abilities. <img src="/-/media/ech-media/images/widgets/elderly/ech_caregiver_stress_01_widget.jpg?h=65&iar=0&w=100&hash=5EA68E0BDAB984B76E1564A96472EF8C" alt="ECH_Caregiver_Stress_01_widget" width="100" height="65" DisableNVelocity="true" />Considerations for caregivers11/20/2023 4:30 AM<img src="/-/media/ech-media/images/widgets/elderly/ech_caregiver_stress_01_widget.jpg?h=195&iar=0&w=300&hash=8B5430B510532665498CB9AC2463DEFE" alt="ECH_Caregiver_Stress_01_widget" width="300" height="195" DisableNVelocity="true" />As our population ages and becomes more ill and frailer, more Americans — actually one in five — find themselves in the role of caregiver. Of the people who need care, two-thirds rely on care from family members, friends and neighbors.  The assistance these caregivers provide might include:  <ul> <li>Activities of daily living (hygiene, dressing, eating, toileting, shopping, housekeeping, managing finances, setting up appointments, preparing food, transportation, etc.).</li> <li>More involved care (giving medications, tube feedings, physical therapy, monitoring behavior of a loved one with cognitive impairment, etc.).</li> </ul> Caregiving can be a 24/7 job. The risk to caregivers is that they can't get enough rest or exercise, recuperate from illness, keep up their own social interactions and family involvement, and neglect their own care. They may begin to see their loved one only as an obligation or a burden and lose the positive feelings of their relationship.  Not only is burnout an issue for caregivers, but it also can be a safety concern for patients. If their caregiver is worn out, there may be no backup plan or person. Are you cut out to be a caregiver? Before you agree to the role of caregiver, be honest with yourself and your loved one's healthcare clinician about your own resources and abilities. Do you have the skill, time, energy, financial resources and possibly home arrangements to do this?  If not, there are resources available to help you explore your options. Here are just a few for families and caregivers seeking information and help: <ul> <li><a rel="noopener noreferrer" href="https://www.olmstedcounty.gov/residents/services-individuals-families/adults-seniors/long-term-care" target="_blank" title="Opens in new browser window">Aging and Elderly Services</a> (Olmsted County).</li> <li><a rel="noopener noreferrer" href="https://semaaa.org/resources/" target="_blank" title="Opens in new browser window">Southeastern Minnesota Area on Aging</a>.</li> <li><a rel="noopener noreferrer" href="http://www.elder-network.org/" target="_blank" title="Opens in new browser window">Elder Network</a>.</li> <li><a rel="noopener noreferrer" href="https://125livemn.org/" target="_blank" title="Opens in new browser window">125 Live</a>.</li> <li><a rel="noopener noreferrer" href="https://mn.gov/senior-linkage-line/" target="_blank" title="Opens in new browser window">Senior LinkAge Line</a>.</li> <li>Your place of worship. Many faith groups have volunteers who provide support in a variety of ways. </li> </ul> If you step up, be sure to have your own personal support system — friends, family members, church, a support group — in place to help you care for yourself. Don't be afraid or embarrassed to tell your support system what you need, whether it's having someone come for an hour so you can putter in the garden or going to a movie with you as an "escape."  Working with a care team Medical appointments become a way of life for patients and caregivers. Be sure you go to them with your loved one. You're not intruding and being there can help both of you. The appointment can be as much about your caregiving role as the medical needs of the patient.  <ul> <li>Tell the care team member that you're the caregiver. The patient's care plan should include instruction, guidance and support for you. Don't be afraid to ask for that. </li> <li>Let them know what type of tasks you're doing for the patient. Be very specific about the areas where you need more instruction, such as how to help with toileting, preparing low-sodium meals or performing physical therapy at home. </li> </ul> Caregivers are an amazing breed and an essential member of their loved one's care team. Robert Stroebel, M.D., is a physician in the Division of Community Internal Medicine, Geriatrics and Palliative Care at Mayo Clinic in Rochester and practices at Mayo Family Clinic Southeast. He has practiced internal medicine for the past 30 years, with a career focus in practice redesign. Robert Stroebel, M.D.Primary Care in Rochester and KassonCaregiver ConsiderationsPrimary Care in Rochester and KassonTake a few simple steps to stay safe while hunting in the woods, fields and lakes this fall. <img src="/-/media/ech-media/images/widgets/activities/ech_hunting_safety_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=5222EAE4231CE777B2506D6358992D4B" alt="ECH_hunting_safety_widget" width="100" height="65" DisableNVelocity="true" />Aim for safety in this year's hunt11/13/2023 4:30 AM<img src="/-/media/ech-media/images/widgets/activities/ech_hunting_safety_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=013D82E7247934ECF18E15FA965484D7" alt="ECH_hunting_safety_widget" width="300" height="195" DisableNVelocity="true" />Fall is the time of year when many of us head to the woods, fields and lakes to hunt. In the Midwest, hunting is often a tradition of spending time with family and friends. Unfortunately, hunting can be dangerous if you don't take proper safety measures. While hunting accidents are uncommon, they can be catastrophic. According to the Minnesota Department of Natural Resources: <ul> <li>Approximately 800,000 hunting licenses are sold each year. </li> <li>From 2010 to 2022, there were 179 hunting accidents. </li> <li>During that time, there were 18 fatalities, as well as spinal injuries with paralysis.</li> </ul> Some general measures for a safe hunt always apply: <ul> <li>Follow gun safety rules. </li> <li>Never use drugs, alcohol or sedatives while hunting. </li> <li>Carry a cellphone or other device to call for help if you need it. Keep it easily accessible.</li> </ul> Two of the more common types of hunting accidents are tree-stand injuries and hearing loss. Following these simple steps will ensure that you'll have a safe hunting experience. Tree-stand safety Tree-stand safety is as important as gun safety. Follow the same approach with a tree stand as you do with your gun. <ul> <li>Always wear a safety harness or belt while checking or using a stand.</li> <li>Use a short tether between you and the tree when attaching your fall-restraint device. The purpose of the tether is to keep you in the stand if you slip or fall, not to catch you after you have fallen.</li> <li>Know what you should do if you slip while using a safety device. Make a plan.</li> <li>Check permanent tree stands each time before use. Replace any worn or weak lumber.</li> <li>Inspect portable stands for loose nuts and bolts before every use.</li> <li>Read, understand and follow the manufacturer's instructions when installing a ready-made tree stand.</li> <li>Choose a tree large enough to support your weight.</li> <li>Never hurry to set up your stand. Take your time to check it over.</li> <li>Make sure someone knows the location of your tree stand and when you will be there, every time.</li> <li>Use a haul line to raise or lower equipment.</li> <li>Keep firearms unloaded and arrows in a covered quiver when going up or down.</li> <li>Stay awake and alert. Always be aware of your position on the tree-stand platform.</li> </ul> Protect your hearing People who use guns are more likely to develop permanent hearing loss. Shooting without hearing protection practically guarantees you will suffer at least some degree of hearing loss during your lifetime. The Occupational Safety & Health Administration (OSHA) recommends that on-the-job exposure to noise of 115 decibels (dBA) not exceed 15 minutes per day. A .22 caliber rifle produces a noise level of 140 dBA; a typical deer rifle can produce noise greater than 175 dBA. You should always wear hearing protection such as ear plugs or muffs when shooting. On this year's hunt, aim for safety, as well as the game. Matthew Bernard, M.D., is a physician in the Department of Family Medicine and practices at Mayo Family Clinic Northwest. He enjoys hunting for deer, pheasant, grouse, squirrel, elk and caribou.Matthew Bernard, M.D.Primary Care in Rochester and KassonHunting SafetyPrimary Care in Rochester and KassonThe two biggest risk factors for lung cancer are smoking history and age.<img src="/-/media/ech-media/images/widgets/medicalimages/ech_lungcancerscreening_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=5A92ECF6A980B2951328B12496AFFD3B" alt="ECH_LungCancerScreening_widget" width="100" height="65" DisableNVelocity="true" />Why screen for lung cancer? 11/16/2023 4:30 AM<img src="/-/media/ech-media/images/widgets/medicalimages/ech_lungcancerscreening_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=9799A8C7B4AEBD186E770A29EA81F487" alt="ECH_LungCancerScreening_widget" width="300" height="195" DisableNVelocity="true" />As with any screening test, the goal is to detect cancer before you have any symptoms, and when it's potentially treatable. Lung cancer is the leading cause of cancer-related death in men and women. It's estimated that 95% of patients at risk for lung cancer are not being screened, so knowing if you are at risk is important for your health. These FAQs can help you determine if you should be screened for lung cancer and when.  Who should be screened? Smoking is a recognized risk factor for lung cancer. The number of pack years of smoking and current smoking status help determine your risk for lung cancer. For example, a one-pack year is equal to smoking one pack per day for one year, or two packs per day for half a year. Guidelines have recently changed, but if you're a current smoker or quit within the past 15 years, talk to your provider to see if you need to be screened for lung cancer.  When should you be screened? Calculators have been developed to help your clinician determine if you should have a low-dose computed tomography (CT) scan. Some but not all scans include non-cigarette inhaled tobacco products. While there are many guidelines and not all experts agree, the U.S. Preventive Services Task Force recommends annual screening with low-dose CT for smokers or individuals who:  <ul> <li>Have quit less than 15 years ago.</li> <li>Have a 20 or more pack-year smoking history.</li> <li>Are between the ages of 50 and 80.</li> </ul> Other groups differ in their recommendations, including criteria to begin and stop screening. An important consideration when deciding whether or not to get a CT scan is your general health, life expectancy and willingness to undergo curative lung surgery.  What type of screening is used?  Currently, only low-dose CT scanning is recommended for lung cancer screening. Chest X-rays aren't sensitive and specific enough to detect lung cancer early enough to make a difference and prevent death from lung cancer.  The best thing for you to do if you smoke is to stop, which reduces your risk of developing lung cancer. The risk begins to decrease at five years but remains higher than lifetime non-smokers for 25 years after quitting.  <a href="/providers/denise-dupras-md">Denise Dupras, M.D., Ph.D.,</a> is a physician in Community Internal Medicine, Geriatrics and Palliative Care at Mayo Clinic in Rochester, Minn.. She earned her medical and doctoral degrees at Mayo Clinic Alix School of Medicine and completed her residency in internal medicine at Mayo Clinic in Rochester. Her interests include medical education, evidence-based medicine and care of LGBTQIA+ patients. Denise Dupras, M.D., Ph.D.Primary Care in Rochester and KassonLung Cancer ScreeningPrimary Care in Rochester and KassonFind out what the risks are and how you can protect yourself.<img src="/-/media/ech-media/images/widgets/people/ech_sti_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=A011C51502A883E14CD7DB5C3ED1A75B" alt="ECH_STI_widget" width="100" height="65" DisableNVelocity="true" />Are you at risk for sexually transmitted infections?11/30/2023 4:30 AM<img src="/-/media/ech-media/images/widgets/people/ech_sti_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=5D38C591A35EA15D3E47D38600794342" alt="ECH_STI_widget" width="300" height="195" DisableNVelocity="true" />If you're sexually active — even if you're in a same-sex relationship or only perform oral sex — you could be at risk for a sexually transmitted infection. Unfortunately, we're seeing a rise of many sexually transmitted infections in the U.S., particularly syphilis, an infection that was nearly eliminated 10 years ago. What are the most common sexually transmitted infections? The most common sexually transmitted infections are: <ul style="list-style-type: disc;"> <li>Gonorrhea and chlamydia: Females don't always have symptoms with these infections, but if left untreated, they risk developing pelvic inflammatory disease, which can cause infertility and difficult pregnancies. These sexually transmitted infections also can lead to long-term chronic pelvic pain and can put women at higher risk of contracting HIV from an infected partner.</li> <li>Trichomoniasis: This small, mobile parasite is transmitted during sex. In some people, it creates an abnormal discharge. Others experience no or few symptoms.</li> <li>Syphilis: This sexually transmitted infection can lead to long-term, irreversible damage to your heart or brain if left untreated.</li> <li>HIV, and hepatitis B and C: These sexually transmitted infections aren't curable, even if they're diagnosed. A vaccine is available for hepatitis B. No vaccine is available for hepatitis C or HIV.</li> <li>HPV: This sexually transmitted infection is responsible for most cervical cancers in women and some genital cancers in men. And it's thought to be the cause of numerous other concerns, including throat cancers, genital warts and other skin conditions.</li> </ul> The good news is that these infections are easy to screen for and treatments are available for most. However, if left untreated, sexually transmitted infections can cause long-term problems, including infertility, chronic pain and some cancers. How do you know if you're infected? Women may not have signs of infection until it's been present for many months. Signs and symptoms tend to appear earlier in men. Symptoms can include: <ul style="list-style-type: disc;"> <li>Abnormal or irregular bleeding from the penis or vagina.</li> <li>Abnormal discharge or abnormal odor from the penis or vagina.</li> <li>Urinary changes.</li> <li>Low pelvic or abdominal pain.</li> <li>New sore or skin lesion on or near the genitals.</li> </ul> However, not every sexually transmitted infection shows itself right away. Signs of HIV, hepatitis C, HPV and syphilis may not appear for months or years, so it's important to always be cautious. It's also important to be honest with any sexual partners if you are diagnosed with an infection so they can be treated, too. What can you do? To protect yourself against sexually transmitted infections, you can: <ul style="list-style-type: disc;"> <li>Use a condom with each sexual encounter.</li> <li>Get screened for sexually transmitted infections regularly, even if you routinely use a condom and after each new sexual partner. Your primary care clinician can easily perform these tests. In the near future, you may even be able to perform these tests yourself.</li> <li>Stay up to date with Pap tests if you're a woman, and penis and testicular exams if you're a man.</li> <li>Ask your partners about their infection history and ensure any recent infections are properly treated.</li> </ul> Contraceptive options, including intrauterine devices, or IUDs, upper arm implants and oral pills can be reliable options for pregnancy prevention. However, these contraceptives don't protect against sexually transmitted infections, so continue to use a condom every time. It's also OK to ask new partners to get screened before you become sexually active with them. If you have a concern or questions, talk with your primary care clinician. <a href="/providers/jenna-johnson-cnp">Jenna Johnson, APRN, C.N.P., D.N.P.</a>, is a nurse practitioner in Community Internal Medicine, Geriatrics and Palliative Care. She provides primary care with an emphasis on women's health. Jenna Johnson, APRN, C.N.P., D.N.P.Primary Care in Rochester and KassonSexually Transmitted InfectionsPrimary Care in Rochester and KassonNo home monitoring system has been found to prevent SIDS.<img src="/-/media/ech-media/images/widgets/kids/babycrib.jpg?h=65&iar=0&w=100&sc_lang=en&hash=FC65CFFEFF77E8702192571A5C21528B" alt="BabyCrib" width="100" height="65" DisableNVelocity="true" />Can home baby monitors prevent Sudden Infant Death Syndrome?11/27/2023 4:30 AM<img src="/-/media/ech-media/images/widgets/kids/babycrib.jpg?h=205&iar=0&w=315&sc_lang=en&hash=42D1286FE85B0743D07027F4F95F64D2" alt="BabyCrib" width="315" height="205" DisableNVelocity="true" />Picture this: You're in the hospital nursery with your newborn baby and your doctor starts talking about sudden infant death syndrome (SIDS) and safe sleep. You start looking into how you can prevent SIDS from happening to your child and find the Owlet, a sleep sock baby monitor to track heart rate and oxygen. Some sources say that the device prevents SIDS and others say it doesn't. What's the truth? The truth is that home cardiorespiratory (heart and breathing) monitors (e.g., Owlet) do not reduce the risk of or prevent SIDS. Owlet is considered a wellness device by the Federal Drug Administration (FDA), which means that it is not intended for use to diagnose, cure, prevent or treat disease. And it isn't required to meet the same regulatory requirements as medical devices. The FDA released a warning letter on Oct. 5, 2021, to Owlet for marketing their products as "diagnostic" tools — which require a special clearance that Owlet didn't have — which led their Smart Sock to be pulled from the market. Since then, they have released other monitoring socks that are marketed as wellness devices. Some families might wonder: Is it still okay to use the Owlet? The answer is that there is no absolute reason to avoid using the Owlet, but there are considerations to keep in mind. These products have been studied and found to have frequent false alarms (alarming that baby's oxygen or heart rates are low or abnormal when they are actually normal), which can lead to increased parental anxiety. There is also the concern that using these baby monitors may provide a false sense of security, leading families to not follow the other safe sleep recommendations. Not following these recommendations could potentially put the baby at an increased risk for SIDS. Pediatricians recommend the following safe sleep guidelines as outlined by the American Academy of Pediatrics (AAP): <ul> <li>Place infants on their backs, in their own sleep space, with no other people.</li> <li>Use a crib, bassinet or portable play yard with a firm, flat mattress and a fitted sheet. Avoid the baby sleeping on a couch, armchair or a seating device, like a swing or car safety seat (except while riding in the car).</li> <li>Keep loose blankets, pillows, stuffed toys, bumpers and other soft items out of the sleep space.</li> <li>Breastfeed if possible.</li> <li>Avoid smoking. </li> </ul> Owlet received FDA approval on June 16, 2023, for the not-yet-released BabySat monitor to be used for home monitoring of heart rate and oxygen in certain babies. The BabySat is only recommended to be used for babies between 1 and 18 months of age, weighing between 6 and 30 pounds, and under the direct supervision of a doctor who sets the alert ranges for each individual baby. This device will be an FDA-cleared medical device and is expected to be available with a prescription later this year. The BabySat may be used as an alternative to the previously used home monitors in infants with special healthcare needs (e.g., premature babies with apnea of prematurity or bronchopulmonary dysplasia or term babies with upper airway anomalies, central nervous system disorders, or neuromuscular disorders) or requiring home oxygen therapy. The BabySat is still not recommended as a device to prevent SIDS, as no home monitoring system has been found to prevent SIDS. What does this mean for your baby? If your baby is otherwise healthy and your doctor hasn't recommended home heart and oxygen monitoring, they don't need a home monitoring device. Pediatricians recommend following the safe sleep recommendations from the AAP and reaching out to your primary care clinician with any questions. Noelle Torrance, M.D., is a third-year resident in Pediatric and Adolescent Medicine at Mayo Clinic in Rochester, Minnesota. Following residency, she plans to practice as a primary care pediatrician.Noelle Torrance, M.D.Primary Care in Rochester and KassonSIDS Baby MonitorsPrimary Care in Rochester and KassonTips and tricks to determine when to watch and wait versus seek medical care.<img src="/-/media/ech-media/images/widgets/kids/littlegirlholdingstomach.jpg?h=65&iar=0&w=100&sc_lang=en&hash=2485D46312CB9964173AD21DE72137B9" alt="LittleGirlHoldingStomach" width="100" height="65" DisableNVelocity="true" />How to know when abdominal pain is more than just a 'tummy ache'11/9/2023 4:30 AM<img src="/-/media/ech-media/images/widgets/kids/littlegirlholdingstomach.jpg?h=205&iar=0&w=315&sc_lang=en&hash=5511127A3029372F711861D570164A60" alt="LittleGirlHoldingStomach" width="315" height="205" DisableNVelocity="true" />"Mom, my tummy hurts." This is one of the most common complaints parents hear. How do you know when to wait it out and when to seek treatment? How do you know what level of attention is warranted? This complaint can be difficult to decipher for parents. Luckily, there are some tips and tricks that can help. Start with a few questions <ul style="margin-top: 0in; list-style-type: disc;"> <li>Did it start suddenly or slowly?</li> <li>What do you observe has changed about your child?</li> <li>Are they still playing and acting like their usual self? Or are they crying, refusing to move or doubled over as if protecting their stomach? </li> <li>Are there any symptoms accompanying the abdominal pain?</li> </ul> Red flags Go to the emergency department immediately if any of the following are true: <ul style="margin-top: 0in; list-style-type: disc;"> <li>Sudden onset of significant pain. </li> <li>Severe pain.</li> <li>Refusing to move.</li> <li>Refusing to stop moving (e.g., cannot find a comfortable position). </li> <li>Doubled over and holding or protecting the stomach. </li> <li>Uncontrollable crying or constant whimpering. </li> <li>Fever 100.4 degrees Fahrenheit or higher. </li> <li>Uncontrollable vomiting. </li> <li>Blood in bowel or urine. </li> <li>Yellowing of the skin or eyes. </li> <li>Not urinating at least twice in the last 24 hours. </li> <li>Unable to wake up and answer questions appropriately.</li> </ul> If the pain didn't start suddenly and isn't severe enough to significantly change your child's behavior, then you have a little time to dig deeper into what they are feeling. Ask questions like: 1) What does it feel like? 2) Point with one finger to where it hurts. 3) What makes it feel better/worse? The answer to these questions can give you clues to the origin of their pain. Common causes of abdominal pain by location <ul style="margin-top: 0in; list-style-type: disc;"> <li>Upper abdomen: Pain in the upper abdomen without any of the above red flag symptoms is usually heartburn or indigestion. The clues that your child is experiencing indigestion or heartburn are burping, nausea or a sour taste in the mouth. To help with these symptoms, have your child drink a glass of water and eat a piece of bread. Having a bowel movement will typically also help the symptoms. </li> <li>Belly button: Pain around the belly button without any of the above red flag symptoms is common and can usually be handled at home. This pain is often caused by anxiety, stress, indigestion or heartburn. If the pain moves to the lower right or is associated with fever, vomiting, inability to have a bowel movement or pass gas, you should have your child evaluated for possible appendicitis. If the pain is severe, you should go to the emergency department. To help with anxiety or stress symptoms, you can have the child rest, provide a gentle belly rub and provide distraction with a quiet game, book or movie. </li> <li>Side(s) of the abdomen: Pain in the left abdomen without any of the above red flag symptoms is commonly constipation. However, if the pain starts on the far side of the abdomen and moves towards the groin, it could be a sign of kidney stones. If the pain is in the right lower abdomen or is associated with fever, vomiting or the inability to have a bowel movement or pass gas, you should have your child evaluated for possible appendicitis. If the pain is severe you should go to the emergency department. If your child suffers from constipation, have them drink extra water and spend time trying to have a bowel movement. If the issue remains for an extended period of time, schedule an appointment with their primary care clinician. If you have concerns about kidney stones, offer additional water and schedule an appointment with your child's primary care clinician. </li> <li>Pelvis or groin: Pain in the pelvis or groin without any of the above red flag symptoms could be caused by menstrual cramps or a urine infection. Urine infections also are typically associated with burning during urination, feeling an urgency to urinate with little urine output and wetting underwear or bedding when previously potty trained. Using a heating pad and taking ibuprofen (e.g., Advil) or acetaminophen (e.g., Tylenol) can provide comfort for menstrual cramps. If you suspect a urine infection, have the child drink lots of water and schedule an appointment with their primary care clinician.</li> </ul> <a href="/featured-stories/tummy-ache">Rachel King, M.D.</a>, is a pediatric resident in Community Pediatric and Adolescent Medicine in Rochester, Minn., with a special interest in pediatric emergency medicine. Rachel King, M.D.Primary Care in Rochester and KassonTummy AchePrimary Care in Rochester and KassonTips to reduce or reverse symptoms of gastroesophageal reflux disease (GERD).<img src="/-/media/ech-media/images/widgets/people/manholdingthroat.jpg?h=65&iar=0&w=100&sc_lang=en&hash=90DE0A680D022C6892003C20827B5A75" alt="ManHoldingThroat" width="100" height="65" DisableNVelocity="true" />GERD: 10 lifestyle changes to reverse reflux12/14/2023 12:00 AM<img src="/-/media/ech-media/images/widgets/people/manholdingthroat.jpg?h=205&iar=0&w=315&sc_lang=en&hash=CA1CEB02A554730757AEE667081EE0A8" alt="ManHoldingThroat" width="315" height="205" DisableNVelocity="true" />Gastroesophageal reflux disease (GERD), commonly known as heartburn or reflux, occurs when stomach acid repeatedly flows backward into the esophagus, the tube connecting the mouth and stomach. Over time, this backwash can irritate the linking of the esophagus resulting in symptoms.  Symptoms of GERD include:  <ul> <li>Burning sensation in the chest (heartburn). </li> <li>Upper abdominal pain or chest pain.</li> <li>Regurgitation of food or stomach acid into the mouth.</li> <li>Persistent cough. </li> <li>Difficulty swallowing. </li> </ul> <img alt="GERD" style="width: 250px; height: 249px; float: right;" src="/-/media/ech-media/images/gerd.jpg?h=249&w=250&sc_lang=en&hash=5B47C52798BDCC43B8946C5A4B09067C" />Many people with GERD can reduce their symptoms without prescription medications or invasive procedures. Here are 10 ways you can reverse the reflux.  Maintain a healthy weight: Obesity puts extra pressure on the stomach, forcing stomach acid into the esophagus. Weight loss is the best way to reduce reflux.  Wear loose clothes: Tight clothing, like belts and waistbands, also increase pressure in the abdomen, causing heartburn.  Eat smaller, frequent meals: Large meals overfill the stomach, increasing the chance of reflux.  Stay upright after eating: Sitting up or standing after meals allows gravity to help food pass through the stomach, preventing backflow into the esophagus. Wait at least 2 hours before lying down.  Avoid trigger foods: Certain foods make heartburn worse, especially spicy and fatty foods, tomatoes, citrus juices, coffee, soda, chocolate and alcoholic drinks.  Quit smoking: Nicotine causes the lower esophagus to relax and also stimulates the production of stomach acid.  No bedtime snacks: Eating before bed can cause heartburn at night and interrupt sleep.  Elevate your head at night: Raising the head of your bed with bed blocks allows gravity to keep stomach acid from backing into the esophagus. Extra pillows usually are not enough.  Try an antacid: Taking an over-the-counter antacid 30 to 60 minutes after meals or at bedtime can temporarily reduce reflux symptoms.  Relax: Stress can increase our awareness of reflux symptoms and promote overeating. Relaxation techniques such as structured breathing, yoga and meditation can be helpful.  Incorporating one or more of these tips into your daily routine can provide significant relief from GERD symptoms. If your symptoms fail to improve or worsen, visit with your care team to discuss whether additional treatment or testing is necessary.  <a href="/providers/matthew-heinrich-mdmba">Matthew Heinrich, M.D., M.B.A.</a>, is an internal medicine physician in Community Internal Medicine, Geriatrics and Palliative Care and practices in the Baldwin building in Rochester, Minn. He earned his medical degree at Texas Tech University Health Sciences Center School of Medicine in Lubbock, Texas. His interests include primary care, evidence-based medicine and care of LGBTQIA+ patients. Matthew Heinrich, M.D., M.B.A.Primary Care in Rochester and KassonGERDPrimary Care in Rochester and Kassonc<img src="/-/media/ech-media/images/widgets/randomimages/ech_handwashing_01_widget.jpg?h=65&iar=0&w=100&hash=F1D34FB2B69381D56E49C332B4285C1B" alt="ECH_Handwashing_01_widget" width="100" height="65" DisableNVelocity="true" />Break the chain of infection12/7/2023 12:00 AM<img src="/-/media/ech-media/images/widgets/randomimages/ech_handwashing_01_widget.jpg?h=195&iar=0&w=300&hash=D2E73E45F882DD721A0DE1C81625BC20" alt="ECH_Handwashing_01_widget" width="300" height="195" DisableNVelocity="true" />'Tis the season for families to gather in their homes and celebrate the holidays. However, we are not the only ones celebrating — COVID-19, influenza, respiratory syncytial virus (RSV) and countless other bugs and germs, such as cold viruses and stomach flu, are thrilled to have us huddled together indoors, shaking hands and sharing towels and door handles. It just makes their job of spreading disease all the easier. These last years have reminded us that the simplest things are our best weapons against infection (masking, social distancing, etc). We have been reminded that breaking the chain of infection isn't just a doctor's prescription but includes wisdom from your mother, like "Wash your hands!" In addition to getting vaccinated for COVID, influenza and RSV, here are a few tips to make sure you're doing handwashing right. When to wash <ul> <li>Before, during and after preparing food.</li> <li>Before eating.</li> <li>Before and after caring for someone sick.</li> <li>After changing a diaper, blowing your nose, coughing, sneezing, using the toilet or touching garbage.</li> <li>After touching an animal, animal food or animal waste. </li> </ul> How to wash <ol> <li>Wet. Use clean, running water (no standing water). Any temperature is fine. </li> <li>Lather. Any soap will work. There's no evidence that soaps with special “antibacterial” ingredients are better at preventing disease. </li> <li>Scrub. Studies show that about 20 seconds is the right amount for most situations (sing the 'Happy Birthday' song to get the timing right). Don't forget the back of your hands and under your nails. </li> <li>Rinse. Again, clean, running water is a must. Standing water leads to recontamination. </li> <li>Dry. Wet hands transfer germs more easily. Dry them on a clean towel or air dry.</li> <li>No soap and water? No problem! Hand sanitizers with at least 60 percent alcohol will do the job. </li> </ol> COVID, influenza, RSV and their friends are here to ruin your holidays, so be safe and thoughtful this holiday season. Get vaccinated and make sure you follow these hand-washing tips to keep you and your family healthy during this holiday season! <a href="/providers/luke-hafdahl-md">Luke Hafdahl, M.D.</a>, is a primary care physician in Community Internal Medicine, Geriatrics and Palliative Care in Rochester, Minn., and practices in the Baldwin building.Luke Hafdahl, M.D.Primary Care in Rochester and KassonHandwashing BenefitsPrimary Care in Rochester and KassonIf you have guns in your home, make sure your kids are safe.<img src="/-/media/ech-media/images/widgets/kids/ech_kidsguns_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=BD1CE382D549E2A1F1A62008A0C3D266" alt="ECH_KidsGuns_widget" width="100" height="65" DisableNVelocity="true" />Keeping kids safe around guns12/11/2023 12:00 AM<img src="/-/media/ech-media/images/widgets/kids/ech_kidsguns_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=283E2DD6F7BAB7EFA0DDE8ABBE605A6B" alt="ECH_KidsGuns_widget" width="300" height="195" DisableNVelocity="true" />Kids are curious and quick. That's why guns and kids can be a deadly combination.  <ul> <li>It's estimated that about one-third of households with children ages 18 and under have a gun in the home. </li> <li>Children and adolescents who live in or visit homes with firearms are at an increased risk of fatal and non-fatal firearm-related injuries, suicide and homicide. </li> </ul> If you, as a parent, grandparent or other caregiver, keep guns in your home, here are some steps you can take to make sure kids are safe:  <ul> <li>Make sure guns are not loaded. </li> <li>Store them in a locked location, such as a gun safe, out of the reach and sight of children.</li> <li>Store ammunition in a separate locked location that's also out of the reach and sight of children. </li> <li>Hide the keys and combinations. </li> <li>When a gun isn't in its lock box, keep your eye on it. Don't leave guns on a nightstand, table or other place a child can find or reach it. </li> <li>Make sure all guns have effective, child-resistant gun locks. </li> <li>If a visitor has a gun in a backpack, briefcase, handbag or unlocked case, provide them with a locked place to store it while they're in your home. </li> <li>If you decide to remove a gun from your home, dispose of it safely. To find out how to do that, contact your local law enforcement department. </li> </ul> Also, take time to talk with your kids. Explain how a gun they might see on television or a video game is different from a gun in real life, which can hurt people. Teach them never to touch a gun and to tell an adult immediately if they see one. Once you think your child is ready, enroll them in a gun safety training class.  Matthew Bernard, M.D., is a physician in Family Medicine at Mayo Family Clinic Northwest. He enjoys hunting for deer, pheasant, grouse, squirrel, elk and caribou. Matthew Bernard, M.D.Primary Care in Rochester and KassonKids Gun SafetyPrimary Care in Rochester and KassonWhen to consider medications or surgery to achieve weight loss.<img src="/-/media/ech-media/images/widgets/randomimages/scale_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=4949805C6DA1B4696A5167EAC8C32292" alt="Scale_widget" width="100" height="65" DisableNVelocity="true" />When diet and exercise are not enough for weight loss12/21/2023 12:00 AM<img src="/-/media/ech-media/images/widgets/randomimages/scale_widget.jpg?h=205&iar=0&w=315&sc_lang=en&hash=03F6E85FA7174CD40A2030AD045DEF3F" alt="Scale_widget" width="315" height="205" DisableNVelocity="true" />There are times when diet and exercise are not enough to achieve weight loss and additional help in the form of medicines and surgery is needed. Here are some things to consider when thinking of weight-loss medications.  Who should take weight-loss medications? Your body mass index (BMI), which is a measurement of your weight relative to your height, is used to define overweight and obesity. Adults with a BMI between 25 and 30 are considered overweight and those with a BMI of 30 or greater are considered obese. The Food and Drug Administration (FDA) has approved the use of weight-loss medications in adults who:  <ul> <li>Have a BMI of 30 or greater.</li> <li>Have a BMI between 27 and 29.9 and have weight-related medical conditions such as diabetes, high cholesterol, heart disease or high blood pressure. </li> </ul> The first step in deciding if a weight-loss medication is right for you is to review your blood work and medical history with your healthcare clinician. Remember that although medications can help achieve success with weight loss, they can also be harmful and lead to serious side effects if not prescribed appropriately. They also do not replace diet and exercise, which alone can result in about 5% weight loss.  How do weight-loss medications work? Weight-loss medications work by reducing your appetite or changing the way you digest food. They help achieve a better hormonal balance between the stomach and brain to change the way your body and mind respond to food.  How do I pick the right medication? There is no one best option. It's more about finding one that fits your lifestyle and health profile. You may have other health conditions that may benefit from a certain medication. The goal is to lose at least 5% to 10% of your starting body weight, which will significantly improve overall health.  How long do I take weight-loss medications? Most weight loss typically takes place within six months of starting weight-loss medications. Some people achieve success around this time, while others don't. It's important to follow up with your healthcare clinician often, especially when you hit roadblocks. As a rule of thumb, if you do not lose at least 5% of your starting weight after 12 weeks on the full dosage of your medication, your healthcare clinician may recommend that you stop taking it and switch to a different medication.  Many people gain back some of the weight that they lose when they stop taking weight-loss medication, so it's important to continue practicing healthy lifestyle habits to help limit weight gain.  What are the available medicines for weight loss?  Weight-loss medications are no magic pill, but if used in the right setting, they may help you lead a healthier life. Pregnant women should never take weight-loss medications. Women who are planning to get pregnant should also avoid these medications, as some may harm a fetus.  These medications have been approved by the FDA for weight loss in adults and children ages 12 years and older, except for Contrave, which is indicated only for adults. Another medication, Setmelanotide (Imcivree) is approved only for children ages 6 years and older who have rare genetic disorders causing obesity.  <ul> <li>Orlistat (Xenical): This medication works by reducing the amount of fat your body absorbs from the foods you eat. A lower-dose version, Alli, is available without a prescription in many countries, including the U.S. Common side effects include diarrhea, oily stools, gas and stomach cramps. </li> <li>Naltrexone-bupropion (Contrave): This medication is a mix of naltrexone, which is used to treat alcohol and drug dependence, and bupropion, which is used to treat depression or help people quit smoking. This medication makes you feel less hungry or full sooner. Side effects are constipation, diarrhea, dry mouth, headache, increased blood pressure, increased heart rate, insomnia and liver damage. It should not be used if you have uncontrolled high blood pressure, a history of seizure or eating disorders, or are dependent on opioid pain medication. </li> <li>Phentermine (Lomaira, Adipex-P): This medication, which curbs your appetite, is FDA-approved for short-term use only — up to 12 weeks. Side effects include increased heart rate and blood pressure, insomnia, constipation, dry mouth and nervousness. </li> <li>Phentermine/topiramate (Qsymia): This medication is a mix of phentermine, which lessens your appetite, and topiramate, which is used to treat seizures or migraine headaches. This medication works by making you less hungry or feel full sooner. Side effects include racing heartbeat, constipation, dry mouth, dizziness, trouble sleeping, tingling and a sudden decrease in vision. </li> <li>Liraglutide (Saxenda): This medication, also used to treat diabetes, mimics a hormone called glucagon-like peptide 1 (GLP-1) which targets areas of the brain that regulate appetite and food intake. It may make you feel less hungry or full sooner. It is given as a daily injection. Side effects include constipation or diarrhea, nausea, abdominal pain and rapid heart rate. It also may increase the chances of developing pancreatitis. </li> <li>Semaglutide (Wegovy): Approved in June 2021, this medication also mimics GLP-1 and is given as a weekly injection. Common side effects are similar to liraglutide and include nausea, diarrhea and stomach pain. It should not be given to people with a personal or family history of certain thyroid cancers or a rare condition called Multiple Endocrine Neoplasia Syndrome type 2 (MEN 2). </li> <li>Tirzepatide (Zepbound): Just approved by the FDA in November 2023, this medication is also part of the medication class that mimics GLP-1 and helps reduce food intake and appetite. However, it also imitates a second hormone called GIP, which along with reducing appetite, may improve how the body breaks down sugar and fat. It is administered by injection once a week. Side effects include abdominal pain, constipation, diarrhea and indigestion. </li> <li>Setmelanotide (Imcivree): This medication is FDA-approved only for children 6 years and older who have specific rare genetic conditions causing obesity confirmed by genetic testing. </li> </ul> It's important to understand the risks, benefits and limitations of these medications. Side effects may be bothersome. Long-term safety data are limited and they can be expensive. Be sure to consult your primary care clinician before starting any weight-loss medication.  <a href="/providers/ramona-dejesus-md">Ramona DeJesus, M.D.</a>, is a general internist in Primary Care in Rochester and Kasson's Division of Community Internal Medicine, Geriatrics and Palliative Care. She completed her medical degree at the University of Florida and completed her residency at Mayo Clinic in Rochester. She is board-certified in internal and obesity medicine. Her interests include chronic disease management in primary care and population health management of high-risk patients. Ramona DeJesus, M.D.Primary Care in Rochester and KassonMeds Weight LossPrimary Care in Rochester and KassonLearn the difference between these common diagnoses.<img src="/-/media/ech-media/images/widgets/kids/manboyfloorplay.jpg?h=65&iar=0&w=100&sc_lang=en&hash=336BB0A1BF3EE90CC8476B8680841925" alt="ManBoyFloorPlay" width="100" height="65" DisableNVelocity="true" />Shake, rattle and (eye) roll: Is it a tic? Seizure? Something else?12/18/2023 12:00 AM<img src="/-/media/ech-media/images/widgets/kids/manboyfloorplay.jpg?h=205&iar=0&w=315&sc_lang=en&hash=93F1BE4D98F7B759E72268AA43ADE760" alt="ManBoyFloorPlay" width="315" height="205" DisableNVelocity="true" />As kids settle into the school year, it can be common to notice new behaviors. Perhaps a teacher notices that your child often seems to stare off into space. Maybe your child mentions a friend has started making odd, jerking movements every few minutes. This article will cover some common reasons that children may experience these symptoms and what you can do about it.  Tic disorders A tic is a brief movement or sound that is repeated frequently in the same way. Common examples would include throat clearing, sniffing, eye blinking or shoulder shrugging. Sometimes people with a tic disorder can stop these movements for a brief time if they focus hard on preventing it, but for the most part, they can't stop the tics. They may not even be aware that they are happening, or they may feel an intense urge that only goes away after the tic.  As many as 1 in 10 grade school children will have tics at some point. For the vast majority of kids, these will go away on their own over time (termed a provisional tic disorder). Stress, anxiety, poor quality sleep and even some medications can make tics worse. Sometimes these tics can run in families. You may be able to find another close relative who had tics for a time. Less than 1% of children will be diagnosed with Tourette syndrome, a disorder that is characterized by multiple types of tics that do not go away over time. Fortunately, using rude or obscene gestures, called copropraxia, or words, called coprolalia, is quite rare.  How are tic disorders treated?  <ul> <li>Ignore it: Tics are not dangerous and should not impact school performance, development or socialization For the majority of kids, tics will go away after a year or so. However, if tics are causing distress — for example, bullying at school — therapy may be an option. </li> <li>Therapy: Habit reversal training is an effective treatment strategy for children with a tic disorder. This process involves training a child to recognize the urge to tic and then replace that with another behavior. Over time, the need to tic should decrease. </li> <li>Medications: There are prescription medications that can decrease the frequency and severity of tics. Like all medications, these can have side effects, so they are best used when tics are causing distress or impairing functioning. You should have a thorough discussion with your child's clinician before starting any medication. </li> </ul> Seizure disorders A seizure is a temporary, uncontrolled burst of electrical activity between brain cells, or neurons. Though the term brings to mind the type of full-body shaking convulsions (called a generalized tonic-clonic seizure) we see depicted on television, seizures can take on a wide variety of forms. A common type of seizure in school-age children is called absence seizures. Like tics, absence seizures usually only last a few seconds and occur multiple times throughout the day. Children with these seizures will suddenly stare off into space and may have facial movements, like eye blinking or lip smacking, and then will go back to what they were doing before. Many will not even realize anything happened.  Although absence seizures are brief, they are important to recognize and treat because they can negatively impact learning and school performance. Since they tend to be frequent, kids end up missing out on a lot of teaching and are constantly trying to catch up with the information they miss. Children with seizures also need additional supervision around water or with activities like riding a bike where they might injure themselves if they were to lose consciousness.  How are absence seizures treated?  <ul> <li>Medications: Almost all seizure disorders, including absence seizures, need to be treated with specific anti-seizure medications. A pediatric neurologist manages these. About 2 out of 3 kids with absence seizures will eventually outgrow their seizures and may not need to be on medications long-term. </li> </ul> What to do if my child has abnormal movements? It can be scary if your child is doing a new behavior that just seemed to appear one day. Fortunately, the vast majority of spells are not seizures. If you, your child's teacher or other caregiver is concerned, it's best to set up an appointment with your child's primary care clinician. They will help work through whether the episodes are tics, seizures, a mood disorder like anxiety or depression, a reflection of sleep problems, behaviors or something else entirely. In the meantime, here are a few things you can do to get the most out of that appointment:  <ul> <li>Find a quiet, private time to ask your child about the behavior. Have they noticed the movement or sound that they make? Can they tell when it is about to happen? Has anyone else commented on it? Are they feeling anxious or worried about something?</li> <li>Don't draw attention to the episodes. For tics, this is likely to make them worse. Scolding your child or instructing them to stop will not decrease seizures. </li> <li>Try to get a video of the movement/vocalization. This can be very helpful to show your child's primary care clinician. </li> <li>Ask around for family history — Did grandpa have tics as a kid? Is there a cousin with seizures? Beyond second-degree relatives (e.g., grandparents, aunts, uncles, cousins), family history is less relevant. </li> <li>If you haven't already, talk to your child's teacher. Has school performance declined this year? Are the episodes happening both at home and school? </li> </ul> Erin Triplet, M.D., Ph.D., is a resident in Community Pediatric and Adolescent Medicine in Rochester, Minn. Her interests include pediatric neurology, genetics and gene therapy research. Erin Triplet, M.D., Ph.D.Primary Care in Rochester and KassonTics SeizuresPrimary Care in Rochester and KassonBreaking your activity nutrition into pre-workout, intra-workout and post-workout fuel makes it easier to digest.<img src="/-/media/ech-media/images/widgets/food/athletenutrition.jpg?h=65&iar=0&w=100&sc_lang=en&hash=4C53B3C5A6D21288BE1316784A4C1452" alt="AthleteNutrition" width="100" height="65" DisableNVelocity="true" />Active lifestyles require good nutrition1/4/2024 12:00 AM<img src="/-/media/ech-media/images/widgets/food/athletenutrition.jpg?h=205&iar=0&w=315&sc_lang=en&hash=F0D018BA74882EAEE524A840CFA4EC8B" alt="AthleteNutrition" width="315" height="205" DisableNVelocity="true" />New year, new resolutions, new exercise plans. Do we want to fuel our physical activity with our old nutritional habits? Fueling the athlete inside you doesn't have to be difficult, but just like your New Year's resolutions, it should be intentional. Breaking sports nutrition into pre-workout, intra-workout and post-workout fuel makes it much easier to digest.  Pre-workout meals should emphasize carbohydrates for a quick energy source during your workout. A high carbohydrate meal with a protein source and low fat is best 30 minutes to 2 hours before your planned exercise. Why low in fat? Everyone is different, but many people experience an upset stomach when exercising after a meal high in fat, as fat is the slowest of the macronutrients to move through the digestive tract. Some examples of great pre-workout meals include: <ul> <li>Oats with Greek yogurt and fruit. </li> <li>A bagel with a light layer of cream cheese and a hard-boiled egg. </li> <li>A smoothie with protein powder. </li> <li>A protein shake made with bananas. </li> </ul> Intra-workout fuel isn't required for most typical workouts, but it's essential to remain hydrated. Sip on water while you exercise. If you plan on performing high-intensity exercise for more than 30 minutes, a sports drink containing sugar and electrolytes helps you keep your intensity longer. A quick trick to know if you're drinking enough fluids during a workout involves weighing yourself right before and right after you exercise. If you weigh less afterward, you're losing water — better drink up. Workouts over an hour may require extra sugar while exercising — try a sports drink, applesauce packet or even fruit snacks to top off your energy stores.  Post-workout meals should include complex carbohydrates and protein to fuel recovery and replenish your nutrient stores for your next workout. Rehydration is also important — for every pound lost during your workout, 16 to 24 oz. of fluid are required for rehydration. Examples of post-workout meals include: <ul> <li>Chicken, rice and veggies. </li> <li>A whole grain wrap filled with sliced turkey and veggies. </li> <li>A taco or burrito bowl. </li> <li>A smoothie with protein powder and peanut butter or avocado. </li> </ul> As you tackle your New Year's resolutions and physical activity goals for 2024, consider the ideas above as a starting point. If you find yourself asking more questions, be open to a consultation with a registered dietitian nutritionist.  Visit these websites for more information on nutrition for an active lifestyle: <ul> <li><a rel="noopener noreferrer" href="https://www.eatright.org/fitness/physical-activity/exercise-nutrition/timing-your-pre-and-post-workout-nutrition" target="_blank" title="Opens in new browser window">Timing your Pre- and Post-Workout Nutrition (eatright.org)</a>. </li> <li><a rel="noopener noreferrer" href="https://www.medicalnewstoday.com/articles/nutrition-for-athletes" target="_blank" title="Opens in new browser window">Nutrition and athletic performance: What to consider (medicalnewstoday.com)</a>.</li> </ul> Alaina Bodi is a dietetic intern at Mayo Clinic in Rochester. She received her Bachelor of Science in Dietetics/Nutrition, Fitness and Health from Purdue University. During her time at Purdue, she interned for Purdue Athletics and the Green Bay Packers. Alaina BodiPrimary Care in Rochester and KassonAthlete NutritionPrimary Care in Rochester and KassonTeenager inspires family members to donate blood and save lives.<img src="/-/media/ech-media/images/widgets/blooddonation/blooddonationschrom.jpg?h=65&iar=0&w=100&sc_lang=en&hash=D94901D7D9C8980C9AFE085B253D5108" alt="BloodDonationSchrom" width="100" height="65" DisableNVelocity="true" />Blood donation becomes a family affair1/11/2024 12:00 AM<img src="/-/media/ech-media/images/widgets/blooddonation/blooddonationschrom.jpg?h=205&iar=0&w=315&sc_lang=en&hash=3AC1E80DB1E381F30FEC01FB489537D0" alt="BloodDonationSchrom" width="315" height="205" DisableNVelocity="true" />On Christian Schrom's 16th birthday, he donated blood for the first time. He wanted to donate with his dad and grandma, who had a long-standing practice of donating blood together. "Normally we donate early in the morning," says Ryan, Christian's dad. "Because whenever we come in to donate, we always go for breakfast afterward. It's just kind of a little tradition that we do." The unique family tradition was started by Jody, Christian's grandma and Ryan's mom, who has donated whole blood more than 60 times. "I probably started donating when I was about 20. I have done it for a long time," says Jody. "It's just something I like to do. You feel so good about your donation because you know you are helping people." Jody has instilled the same giving spirit into her son. "Like Mom said, you get to feel good about it, and you're helping someone," says Ryan. "There's enough bad in the world. Donating blood is just a little thing, but it's important and it's helpful." Now when the Schrom family goes out for breakfast after donating, they need a bigger table. When Christian donated for the first time, he didn't just go with his dad and grandma. He made sure to bring his mom and grandpa, too. "Christian's mom had only donated blood once before, and I am not sure if his grandpa had ever donated," says Ryan. "Now since his birthday, Grandpa has donated every time Grandma has gone, and my wife has gone in again as well." Following the family tradition started by his Grandma Jody, Christian has inspired others to donate blood and help save lives.  To schedule a blood donation appointment at the Northwest Blood Donor Center or the Hilton Building Blood Donor Center, call the Mayo Clinic Blood Donor Center at <a href="tel:5072844475">507-284-4475</a>. Be sure to watch for more information by visiting the <a rel="noopener noreferrer" href="https://connect.mayoclinic.org/page/blood-donor-program/" target="_blank" title="Opens in new browser window">Blood Donor Program blog</a>, the <a rel="noopener noreferrer" href="http://www.mayoclinic.org/donateblood" target="_blank" title="Opens in new browser window">Minnesota Blood Donor Program website</a> or <a rel="noopener noreferrer" href="https://www.facebook.com/blooddonorcentermc?ref=br_tf" target="_blank" title="Opens in new browser window">Facebook</a> page. Primary Care in Rochester and KassonBlood Donation SchromPrimary Care in Rochester and KassonFollow these tips to prevent fractures and chronic pain.<img src="/-/media/ech-media/images/widgets/activities/exerciseclass.jpg?h=65&iar=0&w=100&sc_lang=en&hash=269E0B98CFA579693E290B0D716F2E22" alt="ExerciseClass" width="100" height="65" DisableNVelocity="true" />Keeping bones healthy: 5 simple recommendations1/29/2024 12:00 AM<img src="/-/media/ech-media/images/widgets/activities/exerciseclass.jpg?h=205&iar=0&w=315&sc_lang=en&hash=A16A1BCF452005D9D37374DDB1544CFC" alt="ExerciseClass" width="315" height="205" DisableNVelocity="true" />Bone health is crucial to prevent fractures, which can lead to chronic pain and even impair your ability to live independently. Below are five simple recommendations to keep aging bones healthy and strong. Get enough calcium. Adults should consume 1,000 to 1,200 mg of calcium per day, or three to four servings of calcium-rich foods, such as yogurt, milk and cheese. Almond milk is also rich in calcium. Calcium intake should occur throughout the day to optimize absorption. If a person is lactose-intolerant or unable to obtain enough calcium through diet alone, a calcium supplement of 600 mg once or twice per day can be substituted. Take a vitamin D supplement. People who live in northern parts of the U.S. and have limited sun exposure should take a vitamin D supplement. Total vitamin D intake should be between 800 to 1000 IU per day. Most multivitamins provide close to the recommended dose of daily vitamin D. Some milk is also fortified with vitamin D. Avoid nicotine and excess alcohol. Both nicotine and alcohol negatively impact bone health. Nicotine impacts the bone directly by impairing the production of bone-building cells and decreasing the body's absorption of calcium. Excessive alcohol intake impairs vitamin D absorption, which will decrease bone strength. To optimize bone health, you should avoid nicotine and use alcohol sparingly. Exercise three or four times weekly. Exercise helps build bones, promote balance and improve overall fitness. Exercise programs should include resistance training, like water aerobics or resistance bands; balance training, like Tai Chi or yoga; and aerobic exercise like walking or ellipticals. Exercise programs can be performed at home or with a group at a community center or gym. Ask your doctor about your bone health. Certain medical conditions and medications can cause bone loss. Anti-seizure medications, chronic steroids and acid blockers, among others, decrease bone density. People with a family history of osteoporosis are at greater risk for this condition. Women should undergo assessment of their bone health with bone mineral density testing at age 65, if not earlier. Men should consult with their doctors about their individual risks for decreased bone density. <a href="/providers/melissa-bogin-md">Melissa Bogin, M.D.</a>, is a board-certified Internist and geriatrician-in-training in Community Internal Medicine, Geriatrics and Palliative Care at Mayo Clinic in Rochester. Her clinical interests include caring for older adults in both the outpatient and nursing home settings.Melissa Bogin, M.D,Primary Care in Rochester and KassonBone HealthPrimary Care in Rochester and KassonWhat do you know about this "silent" eye disease that can strike anyone?<img src="/-/media/ech-media/images/widgets/people/eyeexamman.jpg?h=65&iar=0&w=100&sc_lang=en&hash=B8690630AB6FF603BF744EA05B0AF76C" alt="EyeExamMan" width="100" height="65" DisableNVelocity="true" />Test your glaucoma IQ1/22/2024 12:00 AM<img src="/-/media/ech-media/images/widgets/people/eyeexamman.jpg?h=205&iar=0&w=315&sc_lang=en&hash=4E0AFF3EC847E5CA8298B0FDF22247CD" alt="EyeExamMan" width="315" height="205" DisableNVelocity="true" />Musician Bono. Actresses Roseanne Barr and Whoopi Goldberg. Baseball Hall of Famer Kirby Puckett. All have been affected by glaucoma. But you don't have to be famous — anyone can contract this "silent" eye disease, which typically has no symptoms until damage has been done. So take a moment to test your glaucoma IQ.  Q: What is glaucoma? A: Glaucoma is a disease that is caused by increased pressure in the eye, leading to nerve damage and blindness.  Q: Why is it important to recognize glaucoma early? A: The effects of glaucoma can be so gradual that you may not notice a change in your vision until the condition is at an advanced, irreversible stage. If glaucoma is recognized early, vision loss can be slowed or prevented.  Q: What are the types of glaucoma? A: There are two main types:  <ul> <li>Angle-closure glaucoma. This type can come on suddenly and is caused by a rapid rise in eye pressure due to poor drainage. </li> <li>Open-angle glaucoma. This is the most common type of the disease. Pressure build-up is gradual and so is loss of vision.</li> </ul> Q: Who is at risk for glaucoma? A: Glaucoma occurs mostly in people age 60 or older. African Americans are at higher risk, while angle-closure glaucoma is more common in Asians. A family history of glaucoma also is a risk. In addition, certain medical conditions, including hypertension, sleep apnea and long-term corticosteroid use can put you at risk.  Q: What are the symptoms of glaucoma?  A: The most common symptoms are vision loss, needing more light for reading or tasks, eye pain, seeing halos or rainbows around lights or redness in your eye. You also may experience narrowing of vision or tunnel vision, difficulty distinguishing boundaries and colors, headaches, nausea and vomiting.  Q: When should I see a doctor? A: If you experience sudden or rapidly changing vision, in addition to severe headache, severe eye pain, nausea or vomiting, you should seek care immediately.  Q: Is there a test for glaucoma? A: If you are having any symptoms of glaucoma, ask your primary care clinician to do an eye (funduscopic) exam and test your field of vision. If needed, you may be referred to an ophthalmologist for more detailed testing. This process includes a tonometry test that measures the pressure in the eyes. If you think you are at risk, you should address your concerns with your primary care clinician. Glaucoma screening is frequently done when getting your vision checked.  Q: How is glaucoma treated? A: Several treatments are available, depending on the type of glaucoma:  <ul> <li>Closed-angle glaucoma. Urgent treatment is required, which can include IV medications and/or laser surgery. This treatment often is done also in the unaffected eye as a preventive measure. </li> <li>Open-angle glaucoma. The most common treatment is eye drops. Sometimes pills are prescribed to lower the pressure inside the eye. </li> </ul> If these more conservative treatments aren't effective or the glaucoma is more severe, there are surgical options. These include laser therapy to open blocked channels and fluid drainage through minimally invasive surgeries.  Q: Is there anything new in glaucoma treatment? A: There's been improvement in laser and minimally invasive surgery techniques. In addition, new topical medications have been approved.  Q: Can glaucoma be cured? A: Open-angle glaucoma cannot be cured and damage caused by the disease cannot be reversed. It's a chronic disease best managed by early detection and regular assessment, in addition to the treatments described above. Treatment for glaucoma is generally lifelong.  Angle-closure glaucoma is an ophthalmologic emergency. Treatment depends on the cause, such as pupillary block, blockage by a tumor and hyperopia. Getting immediate care to relieve the high pressure can lead to better results.  <a href="/providers/bernard-aoun-md">Bernard Aoun, M.D.</a>, is a physician in Community Internal Medicine, Geriatrics and Palliative Care at Mayo Family Clinic Northwest and Senior Services. He specializes in internal medicine and geriatric medicine. Bernard Aoun, M.D.Primary Care in Rochester and KassonGlaucomaPrimary Care in Rochester and KassonThe Rochester 41st Street Vaccine Clinic is closing Dec. 29. All vaccine appointments will occur at a primary care clinic location beginning Jan. 2.<img src="/-/media/ech-media/images/widgets/people/multigenerationalfamily.jpg?h=65&iar=0&w=100&sc_lang=en&hash=0E1398648E063109E493DC62899D48D6" alt="MultigenerationalFamily" width="100" height="65" DisableNVelocity="true" />Still need your flu or COVID-19 vaccine?12/21/2023 12:00 AM<img src="/-/media/ech-media/images/widgets/people/multigenerationalfamily.jpg?h=205&iar=0&w=315&sc_lang=en&hash=37FCE57E3BBEA6B33E09BFBCF96B186E" alt="MultigenerationalFamily" width="315" height="205" DisableNVelocity="true" />All people 6 months of age and older are encouraged to get their influenza vaccination, commonly referred to as the 'flu' vaccine. The Centers for Disease Control and Prevention recommends that people are vaccinated for flu as soon as possible to ensure they are fully vaccinated for the season. The Rochester 41st Street Vaccine Clinic is closing on Dec. 29 at the end of the business day. Online scheduling for flu and COVID-19 vaccines is still available through your portal account or by calling your primary care clinic. Beginning Jan. 2, all vaccine appointments will occur at a <a href="/locations">primary care clinic location</a>. Both flu and COVID-19 share common upper respiratory symptoms, such as fever, cough, shortness of breath, fatigue, sore throat, runny or stuffy nose, muscle pain and body aches, headache and vomiting. Both illnesses can also cause diarrhea, although it's more frequent in children with flu but can occur at any age with COVID-19. Change or loss in taste or smell is also possible in both, although this symptom is more frequent with COVID-19. Complications from flu and COVID-19 can result in severe illness, including pneumonia, organ failure, heart attack, brain inflammation, stroke, hospitalization and death. Learn more about <a rel="noopener noreferrer" href="https://www.mayoclinic.org/diseases-conditions/flu/symptoms-causes/syc-20351719" target="_blank" title="Opens in new browser window">influenza</a> and <a rel="noopener noreferrer" href="https://www.mayoclinic.org/diseases-conditions/coronavirus/symptoms-causes/syc-20479963" target="_blank" title="Opens in new browser window">COVID-19</a> symptoms and causes on MayoClinic.org. Patients who believe they have flu or COVID-19 should utilize the Check Symptoms tool within the patient portal to assess their symptoms or contact their primary care clinician's office. Put up your best defense — schedule your flu and COVID-19 vaccinations today.Primary Care in Rochester and KassonMass Vaccine Clinic ClosingPrimary Care in Rochester and KassonTeens are in a unique stage of development. They know they need you, but they don't want to need you.<img src="/-/media/ech-media/images/widgets/teens/teentalk.jpg?h=65&iar=0&w=100&sc_lang=en&hash=3E115F499B863043DA5FBC8ACFD26CDE" alt="TeenTalk" width="100" height="65" DisableNVelocity="true" />Is parenting a teenager possible? Yes!1/15/2024 12:00 AM<img src="/-/media/ech-media/images/widgets/teens/teentalk.jpg?h=205&iar=0&w=315&sc_lang=en&hash=6913433280DBACF8AD752EB19165E9CF" alt="TeenTalk" width="315" height="205" DisableNVelocity="true" />Parenting a teenager can at times be rewarding and even fun, but it often results in feelings of frustration and a sense of a lack of control. Some interactions resemble two adults having an engaging conversation and then some interactions bring you back to raising a toddler.  Teens are in a unique state of development. They know they need you, but they don't want to need you. They crave independence. They seek peer interactions and approval. Most teens care much less about what their parents think than what their peers think. This dynamic can lead to frequent arguments as you navigate independence versus parental authority.  Communication and mutual respect is the key. Although it feels contrary to how you may have been raised, it's important to show your teenager respect. We can respect our teens by explaining the rationale behind our decisions, giving opportunities for independence, staying calm, taking an interest in their interests and asking their opinions. In turn, you can expect them to show respect in their interactions with you.  10 tips for parenting your teen: <ol> <li>Take time to connect. This approach is unique to each teen, so connect with your teen over something they are interested in or you can do together. Some ideas are sporting events, shopping, cooking, exercising or just talking. Show up for them to important events or activities. </li> <li>Provide clear expectations. Have rules about curfew, friends, social gatherings and cell phones. Then stick to them. </li> <li>Listen to their opinions. Sometimes even let them influence yours.</li> <li>Expect responsibility. Your teen should be responsible for their own chores; after all, you won't always be there to clean up after them. Begin early by teaching them how to manage their money and save for their own wants and needs.</li> <li>Don't lecture. Brevity is a parent skill. Get to the point.</li> <li>Take the blame. Allow your teen to use you as their "out" when peer pressure is weighing on them. Let them refer to you as the "lame parents" who won't allow them to go to that party or who make them do their homework.</li> <li>Expect them to believe — and act like — the world revolves around them.</li> <li>Discuss drugs, alcohol and sex. Don't wait until something has already happened; plan ahead. It will be awkward but worth it. </li> <li>Show your love for them. Tell them how much you love them or do something special for them "just because." Some day (no guarantees) they will let you know how much they appreciated it. </li> </ol> Want to learn more about raising teenagers? Check out the <a rel="noopener noreferrer" href="https://infoaboutkids.org/" target="_blank" title="Opens in new browser window">InfoAboutKids.org</a> website or read the book, "How to Talk So Teens Will Listen and Listen So Teens Will Talk," by Adele Faber and Elain Mazlish.  <a href="/providers/hannah-mulholland-licswmsw">Hannah Mulholland, L.I.C.S.W., M.S.W.</a>, is a clinical social worker serving children and adolescents in Primary Care in Rochester and Kasson's Division of Integrated Behavioral Health. Hannah Mulholland, L.I.C.S.W., M.S.W.Primary Care in Rochester and KassonParenting TeensPrimary Care in Rochester and KassonIf feelings of sadness are getting in the way of caring for your new baby, reach out to your care team for help.<img src="/-/media/ech-media/images/widgets/people/postpartumdepression.jpg?h=65&iar=0&w=100&sc_lang=en&hash=FF089B77DCC63A75CE3A9F204FFB098B" alt="PostpartumDepression" width="100" height="65" DisableNVelocity="true" />FAQs about 'baby blues,' and postpartum depression1/25/2024 12:00 AM<img src="/-/media/ech-media/images/widgets/people/postpartumdepression.jpg?h=205&iar=0&w=315&sc_lang=en&hash=70DADA0C68543B2FC5AC2813084D7649" alt="PostpartumDepression" width="315" height="205" DisableNVelocity="true" />Postpartum depression is a common mental health condition that affects about one in 10 women during the year after giving birth. Parents are screened for postpartum depression at their baby's well-child visits, which take place during the first year of life. This screening involves a survey which the baby's clinician will review during the visit. This screening process takes place at all primary care pediatric and family medicine practice sites in Rochester and Kasson. Here are answers to a few of the questions new parents frequently ask: Q: How do I know if I have postpartum blues or postpartum depression? A: Postpartum blues is extremely common in the first days to weeks after delivering a baby. Having a new baby at home can be quite stressful and cause symptoms such as crying for no apparent reason, mood swings, difficulty concentrating, sadness and anxiety. These emotions are a normal response to the stress, hormonal changes and poor sleep that come with a new baby. These “baby blues” should come and go, fade within a couple of weeks after delivery and not prevent you from caring for yourself or your baby. Postpartum depression can happen anytime during the year following the birth of your child, although it most commonly appears sometime in the first two months. The symptoms can be similar to postpartum blues, but are more severe and also include loss of interest or pleasure in doing things, loss of motivation, feelings of hopelessness or guilt, loss of interest in caring for your baby or feeling like you would be better off dead. These symptoms don’t come and go like those of postpartum blues; they last longer than a week or two; and they can get in the way of your ability to take care of yourself and your baby. If you, your partner or your family are worried you may have postpartum depression, it's important to tell your — or your baby’s — healthcare clinician so they can make a diagnosis and provide you and your baby the help you need. Q: What causes postpartum depression? What can I do to prevent it? A: No one knows why or how postpartum depression develops. However, some parents seem to be at higher risk. Risk factors for postpartum depression include: <ul> <li>Having had it with a previous birth.</li> <li>Depression before or during pregnancy.</li> <li>Family history of depression.</li> <li>History of severe premenstrual syndrome (PMS).</li> <li>Poor social or financial support.</li> <li>Other stressful life events during pregnancy or after delivery.</li> </ul> While these risk factors cannot always be avoided, staying as healthy as possible during your pregnancy may help. Be sure to exercise, eat a healthy diet and practice stress-reducing techniques. Be sure to follow up with your healthcare clinician before and after the birth of your child to make sure signs of depression are identified and managed early. Q: What will happen if I am diagnosed with postpartum depression? A: This is a clinical disease, just like high blood pressure or diabetes. Being diagnosed with postpartum depression does not mean you are a bad parent or that your baby will be taken away from you. But just like high blood pressure or diabetes, it's important to manage this disease to prevent any consequences to your or your baby’s health. Some parents with postpartum depression improve their symptoms with a combination of talk therapy with a counselor or therapist and self-management interventions such as exercise, meditation, healthy eating and socializing with friends. Many people also need antidepressant medications to resolve their symptoms. These medications are effective, and many of them are safe to take while breastfeeding. Your healthcare clinician can find one that will work well for you. Q: Am I going crazy? A: No! Postpartum depression is common, but it's also very serious. Sometimes parents with postpartum depression feel like they want to harm themselves or their baby. This doesn’t mean you are crazy or a bad person; however, these feelings shouldn’t be brushed off, and you need to contact your healthcare clinician or call 911 immediately if you experience them. Rarely, some parents also develop postpartum psychosis. This condition can cause you to see or hear things other people don’t, feel paranoid or like you don’t know where you are. These are very serious symptoms that require immediate medical attention. Most parents with postpartum depression do not experience these severe symptoms but still feel like they are "losing it" because they think that they should be happy to have a new baby in their life. Do not let embarrassment or shame prevent you from seeking help. These feelings are common and can be treated with the help of your healthcare clinician. <a href="/providers/matthew-meunier-md">Matthew Meunier, M.D.</a>, is a family physician with Women's Health fellowship training in the Mayo Clinic Department of Family Medicine. He is the program director of the Family Medicine Residency Program in Kasson, Minn. Matthew Meunier, M.D.Primary Care in Rochester and KassonPostpartum DepressionPrimary Care in Rochester and KassonThis disturbing obsession brings fear, anxiety and stress to millions of victims.<img src="/-/media/ech-media/images/widgets/people/stalking.jpg?h=65&iar=0&w=100&sc_lang=en&hash=30CE5D76F558A1083A8AAA1641B33FEB" alt="Stalking" width="100" height="65" DisableNVelocity="true" />Stalking: An alarming and intrusive issue1/18/2024 12:00 AM<img src="/-/media/ech-media/images/widgets/people/stalking.jpg?h=205&iar=0&w=315&sc_lang=en&hash=2ED9551097FF23C52139A289476AF01A" alt="Stalking" width="315" height="205" DisableNVelocity="true" />Stalking involves harassing another human with obsessive attention. Some may think stalking only refers to being followed by another human in an unwanted manner. However, stalking can take many forms: <ul> <li>Threatening someone, their family or friends. </li> <li>Non-consensual communication, such as repeat phone calls, emails, texts or unwanted presents. </li> <li>Non-consensual physical contact, such as physical or sexual assault, following or tracking someone and watching from a distance repetitively. </li> </ul> Did you know over 3 million people are stalked every year? This figure does not include incidents that have not been reported to law enforcement. All genders are susceptible to stalking; however, women are stalked more than twice as often as other genders and fewer than one-third of victims report it to the police.  Did you know that more than two-thirds of victims know their stalker? A common example is a woman being stalked by her former spouse or someone who has romantic interests in her. More than two-thirds of victims report being fearful of physical harm or death. Many stalkers threaten their victims to comply by making violent threats, such as threatening their loved ones.  What to do if you or a loved one is being stalked The first thing to do is tell someone — anyone. Many victims are afraid of reporting directly to law enforcement, but if you can start by sharing with a supportive friend, family member, co-worker or supervisor, it can aid in your safety. When someone else knows what is happening, they can offer support and look out for you.  Safety tips <ul> <li>Use the buddy system when going places, including asking a security/staff escort to bring you to your vehicle. Even at the store, someone can walk you to your vehicle to help load your items. </li> <li>Come up with a code word you can share with your family to alert them you are in danger or to notify your children to get out of the home. </li> <li>Make all your social media accounts private or consider temporarily shutting down your profiles. Do not allow apps on your phone to track your location (i.e., Snapchat). </li> <li>When entering your vehicle while in public, do not stop and grab things like paper on your windshield or something set on your tires. Either go back inside a public place immediately and call law enforcement or get in your vehicle and lock the doors — whichever feels safest to you. </li> <li>Make sure your home is secure with proper locks and consider a home camera system. </li> <li>Pay attention to your surroundings when walking and avoid looking at your cell phone. </li> </ul> Lacey Pegram-Olson is a master's social work student at Mayo Clinic in Rochester, Minn. She is also a licensed alcohol and drug counselor. She specializes in treating co-occurring disorders, including substance dependence. She is also involved in crisis work across Southeast Minnesota and has a history of working with adults who have severe and persistent mental illness as well as both adults and adolescents struggling with addiction or mental illness. Lacey Pegram-OlsonPrimary Care in Rochester and KassonStalking TipsPrimary Care in Rochester and KassonA busy college student shares his experience with the Mayo Clinic app.&nbsp;<img src="/-/media/ech-media/images/widgets/randomimages/handholdingcellphone.jpg?h=65&iar=0&w=100&sc_lang=en&hash=2F201DC6C8C3E086BB0BD0D2DA6B81EF" alt="HandHoldingCellPhone" width="100" height="65" DisableNVelocity="true" />Mayo Clinic app makes scheduling, checking results, proving vaccination a breeze1/11/2022 4:30 AM<img src="/-/media/ech-media/images/widgets/randomimages/handholdingcellphone.jpg?h=205&iar=0&w=315&sc_lang=en&hash=4107662B694EEECDA474FD5D57C930BD" alt="HandHoldingCellPhone" width="315" height="205" DisableNVelocity="true" />Lucas Anderson has a few things going on in his life that make time and convenience precious commodities for him.  Lucas, a student and member of Rochester Community and Technical College's baseball team, was named to the Minnesota College Athletic Conference 2021 Spring All-Academic Team. As a patient at Mayo Clinic Health System in Southwest Minnesota, he finds Patient Online Services on the Mayo Clinic App to be a valuable tool to help manage his health care through his hectic schedule.  "The app is easy to use," he says. "If there's something I can do on my own, I'll use the app." When he developed COVID-19 symptoms and needed to schedule a test, he turned to the app to set up the appointment. "I logged in, clicked on 'COVID-19' and set up the appointments," Lucas says. "Pretty simple. I just followed the steps of what to do." When he told his mom about his scheduled appointment, she had some good advice to help his appointment go smoother.  "She told me to use PreCheck-In so I could get right into my appointment when I arrived," he says. "I logged in and clicked on PreCheck-In, right by my appointment, and answered a couple questions. Easy." Once Lucas was done with the test, he was eager to get his results. The app came in handy once again.  "I checked about every couple hours, and then I got the email that said my results were in," he says. "So I hit the link and checked my results." Thankfully, the results were negative.  Lucas also has found that the Mayo Clinic App made it a breeze for him to show proof of COVID-19 vaccination.  "I needed to show vaccination proof a couple of times, the app made that pretty simple," he says. "I didn't have to look for the slip of paper or the card — I just showed the proof on my phone. I always have my phone, so I always have my proof." He says that he'll continue to use the app to schedule other appointments.  "The app is easy to use, easy to navigate," he says. "Anytime I need to do something on my own at Mayo, I use the app. It's easy to pull it up and check what I need to do." "It's this kind of feedback from patients that lets us know our work is having a positive impact," says <a rel="noopener noreferrer" href="https://www.mayoclinichealthsystem.org/providers/gokhan-anil-md" target="_blank">Gokhan Anil, M.D.</a>, regional chair of Practice for Mayo Clinic Health System in Southwest Minnesota. "This digital connection through the app and Patient Online Services is an integral part of how we interact with patients. We'll continue to work to ensure that these connection points are accessible to patients and keep them digitally engaged in their care."Primary Care in Rochester and KassonAnderson Mobile AppPrimary Care in Rochester and KassonProper screening and lifelong good eye health start at birth.&nbsp;<img src="/-/media/ech-media/images/widgets/kids/babyeyeexam.jpg?h=65&iar=0&w=100&sc_lang=en&hash=FB59C51D627B31319918EB8D75E44379" alt="BabyEyeExam" width="100" height="65" DisableNVelocity="true" />Get an early start on eye health2/7/2022 4:30 AM<img src="/-/media/ech-media/images/widgets/kids/babyeyeexam.jpg?h=205&iar=0&w=315&sc_lang=en&hash=AA970077EFF39FC9FFAABAF593AE77D1" alt="BabyEyeExam" width="315" height="205" DisableNVelocity="true" />One of the first tests a newborn undergoes is a check for eye health. Healthy eyes not only support good vision, but also success in school, sports, social activities and work.  Your health care team has the information you need to make sure your children's eyes remain healthy, no matter their age.  Routine childhood vision screening Here are the recommended childhood vision screenings by age:  <ul> <li>Newborn Starting after birth, your primary provider will routinely check the "red reflex" of the eye. With this check, he or she is looking to see if something, such as a cataract or mass, is blocking light reflection off the retinas. </li> <li>Infant  Your primary provider will continue to check the red reflex at well-child visits and may ask about eye alignment. It's important to let your provider know if you notice your child has crossed eyes or a "<a rel="noopener noreferrer" href="https://www.mayoclinic.org/diseases-conditions/lazy-eye/symptoms-causes/syc-20352391" target="_blank">lazy eye</a>" because catching these problems early makes correction more effective. </li> <li>Preschool  At a well-child visit around age 3, your child will have his or her first vision screening using either an eye chart or a vision "spot screener" tool. This screening will help identify any problems with your child's ability to see things clearly. </li> <li>School-age Many schools will perform periodic vision screening for students, and your care team will continue to offer vision screening at well-child visits. If any of these screenings are abnormal, an optometrist or ophthalmologist should evaluate your child. <a rel="noopener noreferrer" href="https://www.mayoclinic.org/diseases-conditions/nearsightedness/symptoms-causes/syc-20375556" target="_blank">Nearsightedness, or myopia</a> (difficulty seeing objects in the distance), is the most common vision issue for school-aged children and can be corrected with eyeglasses. </li> </ul> Eye protection Eye injuries are the leading cause of blindness in kids, and sports are the major source of eye injuries in school-age children. Baseball, basketball, soccer, football and hockey are the sports most associated with eye injury, so your child should wear eye protection during these activities.  In addition to injuries, it's never to early to protect eyes from the sun. The best sunglasses will block at least 99% of ultraviolet (UV) and and UV B rays. Look for glasses with large lenses that fit well and close to the eye surface for the best protection.  Red eye or pinkeye <a rel="noopener noreferrer" href="https://www.mayoclinic.org/diseases-conditions/pink-eye/symptoms-causes/syc-20376355" target="_blank">Pinkeye</a>, or redness of the white part of the eye, is a common infection in childhood. It can be caused by bacteria, a virus, or an allergy: <ul> <li>Virus  Viruses cause most cases of pinkeye, which is also called conjunctivitis. One way to think of viral conjunctivitis is an "eye cold." Viral conjunctivitis can be contagious, so good hand-washing is key to help prevent it from spreading. </li> <li>Bacteria  It can sometimes be difficult to distinguish between viral and bacterial conjunctivitis. Most importantly, a bacterial infection will cause a thick, pus-like discharge that continues throughout the day. Within minutes of wiping the eyelids, more discharge appears. Antibiotic eye drops or ointment are prescribed. </li> <li>Allergy  Allergies also commonly cause red eyes. Children often complain of itchy eyes, or they may have a watery discharge. Their eyes may be crusted shut in the morning. They also can have associated symptoms such as sneezing or runny nose, or have a history of asthma or eczema. Treatment consists of antihistamine eye drops.</li> </ul> Symptoms of pinkeye include: <ul> <li>Isolated redness of the eye. </li> <li>Fever, sore throat or respiratory symptoms. </li> <li>Burning, gritty or sandy feeling in the eye. </li> <li>Crusty discharge when waking up or a watery, mucous-like discharge throughout the day. If this happens, use warm compresses to clear the discharge. Antibiotic eye drops will not work for this type of infection and could cause additional irritation. </li> <li>The infection may worsen over the first three to five days, but it typically improves gradually and is gone within two to three weeks. </li> </ul> Newborn issues  Newborn issues include:  <ul> <li>Eye color  Many parents wonder when their baby's permanent eye color will become apparent. Eye color is determined by the production of melanin, a pigmented protein. Melanocytes, the cells that make up melanin, respond to light, so many babies ill have gray or blue eyes right after both. Over the first year of life, the eye color may change with light exposure. Most of the time, these changes become apparent in the first six months, but the final color may not be clear until a baby is 1 year old. </li> <li>Blocked tear ducts Parents may notice clear discharge from one or both of their baby's eyes. This often is caused by <a rel="noopener noreferrer" href="https://www.mayoclinic.org/diseases-conditions/blocked-tear-duct/symptoms-causes/syc-20351369" target="_blank">blocked tear ducts</a>. A blocked duct is not dangerous, and it usually will go away over time. Parents may want to gently massage the corner of the eye to help open the duct. Ask your baby's health care team to show you how. If the watery discharge is still present by the time your baby is 1 year old, your health care team may refer you to an ophthalmologist to open the duct. Most blocked tear ducts go away by age 1 without any intervention. Contact your baby's care team if your baby's eyes appear red, or the discharge is yellow-green, since these can be signs of infection. </li> </ul> Between prevention and knowledge of some common eye issues, you and your family are well on the way to maintaining healthy vision.  <a href="http://communityhealth.mayoclinic.org/providers/kara-fine-md">Kara Fine, M.D.</a>, is a pediatrician in Primary Care in Rochester and Kasson's Division of Community Pediatric and Adolescent Medicine. In addition to general pediatrics, she is medical director for the newborn nursery and provider lead for the Pediatric Complex Care Coordination Program. Kara Fine, M.D.Primary Care in Rochester and KassonChild Eye HealthPrimary Care in Rochester and KassonHere are some techniques to lessen the burn.&nbsp;<img src="/-/media/ech-media/images/widgets/people/computereyestrain.jpg?h=65&iar=0&w=100&sc_lang=en&hash=7D14FF38FF2DD0405692C112ECCAE045" alt="ComputerEyeStrain" width="100" height="65" DisableNVelocity="true" />Are your eyes burning after a long day looking at screens?3/24/2022 4:30 AM<img src="/-/media/ech-media/images/widgets/people/computereyestrain.jpg?h=205&iar=0&w=315&sc_lang=en&hash=EE61ABCC8D36A213CB3EBECE180CD103" alt="ComputerEyeStrain" width="315" height="205" DisableNVelocity="true" />If you've gotten up from a long day at the computer or just put your phone down, your eyes may be burning.  These devices strain the eyes, and this eye strain should not be overlooked. While this strain shouldn't affect your eyes long term, it can affect work-life satisfaction and effectiveness.  The main contributors to this strain are:  Dry eyes People blink roughly 50% less when using a device, so eyes dry out quickly. Try to take breaks, using the 20/20/20 rule. That means for every 20 minutes of device time, look away 20 feet for 20 seconds and blink normally.  Glare Glare is light that comes from another source and interferes with your ability to see your devices properly. The source could be office lighting or the sun.  Mild glare can often be difficult to perceive, but it gradually causes you to squint or lean awkwardly at your devices.  To combat glare, consider applying an anti-glare screen filter to your device's screen. If possible, angle direct office light or natural light away from the device screen.  Poor text color and size Text color and size often leads to eye strain, as well. Text that has poor contrast with the background color will lead to squinting. Black text on a white background is the most discernible combination.  Text that is too small can not only make you squint, but also it can force you to lean forward. This can stress your neck and upper back. Most computer programs have zoom features to increase text size. Also consider computer glasses if you use bifocals.  Nicholas C. Smith, Ph.D., CPE, is an ergonomist in Occupational Safety in Rochester. He completed his doctoral degree in industrial and systems engineering at Auburn University. His focus is understanding how ergonomic injuries affect health care quality and patient outcomes. Nicholas C. Smith, Ph.D., CPEPrimary Care in Rochester and KassonComputer Eye StrainPrimary Care in Rochester and KassonStick to your exercise resolutions and reap the results with these 12 tips.&nbsp;<img src="/-/media/ech-media/images/widgets/activities/winteroutdoorexercisemask.jpg?h=65&iar=0&w=100&sc_lang=en&hash=DFFE9F4176D656A8861E48B1D9267BB1" alt="WinterOutdoorExerciseMask" width="100" height="65" DisableNVelocity="true" />12 tips for sticking to your healthy resolutions2/3/2022 4:30 AM<img src="/-/media/ech-media/images/widgets/activities/winteroutdoorexercisemask.jpg?h=205&iar=0&w=315&sc_lang=en&hash=A497CF0B38EE7B7D1C0A1CDA3F864F95" alt="WinterOutdoorExerciseMask" width="315" height="205" DisableNVelocity="true" />The start of 2022 is not only the beginning of a new year, but also a time for new resolutions for becoming a healthier version of you. But research shows that those well-intentioned resolutions typically don't last more than six weeks.  These 12 ideas may help you stick to those resolutions and reap their results:  <ol> <li>Set your workout clothes out the night before, ready to grab for your daily routine. </li> <li>Schedule your workout times on your calendar — and set a reminder. Make your goals reasonable for where you are on your health journey. Start small. Begin with one day a week and work your way up to three or more times a week. </li> <li>Consider getting a workout buddy. It's sometimes more fun to work out with another. It also can help keep you accountable. If you can't find a buddy due to schedules, signing up for an online fitness class can help keep you motivated. </li> <li>Use a workout or tracking app. Two popular ones are MyFitnessPal and Map My Fitness. These apps even synchronize with each other to gather all your information. </li> <li>Have fun. Research shows that if you enjoy your activity, you are more likely to stick with it long term. Go for a swim, cheer when you hit a goal, infuse your fitness with fun. </li> <li>Try something new. If your routine is the treadmill, try an online fitness class. Change it up so you don't get stuck or bored. Novelty makes movement interesting. </li> <li>Instead of sitting during your breaks, take a walk. Explore new areas near you.</li> <li>Remember why you started your journey and don't lose sight of it. Whatever the reason — being a role model for your children, making memories with your spouse, preventing chronic conditions, maintaining a high quality of life as you age, feeling better or being more confident — write it down for inspiration, especially on low-energy days. </li> <li>Make a meal plan and then shop at the grocery store to pick up food based on this plan. This will not only save you money and time, but also ensure that you always have healthy food on hand. </li> <li>Make time to relax. It's OK to take time for yourself. Self-care helps you stay motivated and energized so you are more likely to stick with your plan. </li> <li>Make it family time. Think about playing an active game such as kickball, tag or touch football, or shooting baskets. Go on a scavenger hunt, ice skating or sledding, or set up an obstacle course in your backyard. </li> <li>Allow yourself a little wiggle room. You may occasionally miss a workout or indulge in a rich dessert, and that is OK. </li> </ol> Danielle P. Johnson, M.S., P.T., is a wellness physical therapist at the Mayo Clinic Healthy Living Program in Rochester. She specializes in combining physical therapy with whole-body wellness, and integrating fundamental and natural movement patterns, as well as practical and playful movement, into daily experiences. Danielle P. Johnson, M.S., P.T.Primary Care in Rochester and KassonExercise TipsPrimary Care in Rochester and KassonThese tips can help children deal with this difficult time.&nbsp;<img src="/-/media/ech-media/images/widgets/kids/childgrief.jpg?h=65&iar=0&w=100&sc_lang=en&hash=FC256D6F21C89B5224038DBC0C3B6852" alt="ChildGrief" width="100" height="65" DisableNVelocity="true" />Helping children and teens cope with death, dying3/21/2022 4:30 AM<img src="/-/media/ech-media/images/widgets/kids/childgrief.jpg?h=205&iar=0&w=315&sc_lang=en&hash=6DCCC0544A21A1B33D946FC7634C61F9" alt="ChildGrief" width="315" height="205" DisableNVelocity="true" />In a world with so much trauma, especially during the COVID-19 pandemic, adults struggle to find words to express themselves and find normalcy in life. If this is difficult for adults, how can children and teens be expected to find their way?  It is important for adults to help children and teens express themselves by teaching techniques that help them with their grief.  Here are a few ideas to help:  <ol> <li>Be honest with them for their age and level of understanding. </li> <li>Use accurate words, such as "dying," "death" and "died." It may sound harsh to use these words, but "losing" a loved one means "we can go find them" to a child. Many might also say, "They went home (heaven, meet their maker, etc.)," and the child thinks they are coming back. Honest words are important. </li> <li>It is OK to not have all the answers. It is important to share your beliefs and hopes. </li> <li>Give them all the information and give them choices. For example, tell them what to expect at a funeral and ask them questions such as which family member they want to sit with, would they like to see grandpa in the casket or in a picture, and do they want to go to the graveside or wait with family at home. </li> <li>Provide activities that might help them, such as coloring, journaling, reading age-appropriate books on grief, finger painting or block-building. Then ask about their creation or what they read. </li> <li>Talk about feelings and let them know that all feelings are OK — even anger. Validate their feelings and help them find ways to express them. If they are angry, perhaps suggest screaming into a pillow, exercising, ripping paper, or listening to music and dancing. If they feel sad, perhaps suggest coloring or writing a story, letting them talk, or writing a letter. Other ways to express feelings include hugs; tears; squishing Play-Doh or stress balls; playing with fidget toys; playing with a pet; and sharing stories. </li> </ol> Remember that children face a wide range of emotions and sometimes quickly. Their instantly happy mood, laughter and playful nature does not mean they are being disrespectful or they did not love the person.  If they need extra support, seek help from a counselor or a grief group.  Grief is different for every person, and that is normal. What works for one child or teen may not work for the other.  Mayo Clinic Hospice is offering a Healing Adventures Camp on May 4 for children ages 5–17 who have experienced a death. See this flyer, which is available in <a href="/-/media/ech-media/documents/englishhealingadvflyer.pdf?sc_lang=en&hash=F6E7F41827B93495683B046E75B97EE8">English</a> and <a href="/-/media/ech-media/documents/spanishhealingadvflyer.pdf?sc_lang=en&hash=A4947227E55B94DF77B115118B1171CD">Spanish</a>, for more information. If you are interested in registering your child or teen, complete the <a rel="noopener noreferrer" href="https://surveys.mayoclinic.org/jfe/form/SV_bKuPNL8kXocPS9E" target="_blank">registration form</a>.  The Rev. Ana Wilson, M.Div., BCC, is an ordained minister and board-certified chaplain who works as a bereavement coordinator with Mayo Clinic Hospice. She struggled with her own grief when her grandparents and her mom died within two months. This caused her to run away from grief and prolonged her grieving process. Today, she finds her passion in helping people embrace their grieving and learn to deal with their grief over time. Rev. Ana Wilson, M.Div., BCCPrimary Care in Rochester and KassonGrief Children TeensPrimary Care in Rochester and KassonFind out how to protect yourself and your unborn baby from infection.&nbsp;<img src="/-/media/ech-media/images/widgets/people/pregnantultrasound.jpg?h=65&iar=0&w=100&sc_lang=en&hash=8CE626828E7F652FE6FA12D30AA35C65" alt="PregnantUltrasound" width="100" height="65" DisableNVelocity="true" />Prenatal infections: Prevention and awareness2/14/2022 4:30 AM<img src="/-/media/ech-media/images/widgets/people/pregnantultrasound.jpg?h=205&iar=0&w=315&sc_lang=en&hash=9D23B7D7C761B0D0C25AA0DF5AC348F1" alt="PregnantUltrasound" width="315" height="205" DisableNVelocity="true" />Avoiding infection is a health topic on everyone's mind these days. During pregnancy, avoiding infection and illness become even more important.  Some infections, like chickenpox or toxoplasma, have specific harmful effects on a developing infant. Other infections, like the seasonal flu, don't directly harm a baby, but they seem to make people who are pregnant sicker than those who are not pregnant.  Staying healthy during pregnancy can seem like a complex topic, especially amid the COVID-19 pandemic.  Here are some basic guidelines to avoiding infections while pregnant: Prior to pregnancy The best time to think about illness prevention in pregnancy is before you become pregnant. If you're contemplating becoming pregnant, you can take some basic steps to optimize your health and strengthen your immune system, including:  <ul> <li>Making sure you're up to date on all routine vaccinations and preventive care. </li> <li>Eating a balanced diet. </li> <li>Maintaining a healthy weight. </li> </ul> During pregnancy Avoid respiratory illnesses:  <ul> <li>During pregnancy, seasonal flu shots and COVID-19 vaccination and booster vaccinations, are strongly recommended. </li> <li>Follow current public health recommendations on social distancing and masking. </li> <li>Avoid contact with people who are sick. </li> </ul> Women who are pregnant are more susceptible to foodborne illnesses. Certain foods should be avoided, including:  <ul> <li>Unpasteurized milk and dairy products. </li> <li>Raw or undercooked meats and poultry. </li> <li>Foods with a higher risk of carrying Listeria bacterium, like processed deli meats. </li> </ul> Be cautious of insect- and animal-borne diseases: <ul> <li>If you have a cat, especially one that goes outdoors, have a family member clean the litter box while you are pregnant to avoid toxoplasmosis. </li> <li>If you live in an area where insect-born diseases like Lyme disease or West Nile virus are common, be sure to avoid insect exposure as much as you can. Consider using insect repellant if you need to be outdoors during times when insects are active. </li> <li>If you plan to travel, especially to a tropical area, but sure you know about potential illnesses in that area, such as Zika virus. </li> </ul> Vaccines It is a common misconception that vaccines are less safe to receive during pregnancy. However, the only vaccines that should be avoided while pregnant are live vaccines. These include the nasal version of the influenza; measles, mumps, and rubella; and varicella (chickenpox) vaccines. Getting routine vaccinations is recommended in pregnancy due to the mother's risk of having more severe disease.  If you do become ill Despite all prevention measures, illness can sometimes happen. If you become sick when you are pregnant, don't panic. Talk with your obstetrician, midwife, or other health care provider and come up with a plan for treatment. Discuss over-the-counter medications for symptoms with your health care team before using them.  <a href="https://communityhealth.mayoclinic.org/providers/marla-dewitt-tesch-md/">Marla DeWitt, M.D.</a>, is a physician in Primary Care in Rochester and Kasson's Department of Family Medicine. She practices in the Baldwin Building in Rochester. Marla DeWitt, M.D.Primary Care in Rochester and KassonInfections During PregnancyPrimary Care in Rochester and KassonIf you've been experiencing balance difficulties, or burning, tingling or numbness in your feet, legs or hands, it may be due to peripheral neuropathy.&nbsp;<img src="/-/media/ech-media/images/widgets/feet/rubbingfeet.jpg?h=65&iar=0&w=100&sc_lang=en&hash=52CC36D2B8C4FB2D7FD6FE572E8ACFCF" alt="RubbingFeet" width="100" height="65" DisableNVelocity="true" />What is peripheral neuropathy?3/31/2022 4:30 AM<img src="/-/media/ech-media/images/widgets/feet/rubbingfeet.jpg?h=205&iar=0&w=315&sc_lang=en&hash=82F5A31FC61C69BECAA51223868057E4" alt="RubbingFeet" width="315" height="205" DisableNVelocity="true" />Peripheral neuropathy is a condition where the longest nerves running down the arms and legs are irritated and damaged at the ends, leading to symptoms beginning at those points — typically in the feet first. Peripheral neuropathy is estimated to affect 2%–3% of the population. However, with increasing rates of conditions such as diabetes, the number of people afflicted with peripheral neuropathy also is expected to increase.  The peripheral nervous system is made up of two major components: the large fibers and the small fibers. Which fibers are affected can lead to specific symptoms.  Large fiber symptoms are:  <ul> <li>Numbness. </li> <li>Balance difficulties, particularly on uneven surfaces. </li> <li>"Thick" or "dead" feeling in the feet. </li> <li>Weakness. </li> </ul> Small fiber symptoms are:  <ul> <li>Burning. </li> <li>Itching. </li> <li>Tingling. </li> <li>Hypersensitive feet. </li> </ul> In certain cases, peripheral neuropathy may be related to another medical condition, such as diabetes or specific vitamin deficiencies. An evaluation with your primary care physician, nurse practitioner or physician assistant can identify these causes in a timely manner. Several oral and topical medications can reduce painful sensations and symptoms.  If you feel as though you may be affected by peripheral neuropathy, you're encouraged to discuss your symptoms with your primary care provider to begin workup of your symptoms. The Integrated Community Specialties — Neurology practice is also available to collaborate with your health care provider to help diagnose and manager peripheral neuropathy.  Scott Speelziek, M.D., is a physician in Integrated Community Specialties — Neurology and practices in the Baldwin building and Mayo Clinic Health System in Owatonna. Scott Speelziek, M.D.Primary Care in Rochester and KassonPeripheral NeuropathyPrimary Care in Rochester and KassonThis color change may be Raynaud's disease.&nbsp;<img src="/-/media/ech-media/images/widgets/people/blowingonfingers.jpg?h=65&iar=0&w=100&sc_lang=en&hash=B4111F087D5D97C242DA3610453C4B2B" alt="BlowingOnFingers" width="100" height="65" DisableNVelocity="true" />Why do my fingers turn blue?2/17/2022 4:30 AM<img src="/-/media/ech-media/images/widgets/people/blowingonfingers.jpg?h=205&iar=0&w=315&sc_lang=en&hash=BE63C96D1F00BA00A16EC4B6BE6DA982" alt="BlowingOnFingers" width="315" height="205" DisableNVelocity="true" />Raynaud's disease is a condition where the small arteries, typically in the fingers and toes, spasm. This temporarily decreases blood flow in response to cold conditions or stress. The decreased blood flow results in a change in skin color — white and then blue.  This color change is often accompanied with feelings of cold and numbness in the affected area. As the skin warms, it may turn red, and throb, tingle or swell. Normal blood flow typically returns in 15 minutes. Taking food out of the freezer or going outside without gloves or mittens on can trigger symptoms.  It's not know what causes Raynaud's disease, but it's more common in women and most often begins between the ages of 15 and 30.  While it can occur in people who are healthy, it's more common in patients who:  <ul> <li>Smoke.</li> <li>Have other diseases involving arteries or connective tissues. </li> <li>Have carpal tunnel syndrome. </li> <li>Have an injury to the hands or feet. </li> <li>Use certain medications, such as high blood pressure, migraine, chemotherapy agents and some over-the-counter cold medications. </li> </ul> Treatment depends on how severe your symptoms are and if you are having complications. Generally protecting the part of your body that is affected from the cold is the first treatment. Often it is all that is needed to prevent the symptoms.  So bundle up before going outdoors. If your symptoms are severe, it can damage tissues and lead to sores, skin ulcers or dead tissue. If you have symptoms of severe Raynaud's disease, contact you health care team to discuss treatment options.  <a href="https://communityhealth.mayoclinic.org/providers/denise-dupras-md/">Denise Dupras, M.D., Ph.D.</a>, is a physician in Community Internal Medicine, Geriatrics and Palliative Care at Mayo Clinic in Rochester. She completed her medical and doctoral degrees at Mayo Clinic Alix School of Medicine and her residency in internal medicine at Mayo Clinic in Rochester. Her interests include medical education, evidence-based medicine and care of LGBTQIA+ patients. Denise Dupras, M.D., Ph.D.Primary Care in Rochester and KassonRaynauds DiseasePrimary Care in Rochester and KassonHow much you eat is as important as what you eat.&nbsp;<img src="/-/media/ech-media/images/widgets/food/ech_portions_01_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=1E92F37A91C22E672644B2D0B63E33AB" alt="ECH_Portions_01_widget" width="100" height="65" DisableNVelocity="true" />Right-size portions for healthy eating3/17/2022 12:43 PM<img src="/-/media/ech-media/images/widgets/food/ech_portions_01_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=0D25B76175A483F1AE0767743411B96D" alt="ECH_Portions_01_widget" width="300" height="195" DisableNVelocity="true" />How much you eat is as important as what you eat if you're trying to lose weight and keep it off. That heap of pasta on your plate is a portion, but it's probably not a serving size, which is a precise, recommended amount of food that is measured in cups, ounces or tablespoons.  You'll find serving sizes on the Nutrition Facts labels of a vast range of products from applesauce to bacon to cheddar cheese. Remember to check the number of servings per container. For example, toaster pastries come two to a pack, but a serving is just one. Or a serving of Doritos is 11 chips — not the whole bag.  Reading Nutrition Facts labels can provide information that will help you save hundreds of unwanted calories per day.  'See' your portions Portion size — the amount on your plate — matters. Research has shown that people consistently eat more food when offered larger-sized portions. But you don't need to memorize a food list or carry around measuring cups to get a better handle on serving sizes.  Instead, use common visual cues to remind yourself of appropriate serving sizes. How? Many foods match up to everyday objects.  Some one-serving examples include:  <ul> <li>A baseball equals a medium pepper, a half-cup of green beans or one-third of a cup of tomato sauce. </li> <li>A hockey puck equals one-half of a bagel, a half-cup of pasta or a half-cup of dry cereal. </li> <li>A deck of cards equals 3 ounces of meat or fish. </li> <li>A pair of dice equals two 1-ounce portions of hard cheese. </li> </ul> For more serving-size photos and information, visit Mayo Clinic's <a rel="noopener noreferrer" href="https://www.mayoclinic.org/healthy-lifestyle/weight-loss/multimedia/portion-control/sls-20076148" target="_blank">Portion Control webpage</a>.  Tips for right-sizing portions Try these tips to right-size your portions:  <ul> <li>Pour the amount of cereal you usually eat into a bowl, measure it and compare it to the recommended serving size. Do this for some of your go-to foods so you get used to seeing what the correct portion looks like. </li> <li>Until you get the hang of portion sizes, consider buying a plate divided into portions for each of the food groups. When filling your plate, keep in mind that half of your plate should be fruits and vegetables. Good choices include spinach, carrots, lettuce, cabbage, broccoli, cauliflower, tomatoes, cucumbers, beets and peppers. Grains fill another quarter section. Choose brown rice, whole-wheat pasta or whole-wheat tortillas. Protein completes the last quarter of the plate. Healthy options include chicken or turkey without the skin, fish and other seafoods, beans, soy, and lean cuts of beef and pork. Round out your meal with an 8-ounce glass of fat-free milk. </li> <li>Use smaller plates to trick your eye — and brain — into thinking portions are larger. </li> <li>Dish proper portion sizes onto plates in the kitchen rather than passing food family style. </li> <li>Eyeball the size of your portion at a restaurant. If your portion is too large, share your meal or ask for a to-go box. If you opt for the to-go box, package up the take-home portion before you start eating. </li> <li>Use snack-size storage bags to portion foods like crackers, cereal, chips and nuts. Make it a part of your routine when putting away groceries. Then when a snacking urge hits, you'll have the right-size snack portions at hand. </li> <li>Tell family, friends and co-workers that you're watching your portion sizes. Share strategies you're using to add accountability to your efforts. </li> </ul> Michaeleen Burroughs, M.S., RDN, LD, has worked at Primary Care in Rochester and Kasson's Department of Family Medicine for 27 years. She helps patients at Mayo Family Clinics Kasson, Northeast, Northwest and Southeast. Her areas of interest are diabetes and child and adult weight management. Michaeleen Burroughs, M.S., RDN, LDPrimary Care in Rochester and KassonRight Size PortionsPrimary Care in Rochester and KassonIn most cases, mild swelling in your feet should go away on its own. But if it lasts, you should talk with your care team.&nbsp;<img src="/-/media/ech-media/images/widgets/feet/ech_swollenfeet_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=C196C7545349CFF93E76117907A6FEF4" alt="ECH_SwollenFeet_widget" width="100" height="65" DisableNVelocity="true" />Answers to FAQs about swollen feet2/28/2022 4:30 AM<img src="/-/media/ech-media/images/widgets/feet/ech_swollenfeet_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=8D54DB09A2A19BAEF232B88E44E4E9D9" alt="ECH_SwollenFeet_widget" width="300" height="195" DisableNVelocity="true" />Swollen feet aren't uncommon, but the swelling can be alarming. Why is this happening? Should you be concerned? Was it something you ate? Is it related to your medications? What can you do to get rid of it?  Everyone experiences unwanted swelling to a certain degree, such as occasional sock marks — the indentation caused by the cuff of your socks at the end of the day. While you may not have paid much attention to this before, it may be the first manifestation of something more serious.  Here are some answers to questions that come up about swollen feet.  What is it? "Edema" is the term used for fluid buildup in the tissues.  Edema has two types:  <ul> <li>Generalized edema  This may be associated with many conditions, including heart, liver or kidney disease, sleep apnea, malnutrition, pregnancy or pre-menstruation, or allergic reaction. </li> <li>Localized edema  This type of edema is confined to one area. It may be related to deep vein thrombosis (blood clot), bacterial skin infections or leaky veins, as well as certain medications. It's important to notice if the swelling comes on quickly and it it's in one or both legs. Sudden onset in just one leg may be a sign of a blood clot. </li> </ul> How do you know if you have edema? Signs of edema include pitting, which is when a dent is left in the swollen area after sustained pressure; heavy legs; puffy arms; shiny or discolored skin; or swelling that improves while you sleep and returns during the day.  What can you do? In most cases, mild edema takes care of itself and requires nothing more than time.  For edema that persists, try:  <ul> <li>Leg elevation  This involves raising your legs above the level of your heart. </li> <li>Compression  Wearing tight-fitting stockings that prevent fluid from accumulating in your legs in the first place. </li> <li>Movement  Pumping your muscles will help move fluid out of the legs. </li> <li>Salt reduction  Eating less salt (sodium) can affect edema. Processed, packaged and prepared foods tend to be high in sodium, since salt is a natural preservative and flavor enhancer. The American Heart Association suggests a maximum daily salt intake of 2,300 milligrams, which is equivalent to one teaspoon of salt daily. When possible, prepare your own meals and limit added salt.</li> </ul> When should you see your health care team? It's never wrong to consult your care team if you notice new swelling. Your care team can identify causes for your swelling, review your medications and evaluate you for underlying conditions. This is especially important if you experience difficult breathing, significant weight gain, chest discomfort or progressive symptoms.  <a href="https://communityhealth.mayoclinic.org/providers/ryan-giddingsconnolly-md">Ryan Giddings Connolly, M.D.</a>, is a physician in Community Internal Medicine, Geriatrics and Palliative Care in Rochester. He earned his medical degree from Boston University and completed his residency training in internal medicine at Mayo Clinic in Rochester. His interests include palliative medicine and medical education. Ryan Giddings Connolly, M.D.Primary Care in Rochester and KassonSwollen FeetPrimary Care in Rochester and KassonTurmeric is a golden-yellow spice, but is it the wonder drug media claims it is?&nbsp;<img src="/-/media/ech-media/images/widgets/food/ech_turmeric_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=70BA169D3B10C7C22DC1657E23D0837A" alt="ECH_Turmeric_widget" width="100" height="65" DisableNVelocity="true" />What the heck is turmeric?3/14/2022 11:08 AM<img src="/-/media/ech-media/images/widgets/food/ech_turmeric_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=C9926A86ED0323174A81E88B860BD61C" alt="ECH_Turmeric_widget" width="300" height="195" DisableNVelocity="true" />You may have it in your spice rack or enjoy it in some of your favorite meals. But can turmeric, an ancient golden-yellow spice, be good for you?  Turmeric is the root of a plant similar to ginger. It's been used in cooking since 600 B.C. for its color and flavor, and as an ingredient in curries and mustard. But it's also long been used for medicinal purposes.  Turmeric naturally contains curcumin, which has been found to be an antioxidant and anti-inflammatory. It is widely promoted to treat joint pain and improve mobility, and it's reported to have benefits for digestion, depression, immunity, heart disease, memory and cognition. Turmeric is available in capsules, tablets, powder, softgels and gummies.  The Food and Drug Administration hasn't approved turmeric in any form for any use. As a dietary supplement, the potency or amount of turmeric in any product cannot be guaranteed, unless it's been verified by U.S. Pharmacopeia. If it has been verified by U.S. Pharmacopeia, this will appear on the label.  Does turmeric work? Limited data in small studies show its effectiveness in providing some improvement in joint pain, anxiety and depression, and decreasing triglycerides and low-density lipoprotein, or LDL or "bad," cholesterol. Researchers are delving into the effect of curcumin on cancer because of its anti-inflammatory properties. Other areas of research are diabetes, inflammatory bowel disease and Crohn's disease.  What are the risks? Turmeric can cause nausea and diarrhea in higher doses and prevent absorption of iron, leading to anemia. It also increases the risk of bleeding.  Curcumin interacts with enzymes important in drug metabolism and can interact with drugs you're taking. Some products add black pepper to improve absorption, which contains another compound that interferes with metabolism.  What's the bottom line? It's too early to declare turmeric a wonder drug. That's because limited data support the claimed health benefits of turmeric. Research continues to explore what if any benefits can be gained from turmeric or curcumin. Also, turmeric comes with clear risks — some serious — including unintended drug interactions.  Since it's unclear how turmeric may react with medications and affect existing conditions, be sure to talk with your health care professional before consuming turmeric to alleviate a health problem or disease.  If you'd like more information on turmeric, you can check out these articles and a video from Mayo Clinic: <ul> <li><a rel="noopener" href="https://newsnetwork.mayoclinic.org/discussion/mayo-clinic-q-and-a-turmerics-anti-inflammatory-properties-may-relieve-arthritis-pain/" target="_blank">"Mayo Clinic Q&A: Turmeric's anti-inflammatory properties may relieve arthritis pain."</a></li> <li><a rel="noopener" href="https://www.mayoclinic.org/diseases-conditions/cancer/expert-answers/curcumin/faq-20057858?_ga=2.179816748.946672225.1580396214-1787135078.1580396214" target="_blank">"Curcumin: Can it slow cancer growth?"</a></li> <li><a rel="noopener" href="https://www.youtube.com/watch?time_continue=8&v=YHgA8wX3V60&feature=emb_logo" target="_blank">"Mayo Clinic Minute: Are There Health Benefits to Taking Turmeric?"</a></li> </ul> <a href="https://communityhealth.mayoclinic.org/providers/denise-dupras-md/">Denise Dupras, M.D., Ph.D.</a>, is a physician in Primary Care in Rochester and Kasson's Division of Community Internal Medicine, Geriatrics and Palliative Care. She completed her medical and doctoral degrees at Mayo Clinic Alix School of Medicine, and her residency in internal medicine at Mayo Clinic in Rochester. Her interests include medical education and evidence-based medicine. Denise Dupras, M.D., Ph.D.Primary Care in Rochester and KassonTurmericPrimary Care in Rochester and KassonFrom mental health services to paperwork, Primary Care is a health care resource for members of the military.&nbsp;<img src="/-/media/ech-media/images/widgets/people/ech_echmilitary_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=CF7C0C8AEF7860BC2507572B7E924F31" alt="ECH_ECHmilitary_widget" width="100" height="65" DisableNVelocity="true" />Primary Care helps military members with services big and small3/10/2022 4:30 AM<img src="/-/media/ech-media/images/widgets/people/ech_echmilitary_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=ED4547DFC6DCC1D4AD1977875D8CDE73" alt="ECH_ECHmilitary_widget" width="300" height="195" DisableNVelocity="true" />Over 17 million people in the U.S. are military veterans. Over 270,000 of those veterans are in Minnesota. And thousands of those veterans live in the areas served by the practices of Primary Care in Rochester and Kasson.  Approximately 28% of veterans are identified as having a service-connected disability in addition to other health needs. Primary Care in Rochester and Kasson strives to be military-friendly, whether it's offering mental health services or simply helping fill out Veterans Affairs paperwork.  Care teams at Primary Care in Rochester and Kasson understand the importance of knowing if a patient or an immediate family member has served in the military. Asking veterans questions about their service helps health care professionals understand their medical issues and concerns, establishes an ongoing relationship, and may lead to a timely referral to specialized medical resources.  For example, if a patient served in Vietnam, this may signal the patient's health care professional to ask about Agent Orange exposure. Or if a patient is just home from a military deployment, the health care professional may ask how the patient is adjusting to life at home and work. Military service even could be a trigger to ask a patient about hearing issues or preventive health services that had to be postponed due to deployments.  On a broader scale, Mayo Clinic leaders work with national Veterans Affairs officials on how best to care for veterans and service members, whether it's through patient care, research or education. Mayo Clinic has a long history of attracting staff and students with prior military service, starting with the Mayo brothers themselves.  Department of Veterans Affairs <ul> <li>Military members in <a rel="noopener noreferrer" href="https://www.minneapolis.va.gov/index.asp" target="_blank">Minneapolis</a> and <a rel="noopener noreferrer" href="https://www.va.gov/minneapolis-health-care/locations/rochester-va-clinic/" target="_blank">Rochester</a> have access to Veterans Affairs health care facilities. </li> <li>To find a Veterans Affairs health system near you, as well as many other resources, visit the <a rel="noopener noreferrer" href="https://www.va.gov/" target="_blank">Department of Veteran Affairs website</a>. </li> </ul> Mental health <ul> <li>Depression Improvement Across Minnesota, Offering a New Direction, also known as DIAMOND, brings together a primary care physician; nurse practitioner or physician assistant; care manager; and consulting psychiatrist for Minnesota adults with depression. These adults are seen in the primary care setting, with a focus on relapse prevention. Ask your care team for more information. </li> <li>Veterans and active-duty military personnel can find help with depression and post-traumatic stress disorders (PTSD), including a 24-hour help line and support groups through the <a rel="noopener noreferrer" href="https://www.nami.org/Find-Support/Veterans-and-Active-Duty" target="_blank">National Alliance on Mental Illness</a>. </li> <li>The Department of Veterans Affairs offers overall <a rel="noopener noreferrer" href="https://www.mentalhealth.va.gov/" target="_blank">mental health services</a> and care and information specific to <a rel="noopener noreferrer" href="https://www.ptsd.va.gov/" target="_blank">PTSD</a>. </li> </ul> Mayo Clinic employee veterans For veterans who work for Mayo Clinic, the Veterans Mayo Employee Resource Group (MERG) offers not only support and resources, but also the opportunity to participate or volunteer at veteran- and military-related events.  <a href="https://www.mayoclinic.org/biographies/franz-walter-b-iii-m-d/bio-20053435">Walter Franz III, M.D.</a>, is a physician in Primary Care in Rochester and Kasson's Department of Family Medicine. He is active in health care for veterans and active military members, and he chairs Mayo Clinic's Veterans Mayo Employee Resource Group. He is a retired colonel in the U.S. Army. Walter Franz III, M.D.Primary Care in Rochester and KassonVeteran ServicesPrimary Care in Rochester and KassonFind out what signs to look for and how to help.&nbsp;<img src="/-/media/ech-media/images/widgets/beverages/ech_wineglass_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=66DCEE90E62E635801437248E5CA73BA" alt="ECH_WineGlass_widget" width="100" height="65" DisableNVelocity="true" />Is someone you know affected by alcohol use disorder?4/11/2022 4:30 AM<img src="/-/media/ech-media/images/widgets/beverages/ech_wineglass_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=83C87A639FDD84D0AE1EC1F32C890256" alt="ECH_WineGlass_widget" width="300" height="195" DisableNVelocity="true" />Cheers! April is Alcohol Awareness Month. It's a great time to reflect on your drinking patterns.  Most adults in the U.S. who drink alcohol do so moderately and without complications. Unfortunately, that is not the case for everyone.  Alcohol use disorder affects approximately 15 million adults in the U.S. An estimated 95,00 people die from alcohol-related causes annually. This makes alcohol consumption the third leading preventable cause of death in the nation. Even more concerning is that alcohol consumption during COVID-19 lockdowns increased by 60%.  According to the National Center for Drug Abuse Statistics:  <ul> <li>25.8% of people 18 and older report binge drinking in the past 30 days. </li> <li>Every day, 261 people in the U.S. die due to excessive alcohol use. </li> <li>80% of these deaths involve adults 35 or older. </li> <li>Men are three times as likely as women to die due to alcohol abuse. </li> <li>22.5% of acute alcohol-related deaths are due to suicide. </li> </ul> Signs to look for There are many signs to look for when determining if someone is affected by alcohol use disorder. Some are apparent, while others require you to take notice. Signs of an alcohol use disorder fall in the categories of tolerance, social impairment, impaired control, withdrawal symptoms and recurrent use.  The three categories of alcohol use disorder — mild (two to three criteria), moderate (four or five criteria) and severe (six or more criteria) — are based on the following criteria:  <ul> <li>Drinking more or for a longer period than originally planned. </li> <li>Trying to cut down on or quit drinking but not being able to. </li> <li>Spending a lot of time drinking or being sick due to drinking. </li> <li>Craving alcohol or the strong need for a drink. </li> <li>Noticing that drinking causes problems at home, work or school. </li> <li>Continuing to drink despite the trouble it causes. </li> <li>Ending up in risky or dangerous situations due to drinking. </li> <li>Quitting activities that once were important. </li> <li>Feeling depressed or anxious, or another health problem. </li> <li>Needing to drink more to achieve the desired effect. </li> <li>Noticing the presence of withdrawal symptoms. </li> </ul> Take the challenge Participate in an alcohol-free weekend in observance of Alcohol Awareness Month.  Here's how you can participate:  <ul> <li>Take the 72-hour challenge.  Spend 72 hours without alcohol. Make sure you and your family participate in this activity, and monitor symptoms of discomfort or cravings within the three days. </li> <li>Start conversations.  It is your role as a caring adult to initiate difficult conversations to increase awareness. Speak with friends and family members who you've noticed rely on heavy drinking and encourage them to take the 72-hour challenge. As a parent, teach your children about alcohol misuse and help them build skills to cope. </li> <li>Throw dry parties.  Use the month of April to throw alcohol-free, clean and healthy parties for adults. Invite friends, neighbors and family to enjoy social gatherings without a trace of liquor. Serve kombucha, mocktails, sparkling juice and club sodas to set an example. </li> </ul> Get help When people recognize that their drinking has become problematic and they're willing to address it, only then can they move forward. Seeking out treatment is a good next step.  Here are links to locate evidence-based, quality treatment programs and additional support.  <ul> <li><a rel="noopener noreferrer" href="file:///C:\Users\rah06\AppData\Local\Microsoft\Windows\INetCache\Content.Outlook\0Q0KS7RK\%20%20https\findtreatment.samhsa.gov\" target="_blank">Substance Abuse and Mental Health Service Administration</a>. </li> <li><a rel="noopener noreferrer" href="https://alcoholtreatment.niaaa.nih.gov/" target="_blank">National Institute on Alcohol Abuse and Alcoholism</a>. </li> <li><a rel="noopener noreferrer" href="https://www.aa-meetings.com/" target="_blank" title="Link opens in a new window">Alcoholics Anonymous, or AA</a>. This group is run by a community of people in recover. They have free meetings in almost every city or town around the country. </li> <li><a rel="noopener noreferrer" href="https://al-anon.org/al-anon-meetings/" target="_blank">Al-Anon and Alateen</a>. They have free meetings to help people who have been affected by a loved one's addiction. </li> </ul> Recovery strategies It's one thing to stop using or drinking, but it's another to be actively involved in recovery.  These 10 strategies can help people in their recovery: <ol> <li>Get rid of all alcohol.  Create a safe space for your body, mind and spirit. </li> <li>Remember your disease.  It's alcohol-"is"-m, not alcohol-"was"-m. Addiction is persistent and patient at waiting for people who think they've been "cured."</li> <li>Don't forget your last use or your last drink.  Remember and recognize what you've been through to deter you from doing it again. </li> <li>Remember that one is never enough.  Once you start, one is never enough, and a thousand is too many. </li> <li>Think the drink through to the end.  If you're tempted to drink, think about where it will lead you. </li> <li>Use the 24-hour plan.  Focus on staying sober today — this hour, this minute. Don't focus on remaining sober the rest of your life. </li> <li>Recognize urges and allow them to pass.  When you feel the urge to drink, rather than deny them, practice noticing them, accepting them, naming them, and talking with someone about them. </li> <li>Postpone drinking and using.  Alcoholics tend to be excellent procrastinators, so use that strength to put off the drink until later. Keep a list of things you can do to procrastinate. </li> <li>Use the telephone.  Get the number of others who can be and are supportive. Practice calling them daily. If you call people before you need them, then you'll be more likely to make the call when you're struggling. </li> <li>Examine how decisions will affect your recovery.  When making life decisions, whether it's getting a new apartment or changing jobs, ask yourself, "How will this affect by sobriety, my recovery, and my ongoing health and wellness?"</li> </ol> Kileen Smyth, L.I.C.S.W., M.S.W., and Chad Ellis, L.I.C.S.W., are clinical social workers in Primary Care in Rochester and Kasson. Both have worked within the Department of Psychiatry at Mayo Clinic in Rochester for years in the Addictions Program. They are psychotherapists in Primary Care in Rochester and Kasson's Integrated Behavioral Health Division at Mayo Family Clinics Northeast and Northwest. Kileen Smyth, L.I.C.S.W., M.S.W., and Chad Ellis, L.I.C.S.W.Primary Care in Rochester and KassonAlcohol Use DisorderPrimary Care in Rochester and KassonBlood and organ donation can save lives.&nbsp;<img src="/-/media/ech-media/images/widgets/blooddonation/blooddonortable.jpg?h=65&iar=0&w=100&sc_lang=en&hash=B6A8BD0FCEB888EFC9B30793FE7B9213" alt="BloodDonorTable" width="100" height="65" DisableNVelocity="true" />Save a life. Donate4/25/2022 4:30 AM<img src="/-/media/ech-media/images/widgets/blooddonation/blooddonortable.jpg?h=205&iar=0&w=315&sc_lang=en&hash=1AB3BB99505BDFD34D37BB5571156961" alt="BloodDonorTable" width="315" height="205" DisableNVelocity="true" /><a rel="noopener noreferrer" href="https://www.donatelife.net/" target="_blank">Donate Life America</a> raises awareness about organ donation, inspires people to register as a donor, and honors those who have saved a life through the gift of donation. Every April, Donate Life Month highlights organ transplants. However, blood donation also is critical for these patients.  Blood and organ donation go hand in hand. Blood donation is crucial in helping with a successful organ or tissue transplant. For a transplant patient to receive the gift of life from a donor, the transplant team needs to make sure that they have the correct blood type to support the procedure. Thanks to donors, like those who come to the Mayo Clinic Blood Donor Program, the procedure can move forward with an adequate supply of blood available.  Every two seconds someone in the U.S. needs a blood donation. During most organ or bone marrow transplant procedures, a person will need at least one to two units of blood. Those who need a liver transplant may need up to 20 or more units of blood.  Whether it's a patient with cancer awaiting an organ or a patient receiving a transplant, they will need blood. Thousands of Mayo Clinic patients depend on the generosity of blood donors like you. Consider scheduling an appointment to donate to ensure blood is available for a loved one or other patients in need. You can choose to donate blood at one of these locations at Mayo Clinic in Rochester, Minnesota: <ul> <li> Hilton Building, first floor This location is open weekdays from 6 a.m. to 4:30 p.m., and until 7 p.m. every second Thursday of the month. </li> <li> Saint Marys Campus This location is on the main floor of the Joseph Building, M-86. This location is open weekdays from 8 a.m. to 3 p.m. </li> </ul> For more information about donating blood in Rochester, call the Mayo Clinic Blood Donor Program at <a href="tel:5072844475">507-284-4475</a> or contact the program by <a href="mailto:mailto:donateblood@mayo.edu">email</a>. You also can visit the <a href="https://www.mayoclinic.org/blood-donor-program/minnesota">Mayo Clinic Blood Donor Program webpage</a> for more information. Primary Care in Rochester and KassonBlood Organ DonationPrimary Care in Rochester and KassonKeeping your attention on the road is critical to safety.&nbsp;<img src="/-/media/ech-media/images/widgets/people/distracteddriving.jpg?h=65&iar=0&w=100&sc_lang=en&hash=C25E74B2446AE46D50744EFC07311AED" alt="DistractedDriving" width="100" height="65" DisableNVelocity="true" />Distracted driving: Just don't do it4/28/2022 4:30 AM<img src="/-/media/ech-media/images/widgets/people/distracteddriving.jpg?h=205&iar=0&w=315&sc_lang=en&hash=153F3C097629843BB8EB9FE750AD9E0F" alt="DistractedDriving" width="315" height="205" DisableNVelocity="true" />The statistics are staggering. Distracted driving causes more than 3,000 fatalities and an estimated 424,000 injuries each year in the U.S. alone. About 1 in 5 victims of auto crashes involving a distracted driver are outside of the vehicle.  Distracted driving is defined as anything that takes your attention off the road.  Driver distraction has four main types:  <ul> <li>Manual  Manipulating something other than the steering wheel. </li> <li>Visual  Looking at something other than the road. </li> <li>Auditory  Hearing something not related to driving. </li> <li>Cognitive Thinking about something other than driving. </li> </ul> Many people think of cellphone use as the sole form of distracted driving, but other examples of distracted driving that put yourself and your passengers, and pedestrians, at risk include:  <ul> <li>Adjusting your rear-view mirror to check on backseat passengers. </li> <li>Styling your hair. </li> <li>Putting on makeup. </li> <li>Eating. </li> <li>Changing temperature controls. </li> <li>Following your GPS navigation. </li> <li>Driving while angry or crying. </li> </ul> It's important to remember modern cellphone use isn't just texting anymore. Drivers also use their phones to snap pictures, record video, chat or video chat. What makes cellphone use while driving so dangerous is that it involves not just manual distraction, but also visual and cognitive distraction.  Every person is at risk of being a victim of a distracted driving accident, even those who don't drive. Therefore, it's important to focus on awareness of this issue, identify ways to combat it, and make personal pledges to stop distracted driving behaviors.  Certain age groups are more likely to drive distracted or be involved in fatal accidents because of distracted driving. According to 2018 data, 25% of distracted drivers involved in fatal crashes were age 19-20. Drivers age 15-19 were more likely to be distracted at the time of a fatal crash, compared with all other age groups.  But what can be done to prevent and stop distracted driving?  For those with teens or novice drivers, the importance of distracted driving must be emphasized by having open and honest discussions about it. Also, clear rules and expectations should be set for teens — both when they drive and when they are passengers in a vehicle. Emphasize that driving is a skill that requires their full attention, so those texts and phone calls can wait.  An excellent resource to refer to is the Centers for Disease Control and Prevention's (CDC) distracted driving tools, including a <a rel="noopener" href="https://www.cdc.gov/teen-drivers/parents-are-the-key/driving-agreement.html" target="_blank" title="Opens in new browser window">parent-teen driving contract</a> outlining expectations and potential consequences of distracted driving. It should be noted that violating this driving contract might not just lead to potential penalization from parents. Most U.S. states have enacted <a rel="noopener" href="https://www.ghsa.org/state-laws-issues/distracted-driving" target="_blank" title="Opens in new browser window">graduated driver licensing laws</a> regarding the use of cellphones by teens and novice drivers. Violating these laws potentially involves legal consequences, as well.  It's important to set a good example for your children when you are behind the wheel. Talking or texting on the phone while driving sends a hypocritical "Do as I say, not as I do" message to them that sticks with them later. Instead, designate cars as "no phone zones" and speak out whenever a driver in a nearby car seems distracted.  You also can set limits on yourself and young drivers by using cellphone blocking technology — most often in the form of a smartphone app. These apps all have the basic technology to prohibit calls or texts while a vehicle is in motion, with many offering more advanced features. Don't worry, as these blocks have no affect when using your phone as a passenger, riding public transportation or other situations.  While multitasking is a constant part of life, it shouldn't occur while operating a vehicle. Resist the urge to do anything but drive when you are behind the wheel. By remaining focused on the road with both hands on the wheel, you are doing everything you can to keep yourself and everyone in and around your vehicle safe from becoming the victim of a distracted driving accident.  <a rel="noopener" href="https://communityhealth.mayoclinic.org/providers/rachael-passmore-do/" target="_blank">Rachael Passmore, D.O.</a>, is a physician in Primary Care in Rochester and Kasson's Department of Family Medicine in Rochester. She completed her medical degree at Des Moines University and her residency in family medicine at Baylor College of Medicine Family Medicine Residency in Garland, Texas. Her research interests include preventive care and integrative medicine. Rachael Passmore, D.O.Primary Care in Rochester and KassonDistracted Driving 2022Primary Care in Rochester and KassonLearn about the warning signs and treatment of hoarding disorder.&nbsp;<img src="/-/media/ech-media/images/widgets/randomimages/ech_hoarder_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=F6676DD4EAE0FD6E6DA9F161C9CBED0F" alt="ECH_hoarder_widget" width="100" height="65" DisableNVelocity="true" />How much stuff is too much stuff?4/21/2022 4:30 AM<img src="/-/media/ech-media/images/widgets/randomimages/ech_hoarder_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=1615B71B3DE4EA4FCA9465EC6B0E6648" alt="ECH_hoarder_widget" width="300" height="195" DisableNVelocity="true" />Everyone likes to acquire and hold onto things for a variety of reasons. This item is unique. It reminds me of an important event in my life. It's a great deal. I could have a use for it one day.  Most people have a balance among what they obtain, hold onto and let go. However, for some, having too much can lead to significant problems in day-to-day living.  Hoarding disorder affects about 3%–6% of the population.  Common characteristics of hoarding include:  <ul> <li>Excessive acquisition of items with limited objective value or immediate use. </li> <li>Difficulties discarding, giving away or recycling accumulated items. </li> <li>Problems with organization, attentiveness, memory and decision-making. </li> <li>Excessive buildup of clutter in living spaces. </li> <li>Avoidance of managing the clutter. </li> </ul> Hoarding disorder isn't the same as being a collector or pack rat.  Collectors tend to focus on a specialized area of interest rather than a wide range of different things. They also may collect items that have recognized value. Pack rats may hold onto many sentimental items, but it may not result in problems with their living spaces.  With hoarding disorder, living spaces can no longer be used for their intended purpose due to excessive clutter. For example, a person's kitchen counters and stove become so cluttered that meals cannot be prepared. A bathroom is so filled with miscellaneous office supplies that the toilet or shower cannot be used.  The most commonly hoarded items are information, including books, magazines, mail and scraps of paper; clothing; household items, including coffee mugs, towels and pens; and crafts. In more serious cases, some people excessively accumulate food or pets, which can result in unsanitary living conditions.  People who hoard hold strong beliefs about their possessions, including their uniqueness, future use and not wanting to be wasteful. They also tend to have a strong degree of emotional attachment to their possessions, feel highly responsible for retaining their items and can become increasingly territorial when there is any threat to discarding or losing their things.  Continued hoarding behavior increases the risk for other health and safety problems, including:  <ul> <li>Narrow pathways between piles of newspapers, books and bags of clothing can be a significant fall risk, especially for the elderly and others with mobility problems. </li> <li>Attempts to conceal hoarding from others can result in isolation and feeling more disconnected from others and increases the risk of depression. </li> <li>Others may struggle financially by spending a great deal on storage facilities for their possessions rather than covering important expenses, such as food and utilities. </li> </ul> Hoarding behaviors can start during the teenage years. However, the problems with clutter in living spaces and other responsibilities in life gradually develop over time, so impairment usually starts to show up in middle-aged and older adults. Hoarding is equally common in men and women, and often is associated with other mental health problems, such as depression.  Researchers have found that hoarding may be related to:  <ul> <li>Family history  Hoarding tendencies or the full disorder may tend to run in families. This may be due to shared genetics or by learning patterns of acquiring and retaining items. </li> <li>Personality  Indecisiveness and perfectionism are common traits among those who hoard. </li> <li>Stressful life events  Sustaining significant losses in life, such as the death of a family member or destruction of possessions in a fire or natural disaster, can increase the risk of developing hoarding disorder. </li> </ul> Treatment for hoarding disorder can be challenging since the problem usually has been going on for several years in private. Plus, the prospect of decluttering can be distressing for the person due to the high degree of emotional attachment to their items, general avoidance tendencies, and strong beliefs about acquiring and retaining. Sometimes treatment is motivated by external factors, such as the threat of eviction, legal action or frustrated family members. Addressing personal motivators for treatment is essential for engagement.  Cognitive behavioral therapy is the most evidence-based treatment approach for hoarding. No medications are indicated for hoarding, although the use of antidepressants may help when a depressive disorder is present. In some cases, family therapy also may help.  Cognitive behavioral therapy for hoarding tends to be more intense and takes longer than other anxiety conditions, such as panic, post-traumatic stress or social-anxiety disorders.  Treatment focuses on:  <ul> <li>Gradually changing patterns and learning new skills. </li> <li>Encouraging participation with others who are healthy and can offer practical assistance. </li> <li>Conducting home visits to apply skills to manage clutter. </li> <li>Providing follow-up to prevent relapse. </li> </ul> Among the skills cognitive behavioral therapy teaches are:  <ul> <li>Identifying and challenging beliefs about acquiring and retaining items. </li> <li>Resisting urges to accumulate more items. </li> <li>Organizing and making decisions over where to start in their home, including how to make the best use of storage space. </li> <li>Increasing tolerance for sorting through possessions, including making decisions over keeping, recycling or throwing them away. </li> <li>Preventing clutter from taking over cleaned areas of the home. </li> <li>Increasing involvement with more meaningful activities and social supports. </li> </ul> Hoarding disorder is a treatable but challenging condition. Some communities, counties and social service agencies may have additional resources and specialists available.  <a rel="noopener noreferrer" rel="noopener noreferrer" href="https://www.mayoclinic.org/biographies/sawchuk-craig-n-ph-d-l-p/bio-20085911" target="_blank">Craig Sawchuk, Ph.D., L.P.</a>, is a clinical psychologist in Primary Care in Rochester and Kasson's Division of Integrated and Behavioral Health. He is the co-chair of Integrated Behavioral Health as well as co-chair of Professionalism within the Department of Psychiatry and Psychology at Mayo Clinic in Rochester.  Dagoberto Heredia Jr., Ph.D., L.P., is a clinical psychologist in the departments of Psychiatry and Psychology and Endocrinology at Mayo Clinic in Rochester. Craig Sawchuk, Ph.D., L.P., and Dagoberto Heredia Jr., Ph.D., L.P.Primary Care in Rochester and KassonHoarding DisorderPrimary Care in Rochester and KassonFocus on health equity, leaving no one behind in the journey to health.&nbsp;<img src="/-/media/ech-media/images/widgets/people/womancomputercreditcard.jpg?h=65&iar=0&w=100&sc_lang=en&hash=AE4AE66FAEFCC69B622854ED88FCA870" alt="WomanComputerCreditCard" width="100" height="65" DisableNVelocity="true" />April is National Minority Health Month4/14/2022 4:30 AM<img src="/-/media/ech-media/images/widgets/people/womancomputercreditcard.jpg?h=205&iar=0&w=315&sc_lang=en&hash=E74440C41798E8351960849C632A4805" alt="WomanComputerCreditCard" width="315" height="205" DisableNVelocity="true" /> Booker T. Washington was born into slavery, but he went on to be an educator, reformer, adviser to presidents — and he was an influential spokesman for African Americans. In April 1915, recognizing that health is the key to progress and equity in all other things, he proposed National Negro Health Week. He called on multiple key stakeholders within the African American community to unite in a national health movement.  In 2002, this call was supported with a concurrent resolution from Congress that stated that "A National Minority Health and Health Disparities Month should be established to promote educational efforts on the health problems currently facing minorities and other health disparity populations." The resolution went on to state that this month encourages "all health organizations and Americans to conduct appropriate programs and activities to promote healthfulness in minority and other health disparity communities." National Minority Health and Health Disparities Month has now become National Minority Health Month, and it's observed in April — a time to focus on and advance health equity for all historically and intentionally excluded or disinvested communities across the country.  What are health inequities? What is health equity? Health inequities are health differences that are avoidable, unnecessary, unfair and unjust. On the other hand, health equity means that everyone can be as healthy as possible, and there are no avoidable, unfair or remediable health differences among groups of people — whichever way these groups are described — such as by race, gender, economics, geography or otherwise.  Unfortunately, racial and ethnic minority populations in the U.S. are significantly affected by health inequities, and people in these populations are much more likely to die from certain diseases, compared to the general population. The disproportionate effects the COVID-19 pandemic has had on racial and ethnic minority populations in the U.S. has provided a glimpse into these inequities, which are deeply rooted. What is the cause of the health inequities?  Systemwide bias and institutionalized racism continue to contribute to inequities across the U.S. and have devastating effects on society, particularly what are called the social determinants of health.  Social determinants of health are the circumstances where people live, learn, work and play. They are the biggest drivers for the health of communities and individuals, and are closely linked to health inequities. For instance, people who are poor and who live in areas where poverty is more common tend to have poorer health outcomes than people who live in areas with more material means and less poverty.  Many of the foundations of these social determinants of health are deeply rooted in the history of racism that must be confronted to make any progress. Many leading health organizations, including Mayo Clinic, now recognize the role of systemwide bias and institutionalized racism, and have pledged to address it, investing time, money and talent in these efforts. What is your role in the efforts to achieve health equity? To address health inequities, an equity lens must be applied to everything. Having an equity lens means that in every step of caring for patients, a pause must be taken to intentionally consider whether what will be done will improve or worsen health inequities. This includes every step of the health journey of patients and communities, from access to quality health care, continuous assessment of outcomes of health to identify ongoing inequities and development of interventions that address these inequities.  Bias, whether conscious or unconscious, also is one of the contributors to health inequities affecting minority groups. One way to contribute is to frankly consider what your biases are?  It is also crucial to address more upstream issues that contribute to ongoing health inequities. These issues include improving access to healthy food, safe opportunities for physical activity, education opportunities, focus on career pipelines, and fairness in employment and wages for all racial and ethnic minority population communities across the country. For 2022, the Department of Health and Human Services' Office of Minority Health has selected "Give Your Community a Boost" as the theme, given the disproportionate effects the COVID-19 pandemic has had on racial and ethnic minority populations in the country. Whatever your role, promoting COVID-19 vaccination, including boosters, within your family, social networks and communities is a tangible thing that can be done.  <a href="https://communityhealth.mayoclinic.org/providers/jane-njeru-mbchb/">Jane Njeru, M.B., Ch.B.</a>, is a physician in Primary Care in Rochester and Kasson's Division of Community Internal Medicine, Geriatrics and Palliative Care. She completed medical school at the University of Nairobi in Kenya and her residency in internal medicine at Mayo Clinic in Rochester. Her interests include developing interventions to reduce health disparities, with special focus on patients with limited English proficiency, immigrants and refugees.  Jane Njeru, M.B., Ch.B.Primary Care in Rochester and KassonMinority Health MonthPrimary Care in Rochester and KassonFind out more about Mayo Clinic's commitment to keeping patients safe.&nbsp;<img src="/-/media/ech-media/images/widgets/randomimages/safezone.jpg?h=65&iar=0&w=100&sc_lang=en&hash=BBFCE94DA98AE9357A573EEEAAC929C2" alt="SafeZone" width="100" height="65" DisableNVelocity="true" />Making Mayo Clinic safe for its youngest patients4/4/2022 4:30 AM<img src="/-/media/ech-media/images/widgets/randomimages/safezone.jpg?h=205&iar=0&w=315&sc_lang=en&hash=442D756AD81F6F57B28555031C7CC0AE" alt="SafeZone" width="315" height="205" DisableNVelocity="true" />Taking children to a clinic appointment can be difficult. While waiting to be seen, kids want to run around the waiting area, talk loudly and disrupt a generally quiet room. And sometimes a parent or even an older sibling will try to manage the children by a soft tap or push, or even a hard slap.  However, this kind of response does not create a safe environment for the misbehaving children or other patients in the waiting area. The waiting room is scary enough without seeing someone push or hit someone else.  To create a safe area for all our patient, Mayo Clinic is participating in a <a rel="noopener noreferrer" href="https://nohitzone.com/" target="_blank">national program</a> and creating what are called "No-Hit Zones." A No-Hit Zone is an environment where no one shall hit another person.  How you can help If your children become disruptive — talking loudly, running around or crying, for example — you can work to redirect their energy. Talk to them calmly. Ask if they want to walk around the waiting area with you and look at something new. Try to play a game with them or offer them a different activity. You can even reach out to Mayo Clinic staff for stickers or a cup of water to disrupt the behavior.  Understand, too, that Mayo Clinic staff will step in if they see anyone hit anyone else. They will remind you that Mayo Clinic is a No-Hit Zone where hitting is not tolerated. They also will help you redirect your child in a nonviolent way.  Mayo Clinic recognizes that as a parent, you choose how you discipline your children. However, in the No-Hit Zone at Mayo Clinic, you're asked to follow the policy of nonviolence.  To help you better understand what a No-Hit Zone is and how to encourage good behavior, you can use the information in this Mayo Clinic booklet: "<a rel="noopener noreferrer" href="https://mcforms.mayo.edu/mc5700-mc5799/mc5749-03.pdf" target="_blank">Keeping Kids Safe: This is a No-Hit Zone</a>." <a rel="noopener noreferrer" href="https://www.mayoclinic.org/biographies/graff-arne-h-m-d/bio-20095977" target="_blank">Arne Graff, M.D.</a>, is a physician in the Mayo Center for Safe and Healthy Children and Adolescents at Mayo Clinic in Rochester. He completed his residency in family medicine at the University of Wyoming in Cheyenne, Wyoming, and his forensic medicine fellowship at Brown University in Providence, Rhode Island. His practice includes clinics in Minnesota, North Dakota and Wisconsin for consults in child maltreatment and neglect. Arne Graff, M.D.Primary Care in Rochester and KassonNo Hit ZonePrimary Care in Rochester and KassonHaving access to health records speeds up care.&nbsp;<img src="/-/media/ech-media/images/widgets/blooddonation/norealjumaili.jpg?h=65&iar=0&w=100&sc_lang=en&hash=D003A32B9365C59D3ED896686175A6C4" alt="NoreAlJumaili" width="100" height="65" DisableNVelocity="true" />Creating a Patient Online Services account helped teen respond to COVID-19 infection4/12/2022 4:30 AM<img src="/-/media/ech-media/images/widgets/blooddonation/norealjumaili.jpg?h=205&iar=0&w=315&sc_lang=en&hash=6DA5D17810BD6043C0B7C13527A89872" alt="NoreAlJumaili" width="315" height="205" DisableNVelocity="true" />Nore Al Jumaili started coughing and had a fever. A family member had recently been diagnosed with COVID-19 and had begun home quarantine. So the 14-year-old's mom took her to Mayo Clinic for a COVID-19 test.  When she was there, Nore was told she could find her test results on <a rel="noopener noreferrer" rel="noopener noreferrer" href="https://onlineservices.mayoclinic.org/content/staticpatient/showpage/patientonline" target="_blank">Patient Online Services</a>.  But Nore hadn't created her own Patient Online Services account. Until Nore was 13, her mom had full access to her health records through Patient Online Services. At 13, parental access is limited, so Nore's mom could see her daughter's allergy and immunization lists, secure messages, and Mayo Clinic Express Care Online visits, but she couldn't review any of Nore's test results.  Nore decided it was time to create her own account.  "A friend of mine told me that I could call Mayo Clinic and ask them to create an account for me," she says. "She told me my mom or dad would need to be there when I called. That seemed easy enough, so I called." Nore spoke with an agent who she says made it easy for her and her mom to set up an account.  The account was created quickly, and Nore was able to check her test results. Unfortunately, she had tested positive and needed to quarantine, but she says her symptoms were pretty mild and she's doing great now, as is her family member.  How to create a Patient Online Services account for a teenager Any Mayo Clinic patient 13 to 17 years of age can create a Patient Online Services account.  Here's how:  <ol> <li>Make sure both the teenager and the parent or guardian are present for the call. It's good to have the teenager's Mayo Clinic number available. The teenager also needs to have an email address to receive emails from Mayo as part of the account creation process. </li> <li>Call Mayo Clinic Customer Assistance at <a rel="noopener noreferrer" href="tel:8778580398" target="_blank">877-858-0398</a>. </li> <li>Select option "5."</li> <li>Tell the agent that you want to create an account for a teenager. </li> <li>Both parent and teen will answer questions from the agent to validate who they are. Questions can include such things as the Mayo Clinic number, name of their health care professional, birth date or full address. </li> <li>Emails are sent with links to finish creating the account. </li> <li>Agents will help complete the process, including logging in to the newly created account. </li> </ol> It's important that teens can answer the agent's questions without any prompting.  Revised process during pandemic "Nore was able to create her own account over the phone after we adjusted our process during the early COVID-19 response. We found a remote solution for teen patients at a time when patients and parents may have been unable to be on-site," explains a Mayo Clinic compliance officer.  Prior to this, teens and their parent or guardian needed to go to Mayo Clinic to create this account. Due to the success of the process, and feedback from our teen patients and their parents, we will continue this process to allow creation of accounts by phone.  Nore created her account because she needed to get her test results. But she and other teens also need their own accounts for video appointments, online scheduling of appointments, other test results, and full access to their electronic health record.  The staff in Primary Care in Rochester and Kasson can help teens create their own Patient Online Services accounts. As Nore says, "It's easy."Primary Care in Rochester and KassonTeen Patient Online Services AccountPrimary Care in Rochester and KassonExercise improves your physical and mental well-being.&nbsp;<img src="/-/media/ech-media/images/widgets/elderly/ech_healthier_aging_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=F8FF45FA5E5F40C4A87181A66B4E4D1A" alt="ECH_healthier_aging_widget" width="100" height="65" DisableNVelocity="true" />Enjoy the benefits of exercise5/26/2022 4:00 AM<img src="/-/media/ech-media/images/widgets/elderly/ech_healthier_aging_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=E982965E357061F5D5C8CA625F44662C" alt="ECH_healthier_aging_widget" width="300" height="195" DisableNVelocity="true" />Spring is here, and summer is around the corner. This is a great time to take advantage of the warmer weather, get outdoors and incorporate more regular exercise.  Exercise improves muscle strength and overall fitness, and it slows bone density loss. Studies have shown that older adults who exercise regularly are less likely to fall or sustain fractures.  Together with a healthy diet, exercise can reduce the risk for heart disease and strokes. It's a fantastic way to help maintain a healthy weight, blood pressure, cholesterol and blood sugar.  What's more, being physically active is associated with a lower risk of developing certain cancers, including cancers of the breast, bladder and colon.  Not only does exercise improve physical health, but also it helps improve mental health and well-being. Exercise can reduce anxiety levels and the risk of major depression. Exercising regularly can improve concentration, memory, mood and thinking. It also can improve sleep quality and overall energy levels.  Most importantly, exercise can be fun. You can exercise individually or with others. It's a wonderful way to relieve stress.  Moderate-intensity exercise is generally safe for most people, although you should consult with your health care team before beginning an exercise program.  When taking part in moderate-intensity exercise, you can still comfortably have a conversation with another person, but you'd rather not. Adults are encouraged to incorporate 150 minutes of moderate-intensity every week. This means 20–30 minutes of exercise per day most days out of the week. This exercise does not have to be performed in one session. A 15-minute walk during your lunch break and another 15-minute walk after dinner would meet the daily requirement.  If you are new to exercise, it's important to start low and go slow. Find opportunities to move more and sit less. Even a few minutes of exercise every day can reap significant benefits. The key is consistency. Exercising some every day will allow you to build strength and endurance over time, which will eventually help you achieve your exercise goal.  So lace up and enjoy the benefits of exercise.  <a href="https://communityhealth.mayoclinic.org/providers/benjamin-lai-mbbchbao/">Benjamin Lai, M.B., B.Ch., B.A.O.</a>, is a physician in Primary Care in Rochester and Kasson's Department of Family Medicine. He is the assistant medical director of Mayo Clinic's Opioid Stewardship Program and is involved in medical student and resident education. He is an avid year-round runner. Benjamin Lai, M.B., B.Ch. B.A.O.Primary Care in Rochester and KassonExercise BenefitsPrimary Care in Rochester and KassonIf you're thinking of going gluten-free, consider these facts.&nbsp;<img src="/-/media/ech-media/images/widgets/food/ech_glutenfreediet_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=A7C1D69048F89C23317846C27B47C561" alt="ECH_GlutenFreeDiet_widget" width="100" height="65" DisableNVelocity="true" />Getting the facts about going gluten free5/12/2022 4:30 AM<img src="/-/media/ech-media/images/widgets/food/ech_glutenfreediet_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=06C0BEDAAFB83D316135247B8FF89F8C" alt="ECH_GlutenFreeDiet_widget" width="300" height="195" DisableNVelocity="true" />If you're considering going gluten free, you will want to consider these facts into your decision.  Gluten is a protein. It's found in wheat, barley, rye, triticale (a hybrid of wheat and rye), as well as wheat varieties like spelt, kamut, farro and durum. It's also found in products like bulgur and semolina.  A gluten-free diet is essential for managing the symptoms of certain conditions. <img alt="CeliacDisease" src="/-/media/ech-media/images/celiacdisease.jpg?h=520&w=350&sc_lang=en&hash=1E5ABEDCB6331733C08C98AA9B822128" class="alignright" style="height: 520px; width: 350px; float: right;"> A gluten-free diet is essential to manage celiac disease, which damages the lining of the small intestine and prevents the normal absorption of nutrients. Such a diet also is essential to manage dermatitis herpetiformis, a skin disease marked by rashes and blisters that damages the intestine. People with nonceliac gluten sensitivity can have similar symptoms, but nonceliac gluten sensitivity won't damage the intestine.  For people with these diseases, just 50 milligrams of gluten — the amount in one small crouton — is enough to cause trouble. This small quantity means gluten needs to be treated like other food allergies by avoiding cross-contamination throughout processing at home and in restaurants. Those with nonceliac gluten sensitivity can be affected by varying amounts of gluten. Symptoms include: <ul> <li>Recurring abdominal pain. </li> <li>Chronic diarrhea or constipation. </li> <li>Joint pain. </li> <li>Unexplained infertility. </li> <li>Low bone density. </li> </ul> Celiac disease is not common. About 2 million people in the U.S. have celiac disease and about 1 percent of people around the world have celiac disease. If you're concerned you might have a gluten intolerance, talk with your health care provider, who may refer you to a specialist. Celiac disease can be diagnosed with a blood test. However, starting a gluten-free diet on your own can complicate the diagnostic process. There are no recommended methods to test for nonceliac gluten sensitivity. Some health care professionals offer saliva, blood or stool testing, but these tests haven't been validated.  No evidence suggests that a gluten-free diet is healthier. There is no evidence that a gluten-free diet is healthier, or that it will help you lose weight, give you more energy or treat autism.  Gluten-free diets can lack needed vitamins, minerals and fiber. For example, many gluten-containing products, such as breads and cereals are fortified with essential B vitamins. And whole wheat is a major source of fiber. While the availability of gluten-free products has skyrocketed, many of these products tend to be lower in B vitamins, folate and iron because they're not fortified, studies have also shown they can be lower in protein and fiber. And just because bakery goods and snacks are gluten-free doesn't give you permission to eat as much as you like. They can be high in refined carbohydrates, fat, sugar, salt and calories — just like their gluten-containing counterparts.  Some foods are naturally gluten-free. Some foods are naturally gluten-free, such as unprocessed meats, poultry, fish, eggs, unprocessed beans and nuts, fruits, vegetables, corn, rice, potatoes and most low-fat dairy products.  Going gluten-free is challenging.  Since gluten is in countless products from traditional breads, cereals, pastas, pizza and beer, to soy sauce, gravies, salad dressing, candy, corn chips and ice cream, going gluten free is a major challenge. You need to become a devoted reader of product labels, ingredient lists and menu information at restaurants.  For people with celiac disease, dermatitis herpetiformis or nonceliac gluten sensitivity, avoiding gluten and eating a healthy, well-balanced diet takes knowledge, awareness and persistence — every day. But eating gluten-free does get easier with time, and for people with these conditions, the rewards are worth it.  If you've been diagnosed with one of these conditions, your dietitian, as well as support groups, reputable apps and websites, and gluten-free cookbooks, are excellent resources for creating a healthy and enjoyable gluten-free diet. If friends or family are on a gluten-free diet, be respectful and don't just assume they're hopping on the latest fad diet.  Rose Prissel, M.S., RDN, LD, is a dietitian at Mayo Clinic in Rochester working in pediatric and adult nutrition, with a focus on preventive care, sports nutrition and weight management. Rose Prissel, M.S., RDN, LDPrimary Care in Rochester and KassonGluten Free DietPrimary Care in Rochester and KassonThis new vaccine simplifies pneumococcal protection for adults at risk.&nbsp;<img src="/-/media/ech-media/images/widgets/elderly/ech_mentally_fit_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=D7DF4F4357FED49854B60D451425AB38" alt="ECH_mentally_fit_widget" width="100" height="65" DisableNVelocity="true" />Mayo Clinic now recommends a new pneumococcal conjugate vaccine for some4/27/2022 4:30 AM<img src="/-/media/ech-media/images/widgets/elderly/ech_mentally_fit_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=6BE88A9653CBA5E3646F5F84BFBCE581" alt="ECH_mentally_fit_widget" width="300" height="195" DisableNVelocity="true" />Pneumococcal bacteria cause a variety of serious, invasive infections, resulting in hospitalization or death. The vaccines used to prevent these infections cover different strains of the pneumococcal bacteria. Now we have newer vaccines for adults that cover more strains that are of concern to adults. Children will still get same vaccine as before. This is PCV13. The PCV stands for pneumococcal conjugate vaccine. Its brand name is Prevnar 13. The 13 signifies the number of strains of pneumococcal bacteria it defends against. It works well in this age group. But now adults will be getting a newer vaccination at Mayo Clinic. This is PCV20. Its brand name is Prevnar 20. The 20 represents the strains of pneumococcal bacteria that this vaccine covers. Mayo Clinic will be recommending a single dose of this vaccine for adults who need protection against pneumococcal bacteria. This includes adults 65 years and older. It also includes those 19 to 64 years of age who have medical conditions or other problems that increase their risk for infection with pneumococcal bacteria. In the past adults 19 to 64 years of age needed one to three doses of pneumococcal vaccine with one to two types of pneumococcal vaccine. Care teams will work with adults who have already received some vaccines against pneumococcal bacteria. They may not need the PCV20. Some may just need the older vaccine that had been used. Contact <a href="https://communityhealth.mayoclinic.org/contact-us">your health care team</a> to determine which vaccine is right for you.  <a rel="noopener noreferrer" href="https://communityhealth.mayoclinic.org/providers/robert-jacobson-md/" target="_blank">Robert M. Jacobson, M.D.</a>, is medical director of the Primary Care Immunization Program in Southeast Minnesota. He is a physician in Community Pediatric and Adolescent Medicine in Rochester. Robert M. Jacobson, M.D.Primary Care in Rochester and KassonPneumococcal Vaccine PCV20Primary Care in Rochester and KassonThis pregnancy complication is defined by elevated blood pressure and damage to another organ system.&nbsp;<img src="/-/media/ech-media/images/widgets/people/pregnancybp.jpg?h=65&iar=0&w=100&sc_lang=en&hash=AF59613011FEF026369A1ED758CF635E" alt="PregnancyBP" width="100" height="65" DisableNVelocity="true" />What is preeclampsia?5/16/2022 4:30 AM<img src="/-/media/ech-media/images/widgets/people/pregnancybp.jpg?h=205&iar=0&w=315&sc_lang=en&hash=0A42BD2229A7FE5C2F76640511CBE5D9" alt="PregnancyBP" width="315" height="205" DisableNVelocity="true" />Preeclampsia is a complication that can occur in the second half of pregnancy. It is defined by elevated blood pressure and damage to another organ system, such as your liver or kidneys.  Most women do not notice any symptoms of preeclampsia.  If preeclampsia is severe, you could experience:  <ul> <li>Headaches that are not relieved with acetaminophen (Tylenol). </li> <li>Changes in vision, including blurry vision, spots or flashing lights. </li> <li>Upper abdominal pain, usually under your ribs. </li> </ul> Testing for preeclampsia During each prenatal visit, your health care professional will closely monitor your blood pressure to screen for preeclampsia. if your blood pressure is higher than 140/90 mmHg, or millimeters of mercury, this may prompt further blood pressure monitoring, and possible blood and urine testing. Both elevated blood pressure and abnormal blood and urine testing are needed to diagnose preeclampsia.  How preeclampsia affects your baby, pregnancy Preeclampsia can affect the growth of your baby and decrease the amount of amniotic fluid around the baby. If you are diagnosed with preeclampsia, your baby would be closely monitored with ultrasound and testing before birth.  The only treatment for preeclampsia is to deliver your baby. Depending on the severity of your preeclampsia, your health care professional may recommend that labor is induced earlier than your due date. Induction of labor could include medications to jump-start your labor process. In some cases, a cesarean delivery may be needed.  You also will receive a medication during labor to prevent seizures, as some women with preeclampsia can experience seizures.  Preventing preeclampsia While you can't prevent preeclampsia, it's important to attend all prenatal visits so that your blood pressure can be monitored regularly.  At your initial prenatal visit, you may be asked about possible risk factors for preeclampsia. This will include if you have had preeclampsia before or if you have a family history of preeclampsia. If you are considered at higher risk for preeclampsia, your health care professional may recommend that you take aspirin during your pregnancy. Do not take aspirin, unless directed by your health care professional.  Effects of preeclampsia affect pregnancy Having preeclampsia while pregnant can increase your likelihood of having high blood pressure and heart disease later in life. Make sure your primary care provider is aware of your health history of preeclampsia so that further discussion can take place on how to lower your risk of high blood pressure and heart disease in the future.  Shennin Hudoba, M.D., is a physician in Primary Care in Rochester and Kasson's Department of Family Medicine. She completed her medical degree at Loyola Chicago Stritch School of Medicine and her residency in family medicine at Mayo Clinic in Rochester. Her interests include medical education and women's health. Shennin Hudoba, M.D.Primary Care in Rochester and KassonPreeclampsiaPrimary Care in Rochester and KassonIn addition to those 50 and over, the shingles vaccine is now available for people at least 19 years of age who are or will become immunosuppressed.&nbsp;<img src="/-/media/ech-media/images/widgets/medications/shinglesvaccine.jpg?h=65&iar=0&w=100&sc_lang=en&hash=00343AE622C269E0F27F07E6E9EA6516" alt="ShinglesVaccine" width="100" height="65" DisableNVelocity="true" />Shingles vaccine now available for more people5/19/2022 4:30 AM<img src="/-/media/ech-media/images/widgets/medications/shinglesvaccine.jpg?h=205&iar=0&w=315&sc_lang=en&hash=377EFE1E114A9820A44484965DCEDAD2" alt="ShinglesVaccine" width="315" height="205" DisableNVelocity="true" />Mayo Clinic now recommends the shingles vaccine for people at least 19 years old who are or will become immunosuppressed. Mayo Clinic continues to recommend the vaccine for everyone 50 year and older.  The Shingrix shingles vaccine is not a live virus vaccine. It cannot multiply or cause harm. It works by teaching the body to make immunity against the shingles virus.  The shingles virus is dormant in most people. Shingles occurs when the immune system fails, letting the virus get active again.  Shingles can cause a nasty, painful rash. It can sometimes lead to a great deal of pain that lasts months. And it can sometimes cause blindness. For a person who is immunosuppressed, shingles can kill.  The Shingrix shingles vaccine series consists of two doses. People 50 years and older get these doses eight weeks apart. Those who are or will become immunosuppressed should not wait eight weeks. Instead, they should get the doses four weeks apart.  Those who previously had shingles are still at risk to get shingles again. They should still get this vaccine series.  Those getting a dose can get other vaccinations that are due at the same time. Those who are nursing babies can get vaccinated. We avoid giving the vaccine to people who are pregnant.  All Primary Care in Rochester and Kasson sites carry the Shingrix shingles vaccine. <a href="https://communityhealth.mayoclinic.org/locations">Call your health care team</a> today to get up to date on your vaccines.  <a href="https://communityhealth.mayoclinic.org/providers/robert-jacobson-md/">Robert M. Jacobson, M.D.</a>, is medical director of the Primary Care Immunization Program in Southeast Minnesota. He is a physician in Community Pediatric and Adolescent Medicine in Rochester. Robert M. Jacobson, M.D.Primary Care in Rochester and KassonShingrixPrimary Care in Rochester and KassonConsequences of teen pregnancy can affect the mother and her child.&nbsp;<img src="/-/media/ech-media/images/widgets/medicalimages/pregnancytest.jpg?h=65&iar=0&w=100&sc_lang=en&hash=05D84688EBAB2ED6212F7E1141FF88F4" alt="PregnancyTest" width="100" height="65" DisableNVelocity="true" />Teen pregnancy: Things to think about5/9/2022 4:30 AM<img src="/-/media/ech-media/images/widgets/medicalimages/pregnancytest.jpg?h=205&iar=0&w=315&sc_lang=en&hash=A8E8F7D84519D75893BD0C04A1E62BF7" alt="PregnancyTest" width="315" height="205" DisableNVelocity="true" />While Centers for Disease Control and Prevention (CDC) data show that the rate of teen birth rates in the U.S. have been declining since 1991, this rate is still much higher than other Western industrialized nations. Racial, ethnic and geographic disparities continue to be seen in the U.S. Teens coming from homes with less education and lower incomes, or those who are in foster care, have higher birth rates.  Consequences of teen pregnancy can affect the teen mom and her child. Teen moms drop out of school at a higher rate. Children of teen moms are more likely to have lower achievement in school, higher school dropout rates and an increase in health problems, according to the CDC. These children are also more likely to be incarcerated, have a teen pregnancy themselves and be unemployed as an adult.  Preventing teen pregnancy should be a significant priority.  According to the CDC, prevention efforts of teen pregnancy can include:  <ul> <li>Evidence-based teen pregnancy prevention programs. </li> <li>Community efforts addressing disparities that lead to teen pregnancy. </li> <li>Access to reproduction health services. </li> <li>Support from parents and other trusted adults. </li> </ul> Pediatric health care professionals should take every opportunity to discuss reproductive health needs with their teen patients in a supportive and inclusive manner, making sure all aspects of their medical and social health needs are addressed.  According to the American Academy of Pediatrics, when teen pregnancies occur, health care professionals should encourage early prenatal are and provide guidance to strengthen support of the pregnant teen. The focus should be on family and resources, including insurance, transportation, housing and food. It also helps to start discussions on parenting skills and monitor the teen for further needs, including mental health care, safety, substance use and post-pregnancy contraception.  <a href="https://communityhealth.mayoclinic.org/providers/marcie-billings-md/">Marcie Billings, M.D.</a>, is chair of the Division of Community Pediatric and Adolescent Medicine and a pediatrician with Primary Care in Rochester and Kasson. Her special areas of practice are adolescent medicine and eating disorders. Marcie Billings, M.D.Primary Care in Rochester and KassonTeen PregnancyPrimary Care in Rochester and KassonThe relationship between patients and their health care team is the foundation of safe, effective health care.&nbsp;<img src="/-/media/ech-media/images/widgets/people/ech_care_team_pediatrics_image_widget_01.jpg?h=65&iar=0&w=100&hash=7A3B2F2A5ACBF7FD1F1AB4E190C5C9B8" alt="ECH_Care_Team_Pediatrics_Image_Widget_01" width="100" height="65" DisableNVelocity="true" />During uncertain times, trust your primary care provider5/23/2022 4:30 AM<img src="/-/media/ech-media/images/widgets/people/ech_care_team_pediatrics_image_widget_01.jpg?h=195&iar=0&w=300&hash=355BB57372765716E207CD25FB564786" alt="ECH_Care_Team_Pediatrics_Image_Widget_01" width="300" height="195" DisableNVelocity="true" />The relationship between patients and their health care team is the foundation of safe, effective health care. Critical to this relationship is trust. Patients need to be able to trust their health care team with their lives and know that this team is putting their needs first. A solid trusting relationship does more than just feel good. It also improves patient outcomes. A 2017 study found that patients who trusted their health care team report healthier behaviors, fewer symptoms, higher quality of life and greater satisfaction with their treatment. During the COVID-19 pandemic, trust became even more important. Information about the virus and safety recommendations have been ever-evolving. It can be difficult to keep track of what's fact, what's fiction and the right action for you and your family. During times of uncertainty, turn to and trust the expert advice of your primary care provider. Role of a primary care provider The term primary care provider can seem like a general, slightly vague term. What does it mean? A primary care provider is a health care professional who specializes in diagnosing, treating and preventing a wide variety of conditions. Your primary care provider can be a physician, nurse practitioner or physician assistant. This professional provides care for most nonemergent, routine health care needs. The primary care provider's goal is to deliver the care that's right for you — not use a one-size-fits-all approach. Tailored health care is easier and better for you when you have a meaningful and trusting relationship with your provider. Focus on prevention Benjamin Franklin said, "An ounce of prevention is worth a pound of cure." He was talking about fire protection, but his words can apply to health too. It's much easier to prevent a disease than it is to treat one. Staying up to date on vaccinations and screenings can help you stay healthy and catch health problems early when they're easiest to treat. Your primary care provider will suggest screenings and vaccinations to keep you healthy. Primary care providers give about half of all vaccines in the U.S. and have the expertise to explain the benefits and answer any questions. A trusting relationship with your primary care provider has been vital during the COVID-19 pandemic. Your primary care provider can recommend ways to keep you protected from the virus, including getting vaccinated for COVID-19. Some patients have said they trust their primary care providers to treat them if they get infected with COVID-19, but they are hesitant to follow the same providers' recommendation to be vaccinated for COVID-19. This presents a care disconnect. Unfortunately, one reason for this could be the misinformation and myths circulating about COVID-19 vaccines. If you have questions about COVID-19 vaccines, don't search for answers on Google or social media. Instead, get the facts from your primary care provider or a reputable source like <a rel="noopener noreferrer" rel="noopener noreferrer" href="https://www.mayoclinic.org/" target="_blank">Mayo Clinic</a>. Your primary care provider knows your health history and risk factors, has reviewed vaccine safety and efficacy data, and is focused on keeping you healthy during the pandemic. This professional makes fact-based recommendations that put your health care needs first, especially when preventing a serious, potentially life-threatening disease like COVID-19. Diagnosis and treatment Primary care providers care for patients over a long period of time, often years. Because of this, they are trained to notice health changes and diagnose a wide range of diseases and conditions. They also work with an expert team that provides a well-rounded approach to your health care. Your primary care provider is trusted to diagnose and treat patients during the COVID-19 pandemic. Your primary care provider, along with colleagues in the hospital settings, are at the frontlines of the pandemic. They have seen it all and are equipped to make data-driven treatment plans to care for you. If needed, your primary care provider can coordinate care with a specialist. This person will monitor your updated medical history and status, and follow up with test results, provide meaningful explanations and describe the next best steps in your health care. Selecting a trusted primary care provider If you haven't already, consider doing some research and picking a primary care provider who's right for you. The continuity of care you'll receive and the familiarity you'll experience will help you get the care that's best for you. Choose a primary care provider who: <ul> <li>Makes you feel comfortable discussing health topics. </li> <li>Answers your questions. </li> <li>Communicates well, speaking in terms you can understand. </li> <li>Suggests ways to improve your health. </li> <li>Recommends screenings and exams appropriate for your age and sex. </li> <li>Treats common illnesses and injuries. </li> <li>Involves you as a partner in your care — asks what you think, listens to your concerns and expects you to follow through with action when required. </li> <li>Explains the options when you need treatment. </li> <li>Offers referrals to qualified specialists when necessary.</li> <li>Is board-certified, indicating additional training after medical school, and has passed an exam in a medical specialty. </li> </ul> Primary care includes these specialties: <ul> <li>Family Medicine — Care for people of all ages, providing family-oriented comprehensive care, including obstetrical care and well-woman care, newborn and well-child care, pediatrics and adult/geriatric care. </li> <li>Community Internal Medicine, Geriatrics and Palliative Care — Care for patients age 18 and older. Our providers offer general health and wellness care, including preventive exams. They also help manage complex medical conditions, such as heart disease, emphysema and diabetes. </li> <li>Community Pediatric and Adolescent Medicine — Offers primary care services to infants, children and adolescents through college. </li> </ul> Learn about <a href="https://communityhealth.mayoclinic.org/care-team">Primary Care in Rochester and Kasson</a> and the services we provide. <a rel="noopener noreferrer" rel="noopener noreferrer" href="https://www.mayoclinichealthsystem.org/providers/timothy-van-gelder-md" target="_blank">Timothy Van Gelder, M.D.</a>, and <a rel="noopener noreferrer" rel="noopener noreferrer" href="https://www.mayoclinichealthsystem.org/providers/paul-robelia-md" target="_blank">Paul Robelia, M.D.</a>, are Family Medicine physicians in <a rel="noopener noreferrer" rel="noopener noreferrer" href="https://www.mayoclinichealthsystem.org/locations/owatonna" target="_blank">Owatonna</a> and <a rel="noopener noreferrer" rel="noopener noreferrer" href="https://www.mayoclinichealthsystem.org/locations/zumbrota" target="_blank">Zumbrota</a>, Minnesota, respectively. Timothy Van Gelder, M.D., and Paul Robelia, M.D.Primary Care in Rochester and KassonTrust Primary CarePrimary Care in Rochester and KassonVaxelis vaccine protects against six diseases.&nbsp;<img src="/-/media/ech-media/images/widgets/kids/ech_dadsfeeding_01_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=798E21F9A876ACB652FE7558F1F07707" alt="ECH_DadsFeeding_01_widget" width="100" height="65" DisableNVelocity="true" />New infant vaccine means fewer injections overall5/5/2022 4:30 AM<img src="/-/media/ech-media/images/widgets/kids/ech_dadsfeeding_01_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=45B51FEE6A7B6961D459629BE64917AA" alt="ECH_DadsFeeding_01_widget" width="300" height="195" DisableNVelocity="true" />Your care team has begun using the newly licensed Vaxelis vaccine that protects against:  <ul> <li>Diphtheria. </li> <li>Tetanus, or lockjaw.</li> <li>Pertussis, or whooping cough. </li> <li>Polio</li> <li>Haemophilus influenzae Type B. </li> <li>Hepatitis B. </li> </ul> This vaccine is due at routine infant visits at 2, 4 and 6 months of age. It replaces the Pentacel and Recombivax HB vaccines previously used at those visits that protected against diphtheria-tetanus acellular pertussis, inactivated poliovirus, Haemophilus influenza Type B, and hepatitis B. These vaccines were given as separate injections at 2, 4 and 6 months of age.  The new Vaxelis vaccine will mean two fewer injections for infants in the first six months of life.  Mayo Clinic will continue to give the birth dose of the hepatitis B vaccine on the first day of life. That's important because up to one-fifth of hepatitis B infections in the U.S. are from environmental exposures. That means they appear without a known source contact. They occur through everyday life and occur with contact in the environment. Screening mothers before birth misses some who are infected.  The Vaxelis vaccine will be used to catch up children through 59 months of age who are overdue for the vaccination doses at 2, 4 and 6 months of age. The Pentacel vaccine will continue to be used for the related fourth set of vaccines that are due and routinely given at 15 months of age.  Babies who have already received the two-month doses of the Pentacel and Recombivax HB vaccines can get the four- and six-month doses with the Vaxelis vaccine. Babies who have already received the two- and four-month doses of the Pentacel and Recombivax HB vaccines can get the six-month doses with the Vaxelis vaccine.  All Primary Care in Rochester and Kasson locations have been stocked with the new Vaxelis vaccines.  <a href="https://communityhealth.mayoclinic.org/providers/robert-jacobson-md/">Robert M. Jacobson, M.D.</a>, is medical director of the Primary Care Immunization Program in Southeast Minnesota. He is a physician in Community Pediatric and Adolescent Medicine in Rochester. Robert M. Jacobson, M.D.Primary Care in Rochester and KassonVaxelis VaccinePrimary Care in Rochester and KassonAphasia is a condition that affects your ability to communicate.&nbsp;<img src="/-/media/ech-media/images/widgets/people/difficultcommunication.jpg?h=65&iar=0&w=100&sc_lang=en&hash=ED6A241592AA051A6462239B6359F7FA" alt="DifficultCommunication" width="100" height="65" DisableNVelocity="true" />What is aphasia?6/20/2022 4:30 AM<img src="/-/media/ech-media/images/widgets/people/difficultcommunication.jpg?h=205&iar=0&w=315&sc_lang=en&hash=97B9ECCD8D1B44AD8259B5A1F417CE2F" alt="DifficultCommunication" width="315" height="205" DisableNVelocity="true" />Aphasia is a language disorder caused by damage to regions of the brain that control understanding or expression of language. It may result in decreased effectiveness of communication in understanding or expressing oneself, or sometimes both.  The left side of the brain is responsible for language and speech. The most common cause of aphasia is an injury on the left side of the brain.  People with aphasia may speak in short sentences or perhaps not make sense when communicating. They might mix up words or be unable to find the right word. They may not understand when spoken to. They are often frustrated by their inability to communicate effectively or find the right word.  Causes of aphasia include:  <ul> <li>Stroke, either ischemic, which is a loss of blood supply, or hemorrhagic, which is bleeding into the brain. Both types of stroke damage brain tissue, and they develop suddenly. </li> <li>Serious head injuries. </li> <li>Infections in the brain or the covering of the brain, or meninges. </li> <li>Brain tumors. </li> <li>Surgery or radiation for brain tumors. </li> <li>Dementia conditions, including Alzheimer's, which would develop gradually with degeneration of brain cells in the language region of the brain. </li> </ul> Aphasia is often a sign of a serious problem. Seek emergency care if you or a loved one suddenly develops difficulty speaking, trouble understanding speech, difficulty with word recall or problems with reading or writing.  J. Layne Moore, M.D., M.P.H., is a neurologist in Primary Care in Rochester and Kasson's Integrated Community Specialty Clinic, where he practices in the Baldwin Building. He practices neurology and sleep medicine at Mayo Clinic in Rochester and Mayo Clinic Health System in Faribault. J. Layne Moore, M.D., M.P.H.Primary Care in Rochester and KassonAphasiaPrimary Care in Rochester and KassonTalk to your child's clinician to find out what options are available.&nbsp;<img src="/-/media/ech-media/images/widgets/kids/ech_youngboywindow_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=69E195E19A4E645F3D2D39FD0FACCEA8" alt="ECH_YoungBoyWindow_widget" width="100" height="65" DisableNVelocity="true" />Physical therapy benefits children with bowel, bladder issues6/30/2022 4:30 AM<img src="/-/media/ech-media/images/widgets/kids/ech_youngboywindow_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=5472435767AE99545075DB0B58FE8FF3" alt="ECH_YoungBoyWindow_widget" width="300" height="195" DisableNVelocity="true" />Most children learn to use the bathroom during the toddler years. Potty training typically happens when children can tell you their diaper is wet, show interest in using the bathroom, or have a dry diaper for longer periods of time. For most children, this happens around ages 3 or 4.  As children grow, it's common to have occasional day or nighttime leaks, or <a rel="noopener noreferrer" href="https://www.mayoclinichealthsystem.org/hometown-health/speaking-of-health/qa-constipation-in-children" target="_blank">constipation</a>. But for some children, leaking from the bowel or bladder, or persistent constipation, can negatively affect daily activities and mental health.  When children reach school-age, having control of bowel and bladder function is an important part of social interactions. Teenagers experiencing nighttime accidents may avoid sleepovers or overnight activities away from home due to concerns of having an accident while sleeping. Younger children may fear using the bathroom during school, which increases the likelihood of accidents. Some children withhold urine or stool, which can lead to serious medical concerns.  How does constipation affect children? Children have a smaller abdomen and pelvis area than adults. As the rectum and colon fill with stool, it can press on or block the bladder from emptying completely during urination. It also can limit the amount of urine the bladder can hold. The stool may push on the bladder, causing it to squeeze and leak, which children will not be able to control or stop.  Constipation is often multifactorial and can be difficult for parents and caregivers to identify.  Children may be constipated, even if they have regular bowel movements, if any of the following are true: <ul> <li>Stool stains or streaking are seen in the child's underwear when doing laundry. </li> <li>Child's abdomen appears distended. </li> <li>Child must strain to have a bowel movement. </li> <li>Child has <a rel="noopener noreferrer" href="https://www.mayoclinichealthsystem.org/hometown-health/speaking-of-health/6-helpful-tips-for-managing-urinary-retention-and-incontinence/" target="_blank">frequent urination</a> or feels unable to empty the bladder. </li> <li>Child has regular abdominal pain that is relieved with a bowel movement. </li> </ul> Resolving constipation may reduce or eliminate nighttime bladder leaking.  What treatment options are available for bowel and bladder issues in children? Talk with your child's health care team if you have concerns about bowel and bladder function. A referral to physical therapy is a resource available to help with bowel and bladder issues in children.  Physical therapy may help your child with these issues:  <ul> <li>Day and nighttime leaks from the bowel or bladder. </li> <li>The need to pass urine frequently. </li> <li>The sudden, unexpected need to have a bowel movement or pass urine. </li> <li>Stress incontinence and leaking urine when sneezing, coughing, laughing or playing. </li> <li>A bowel that does not empty all the way. </li> <li>Holding urine or stool and delaying use of the bathroom. </li> <li>Constipation. </li> <li>Frequent urinary tract infections. </li> <li>Urinary reflux. </li> </ul> A physical therapist can evaluate your child's breathing to ensure your child is using abdominal breathing rather than chest breathing. Using abdominal breathing allows the diaphragm to extend below the ribs, causing the pelvic floor to descend. When the diaphragm raises, the pelvic floor is activated to go up and create pelvic contractions.  Pelvic floor therapy includes Kegel exercises to create awareness for contracting and releasing the pelvic floor to enable the bladder to empty fully. Children who do not relax the pelvic floor can't empty the bladder when going to the bathroom. This leads to feeling the need to urinate frequently or causing an accident. Pediatric pelvic floor therapists are specifically trained to help teach children how to coordinate and strengthen these muscles.  Other techniques include a special abdominal massage for children with constipation to increase stool motility, as well as core strengthening exercises and biofeedback, to help children coordinate contraction and relaxation of the pelvic floor.  Throughout your child's care, you can expect a comprehensive team approach, including caregivers and the child, as well as the child's primary care clinician, physical therapist, and other specialists in urology and gastroenterology. Successful treatment requires a collaborative approach and is only as successful as the support and effort of the whole team.  What can you do if your child is embarrassed and does not want to talk about these issues? Bowel and bladder issues in children are more common than people may realize. There is a hesitancy to discuss these issues with family and friends, particularly as children get older.  Reassure your child that what they are experiencing is a medical condition. Assure them that help is available for bowel or bladder issues that affect daily activities or cause feelings of embarrassment in social situations. Your child's health care team can provide education and referral to physical therapy.  Bladder and bowel physical therapy can help your child learn about these things:  <ul> <li>How the bowel and bladder work. </li> <li>Healthy bathroom habits and toilet use. </li> <li>Healthy eating and drinking habits. Milk, chocolate, citrus, spicy foods and certain artificial flavoring can irritate the bladder. </li> <li>How to manage constipation. </li> <li>A personal exercise program. </li> <li>Sensory training. </li> <li>School and social considerations, such as taking a change of clothes to school. </li> </ul> How can you help your child prepare for bowel and bladder therapy? First, if your child is motivated to have the leaks stop, it may improve the results of the therapy. Support from parents at therapy sessions and at home is important to reinforce education and skills learned in therapy. Encourage your child to ask questions and become educated about the medical condition.  Remind your child that the therapy care plan is individualized for his or her specific needs. Just like homework from school, practice the new skills or healthy bowel and bladder habits introduced during therapy at home.  When can I expect my child to stop having bowel or bladder leaks? Every child is different. Depending on the bowel or bladder issue affecting your child and the length of time he or she has had leaks, it may take several weeks to months to see improvements. Most children complete the program in six to eight months.  Working on the physical therapy techniques at home, as well as at physical therapy sessions, can improve results. Discuss bathroom habits and tips with teachers and day care providers to reinforce proper use during time away from home.  Don't wait "until your child grows out of it" to address bowel and bladder issues. Education, lifestyle and diet modification, and proven treatment techniques can resolve or significantly decrease occurrence of bowel and bladder issues affecting children.  JonPaul Dragseth, D.P.T., is a physical therapist specializing in treating children with bowel and bladder dysfunction in Eau Claire, Wisconsin.JonPaul Dragseth, D.P.T.Primary Care in Rochester and KassonChildren Bowel Bladder IssuesPrimary Care in Rochester and KassonWhile you may hesitate to discuss this issue, underlying medical problems can go undiagnosed.&nbsp;<img src="/-/media/ech-media/images/widgets/people/elderlycouplebed_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=4B8E2556651BC54655BBB23F25CFB5FB" alt="OldCoupleBed" width="100" height="65" DisableNVelocity="true" />Men's health: How to discuss erectile dysfunction6/13/2022 4:30 AM<img src="/-/media/ech-media/images/widgets/people/elderlycouplebed_widget.jpg?h=205&iar=0&w=315&sc_lang=en&hash=0DEC0604CA728E18DE513D50E67884EA" alt="OldCoupleBed" width="315" height="205" DisableNVelocity="true" />Erectile dysfunction, commonly known as ED, affects millions of men worldwide. Unfortunately, it's a topic many hesitate to discuss. As a result, sexual health and relationships can suffer, and underlying medical problems can go undiagnosed.  What is erectile dysfunction? Erectile dysfunction is the inability to get an erection or keep one long enough to finish having sex. Other related types of sexual dysfunction include low libido and premature ejaculation. Many people wonder if these problems are simply a normal part of aging, and the answer is no. Most healthy men can get and keep erections into their 70s and 80s.  What causes erectile dysfunction? Sexual health is complex, and an erection relies on the mind and body to cooperate. The physical component of an erection involves blood vessels opening up and engorging the penis with blood so that it hardens.  Several conditions can impair this process, including:  <ul> <li>Medical problems, including high cholesterol, high blood pressure, diabetes and heart disease, which can reduce blood flow into the penis. </li> <li>Smoking, heavy alcohol use and regular use of opiates and cannabis. </li> <li>Neurological problems, such as strokes, multiple sclerosis and peripheral nerve disease. </li> <li>Some prescriptions, particularly blood pressure medicines. </li> <li>Psychological problems, including depression and relationship problems with your partner. </li> </ul> In addition, 40%–50% of men who have had their prostate removed due to prostate cancer may be affected by erectile dysfunction.  Which treatments are effective? Medications like Viagra and Cialis are usually the first step in treatment and are effective for many people. However, a discussion and examination with your primary care team is important to ensure these medications are safe. Your team also can ensure that any underlying medical conditions are identified and effectively managed.  When oral medications fail, don't be discouraged.  Other options include <ul> <li>Vacuum pump: The pump inflates the penis with blood, which then is retained using a constricting band around the base of the penis. This generally allows for 20–30 minutes of erection time. Many men can successfully complete sexual relations with this method, including ejaculation. </li> <li>Medications: Medicine can be injected into the side of the penis or placed directly into the urethra. </li> <li>Penile implant: An implant requires surgery that places inflatable tubes in both sides of the penis. For an erection, these tubes can be inflated using a small pump in the scrotum. An implant allows for normal urination and ejaculation. </li> </ul> How to get help with erectile dysfunction Although some people are hesitant or embarrassed to discuss these issues, sexual health is an important part of a healthy, happy life. Primary care is the perfect place to bring up concerns related to erectile dysfunction because your team has the expertise to help with next steps.  If you are unsure how to start the conversation, start with an online questionnaire like this one that can help you and your primary care team learn more about your erectile symptoms: <a rel="noopener noreferrer" href="https://s3.amazonaws.com/pfizerpro.com/fixtures/viagra/assets/SHIM_VGU610709-01.pdf" target="_blank">Sexual Health Inventory for Men</a>.  <a href="https://communityhealth.mayoclinic.org/providers/david-brennan-md/">David Brennan, M.D.</a>, is a primary care physician in Community Internal Medicine, Geriatrics, and Palliative Care. He practices in the Baldwin Building in Rochester, Minnesota. David Brennan, M.D.Primary Care in Rochester and KassonErectile DysfunctionPrimary Care in Rochester and KassonMinority stress refers to the physical and emotional distress unique to LGBTQ+ and other marginalized communities.&nbsp;<img src="/-/media/ech-media/images/widgets/lgbtqi/counseling.jpg?h=65&iar=0&w=100&sc_lang=en&hash=843785A5FE37D02FD99F6BC24C1B3763" alt="Counseling" width="100" height="65" DisableNVelocity="true" />Minority stress and LGBTQ+ family health6/2/2022 4:30 AM<img src="/-/media/ech-media/images/widgets/lgbtqi/counseling.jpg?h=205&iar=0&w=315&sc_lang=en&hash=FAC43388AC35FAF9BAEA635C09ABDFCB" alt="Counseling" width="315" height="205" DisableNVelocity="true" />Common experiences among LGBTQ+ people relate to social acceptance. For example, an LGBTQ+ person may decide not to disclose a partnership with someone of the same sex. Or a same-sex household may avoid socializing with others in their neighborhood out of fear of not being accepted. It was previously thought that only LGBTQ+ people experienced minority stress. However, recent research has found that loved ones of LGBTQ+ people also experience minority-related stress. For example, parents of an LGBTQ+ child may worry about taunting from the child's peers at school. Grandparents may privately wonder how to discuss the wedding of their LGBTQ+ grandchild with their close friends. These situations are bound by experiences of minority stress, and they negatively affect health. Minority stress Minority stress refers to the physical and emotional distress that is unique to LGBTQ+ and other marginalized communities. If often centers on the anticipation of being rejected, harassed or discriminated against. The consequences of the anticipation of negative outcomes often are shame, concealment and social isolation. Because of the historically negative perceptions and sociopolitical climate about LGBTQ+ people, many LGBTQ+ people experience long-term activation of stress responses. These stress responses place people at risk for many medical conditions, such as sleep difficulties, heart disease, muscle tension, immune disorders, anxiety and depression. It is also important to note that LGBTQ+ people may hold additional marginalized identities that put them at further risk for experiencing minority stress. While research has not yet confirmed these negative effects among loved ones of LGBTQ+ people, it is likely that they are similarly affected Countering minority stress through family health Did you know that family relationships may contribute to over 25% of your health? Many believe that the health of the family is not modifiable. Research suggests that family health factors can be modified to promote a sense of belonging, build confidence and promote flourishing in life.  Consider the questions in the domains below:  Family social and emotional health processes <ul> <li>Does your family discuss problems and feel good about the solutions?</li> <li>Are you happy with your relationships with your family members? </li> <li>Do you feel safe in your family relationships? </li> </ul> Family healthy lifestyle <ul> <li>Does your family help each other to avoid unhealthy habits? </li> <li>As a family, do you make it a point to support and follow medical recommendations?</li> <li>Do you help each other make health changes, despite it going against what may be expected based on family norms? </li> </ul> Family health resources <ul> <li>Does your family have adequate housing? </li> <li>Does your family have enough money at the end of the month after bills are paid? </li> <li>Does your family trust health care professionals for information?</li> </ul> Family external and LGBTQ+ social support <ul> <li>Does your family have people outside of the family to turn to when there are problems at school or work? </li> <li>Does your family have people outside of the family to help with advice, child care, a ride or to help with a loan? </li> <li>If an emergency were to occur, do you have people outside of the family who could provide a place to live? </li> <li>Does your family have people outside of the family to turn to who know about and supports LGBTQ+ issues? </li> </ul> If you rate your family low and you have attempted to address the concerns with little change, consider reaching out to your primary care team to identify resources and help build a strong, lifelong foundation to face minority stress. For any items that you answered no, consider discussing your answer with your health care team.  It's understood that not all people may feel safe with and supported by the people in their life traditionally defined as family members. The people and communities you define as your closest support system may be your chosen family.  Remember, the World Health Organization describes health as "a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity." WHO goes on to say that "The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition." <a href="https://communityhealth.mayoclinic.org/providers/cesar-gonzalez-phdlp/">Cesar Gonzalez, Ph.D., L.P.</a>, is a psychologist in Mayo Clinic's Division of Integrated Behavioral Health and is clinical director of the Transgender and Intersex Specialty Care Clinic at Mayo Clinic in Rochester.  Anne Roche, Ph.D., is a first-year clinical psychology fellow in Primary Care in Rochester and Kasson's Division of Integrated Behavioral Health at Mayo Clinic in Rochester. Cesar Gonzalez, Ph.D., L.P., and Anne Roche, Ph.D.Primary Care in Rochester and KassonLGBTQ Minority StressPrimary Care in Rochester and KassonThis new therapy option can reduce the possibility of a fatal reaction.&nbsp;<img src="/-/media/ech-media/images/widgets/food/peanutallergy.jpg?h=65&iar=0&w=100&sc_lang=en&hash=E8C8F419C65F2855778D05A73D7A5857" alt="PeanutAllergy" width="100" height="65" DisableNVelocity="true" />Life without fear: New treatment for peanut allergies6/27/2022 4:30 AM<img src="/-/media/ech-media/images/widgets/food/peanutallergy.jpg?h=205&iar=0&w=315&sc_lang=en&hash=82B2DDB4AA9413C2A2CFFD61C94CE703" alt="PeanutAllergy" width="315" height="205" DisableNVelocity="true" />It's the time of year when children are looking forward to summer camps, travel, sporting events, county fairs and spending time with friends. If you have a child with a peanut allergy, these traditionally exciting and fun events also can create intense feelings of panic and fear. Because peanut ingestion can be life-threatening, many children — and the adults in their lives — worry about accidental exposure to peanuts every time they go somewhere.  Until recently, the only treatment option for children with peanut allergy was strict avoidance. Strategies to avoid peanut exposure included special "peanut-free" lunch tables at school, turning down snacks or treats after youth sports or at friends' houses, and hypervigilance around reading food labels. The unwanted effect of these strategies was often high levels of anxiety and social exclusion in children with peanut allergies "feeling different." However, in January 2020, the FDA announced the approval of Palforzia, the first oral immunotherapy option for children between the ages of 4–17 with peanut allergy.  Palforzia does not "cure" peanut allergy, but it can reduce the possibility of a fatal reaction.  How does it work? It reduces the severity of allergic reactions, including anaphylaxis, which may occur with accidental exposure to peanuts by giving standardized levels of peanut protein regularly.  How is it given? <ul> <li>First does and second dose, two days apart, administered in a health care setting under observation of a trained health professional. </li> <li>Return every two weeks over a six-month period to receive "up dosing," which is a higher concentration of peanut powder under the observation of a trained health professional. </li> <li>Between visits, Palforzia capsules of the peanut protein are opened and sprinkled onto food and ingested once daily. </li> <li>After six months, continue to administer once daily as maintenance. </li> </ul> Who is eligible? <ul> <li>Children between 4–17 with a diagnosis of peanut allergy. </li> <li>Peanut IgE (blood test) greater than 0.35 and skin testing reaction of 3 inches x 3 inches or greater. </li> </ul> Who is not eligible? <ul> <li>Adults 18 and older. </li> <li>Children under 4.</li> <li>Patients with uncontrolled asthma. </li> <li>Patients with a history of eosinophilic esophagitis or other eosinophilic esophagitis gastrointestinal disease. </li> </ul> Will my insurance cover it?  Most insurers are covering if the eligibility criteria is met.  What are the most common side effects?  <ul> <li>Abdominal pain, nausea and vomiting. </li> <li>Itchy mouth, nose or ears. </li> <li>Runny nose, sneezing. </li> <li>Cough, wheeze. </li> <li>Hives. </li> </ul> What are the risks? <ul> <li>Palforzia can cause anaphylaxis, which may occur at any time during therapy. </li> <li>There is an increased risk of eosinophilic esophagitis. </li> </ul> Will I still need to avoid peanuts and/or carry my epinephrine (EPI) pen?  Yes. Palforzia is not a cure.  An allergy to peanuts is typically not outgrown. It is a lifelong commitment to prevent and protect from exposure. Palforzia will not work for everyone. It can help reduce the chance of a fatal reaction to accidental peanut exposure for children with peanut allergy. So, let's make the commitment to get kids back to looking forward with excitement — not fear — to all activities.  <a href="https://communityhealth.mayoclinic.org/providers/joy-fladagermuth-cnp/">Joy Fladager Muth, APRN, C.N.P.</a>, is a nurse practitioner in Primary Care in Rochester and Kasson's Division of Community Pediatric and Adolescent Medicine. She is one of six pediatric providers serving as integrated community specialists. In this role, Joy provides expert asthma care and consulting services for primary care pediatric patients with asthma in collaboration with Mayo's Pediatric Pulmonology and Pediatric Allergy specialty providers. Joy Fladager Muth, APRN, C.N.P.Primary Care in Rochester and KassonPeanut AllergyPrimary Care in Rochester and KassonYou may have pollen-food allergy syndrome.&nbsp;<img src="/-/media/ech-media/images/widgets/food/eatingfruitsvegetables.jpg?h=65&iar=0&w=100&sc_lang=en&hash=0360FF82BB0DD97975A6CDFB649B01C4" alt="EatingFruitsVegetables" width="100" height="65" DisableNVelocity="true" />Why do fruits and vegetables make your mouth itch and burn?6/9/2022 4:30 AM<img src="/-/media/ech-media/images/widgets/food/eatingfruitsvegetables.jpg?h=205&iar=0&w=315&sc_lang=en&hash=77809FF154AFAD3AD47DC04423EEA63A" alt="EatingFruitsVegetables" width="315" height="205" DisableNVelocity="true" />Pollen-food allergy syndrome, also known as oral allergy syndrome, is a contact allergic response that occurs when eating raw fruits and vegetables. This is the result of cross-reaction to an allergy you have to a pollen.  Cooking those same foods destroys the pollen, and typically you would not react. Generally, these are mild reactions that involve itching of the mouth and mild swelling of the tongue and lips. If you experience shortness of breath, severe swelling or difficulty swallowing, call 911 or contact your clinician immediately.  Most people with pollen-food allergy syndrome have different responses, depending on how much of a certain food they eat. Not everyone reacts to all of the foods listed in this table:  <table style="border-collapse: collapse; width: 100%;"> <tbody> <tr> <td style="width: 20%; border:1px solid; border-color: #bfbfbf;">If you are allergic to:</td> <td style="width: 20%; border:1px solid; border-color: #bfbfbf; text-align: center;">Birch pollen (Spring)</td> <td style="width: 20%; border:1px solid; border-color: #bfbfbf; text-align: center;">Grasses (Summer)</td> <td style="width: 20%; border:1px solid; border-color: #bfbfbf; text-align: center;"> Ragweed pollen (Late Summer) </td> <td style="width: 20%; border:1px solid; border-color: #bfbfbf; text-align: center;">Mugwort pollen (Fall)</td> </tr> <tr> <td style="width: 20%; border:1px solid; border-color: #bfbfbf;">You may react to:</td> <td style="width: 20%; border:1px solid; border-color: #bfbfbf;"> <ul> <li>Almond</li> <li>Apple</li> <li>Apricot</li> <li>Carrot</li> <li>Celery</li> <li>Cherry</li> <li>Hazelnut</li> <li>Peach</li> <li>Peanut</li> <li>Pear</li> <li>Plum</li> <li>Raw potatoes</li> <li>Soybean</li> <li>Some herbs and spices (anise, caraway seed, coriander, fennel and parsley)</li> </ul> </td> <td style="width: 20%; border:1px solid; border-color: #bfbfbf;"> <ul> <li>Kiwi</li> <li>Melons, including cantaloupe, honeydew and watermelon</li> <li>Orange</li> <li>Peanut</li> <li>Tomatoes</li> <li>White potatoes</li> <li>Zucchini</li> </ul> </td> <td style="width: 20%; border:1px solid; border-color: #bfbfbf;"> <ul> <li>Bananas</li> <li>Cucumber</li> <li>Melons, including cantaloupe, honeydew and watermelon</li> <li>Zucchini</li> </ul> </td> <td style="width: 20%; border:1px solid; border-color: #bfbfbf;"> <ul> <li>Apple</li> <li>Bell pepper</li> <li>Broccoli</li> <li>Cabbage</li> <li>Carrots</li> <li>Cauliflower</li> <li>Celery</li> <li>Garlic</li> <li>Onion</li> <li>Peach</li> <li>Some herbs and spices (anise, black pepper, caraway seed, coriander, fennel and parsley)</li> </ul> </td> </tr> </tbody> </table> While blood or allergy testing is possible, it is not always needed. Many people are affected by seasonal allergies, but not everyone has pollen-food allergy syndrome. This syndrome may not appear until adulthood.  While allergies to birch is the most common pollen, summertime grasses, such as timothy and orchard, followed by late summer ragweed and fall mugwort, also can cause symptoms. These are all associated with specific foods.  It is important to keep in mind that some nuts are associated with pollen-food allergy syndrome. Nut allergies can be serious and life-threatening. Talk to your clinician before assuming it is pollen-food allergy syndrome.  What should you do if you think you have pollen-food allergy syndrome? If you think you have pollen-food allergy syndrome, keep a food diary. Pay attention to whether these same foods cause reactions when you eat them cooked versus raw. This will help your clinician determine which foods you may be reacting to.  Keep an antihistamine handy in case you have a reaction. Check with your clinician or pharmacist to see which is best for you.  <a href="https://communityhealth.mayoclinic.org/providers/denise-dupras-md/">Denise Dupras, M.D., Ph.D.</a>, is a physician in Community Internal Medicine, Geriatrics and Palliative Care at Mayo Clinic in Rochester. She completed her medical and doctoral degrees at Mayo Clinic Alix School of Medicine and her residency in internal medicine at Mayo Clinic in Rochester. Her interests include medical education, evidence-based medicine and care of LGBTQIA+ patients. Denise Dupras, M.D., Ph.D.Primary Care in Rochester and KassonPollen Food AllergyPrimary Care in Rochester and KassonThese tips can help you keep moving.&nbsp;<img src="/-/media/ech-media/images/widgets/people/ech_regenerative_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=75138FF190E349299F0A058382071FC5" alt="ECH_regenerative_widget" width="100" height="65" DisableNVelocity="true" />Staying active with joint pain6/16/2022 4:30 AM<img src="/-/media/ech-media/images/widgets/people/ech_regenerative_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=52E46113CB754C8FDAFD48E816DF6D78" alt="ECH_regenerative_widget" width="300" height="195" DisableNVelocity="true" />Whether you're active or upping your exercise goals, the last thing you want is to be sidelined with joint pain. Joint pain affects people at all stages of life from student athletes to seniors. Pain can be a big barrier to not only maintaining a regular exercise program, but also getting started.  These strategies can help keep you active:  Assess where you're at.  A good first step if you want to start a regular routine or up your exercise goals is to check with your primary care provider or see a sports medicine specialist who can assess your overall fitness level and general mobility, and if you have current injuries or pain.  They also may conduct a functional movement screening to evaluate how you move and pinpoint specific issues. For example, you may have decreased range of motion in a hip or shoulder or are stronger on one side than the other. This screening can identify specific rehabilitative exercises that can be performed along with your regular exercise program. These exercises help your body move safely, perform exercises correctly and reduce the risk for injury or worsening symptoms.  These findings will help build a program that's going to be safe and effective for you and let you exercise as pain-free as possible.  Build a successful exercise routine. Whatever your level of fitness, a good exercise routine should be sustainable. Regular exercise provides a host of health-related benefits, including reducing risk of cardiovascular disease, managing weight, maintaining strength and flexibility and supporting bone health.  It also should encompass a combination of activities:  <ul> <li>Cardio, which increases your heart rate and improves your overall cardiovascular fitness. This includes vigorous walking, swimming, biking, playing pickleball, or taking a dance or water fitness class. </li> <li>Strength, which builds and strengthens muscles, improves overall function and improves performance in the gym, as well as activities of daily living. Strength activities include weight training, working with resistance bands, climbing stairs and exercises such as pushups, situps and squats. </li> <li>Flexibility, which stretches muscles and ligaments and promotes range of motion. Stretching, yoga, tai chi and Pilates all focus on flexibility. </li> </ul> And, finally, regular exercise doesn't mean just going to the gym, taking a class or following an online exercise program. It also means moving throughout the day, especially to break up periods of sitting. This unstructured exercise may be sweeping the floor, walking in place by your desk or performing simple stretches when you first get up or before you go to bed.  Customize exercise to you Sore muscles after exercising, especially if people are new to exercise and increasing their activity level, are normal. But sharp or ongoing pain may indicate an injury or chronic problem.  Things to keep in mind are:  <ul> <li>Ease your way into a new exercise program. Try not to go from 0 to 100 overnight, since that may increase your risk of injury. </li> <li>Listen to your body. Don't overdo it. Take a break or tone down your activity for the rest of the day. </li> <li>Keep a small problem small. If you're feeling recurring pain, get it checked out. </li> <li>Build in time to recover between activity sessions. Our bodies need this time to rebuild and repair. </li> </ul> Another strategy is to work with a physical therapist, sports medicine specialist or trainer to determine the right and wrong way to do an exercise or strengthen muscles to support a particular movement or joint.  For example:  <ul> <li>If you suffer from low back pain and are not able to perform a traditional barbell back squat exercise, you could do a modified version: either a split squat (one leg at a time) or a rear-foot-elevated squat. These variations target the same muscle groups but apply external resistance in the form of dumbbells or kettlebells at your side instead of your back. </li> <li>If you have knee pain, using a reverse lunge or hex-bar squat helps reduce stress on your knees and allows you to target the same muscle groups. </li> <li>If you aren't able to perform pushups or variations of the bench press without pain in your upper body, switching to a neutral grip position can reduce stress on the shoulder. Make sure to align the arms in a 45-degree angle with your torso to reduce stress on the shoulder and minimize pain. </li> </ul> Working with an exercise specialist can help you develop a plan that is specific to you and your abilities.  When joint pain begins to restrict the activities you love, it's time to consult with an orthopedic specialist. Together, you'll map out a plan for treatment to keep you moving and enjoying life.  Orthopedic professionals have a wide variety of options in their treatment toolbox. These options range from least invasive, such as physical therapy or medications, to more invasive, including injections or surgery. Their goal is to get patients back to the lives they want to lead.  Break down barriers Joint pain is just one barrier to regular exercise.  Others include:  <ul> <li>Time  To start and maintain regular exercise, people need to carve time out of their schedules. Recent research shows that even short 5- to 15-minute workouts throughout the day can provide health and fitness benefits. Finding these little pockets of time and a consistent workout can go a long way. </li> <li>Knowing where to start  Searching online for workout programs can yield overwhelming results. Once again, sports medicine specialists can provide guidance toward a program that best fits your goals. The choice of workouts should be ones you enjoy and can stick with. </li> <li>Motivation  Whether it's getting started or keeping going, lack of motivation can sink workout resolutions. One successful strategy is to review goals as a reminder of why you want to exercise, whether it's to keep up with the grandkids, feel better or lose weight. </li> <li>Being realistic  Build a foundation by setting goals that can be accomplished in small segments, with each building on the next. For example, if you're just starting, a walk around the block might be the first step, not signing up for a 5K. </li> </ul> The benefits of regular exercise are physical and mental. Make sure you play the long game when it comes to your exercise program. Find a style of exercise that works for you long term and that you can incorporate into your daily life.  For more information on creating an exercise routine, the importance of a strong core, issues for youth athletes and more, check out or video below.  <iframe width="560" height="315" src="https://www.youtube.com/embed/FK8W_ynA_FU" title="YouTube video player" frameborder="0"></iframe> <a rel="noopener noreferrer" href="https://www.mayoclinichealthsystem.org/providers/jacob-erickson-do" target="_blank">Jacob Erickson, D.O.</a>, and <a href="https://www.mayoclinichealthsystem.org/providers/andrew-jagim-phd">Andrew Jagim, Ph.D.</a>, are specialists in Sports Medicine in Onalaska, Wisconsin. Jacob Erickson, D.O., and Andrew Jagim, Ph.D.Primary Care in Rochester and KassonStaying Active Joint PainPrimary Care in Rochester and KassonThese tips may help you stay healthy and productive on the job.&nbsp;<img src="/-/media/ech-media/images/widgets/people/workingpregnant.jpg?h=65&iar=0&w=100&sc_lang=en&hash=4245A905411E7C8488276321614FBAE9" alt="WorkingPregnant" width="100" height="65" DisableNVelocity="true" />Work more comfortably while pregnant6/6/2022 4:30 AM<img src="/-/media/ech-media/images/widgets/people/workingpregnant.jpg?h=205&iar=0&w=315&sc_lang=en&hash=9458FA2B6BDDE38FA5193861CA6925B6" alt="WorkingPregnant" width="315" height="205" DisableNVelocity="true" />For most women, taking nine months off to rest while pregnant is not a possibility. Women often plan to work until their due date to get the most time possible with their baby during parental leave. But <a rel="noopener noreferrer" rel="noopener noreferrer" href="https://www.mayoclinic.org/healthy-lifestyle/pregnancy-week-by-week/in-depth/pregnancy/art-20047441" target="_blank">working during pregnancy</a> isn't always easy.  To stay healthy and productive on the job, it's helpful to understand how to alleviate common pregnancy discomforts.  Nausea Feeling nauseous at work is a common pregnancy discomfort. While commonly called morning sickness, queasiness can occur any time of the day. To keep nausea at bay, avoid things that trigger a sick feeling in your stomach, and snack often. Keep a stash of crackers or another bland food at your desk.  Fatigue You might feel tired as your body works overtime to support your pregnancy, and resting during the workday may not be possible.  To improve energy, try these tips: <ul> <li>Eat foods rich in iron and protein.  Try red meat, poultry, leafy green vegetables, iron-fortified whole-gran cereal and beans. </li> <li>Take short, frequent breaks.  Getting up and moving around for a few minutes can reinvigorate you. </li> <li>Drink plenty of fluids.  Keep a water bottle in your work area so you can sip throughout the day. </li> <li>Cut back on activities.  Scaling back can help you get more rest after the workday ends. </li> <li>Keep up your fitness routine.  Physical activity can help boost your energy level. Try a prenatal fitness class or take a walk after work, as long as it's OK with your health care professional. </li> <li>Go to bed early.  Try to get seven to nine hours of sleep every night. Resting on your left side will maximize blood flow to your baby and ease swelling. Pillows between your legs and under your belly can add comfort. </li> </ul> Movement and stress As your pregnancy progresses, everyday activities, such as sitting and standing, can become uncomfortable. Moving around every few hours can ease muscle tension and help prevent fluid buildup in your legs and feet.  It's also important to limit the amount of stress at work during your pregnancy. Job stress can sap the energy you need to care for yourself and your baby. To reduce the amount of stress at work, share your frustrations with a supportive co-worker, make daily to-do lists and prioritize your tasks, and practice relaxation techniques.  Working during pregnancy isn't always easy. If you have concerns about your work duties affecting your pregnancy, talk with your health care professional.  April Shuneson, APRN, CNM, is a certified midwife at Mayo Clinic Health System in Red Wing, Minnesota. April Shuneson, APRN, CNMPrimary Care in Rochester and KassonWorking PregnantPrimary Care in Rochester and KassonSome birth defects can't be avoided, but moms-to-be can take steps to lower the risk of others.&nbsp;<img src="/-/media/ech-media/images/widgets/people/ech_birth_defects_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=6B61A95FD252E836E05FD9410B216473" alt="ECH_birth_defects_widget" width="100" height="65" DisableNVelocity="true" />5 things you can do to minimize birth defects 7/21/2022 4:30 AM<img src="/-/media/ech-media/images/widgets/people/ech_birth_defects_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=FA656932EA5CC98E0F29E63DC307DCC9" alt="ECH_birth_defects_widget" width="300" height="195" DisableNVelocity="true" />Birth defects happen in about 3%–4% of pregnancies. Many defects result from causes that can't be avoided, such as inherited disorders or chromosomal abnormalities. However, patients who are planning to have a baby, or who are already pregnant, can take steps to minimize the chance of having a baby with a birth defect.  Take a multivitamin with folic acid before and during pregnancy Taking a daily multivitamin with folic acid for at least a month before getting pregnant is something simple all women can do. And it's a step that can have a dramatic impact on preventing serious abnormalities of the brain and spine called neural tube defects. While a multivitamin has a number of good vitamins and minerals that can help with fetus development, folic acid is the critically needed vitamin.  The recommended minimum daily intake of folic acid is 400 micrograms, which is found in most women's multivitamins. Some pregnancies are at higher risk of neural tube defects due to medications and family history. If this is the case for you, your primary care clinician may recommend taking a higher dose of folic acid.  Make sure all vaccinations are up to date Vaccinations can protect you and your baby during pregnancy. Discuss with your primary care clinician which vaccinations you're due for, ideally before you become pregnant.  The measles, mumps and rubella vaccination, commonly referred to as MMR, and varicella, or chickenpox, vaccines, protect against serious viruses that can lead to birth defects in pregnancy. These are both live vaccines, so you need to get them at least one month before you become pregnant. Once you're pregnant, your primary care clinician will check to see that you have protection, or immunity, from these viruses. If you don't, you'll need to get vaccinated after delivery.  It's strongly recommended that pregnant patients be vaccinated for COVID-19. Becoming infected with COVID-19 during pregnancy is associated with an increased risk of preterm birth, increased risk of serious illness in patients who are pregnant and possibly stillbirth. There is no evidence that getting vaccinated for COVID-19 poses a risk in pregnancy or while breastfeeding.  Getting vaccinated for influenza during pregnancy is safe and highly recommended. Pregnant women have an increased chance of serious illness if they develop the flu, which can put both mother and baby at serious risk. Don't delay. Get your flu shot today.  Pertussis, or whooping cough, outbreaks are increasing across the country. Thankfully, a vaccine is available to help. The tetanus diphtheria and acellular pertussis, or Tdap, vaccine, protects against pertussis. It is highly recommended in every pregnancy after 27 weeks gestation.  Commit to a healthy lifestyle before you get pregnant A well-rounded, healthy diet and regular exercise can prevent birth defects, as well as increase your chances of becoming pregnant. Being overweight can contribute to a number of illnesses, such as diabetes, elevated blood pressure and heart disease — all of which increase the risk of birth defects. Obese women have a greater chance of giving birth to babies with spine, heart and cleft palate defects, even if they don't have any other medical conditions.  Avoid risky exposures Exposures to certain substances, called teratogens, have been associated with birth defects.  These include: <ul> <li>Recreational substances and illegal drugs. </li> <li>Medications for acute or chronic diseases. </li> <li>Various infections. </li> </ul> Recreational substances, such as alcohol; tobacco; and illegal drugs, including marijuana, cocaine, heroin and methamphetamines; negatively affect pregnancies in a number of ways. Not only do they increase the risk of birth defects, but also they can contribute to newborns who are small or born early. You should stop using these substances before getting pregnant.  Various medications can be used safely during pregnancy, while other should be limited or avoided. Many over-the-counter cold, flu or pain medications, and many prescriptions, have been associated with birth defects. So it's important to review your medical list with your primary care clinician before getting pregnant. Contact your health care team before starting or stopping any medication while pregnant.  A number of infections have been linked to birth defects, so you should avoid exposure to them, whenever possible.  These include:  <ul> <li>Toxoplasmosis  This infection is caused by a parasite found in soil and animal feces. Wear gloves when working in the garden, thoroughly wash vegetables, don't eat undercooked meats and avoid contact with used cat litter. </li> <li>Cytomegalovirus  People infected with this virus often don't know they have it. However, it can cause birth defects in women who are pregnant. It's found in the urine and other bodily fluids of young children. Pregnant women who have or work with young children should wear gloves when changing diapers and wash their hands frequently. </li> <li>Sexually transmitted infections Avoid unprotected sexual contact with infected people. </li> </ul> See your primary care provider before getting pregnant A prepregnancy or preconception visit with your primary care clinician can help ensure that all your individual risk factors are minimized before you get pregnant. Your primary care clinician can review your medical and family histories to identify potential risk factors and check that you're only on medications that are safe during pregnancy. Occasionally, women have blood tests at this visit to screen for infections that could affect their pregnancy.  Taking these five steps can help ensure you have a healthy baby.  <a href="https://communityhealth.mayoclinic.org/providers/matthew-meunier-md">Matthew Meunier, M.D.</a>, is a family medicine physician with Women's Health fellowship training in the Department of Family Medicine. He is the program director of the Family Medicine Residency Program in Rochester and Kasson. Matthew Meunier, M.D.Primary Care in Rochester and KassonBirth Defect PreventionPrimary Care in Rochester and KassonConsider becoming a blood donor to ensure an adequate blood supply in the community.&nbsp;<img src="/-/media/ech-media/images/widgets/people/ech_blooddonatino.jpg?h=65&iar=0&w=100&sc_lang=en&hash=AAD8880FD40F44431160B264CD030D85" alt="ECH_BloodDonatino" width="100" height="65" DisableNVelocity="true" />Summer fun can bring summer trauma7/18/2022 4:30 AM<img src="/-/media/ech-media/images/widgets/people/ech_blooddonatino.jpg?h=195&iar=0&w=300&sc_lang=en&hash=DD7FDD3176A8A017921A4A8610182812" alt="ECH_BloodDonatino" width="300" height="195" DisableNVelocity="true" />During spring and summer, people are often more active. They travel more, and they spend more time outside. But as the activity level increases, so do the risk of trauma and the need for a consistent blood supply.  At Mayo Clinic, the number of trauma cases and incidents spikes during the warmer months. Maintaining a stable blood supply in preparation for this spike is essential. Trauma cases can arise in an instant, and the story of Mary, a Mayo Clinic patient, shows the importance of having blood products available.  Mary's story. Mary found herself fighting for her life while spending a day on the lake, after being struck by a boat that did not see her. The injuries Mary sustained caused substantial amounts of blood loss, and those around her had to act quickly. While on a Mayo One flight, she began to receive blood transfusions. All Mayo One helicopters are equipped with blood products that come from within the community and are an essential part of the local blood inventory.  After undergoing surgery, Mary was able to leave the hospital 12 days later. She had received 20 units of blood. Mayo Clinic is thankful that Mary's family, first responders and the Mayo team were able to save her life through their quick action and work.  Mary's story is a great reminder that life can change in an instant, and it's important to be prepared. About 40% of those who come to the Mayo Clinic and need blood are trauma patients. When donors come into the blood donor center, they do not know how or when their blood products will be used. But they know that when they give, others live.  The Mayo Clinic Blood Donor Program is responsible for all blood donations within Olmsted County, and it relies heavily on the blood products the community provides. Maintaining the blood supply takes around 100 donors per day, and it is essential in ensuring blood products are available to Mayo Clinic patients like Mary.  Contact the Mayo Clinic Blood Donor Program at <a href="tel:5072844475">507-284-4475</a> or by <a href="mailto:donateblood@mayo.edu">email</a> to schedule your lifesaving appointment today.  Mayo Clinic Blood donor centers are at these locations: Hilton Building, First Floor Weekdays, 6 a.m.–4:30 p.m. This location is open until 7 p.m. every second Thursday of the month. Saint Marys Campus Joseph Building, M-86 Weekdays, 8 a.m.–3 p.m. <a rel="noopener noreferrer" href="https://www.mayoclinic.org/blood-donor-program/minnesota" target="_blank">Learn more about blood donation</a>. Primary Care in Rochester and KassonBlood Donation TraumaPrimary Care in Rochester and KassonWith some basic know-how, you'll master healthy meals for your small household in no time.&nbsp;<img src="/-/media/ech-media/images/widgets/food/ech_cooking_for_two_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=9CB9474F1F1FDAB5833B71DDD6D519E3" alt="ECH_cooking_for_two_widget" width="100" height="65" DisableNVelocity="true" />Cooking for 1 or 2: How to keep it healthy8/8/2022 4:30 AM<img src="/-/media/ech-media/images/widgets/food/ech_cooking_for_two_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=6A47FA178365DA0E22F83B21CD0AB728" alt="ECH_cooking_for_two_widget" width="300" height="195" DisableNVelocity="true" />If you're single or a two-person household, what's your go-to dinner? Cold cereal, grilled cheese and canned soup, microwave meals, Door Dash takeout, or something picked up at the deli on the way home? Sometimes preparing a meal —- much less a healthy, balanced one — can seem overwhelming. But with some basic know-how, you'll master healthy cooking for one or two in no time.  Know your food groups A healthy meal is a balance of proteins, fruits and vegetables, starches and grains, and fats. Let your plate be your guide when figuring out a good balance. Divide it into fours:  <ul> <li>One quarter for vegetables and one quarter for fruit. Two quarters make a half — so half a plateful of veggies and fruit.</li> <li>One quarter for protein-rich foods.</li> <li>One quarter for starches and grains.</li> </ul> For optimal health, choose whole-grain options for at least half of your grains, vary your veggies and fruits (eat the rainbow), get calcium-rich foods with low-fat dairy products and go lean with the protein. For more information, check out <a rel="noopener noreferrer" rel="noopener noreferrer" href="https://www.myplate.gov/" target="_blank">MyPlate.gov</a>.  But how much should be in each segment of your plate? Use these visual cues to serve up adequate but not excessive portions:  <ul> <li>Vegetable servings — size of a baseball.</li> <li>Fruit servings — size of a tennis ball.</li> <li>Carbohydrates or grain servings — size of a hockey puck.</li> <li>Protein or meat servings — size of a deck of cards.</li> <li>Fat servings — size of one or two dice.</li> </ul> Make a plan Start by finding recipes for foods you enjoy. Look for inspiration in cookbooks, magazines or online, including <a rel="noopener noreferrer" rel="noopener noreferrer" href="https://www.mayoclinic.org/healthy-lifestyle/recipes/recipes-2-servings/rcs-20077215" target="_blank">Mayo Clinic's recipes that serve 2</a>. Some sources have menus already planned out, complete with shopping lists. That's a good place to start while you practice your healthy meal skills. Then, use the recipes and your "plate" to build a meal. Try to include a minimum of three different food groups at each meal. Be creative! But don't stop there! Consult your calendar and see what at-home meals you'll need for the week and make a menu for each one. Posting your week's menus on the fridge, kitchen bulletin board or device may help you carry through with your healthy-eating plan — with less temptation to do carry out or reach for the cereal box.  You'll notice that most recipes make more than one or two servings. That's your chance to cook ahead and put your "planned-overs" in the fridge or freezer for those times when you're too tired or busy to cook. They also make for easy, budget-friendly packed lunches.  Adapt your shopping style When cooking for a smaller household, shop the bulk bins, salad bar and deli counter. You can buy just the amount you need to limit waste. You might pay a little more per pound, but if you actually use what you buy, you'll save money in the end. If you do buy larger quantities, freeze them in smaller portions, split groceries with a friend, or cook meals together with a friend or neighbor.  Cook smarter, embrace your freezer Try batch cooking, where you cook once for multiple meals. Here are a few ideas:  <ul> <li>Make a big batch of soup or chili and freeze in individual portions. </li> <li>Cook multiple servings of brown rice. Use some for that day's meal and freeze the rest for casseroles or stir-fries. </li> <li>Make a meatloaf recipe and divide in half. Bake a meatloaf with one half, roll the other half into meatballs. Then freeze the meatballs. </li> <li>Grill extra chicken breasts for salads, casseroles or sandwiches. </li> <li>Make extra servings of pasta for a cold salad the next day. </li> <li>Make a roast in the crock-pot one day. Slice up leftovers and freeze. </li> </ul> Think beyond your stove Some kitchen appliances are great for making smaller meals more efficiently than your full-sized kitchen range. Consider a toaster oven for baking chicken, fish or a small batch of cookies; indoor single-serving grill for quick-cooking burgers or chicken breasts; or a crock-pot for big-batch cooking.  Get started! To help spur healthy, doable meal ideas, here are some easy options for each food group. Start with fruits and veggies and build the rest of your meal around them:  Easy fruits and veggies <ul> <li>Pre-washed, pre-cut fruits and veggies for stir-fry meals or vegetable-based salads.</li> <li>Read-to-eat salad bags or kits.</li> <li>Baby carrots.</li> <li>Salad bar items; use the individual ingredients, such as chopped celery, when making a recipe.</li> <li>Frozen — without sauces, sugar or salt.</li> <li>Steamer bags.</li> <li>Canned — in water or their own juice or without salt.</li> <li>Fruit cups — in water or own juice or unsweetened apple sauce.</li> </ul> Easy proteins <ul> <li>Eggs. Think omelets or breakfast for dinner. Keep hard boiled eggs in the fridge for deviled eggs, egg salad or just as is. </li> <li>Chicken breasts. Bake or grill extra and freeze individually, whole or chopped. </li> <li>Ground beef or turkey. Brown extra, package into smaller amounts for tacos, casseroles, spaghetti, salads, etc. </li> <li>Bacon. Cook extra slices, crumble and freeze for salads or garnish on soups. </li> <li>Low-sodium tuna, canned in water. This is a quick option for salads and sandwiches. </li> <li>Frozen fish. It can be cooked quickly for one meal and enjoyed cold the next day in a salad or warmed for fish tacos. </li> <li>Canned black, red, kidney, navy, butter beans and lentils. Think soups, stews, salads and burgers. </li> </ul> Easy starches <ul> <li>Baked potatoes. Microwave and top with leftover chili or sauteed spinach and mushrooms. </li> <li>Whole-grain pasta, brown rice, barley, quinoa.</li> <li>Whole-grain bread, tortillas or crackers.</li> <li>Whole-grain cereals.</li> <li>Microwaveable rice pouches.</li> <li>Oatmeal. Try a recipe for overnight or baked oatmeal. </li> </ul> Easy dairy <ul> <li> Natural cheese or string cheese. </li> <li>Yogurt.</li> <li>Cottage cheese.</li> <li>Skim or 1% milk.</li> </ul> Rose Prissel, MS, RDN, LD, is a dietitian at Mayo Clinic working in pediatric and adult nutrition, with a focus on preventive care, sports nutrition and weight management. Michaeleen Burroughs, MS, RDN, LD, works with patients throughout Primary Care in Rochester and Kasson. Her areas of interest are diabetes and child and adult weight management. Rose Prissel, M.S., RDN, LD, and Michaeleen Burroughs, M.S., RDN, LDPrimary Care in Rochester and KassonCooking For One TwoPrimary Care in Rochester and KassonKids need the right foods to fuel their sports activities.&nbsp;<img src="/-/media/ech-media/images/widgets/activities/ech_sports_clinic2018_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=BA4BF257D3C4FEC0870814BC202C6492" alt="ECH_sports_clinic2018_widget" width="100" height="65" DisableNVelocity="true" />Game on: What kids should eat to be ready for sports7/25/2022 4:30 AM<img src="/-/media/ech-media/images/widgets/activities/ech_sports_clinic2018_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=14B3D89D68B5FACB73B5420DC215D154" alt="ECH_sports_clinic2018_widget" width="300" height="195" DisableNVelocity="true" />When you have kids in sports, getting them to and from practices, team meetings, games and tournaments is almost a part-time job. Making sure they're fed to fuel their bodies for peak performance and good health is an added challenge. But it's one you can handle with a few simple steps and tips. First, planning is essential. By taking a few minutes to plan quick, healthy family meals, keeping filled water bottles on hand, and prepackaging an assortment of snacks will make it easier to dash out the door. Those healthy meals create the daily nutrition foundation for kids. Snacks before and after activity provide quick energy and supplement meals. They do not replace meals One of these minimeals or snacks will give kids a pregame or practice boost. Make sure they munch on them one to four hours before exercise.  Minimeals or snacks include: <ul> <li>Peanut butter and sliced banana on bread and a yogurt smoothie.</li> <li>Oatmeal with dried or fresh fruit and sliced almonds or walnuts.</li> <li>Low-fat cottage cheese or yogurt with granola and a piece of fruit.</li> <li>Sliced turkey and Swiss cheese sandwich and fruit.</li> <li>Yogurt with cereal or granola.</li> <li>Apple or banana with nut butter.</li> <li>Dairy-based smoothie.</li> </ul> Thirty to 60 minutes before exercise, foods that are low in fat and fiber will improve tolerance and stamina: <ul> <li>Piece of fruit, crackers or a jam sandwich.</li> <li>Fruit puree pouch, such as applesauce.</li> </ul> Kids on a traveling team or heading out of town for a tournament? When you're on the road, kids can still eat for performance and good health. Food items to pack include dried or fresh fruits, nuts or seeds, sliced vegetables, peanut or other nut butter sandwiches, dry ready-to-eat cereals, string cheese or light yogurt. Here are some ideas for navigating away-from-home meals: <ul> <li>At a Mexican eatery, order a burrito or soft tacos with grilled veggies, whole grains and beans, and lean meat or tofu. </li> <li>At a fast-food restaurant, choose a grilled chicken sandwich, hamburger, or veggie burger, with tomato and lettuce, fruit and low-fat milk. </li> <li>At a sub sandwich restaurant, choose a lean protein option, such as turkey, chicken, roast beef or tuna, on whole-grain bread with loads of vegetables. </li> </ul> Whether you're at home or on the road, hydrate, hydrate, hydrate. Like fueling with food throughout the day, adequate hydration starts in the morning and continues all day. For events under an hour, water is sufficient. Provide sports drinks to replace fluids and electrolytes during vigorous physical activity that lasts more than an hour or when temperatures are hot.  Rose Prissel, MS, RDN, LD, is a dietitian at Mayo Clinic working in pediatric and adult nutrition, with a focus on preventive care, sports nutrition and weight management. Rose Prissel, M.S., RDN, LDPrimary Care in Rochester and KassonHealthy Sports EatingPrimary Care in Rochester and KassonMeditation is a simple, quick way to reduce stress, and you can do it wherever you are.&nbsp;<img src="/-/media/ech-media/images/widgets/activities/ech_mindfulness_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=A44E84F9C7FF280C9730CF9DAA5A50EE" alt="ECH_mindfulness_widget" width="100" height="65" DisableNVelocity="true" />Mindfulness meditation: Improve your quality of life7/14/2022 4:30 AM<img src="/-/media/ech-media/images/widgets/activities/ech_mindfulness_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=7952A7FE510778533C58EFF66343BEDB" alt="ECH_mindfulness_widget" width="300" height="195" DisableNVelocity="true" />Meditation is a way to connect with life in the present moment. Meditation may bring a tranquil mind by training your attention to the here and now no matter what is happening and developing the ability to respond instead of reacting to life events. It fosters the ability to observe the stream of thoughts that may crowd your mind and cause overwhelming and unnecessary stress. This practice may result in enhanced physical and emotional well-being.  Key benefits Meditation is an awareness practice. That is the biggest gain of meditation — to be able to be aware of what is going on here and now. Meditation can be performed in different forms to achieve benefits in the mental and physical aspects of life.  Recommended meditation for beginners Start with things that naturally bring your attention to the here or now. This can be a walk or run, or a cup of coffee in silence. It can be savoring food or doing yoga. It also can be sitting still and giving yourself permission to do nothing.  Tips to make meditation a long-term habit Start with minor changes that are doable. Behavioral change starts with a decision. Then add slight changes that are possible to accomplish. Have simple reminders to make the change.  Different meditation for different goals? There are no general rules regarding what meditation is needed for a specific goal. This is a personalized practice. Bring attention to the here and now. Observe the present moment in a nonjudgmental way.  The <a rel="noopener noreferrer" href="https://www.mayo.edu/research/labs/mindful-breathing/overview" target="_blank">Mindful Breathing Laboratory</a> at Mayo Clinic focuses on the study of how self-awareness, mindfulness, physical activity and self-management affect chronic disease. Research led by <a rel="noopener noreferrer" href="https://www.mayo.edu/research/faculty/benzo-roberto-p-m-d/bio-00078256" target="_blank">Roberto Benzo, M.D.</a>, develops and tests interventions that empower people to be more present and open to self-awareness and self-exploration to adopt a lifestyle that provides balance and health.  The Mindful Breathing Lab website has resources available for your journey:  <ul> <li>Audio files for mindful breathing practices  <a rel="noopener noreferrer" href="https://www.mayo.edu/research/labs/mindful-breathing/audio-files" target="_blank">Click the links</a> to listen immediately or download the file to your computer or another device to listen at your convenience. </li> <li>Videos to help with mindful breathing and movement practices  <a rel="noopener noreferrer" href="https://www.mayo.edu/research/labs/mindful-breathing/videos" target="_blank">Click the links</a> to watch immediately or download the file to your computer or another device to watch at your convenience. </li> <li>Mindful Meditation Practice  Join the <a rel="noopener noreferrer" href="https://www.mayo.edu/research/labs/mindful-breathing/patient-events" target="_blank">Mindful Meditation Practice</a> by Zoom each Wednesday from 5:30 to 6 p.m. Central time. This offering is free and open to the public. </li> </ul> Learn more on the <a rel="noopener noreferrer" href="https://www.mayo.edu/research/labs/mindful-breathing?_ga=2.25634621.1468275358.1516125994-1223424782.1480974935" target="_blank">Mindful Breathing Lab website</a>. Primary Care in Rochester and KassonMindful MeditationPrimary Care in Rochester and KassonFive stands for eating five servings of fruits and vegetables a day.&nbsp;<img src="/-/media/ech-media/images/widgets/food/5fruitsvegetables.jpg?h=65&iar=0&w=100&sc_lang=en&hash=00B66F076AC62AE79801EBA288FD0222" alt="5FruitsVegetables" width="100" height="65" DisableNVelocity="true" />5-2-1-0: Raise healthy kids by the numbers8/18/2022 5:30 AM<img src="/-/media/ech-media/images/widgets/food/5fruitsvegetables.jpg?h=205&iar=0&w=315&sc_lang=en&hash=9CE246232DDDA605349EBC724ECBBAA1" alt="5FruitsVegetables" width="315" height="205" DisableNVelocity="true" />Making healthy food and activity choices allows children to grow, develop and maintain a healthy weight so they can play, learn and be their best. But with all the fad diets and media about what should and shouldn't be done when it comes to leading a healthy life, it can be overwhelming and confusing.  With just four numbers to remember, the 5-2-1-0 program provides families with a simple guide and tips.  Starting at the beginning, "5" stands for five serves of fruits and vegetables a day. But how much is a serving? For kids, the serving is the amount of fruit or vegetables that fits in the palm of their hand.  For adults, typical fruit and vegetable servings are:  <ul> <li>A whole fruit the size of a tennis ball.</li> <li>1/2 cup of chopped fruits or veggies. </li> <li>1 cup of raw, leafy greens. </li> <li>1/4 cup of dried fruit. </li> </ul> Some fun ways to eat more fruits and vegetables as a family include: <ul> <li>Be colorful. Make rainbow out of your plate. Challenge each other to find as many different colors of fresh produce as you can. </li> <li>Get creative. Pinterest and other craft websites have fun ideas to encourage kids to try different types of fruits and vegetables that they otherwise would not normally try. </li> <li>Plant a garden. Use the fresh herbs, fruits and vegetables you grow to try new recipes. </li> <li>Stay local. Check out the local farmers market or roadside stand and pick a new fruit or vegetable each week that your family has never tried before. </li> <li>Plan ahead. Plan a week's worth of meals as a family on Sunday so you're less likely to eat fast food or go out to dinner. </li> <li>Set an example. Your kids are watching you, and they'll be more likely to adopt healthy habits if you lead by example. </li> <li>Juice it up. Make smoothies or juices that are packed full of fresh fruits and vegetables. For example, blend one pear, one banana, one cup of spinach, a couple drops of honey, and one cup of almond milk for a delicious green smoothie. Get in the pink by blending one cup of fresh or frozen strawberries, one cup of skim milk and one cup of ice. </li> <li>Come together. Eat your meals sitting down as a family, with the TV off and the cellphones tucked away. </li> </ul> For more fun ways to get at least five servings of fruits and vegetables a day, explore these links: <ul> <li><a rel="noopener noreferrer" href="https://thefamilydinnerproject.org/" target="_blank">The Family Dinner Project.</a> </li> <li><a rel="noopener noreferrer" href="https://www.pinterest.com/" target="_blank">Pinterest.</a> </li> </ul> Find out about Rule 2: Two hours of screen time in an upcoming article.  Tammy Schmit, R.N., is the nurse manager in Community Pediatric and Adolescent Medicine in Rochester, Minnesota. Tammy Schmit, R.N.Primary Care in Rochester and Kasson5210 five fruits vegetablesPrimary Care in Rochester and KassonThe 5-2-1-0 Let's Go! program promotes time for families to make healthy food choices and daily healthy living behaviors.&nbsp;<img src="/-/media/ech-media/images/widgets/kids/twistergame.jpg?h=65&iar=0&w=100&sc_lang=en&hash=C0D9B929A6193746B94D975ACA0C045C" alt="TwisterGame" width="100" height="65" DisableNVelocity="true" />5-2-1-0 Let's Go! It's not just for kids8/4/2022 4:30 AM<img src="/-/media/ech-media/images/widgets/kids/twistergame.jpg?h=205&iar=0&w=315&sc_lang=en&hash=5F5F8ACDA11A985ACCF3F96DE1A5BDF7" alt="TwisterGame" width="315" height="205" DisableNVelocity="true" />People have a healthy body shape that's just right for them. But gaining excess weight is easy to do.  Life's busy for everyone. Summer is winding down. School is about to start.  That quick stop at McDonald's after baseball can turn into a fast food stop multiple times a week. The lazy Saturday afternoon bingeing on Netflix movies slowly turns into night after night in front of the TV. Or maybe it's the addictive new app that you found that's keeping you from the family walk.  Remembering the 5-2-1-0 Let's Go! rule is a way to help your family create healthy habits: <ul> <li>Rule 5 Eat five or more servings of vegetables and fruits per day. </li> <li>Rule 2 Limit recreational screen time to two hours or less per day. </li> <li>Rule 1 Get one hour of physical activity or more per day. </li> <li>Rule 0 Drink zero sugar-sweetened beverages per day. </li> </ul> Preventing obesity can take time, and no one can follow every tip every day. But you can take these steps to prevent putting on excess pounds: <ul> <li>Become knowledgeable. Learn about healthy eating and active living. Creating these habits early will typically carry through your life. </li> <li>Eat meals together. Studies show that having a healthy breakfast reduces tardiness and results in better academic, behavioral and emotional functioning. Clear off the dining table and sit down together. Make the table a "no electronics zone." This promotes mindful eating, which has been linked to eating less later in the day. </li> <li>Avoid foods with added sugar. Over two-thirds of processed foods have added sugar. Keep these foods to a minimum to keep off the excess weight. </li> <li>Watch your portions. Remember that just because the box says that 2 cups is a portion, that may not be the best choice for your body. Keep portion sizes age and body size appropriate. </li> <li>Lead by example. Children will do what you do — not what you say. To promote a healthy lifestyle in your children, show them how to accomplish it by your actions. </li> </ul> Find out more about the rules of 5-2-1-0 Let's Go! in an upcoming article.  Tammy Schmit, R.N., is the nurse manager in Community Pediatric and Adolescent Medicine in Rochester, Minnesota. Tammy Schmit, R.N.Primary Care in Rochester and Kasson5210 IntroPrimary Care in Rochester and KassonThese tips can help you be successful in your journey.&nbsp;<img src="/-/media/ech-media/images/widgets/people/breastfeeding.jpg?h=65&iar=0&w=100&sc_lang=en&hash=71ECAAA03EE755A6BD7A5D6CB115D94B" alt="Breastfeeding" width="100" height="65" DisableNVelocity="true" />Your breastfeeding journey8/22/2022 4:30 AM<img src="/-/media/ech-media/images/widgets/people/breastfeeding.jpg?h=205&iar=0&w=315&sc_lang=en&hash=8EA43D66B0026E5301CD49A094799FA3" alt="Breastfeeding" width="315" height="205" DisableNVelocity="true" />Whether you're pregnant, planning for pregnancy or you've welcomed your new family addition — congratulations. Parenthood is an incredible journey.  Breastfeeding is an excellent source of nutrition for your baby. It also creates a powerful bond between baby and caregiver.  Here are tips for success on your breastfeeding journey: <ul> <li>Ask for help from your care team. If breastfeeding isn't going the way you imagined, Mayo's experts can help. Remember, you are not alone. </li> <li>Breastfeeding shouldn't be painful. Pain can indicate an issue with your baby's latch or another problem. Certified lactation counselors or consultants in primary care can work with you and your baby to optimize feedings. </li> <li>Follow your baby's lead. Your primary care team will closely monitor your baby's weight. Ensuring your baby is making the appropriate number of wet and dirty diapers is something that will be discussed. Watch for cues that will let you know when your baby is hungry. Some early signs include lip smacking and sucking on hands or fingers. Crying is typically considered a late sign of hunger. This means it can be harder to get your baby to feed. In early life, babies need to eat every two to three hours. Once hunger has been quenched, your baby should be more relaxed and satisfied. </li> <li>Use your support system. It's especially important to take care of yourself. Have your partner burp the baby and spend time with them after you have finished feeding. This gives you the time to rest, take a shower or do something for yourself that you enjoy. Accept help from friends and family. Raising an infant takes a village. </li> </ul> Megan Dubbels, R.N., is a registered nurse and certified lactation counselor in Primary Care in Rochester and Kasson's Division of Community Pediatric and Adolescent Medicine.  <a href="https://communityhealth.mayoclinic.org/providers/kara-fine-md/">Kara Fine, M.D.</a>, is a physician in Primary Care in Rochester and Kasson's Division of Community Pediatric and Adolescent Medicine. Megan Dubbels, R.N., and Kara Fine, M.D.Primary Care in Rochester and KassonBreastfeeding TipsPrimary Care in Rochester and KassonLearn more about CBD products and potential risks.&nbsp;<img src="/-/media/ech-media/images/widgets/medications/cbdproducts.jpg?h=65&iar=0&w=100&sc_lang=en&hash=D2F927F6825D0B21FD4D04BFB1D163D0" alt="CBDproducts" width="100" height="65" DisableNVelocity="true" />CBD basics: What you need to know8/29/2022 2:30 AM<img src="/-/media/ech-media/images/widgets/medications/cbdproducts.jpg?h=205&iar=0&w=315&sc_lang=en&hash=19BE4485664127867E5C56CF47B77091" alt="CBDproducts" width="315" height="205" DisableNVelocity="true" />You've heard plenty about CBD products, and you may have even tried them. But what are the issues and concerns with CBD? What it is CBD is a nonpsychoactive derivative of cannabis, also known as marijuana. In other words, you can't get high from it.  The opioid epidemic and chronic pain have driven interest in using CBD products to treat pain. More studies are exploring its effectiveness in relieving pain, but data are still limited.  Complicated to study The Food and Drug Administration, or FDA, has approved only one CBD product — a prescription drug used to treat certain seizures. Other CBD-containing products are illegal at the federal level, even if these products are legal in some states.  No standard regulation Neither the FDA nor other federal regulatory agencies oversee the production or distribution of CBD sold from dispensaries or on the internet. States that have legalized CBD products expect the growers, processors and dispensaries to self-regulate the production, marketing and sales of these products. As a result, products may not be pure, the concentration and dosing may not be accurate, and the labeling may be misleading.  Among CBD products sold online, studies report significant differences in CBD concentrations. There is no consensus on recommended doses. Studies have identified contaminants in CBD, such as pesticides, metal particles and synthetic cannabinoids, along with molds, bacteria and aflatoxins. These contaminates may have entered the plant while it was growing.  What you need to know — for now What you need to know about CBD is there's a lack of evidence for the popular uses of CBD products. And there's a risk of contaminants, as well as misleading labels and legal issues.  Before using CBD products, talk to your health care professional to determine if CBD could potentially interact with drugs on your medication list. To learn more about CBD, check out the <a rel="noopener noreferrer" rel="noopener noreferrer" href="https://naturalmedicines.therapeuticresearch.com/databases/food,-herbs-supplements/professional.aspx?productid=1439" target="_blank">Natural Medicines website</a> and Mayo Clinic's story on the <a rel="noopener noreferrer" rel="noopener noreferrer" href="https://www.mayoclinic.org/healthy-lifestyle/consumer-health/expert-answers/is-cbd-safe-and-effective/faq-20446700" target="_blank">benefits of CBD</a>.  <a href="https://communityhealth.mayoclinic.org/providers/sonya-peters-pac">Sonya Peters, P.A.-C., M.S.</a>, is a physician assistant in Primary Care in Rochester and Kasson's Division of Community Internal Medicine, Geriatrics and Palliative Care at Mayo Family Clinic Northwest. Her areas of special interest are women's health and procedural medicine. Sonya Peters, P.A.-C., M.S.Primary Care in Rochester and KassonCBD BasicsPrimary Care in Rochester and KassonThe new guidelines recommend that all adults 19–59 years be vaccinated for hepatitis B.&nbsp;<img src="/-/media/ech-media/images/widgets/medications/ech_immschedule_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=26209ABFFE871940EFFD25727EC5ED00" alt="ECH_ImmSchedule_widget" width="100" height="65" DisableNVelocity="true" />New guidelines for hepatitis B vaccine 7/28/2022 4:30 AM<img src="/-/media/ech-media/images/widgets/medications/ech_immschedule_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=41308D270409D24116827655081A88F6" alt="ECH_ImmSchedule_widget" width="300" height="195" DisableNVelocity="true" />Hepatitis B is a serious disease caused by a virus that attacks the liver. It can cause lifelong infection and lead to cirrhosis, or scarring, of the liver. Hepatitis B also can lead to liver cancer or liver failure — either of which can lead to death. The best way to prevent hepatitis B is to get vaccinated.  The Advisory Committee on Immunization Practices recently updated its guidelines to include recommendations that adults 19–59 years of age be vaccinated for hepatitis B. Mayo Clinic has adopted this recommendation.  This guidance includes: <ul> <li>Routine hepatitis B vaccination for all infants, starting with a birth dose. </li> <li>Routine hepatitis B vaccination catch-up of all children and adults through age 59 years. </li> <li>Vaccination for those 60 years and older with risk factors for hepatitis B. </li> <li>Vaccination for those 60 years and older who want the protection. </li> </ul> Those who have completed a hepatitis B vaccination do not need boosters. Also, those who have had hepatitis B infection do not need to be vaccinated. Contact you health care team if you have questions.  <a href="https://communityhealth.mayoclinic.org/providers/robert-jacobson-md/">Robert M. Jacobson, M.D.</a>, is medical director of the Primary Care Immunization Program in Southeast Minnesota. He is a physician in Community Pediatric and Adolescent Medicine at Mayo Clinic in Rochester. Robert M. Jacobson, M.D.Primary Care in Rochester and KassonHepatitisB Vaccine RecommendationsPrimary Care in Rochester and KassonRule No. 1 stands for one hour or more of physical activity per day.<img src="/-/media/ech-media/images/widgets/kids/5210_physicalactivity.jpg?h=65&iar=0&w=100&sc_lang=en&hash=5D53CD0587CEBCE69BE7DC6F77E7BD9F" alt="5210_PhysicalActivity" width="100" height="65" DisableNVelocity="true" />Learning Rule No. 1 in 5-2-1-0 Program: Physical activity9/26/2022 4:30 AM<img src="/-/media/ech-media/images/widgets/kids/5210_physicalactivity.jpg?h=205&iar=0&w=315&sc_lang=en&hash=591D3C40679E8E34D2EBEB82CDF7E2E3" alt="5210_PhysicalActivity" width="315" height="205" DisableNVelocity="true" />Making healthy food and activity choices allows children to grow, develop and maintain a healthy weight so they can plan, learn and be at their best. But with all the fad diets and commentary on what should and shouldn't be done when it comes to leading a healthy life, it can be overwhelming and confusing.  With just four numbers to remember, the 5-2-1-0 Program provides parents with a simple guide and tips for their kids. The third number — Rule No. 1 — stands for the recommendation to get at least one hour of physical activity a day.  The best way to keep your kids active is to lead by example. It's no secret that getting the heart pumping and breaking a sweat are sure-fire ways to boost one's mood, maintain a healthy weight and increase energy for the day. If exercise isn't part of your daily routine, it's never too late to start. Making small, gradual changes in your activity level soon will turn into big, lifelong healthy habits for you and your kids. Here are ways to incorporate more movement into the day for you and your family: <ul> <li>Create a healthy competition with the whole family. Track steps with a pedometer with the goal of 10,000 steps per person per day. </li> <li>Break up the day with several activity bursts. Physical activity doesn't have to take place all at one time. It can be just as effective in short bursts throughout the day. </li> <li>Take the stairs at school or work. Park the car far away from the door to the grocery store, movie theater or mall. </li> <li>Pick a form of exercise that you and your kids enjoy. Some fun ideas include jumping rope; playing a team sport; walking the family pet; making snow angels; putting the tunes on and dancing; going for a nature hike; playing a pickup game of basketball, hockey, soccer or kickball; training together for a family walk-run event; swimming at a club or community pool; or sledding. </li> </ul> Find out about Rule No. 0, no sugary drinks, in an upcoming article.  Tammy Schmit, R.N. is the nurse manager in Community Pediatric and Adolescent Medicine in Rochester, Minnesota. Tammy Schmit, R.N.Primary Care in Rochester and Kasson5210 Physical ActivityPrimary Care in Rochester and KassonPick up tips for limiting kids' screen time to two hours per day.&nbsp;<img src="/-/media/ech-media/images/widgets/kids/screentime2.jpg?h=65&iar=0&w=100&sc_lang=en&hash=CE66E663E4C8107123B0D8B0BC791C91" alt="ScreenTime2" width="100" height="65" DisableNVelocity="true" />Learning Rule No. 2 in 5-2-1-0 Program: Limit screen time9/8/2022 4:30 AM<img src="/-/media/ech-media/images/widgets/kids/screentime2.jpg?h=205&iar=0&w=315&sc_lang=en&hash=465D1562DC11E27DD4AD1C5044386465" alt="ScreenTime2" width="315" height="205" DisableNVelocity="true" />The 5-2-1-0 Program provides parents with a simple guide and tips for helping their kids reach and maintain a healthy weight and overall wellness. Rule No. 2 in this program stands for limiting screen time to two hours a day.  Screen time includes watching TV, playing video games, using computer applications and interacting on tablets. But why should parents be concerned about that?  Research shows that screen time is associated with less physical activity, eating more processed snacks, and lack of sleep or poor-quality sleep — all of which are linked to a greater risk for obesity and diseases like diabetes.  Myths about screen time Parents give many reasons for screen time being a default or habit, such as: <ul> <li>Myth No. 1 It's easy and convenient to use screen time, such as using a video as a babysitter. But kids coming off a "screen high" is equivalent to them coming down from a sugar high. </li> <li>Myth No. 2 It's educational. Research shows that, unless an adult is watching with them, kids lack the social connection to help them make sense of what they're viewing and the world around them. </li> <li>Myth No. 3 It helps my child focus. Research has shown a link between screen time and attention-deficit/hyperactivity disorder. If your child can focus on hours of TV, video and computer games but can't sit still during school or classroom time, it could be a sign of attention-deficit/hyperactivity disorder. </li> </ul> How to reduce screen time Screen time isn't a given, and parents can take control. One of the best ways to approach this goal is as a family.  Here are some questions your might discuss:  <ul> <li>What is screen time for your family?</li> <li>When is it available each day and for how long?</li> <li>What are some other choices for healthy activities you could do as a family? Some options might be games, music, sports, outdoor activities or crafts. </li> </ul> These three creative techniques can help you take control and cut down on your child's screen time — and your own: Use a checklist. The kids must complete three or more items on the checklist before screen time.  <ul> <li>Read for 20 minutes. </li> <li>Play outside or work on a craft or project for 30–60 minutes. </li> <li>Finish homework, including math problems. </li> <li>Write in a journal for 10 minutes. </li> <li>Complete an assigned chore. </li> <li>Clean their room and make the bed. </li> </ul> Manage media choices.  <ul> <li>Designate bedrooms as "screen-free zones."</li> <li>Use screens sparingly with kids 2 and under. </li> <li>Choose age-appropriate and quality shows, games and apps. </li> <li>Stay involved with the kids' screen time habits by viewing with them. </li> <li>Create a reward plan with firm but reasonable rules about family media use. </li> <li>Make a rule about no screens during meals. </li> <li>Identify a "family fun space" for working on crafts, putting on plays, playing board games or cards — with no screens allowed. </li> </ul> Designate a weekly "Unplugged Day." <ul> <li>Set an example: Meditate, journal, read or exercise. </li> <li>Identify an evening as a board game night. </li> <li>Make supper together as a family.</li> <li>Buy pedometers for the family and see who gets the most steps in that day. </li> </ul> Decide what the reward should be for taking control of screen time. But make sure it is not more screen time.  Reaching and maintaining a lifelong healthy weight for everyone in your family is a great goal, and it's doable. Your health care team can provide you with more down-to-earth information and tips that even busy families can work into their schedules.  If you'd like to do more reading about screen time, these are excellent resources:  <ul> <li><a rel="noopener noreferrer" href="http://breakingmuscle.com/family-kids/wired-kids-how-screen-time-affects-childrens-brains" target="_blank">"Wired kids: How screen time affects children's brains."</a></li> <li><a rel="noopener noreferrer" href="http://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-8-366" target="_blank">"Active play and screen time in U.S. children aged 4 to 11 years in relation to sociodemographic and weight status characteristics: a nationally representative cross-sectional analysis."</a></li> </ul> Find out about Rule No. 1, one hour of physical activity, in an upcoming article.  Tammy Schmit, R.N., is the nurse manager in Community Pediatric and Adolescent Medicine in Rochester, Minnesota. Tammy Schmit, R.N.Primary Care in Rochester and Kasson5210 Screen TimePrimary Care in Rochester and KassonResources are available. Talk to your health care team today.<img src="/-/media/ech-media/images/widgets/people/divorce_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=61A8BD25A18234E4487C48B161255164" alt="Divorce_widget" width="100" height="65" DisableNVelocity="true" />Domestic violence: You are not alone9/19/2022 4:30 AM<img src="/-/media/ech-media/images/widgets/people/divorce_widget.jpg?h=205&iar=0&w=315&sc_lang=en&hash=3A99FCC838E9DB8271CE7DD6539EA1C7" alt="Divorce_widget" width="315" height="205" DisableNVelocity="true" />Domestic violence, also referred to as intimate partner violence or relationship abuse, comes in many forms. Often, several types of abuse occur simultaneously. These types of abuse can range from physical or sexual abuse to emotional abuse, such as using insults, making threats or acting in an intimidating manner. Also, economic abuse is possible, which entails taking control of household finances.  Moreover, abusive behavior tends to be cyclical.  Research identifies these parts of the cycle: <ul> <li>Tension-building.</li> <li>The abuse incident.</li> <li>Reconciliation, or the "honeymoon phase."</li> <li>A period of calm.</li> </ul> The ups and downs of the abuse cycle can be dizzying, making it difficult to make a change without support.  Anyone in an intimate partnership, no matter the gender identity or socioeconomic status, is susceptible to the harmful and sometimes deadly effects of domestic violence.  If you find yourself resonating with any of the descriptions above, your Mayo Clinic health care team urges you to reach out for help. Whether you share your story with a health care clinician, or a nurse, social worker or therapist, Mayo clinic is a safe and confidential place.  Even if you are not ready to leave your relationship, your health care team can help you on your path to safety. Often this includes working with community resources to find safe housing or financial support. Maybe it's getting help to call a trusted loved one, friend or co-worker.  You also have a larger community network available to you 24/7. You can call the National Domestic Violence Hotline at <a href="tel:8007997233">800-799-7233</a>. Locally, you can reach out to the Women's shelter and Support Center or Victim Services. If there is an immediate threat to your safety, call 911. Always try to keep a fully charged cellphone with you for this purpose.  <a href="https://communityhealth.mayoclinic.org/providers/randa-soubra-licswmsw/">Randa Soubra, L.I.C.S.W., M.S.W.</a>, is an integrated behavioral health therapist based at the Baldwin Clinic. In her work as a therapist — and previously a crisis line worker and transitional housing program manager — she has years of experience working with people who have experienced domestic violence. Randa Soubra, L.I.C.S.W., M.S.W.Primary Care in Rochester and KassonDomestic ViolencePrimary Care in Rochester and KassonFind answers to your questions about head lice in this parent's guide.&nbsp;<img src="/-/media/ech-media/images/widgets/kids/lice.jpg?h=65&iar=0&w=100&sc_lang=en&hash=60359512091D21C664B59DFAA91670D4" alt="Lice" width="100" height="65" DisableNVelocity="true" />Don't sweat the small (crawly) things9/1/2022 4:30 AM<img src="/-/media/ech-media/images/widgets/kids/lice.jpg?h=205&iar=0&w=315&sc_lang=en&hash=F8AE24F3E1563FDE282197C176FD2F1A" alt="Lice" width="315" height="205" DisableNVelocity="true" />You just received a message from your child's school: "Your child has been exposed to head lice." As you immediately feel your scalp start to crawl and itch, you ask yourself: "What are head lice? How do they spread? What do I do next?" Head lice can be stressful and bothersome, but they do not spread diseases or cause significant harm.  Your Primary Care in Rochester and Kasson team has the answers to common questions to help you manage this itchy nuisance: What are head lice? Head lice are tiny wingless insects that are about the size of a sesame seed. A single insect is called a louse. Once fully mature, an adult female louse can lay up to 10 eggs per day. These eggs are firmly attached to hair near the scalp. The eggs and their surrounding shells are called nits. Most nits are yellow or white, but some can blend in with a person's hair color and may be more difficult to see. Once the eggs hatch, the empty shell casings stay in place on the hair shaft. It typically takes around three weeks for an egg to hatch, and for a louse to reach adulthood and begin to make eggs of their own.  Head lice can typically only survive for one to two days away from the scalp. They feed by sucking tiny amounts of blood from the scalp. Head lice inject a small amount of substance into the scalp to make it easier for them to feed. The scalp reacts to this substance, and this causes the itching associated with head lice.  Who gets head lice? Head lice infestation is a common issue that most frequently affects children in preschool and elementary school. Head lice are found worldwide. They will attach to anyone's hair, regardless of how clean or dirty it is.  How do head lice spread? Head lice cannot jump or fly. They can only crawl. Transmission primarily occurs through prolonged head-to-head contact. Contact with the combs, brushes or hats of an infested person provides a much smaller chance of spreading head lice. Dogs, cats and other animals do not spread head lice.  How do you know if your child has head lice?  Monitoring your child's hair regularly helps identify lice before they multiply and potentially spread to others. To confirm a head lice infestation, it is best to find live lice on the scalp.  How do you check for head lice? <ul> <li>Have your child sit in a brightly lit room. Part their hair in sections. Look for crawling lice or nits one section at a time. </li> <li>Live lice are small and move quickly to avoid light. Using a fine-tooth comb may help identify live lice. </li> <li>Finding nits attached to a hair shaft within about a quarter-inch from the scalp suggests the likelihood of an active lice infestation. Nits attached further down the hair shaft usually are already hatched, or they are dead lice. This may suggest an old infestation that need not be treated. </li> <li>Nits are typically best seen on the hair behind the ears and near the hairline on the back of the neck.</li> </ul> How are head lice treated? Head lice should only be treated if you're certain that your child has living lice on the scalp. Check with your clinician before beginning head lice treatment, particularly if your child is 2 years old or younger.  You can purchase many head lice medications over the counter. Home remedies, such as essential oils, petroleum jelly, mayonnaise, butter and olive oil have not been proven to be effective. Always avoid using harmful substances, like gasoline or kerosene, and never place a plastic bag on your child's head.  Here are some additional tips for using lice medications safely and effectively: <ul> <li>An adult should apply lice treatments according to the package directions. </li> <li>Do not rinse the medication off in a shower or bath, as the medication can get on other areas of skin. Instead, place your child's head over a sink and rinse off the medication with warm — not hot — water. </li> <li>Do not use hair conditioner prior to applying the medication, as this may make the medication less effective. </li> <li>After treatment with a medication, use a fine-toothed comb to remove nits and lice. </li> <li>You may need to repeat lice treatment after seven to 10 days, or as directed on the medication package if live lice are still seen after treatment. </li> <li>Check all close contacts and household members for lice and treat if lice are identified. It may help to treat family members who have shared a bed with your child. </li> <li>It also may be beneficial to wash clothing, hats, towels and bedding that have recently come into contact with your child's head. Washing in hot water and drying with high heat should kill any lice on these objects. Seal items that cannot be washed, like stuffed animals, in a plastic bag for two weeks. </li> <li>Do not spray pesticides in your house. Pesticides can harm your family's health and are not necessary to treat lice in your home. </li> </ul> If you do not notice an improvement in your child's symptoms after using the medication, reach out to your child's primary care clinician to discuss other treatment strategies.  <a href="https://communityhealth.mayoclinic.org/providers/julie-hanson-md/">Julie L. Hanson, M.D.</a>, is a pediatrician in Primary Care in Rochester and Kasson's Division of Community Pediatric and Adolescent Medicine. She practices at Mayo Family Clinic Northwest in Rochester. Her areas of interest include refugee and global health, newborn care and complex care management. Julie L. Hanson, M.D.Primary Care in Rochester and KassonHead LicePrimary Care in Rochester and KassonMayo Family Clinic Kasson now offers patients medication to help with opioid addiction.<img src="/-/media/ech-media/images/widgets/people/opioidaddiction.jpg?h=65&iar=0&w=100&sc_lang=en&hash=1A091F7B5D019618FC4F69DE809FA60E" alt="OpioidAddiction" width="100" height="65" DisableNVelocity="true" />Help is on the way for those with opioid addiction9/12/2022 4:30 AM<img src="/-/media/ech-media/images/widgets/people/opioidaddiction.jpg?h=205&iar=0&w=315&sc_lang=en&hash=4D9FA6D70DD8BA80F82BEF2FD655ED5C" alt="OpioidAddiction" width="315" height="205" DisableNVelocity="true" />2021 was the deadliest year to date for drug overdoses in the U.S. More than 107,000 people died of a drug overdose between December 2020 and December 2021, according to the Centers for Disease Control and Prevention's National Center for Health Statistics. Put another way, one person died of an overdose every five minutes during this period.  Minnesota experienced an estimated 22% increase in overdose deaths in 2021, compared to the previous year. Most of those deaths involved an opioid drug, most often fentanyl.  Opioids are powerful and important pain medications. When used for an appropriate period of time under close medical supervision and in specific circumstances, such as after certain types of surgery or injury, opioids can be helpful. Examples of opioid medications include morphine, oxycodone, tramadol and fentanyl. Other forms of opioids include illegal drugs, such as heroin. Several herbal extracts and supplements, including kratom and poppy seed tea, which can be purchased online or in some health food stores, also contain opioidlike properties.  Most people who use opioids long term can develop tolerance and dependence. Tolerance means that a larger quantity of opioids is needed to achieve the desired effect, such as pain relief over time. Dependence means that if opioids are discontinued abruptly, a person may experience withdrawal symptoms.  Some people can develop an addiction to opioids. An addiction occurs when a person struggles to control the use of a drug and continues to use the drug despite having negative physical, psychological or social consequences.  Addiction involves biochemical changes in the brain. Patients with opioid addiction — more appropriately termed opioid use disorder, or OUD — experience cravings for opioids.  An estimated 2.7 million people in the U.S. have opioid use disorder. Effective treatments are available, including a combination of medications and behavioral health therapies.  Medications include: <ul> <li>Methadone Methadone can only be dispensed in federally qualified opioid treatment programs, known as methadone clinics. People usually need to go to these clinics daily to take their methadone, which can be time-consuming and inconvenient. </li> <li>Buprenorphine Buprenorphine, marketed as suboxone and Subutex, can be prescribed by outpatient medical professionals and taken at home by patients. This medication can significantly reduce cravings and withdrawal symptoms. </li> <li>Naltrexone Naltrexone, marketed as Vivitrol, is a monthly intramuscular injection. It does not treat a person's withdrawal symptoms, but it can reduce cravings. Unfortunately, this medication can be difficult to access because insurance does not always provide adequate coverage. </li> </ul> Together with behavioral therapies, including counseling and support groups, research has found that opioid use disorder patients taking one of these medications are much less likely to relapse and overdose. Patients who are treated are more likely to sustain employment, have stable housing and have a better quality of life. By reducing the risk of using street drugs, medications to treat opioid use disorder also can reduce the rates of infectious diseases associated with IV drug use, such as bloodstream bacterial infections, skin infections, hepatitis C and HIV. Medications are now considered the gold standard to treat patients struggling with opioid use disorder. Unfortunately, only 20%–40% of patients with opioid use disorder are receiving treatment.  One of the barriers to buprenorphine treatment is a shortage of health care professionals who can prescribe the medication. Health care professionals need a special license, called a waiver, to prescribe buprenorphine. Most health care professionals do not have the waiver.  The situation is more pronounced in rural areas, as more than half of rural counties do not have a health care professional with a buprenorphine waiver. These areas also often lack access to opioid treatment programs where patients can access methadone.  Mayo Clinic is taking action to address the opioid epidemic and help patients struggling with opioid use disorder. An increasing number of Mayo Clinic primary care clinicians can now prescribe buprenorphine to treat opioid use disorder. Primary care clinicians and nurses at Mayo Family Clinic Kasson have received additional training and can treat patients with opioid use disorder with buprenorphine. This service is limited to patients with a primary care clinician at Mayo Family Clinic Kasson.  If you or someone you know are struggling with opioid use disorder and would like to receive treatment, talk to your primary care clinician.  Mayo plans to gradually expand this service to other locations at Mayo Clinic in Rochester and across Mayo Clinic Health System in Southeast Minnesota in the near future.  <a href="https://communityhealth.mayoclinic.org/providers/benjamin-lai-mbbchbao/">Benjamin Lai, M.B., B.Ch., B.A.O.</a>, is a physician in Primary Care in Rochester and Kasson's Department of Family Medicine. He is the assistant medical director of Mayo Clinic's Opioid Stewardship Program and is involved in medical student and resident education. Benjamin Lai, M.B., B.Ch., B.A.O.Primary Care in Rochester and KassonSuboxone Opioid AddictionPrimary Care in Rochester and KassonRule No. 0 stands for no sugary drinks.&nbsp;<img src="/-/media/ech-media/images/widgets/beverages/osugarydrinks.jpg?h=65&iar=0&w=100&sc_lang=en&hash=3E7DDBDFD9AE92C1C164D9A3F84B21E2" alt="OSugaryDrinks" width="100" height="65" DisableNVelocity="true" />What is rule No. 0 in 5-2-1-0 program?10/13/2022 4:30 AM<img src="/-/media/ech-media/images/widgets/beverages/osugarydrinks.jpg?h=205&iar=0&w=315&sc_lang=en&hash=8250CA90BEDD927F5B6C169AA62DB031" alt="OSugaryDrinks" width="315" height="205" DisableNVelocity="true" />The 5-2-1-0 program provides parents with an easy guide and tips for helping their kids reach and maintain a healthy weight and overall wellness. Rule No. 0 in this program stands for no sugary drinks for kids and teens. This means no fruit juice, no sugar-sweetened soda, no sports or energy drinks, no lemonade or punch, and no sweetened coffee or tea drinks.  While that may sound drastic, the reality is that children — and adults — don't need to drink sugar. A 12-ounce can of soda has the equivalent of 10 teaspoons of sugar. Just one can per day could lead to a weight gain of 15 pounds in a year. Each additional can of soda increases a child's risk of obesity by 60%.  Although fruit juice sounds like a good option, it's not the best beverage choice. Juice products labeled "-ade," "punch" or "drink" often contain less than 5% fruit juice. Limit children to a half-cup of 100% fruit juice a day, and don't give infants under 6 months fruit juice at all. The better choice is fresh fruit, which provides vitamins, minerals, fiber and gives a sense of fullness.  While milk is a nonsugar alternative, if kids drink milk during a break at school and with their lunch, they're getting most of the milk they need for the day. For kids ages 2 through 10, the recommendation is two cups of milk per day. For teens, it's three to four cups. A cup is equal to 8 ounces or one of the half-pint cartons kids get at school.  But there's an alternative to sugary drinks that everybody's body will love — water. Water is essential for good health. It's the No. 1 thirst quencher, low-cost (or free) and contains zero calories. Students who eat healthy, sleep well at night and drink plenty of water have more energy for their studies, sports and other activities.  Here are a few tips and techniques for helping the whole family make the switch from sugary drinks to water:  <ul> <li>Start slowly. Choose a 12-ounce can of soda over a 22-ounce (or larger) bottle. Add water to juice. Ask for unsweetened rather than sweetened iced tea. Forgo the sugar in your coffee. </li> <li>Make water available. Fill a pitcher and put it in the fridge. Make it special by adding slices of lemon, oranges, limes, cucumbers, watermelon or pineapple. Have bottled water on hand to grab and go. </li> <li>Start a family water bottle collection. Go shopping and let everyone pick one that's cool, fun or functional. Carry them to work, school and sports, and keep them around the house. </li> <li>Reward yourselves. If you choose water over sugary drinks at a restaurant, drive-thru, sporting event or other activity, put that money in a jar for a fun family activity or add it to the kids' allowances. </li> <li>Be a role model. The kids are watching. So sip water with meals, grab a bottle for the car, keep your water bottle handy while you're watching TV, cooking dinner or doing housework.  </li> </ul> Tammy Schmit, R.N., is the nurse manager in Community Pediatric and Adolescent Medicine in Rochester, Minnesota. Tammy Schmit, R.N.Primary Care in Rochester and Kasson5210 Sugary DrinksPrimary Care in Rochester and KassonEven if you are unable to donate blood, you can spread the word about blood donation.&nbsp;<img src="/-/media/ech-media/images/widgets/blooddonation/givebloodsavelife.jpg?h=65&iar=0&w=100&sc_lang=en&hash=3615223BF92156354257500A130C8FDA" alt="GiveBloodSaveLife" width="100" height="65" DisableNVelocity="true" />Help spread the word about blood donation10/6/2022 4:30 AM<img src="/-/media/ech-media/images/widgets/blooddonation/givebloodsavelife.jpg?h=205&iar=0&w=315&sc_lang=en&hash=D6A6DBA16A25C70D3DBD7B0E64348C61" alt="GiveBloodSaveLife" width="315" height="205" DisableNVelocity="true" />Every 10 minutes someone in Olmsted County needs blood.  Contrary to widely held belief, blood products do more than just help trauma patients. Blood products are used in everyday patient care — helping premature babies, postpartum mothers, and cancer and surgical patients. No matter if a patient receives whole blood, double red cells, platelets or plasma, their healing starts with someone donating blood.  Many people want to donate blood, but they cannot. Only 37% of the U.S. population is eligible to donate blood. You may be deferred from donating blood due to health conditions, medications or travel.  But do not let a deferral stop you from helping. Your advocacy for blood donation can make a significant impact.  Here are ways you can help without donating:  <ul> <li>Share social media posts and stories about blood donation. </li> <li>Pass on the urgent need for donors to your family, friends and neighbors. </li> <li>Organize a blood drive where you work or at a community organization. </li> <li>Set up a blood donation challenge for a group you are a part of. </li> <li>Tell others about the importance of blood donation. </li> </ul> Every blood donation helps save up to three lives. Imagine how many lives you can help when you organize a blood drive.  Although 37% of the U.S. population can donate blood, less than 10% of those people choose to donate blood annually. For this reason, your help — and your voice — are needed to spread the word about the importance of blood donation. In whatever way you give, you will have the gratitude of the people receiving a lifesaving blood donation.  If you know people who would like to donate blood, have them call the Mayo Clinic Blood Donor Program at <a href="tel:5072844475">507-284-4475</a>, or contact the program by <a href="mailto:mailto:donateblood@mayo.edu">email</a>. Scheduling an appointment to donate blood is easy and helps ensure that blood is available for a loved one or other patients in need.  Be sure to watch for more incentives by visiting the <a rel="noopener noreferrer" href="https://connect.mayoclinic.org/page/blood-donor-program/" target="_blank">Blood Donor Program blog</a>, the <a rel="noopener noreferrer" href="http://www.mayoclinic.org/donateblood" target="_blank">Minnesota Blood Donor Program website</a> or <a rel="noopener noreferrer" href="https://www.facebook.com/blooddonorcentermc?ref=br_tf" target="_blank">Facebook</a> page.  Here's where and when you can donate:  <ul> <li>Hilton Building, First floor, downtown This location is open weekdays from 6 a.m. to 4:30 p.m. It is open until 7 p.m. every second Thursday of the month. </li> <li>Joseph Building M-86, Saint Marys Campus This location is open weekdays from 8 a.m. to 3 p.m.</li> </ul>Primary Care in Rochester and KassonBlood Donation 100622Primary Care in Rochester and KassonFind answers to common eye health and safety questions.&nbsp;<img src="/-/media/ech-media/images/widgets/activities/eyeprotectionsports.jpg?h=65&iar=0&w=100&sc_lang=en&hash=6C14972E4E2DD2A2B4F92BA33BAFAD84" alt="EyeProtectionSports" width="100" height="65" DisableNVelocity="true" />Children's eye health and safety10/20/2022 4:00 AM<img src="/-/media/ech-media/images/widgets/activities/eyeprotectionsports.jpg?h=205&iar=0&w=315&sc_lang=en&hash=58C57B2064D270A99B54B85984436305" alt="EyeProtectionSports" width="315" height="205" DisableNVelocity="true" />Eye injuries are one of the most feared injuries for children and their families. Over 40,000 eye injuries occur each year in the U.S. while playing sports and other activities. While most eye injuries are minor and get better quickly, in some cases an eye injury can be severe and even cause blindness.  Following proper safety steps can prevent an estimated 90% of eye injuries.  Here are some answers to common eye health questions and concerns that I hear from children and their families: Do some sports pose a higher risk for eye injuries? Sports at higher risk of eye injuries include those that involve a ball, puck, stick, bat or racquet, and contact and combat sports, such as boxing and martial arts. Sports at lower risk for eye injuries include cross-country, track and field, cycling, swimming, dance and gymnastics.  Follow your sport's required safety goggles or face protection protocols when participating in these high-risk sports, even if it is simply practicing. For sports at higher risk for eye injuries, it is recommended to wear 3-millimeter polycarbonate lenses.  What can parents do to prevent eye injuries in their children? <ul> <li>Avoid playing with projectile toys such as darts, bows and arrows, or other toys that launch projectiles. Parents should closely supervise children and teenagers if they use these items. </li> <li>Children and teenagers should only use firearms if they have received appropriate firearm safety training. Even seemingly minor guns, like BB guns and paintball guns, can severely damage the eyes. </li> <li>Keep children away from lawnmowers and edge trimmers. If they are old enough to use these tools, they should wear safety goggles. </li> <li>Keep all chemicals and sprays out of reach of small children. </li> <li>Cover any sharp corners of household furnishings with padding. </li> <li>Keep children far away from fireworks, especially projectile fireworks.</li> <li>Teach children how to safely use some common household objects, such as rubber bands, writing utensils, paper clips and scissors. </li> <li>When spending time outdoors, wear sunglasses that provide 99%–100% UVA and UVB protection. </li> </ul> Are computers or other screens bad for a child's eyes? Screens are generally safe for the eyes.  Keep eyes healthy and safe while looking at screens by following these tips: <ul> <li>Do not have the screen too close to your eyes. Keep it at about an arm's length away. </li> <li>The top of the screen should be at approximately eye level. </li> <li>Reduce excessive surrounding lighting, as that can add additional glare to the screen.</li> <li>Limit screen time to two hours per day or less.</li> <li>Follow the 20-20 rule. For every 20 minutes of screen time, you should take at least a 20-second break where you look away form the screen at something off in the distance. </li> <li>Avoid screens at least one to two hours before bedtime. The artificial light can suppress the brain's ability to secrete its own melatonin, and this can negatively affect your child's sleep. </li> </ul> Can eye makeup harm my child's eyes? If applied correctly, eye makeup can be safely used.  Consider these safety tips for eye makeup: <ul> <li>Choose unscented products. </li> <li>Do not apply cream or powder too close to the eyes. </li> <li>If using eyeliner do not apply it to the inner edge of the eyelids.</li> <li>Avoid glittery eye makeup, as it could scratch the eyes. </li> <li>To reduce the risk of infection, wash eye makeup brushes often. </li> <li>Do not share makeup or makeup tools with others. </li> <li>Avoid eye makeup if your eyes have any redness, swelling, drainage or rash. </li> <li>If you wear contact lenses and want to wear eye makeup, make sure you apply eye makeup after inserting contact lenses. </li> </ul> When should you reach out to your primary care provider for eye concerns? <ul> <li>Any injury to the eye or skin around the eye. </li> <li>Excessive tearing.</li> <li>Redness or swelling.</li> <li>Discharge.</li> <li>Eye pain.</li> <li>Changes in vision. </li> </ul> What should parents do for a child's eye if the child has not yet been seen by a health care professional? <ul> <li>Do not rub the eye. </li> <li>Do not apply pressure to the eye.</li> <li>Do not touch the eye and do not try to remove any object stuck in the eye. Your child may blink to have tears naturally flush out small particles. </li> <li>Gently cover cuts or other wounds. </li> <li>Do not apply ointments or medications to the eye. </li> <li>Flush the eye with room-temperature tap water for 15 minutes in the event of chemical exposure. </li> </ul> When should you go to the Emergency Department? <ul> <li>You experience vision loss.</li> <li>Chemicals have been splashed in the eye. </li> <li>Something feels stuck in the eye. </li> <li>You experience severe eye pain. </li> <li>You have a cut on your eye or eyelid.</li> <li>You experience nausea, vomiting or headache after an eye injury.</li> <li>You have blood in the eye or pus draining from the eye. </li> <li>Your eye is swollen shut after facial trauma. </li> <li>One pupil — the black dot in the center of the colored part of your eye — is differently shaped or a different size than the other pupil. </li> </ul> When can I return to sports after my eye injury? You should not return to your sport until your clinician has cleared you to play. Do not use topical or oral pain medications to play through eye pain. Strongly consider wearing proper eye protection when you return to sports, even if it is not required.  <a href="https://communityhealth.mayoclinic.org/providers/luke-radel-md/">Luke Radel, M.D.</a>, is a physician in Primary Care in Rochester and Kasson's Division of Community Pediatric and Adolescent Medicine. He is board-certified in pediatrics and sports medicine. Dr. Radel volunteers as the team physician for the John Marshall High School football team. He was named pediatric sports medicine "Top Doctor" in Minnesota Monthly in 2020 and 2021. He has experience treating youth, collegiate and professional athletes. Luke Radel, M.D.Primary Care in Rochester and KassonEye Health SafetyPrimary Care in Rochester and KassonIntermittent fasting can be dangerous if taken too far. Talk to your health care team before starting this trend.<img src="/-/media/ech-media/images/widgets/food/intermittentfasting.jpg?h=65&iar=0&w=100&sc_lang=en&hash=A3009F527580B9FA38D57C0FD9660E45" alt="IntermittentFasting" width="100" height="65" DisableNVelocity="true" />Intermittent fasting: Fad or valid weight-loss solution?10/31/2022 4:30 AM<img src="/-/media/ech-media/images/widgets/food/intermittentfasting.jpg?h=205&iar=0&w=315&sc_lang=en&hash=732A205665EC2152EF1FF973C5C4AE75" alt="IntermittentFasting" width="315" height="205" DisableNVelocity="true" />Is skipping meals a bad idea or a secret weight-loss weapon? One diet trend that shows no sign of going away soon is intermittent fasting. That's when you voluntarily abstain from food or beverages other than water for a certain amount of time. Some fasting is for religious reasons, while others fast for weight loss. But is intermittent fasting a healthy way to lose weight? The three popular approaches to intermittent fasting are: <ul> <li>Alternate-day fasting Eat a normal, healthy diet one day and then completely fast or have one small meal the next day. Usually, the small meal is fewer than 500 calories.</li> <li>5-2 fasting Eat a normal diet five days a week and fast two days per week.</li> <li>Daily time-restricted fasting Eat normally but only within an eight-hour window each day. For example, skip breakfast, but eat lunch around 11 a.m. and dinner by 7 p.m.</li> </ul> Benefits of intermittent fasting Can intermittent fasting improve your health? Recent research has found that using intermittent fasting for weight loss may have some benefits in the short term. Fasting for a brief time can produce ketosis, which is a process that occurs when the body doesn't have enough glucose for energy, so it breaks down stored fat instead. This causes an increase in substances called ketones. This, coupled with fewer calories consumed overall, can lead to weight loss. Research suggests that alternate-day fasting is about as effective as a typical low-calorie diet for weight loss. Fasting also affects metabolic processes in the body that may work to decrease inflammation, as well as improve blood sugar regulation and physical stress response. Some research shows this may improve conditions associated with inflammation like arthritis, asthma and multiple sclerosis. Little long-term research has been conducted on intermittent fasting to examine how it affects people over time. As a result, long-term health benefits or risks are unknown. Side effects of intermittent fasting Intermittent fasting can have unpleasant side effects. They could include hunger, fatigue, insomnia, irritability, decreased concentration, nausea, constipation and headaches. Most side effects go away within a month. Sticking with an intermittent fasting routine can be easier for some people rather than trying to watch calories every day. Other people, especially those with busy or variable schedules, have more difficulty maintaining an intermittent fasting routine. Is intermittent fasting right for you? Intermittent fasting is safe for many people, but it's not for everyone. Skipping meals is not recommended for people under 18, those with a history of disordered eating, or those who are pregnant or breastfeeding. Athletes may find it difficult to fuel and refuel appropriately for an active lifestyle. If you have diabetes or other medical issues, talk with your health care team before starting intermittent fasting. Also, note that the key to weight loss with intermittent fasting is not to overeat during your eating windows. Eating fewer calories than you expend remains the basis for losing weight. Shortening the eating window may make it difficult to get the vitamins and minerals you need. While on this diet, it is important to eat meals made from quality, healthy ingredients, such as fruits, vegetables, whole grains, low-fat dairy and lean protein. Intermittent fasting can be dangerous if taken too far. A technique called dry fasting restricts food and fluid intake, resulting in severe dehydration and posing serious health concerns. Malnutrition can occur if the caloric restriction is too severe, such as averaging fewer than 1,200 calories per day long term. Romi Londre, R.D.N., is a dietitian in Clinical Dietetics in La Crosse, Wisconsin.Romi Londre, R.D.N.Primary Care in Rochester and KassonIntermittent FastingPrimary Care in Rochester and KassonIf the teen in your life identifies as LGBTQ and shares that information, lending an ear is an important first step.&nbsp;<img src="/-/media/ech-media/images/widgets/teens/stressedteen.jpg?h=65&iar=0&w=100&sc_lang=en&hash=6DA5EF25A31A65D7782FC711C06CB316" alt="StressedTeen" width="100" height="65" DisableNVelocity="true" />Supporting teens who identify as LGBTQ10/27/2022 4:30 AM<img src="/-/media/ech-media/images/widgets/teens/stressedteen.jpg?h=205&iar=0&w=315&sc_lang=en&hash=824E93DAF28CA43E1A47F35C0C536381" alt="StressedTeen" width="315" height="205" DisableNVelocity="true" />It's not uncommon for teens to experience <a rel="noopener noreferrer" rel="noopener noreferrer" href="https://www.mayoclinic.org/diseases-conditions/teen-depression/symptoms-causes/syc-20350985" target="_blank" title="Opens in a new window.">mental health</a> issues like anxiety. It's believed that 1 in 5 young people experiences some type of mental health issue during the teen years. For LGBTQ youth, the statistics are alarming. A recent <a rel="noopener noreferrer" rel="noopener noreferrer" href="https://www.thetrevorproject.org/survey-2022/" target="_blank" title="Opens in a new window.">national survey</a> showed 45% expressed serious <a rel="noopener noreferrer" rel="noopener noreferrer" href="https://www.mayoclinic.org/healthy-lifestyle/tween-and-teen-health/in-depth/teen-suicide/art-20044308" target="_blank" title="Opens in a new window.">suicidal ideation</a>. These teens need support. If the teen in your life identifies as LGBTQ and decides to share that information, lending an ear is an important first step. Supporting children is critical. LGBTQ youth with high levels of support from family had less than half the rate of <a href="https://www.mayoclinichealthsystem.org/hometown-health/speaking-of-health/suicide-isnt-about-dying-its-about-perceived-relief" target="_self" title="Opens in same window.">suicide</a> attempts, compared to youth who felt low to moderate support, according to the survey. Even if it's something that you're not sure of what to do, just be that listening ear, extending your love and support. Don't worry about getting it perfect. And you don't have to do it alone. Mayo has a lot of avenues into different resources, including mental health care professionals and medical professionals — whatever the needs are for that population of kids. Read more about how to help children: <ul> <li><a rel="noopener noreferrer" rel="noopener noreferrer" href="https://www.mayoclinichealthsystem.org/hometown-health/speaking-of-health/5-ways-to-help-teens-overcome-suicidal-thoughts" target="_blank">"5 ways to help teens overcome suicidal thoughts</a>."</li> <li><a rel="noopener noreferrer" rel="noopener noreferrer" href="https://www.mayoclinichealthsystem.org/hometown-health/speaking-of-health/social-media-risks-tips-to-keep-your-children-safe" target="_blank">"Social media risks: Tips to keep your children safe</a>."</li> <li><a rel="noopener noreferrer" rel="noopener noreferrer" href="javascript:return false" target="_blank">"5 things you need to know about mental health and girls</a>."</li> </ul> <a href="https://communityhealth.mayoclinic.org/providers/marcie-billings-md/">Marcie Billings, M.D.</a>, is chair of the Division of Community Pediatric and Adolescent Medicine in Rochester, Minn., and a pediatrician with Primary Care in Rochester and Kasson. Her special areas of practice are adolescent medicine and eating disorders. Marcie Billings, M.D.Primary Care in Rochester and KassonLGBTQ TeensPrimary Care in Rochester and KassonPracticing yoga increases flexibility and range of motion.&nbsp;<img src="/-/media/ech-media/images/widgets/activities/yoga.jpg?h=65&iar=0&w=100&sc_lang=en&hash=2162410B594AF33AFEAE0BDB805E01DA" alt="Yoga" width="100" height="65" DisableNVelocity="true" />I can't do yoga; I'm not flexible10/17/2022 4:30 AM<img src="/-/media/ech-media/images/widgets/activities/yoga.jpg?h=205&iar=0&w=315&sc_lang=en&hash=8DE9378792E5A92033535ABF4A8DFF3E" alt="Yoga" width="315" height="205" DisableNVelocity="true" />Many people state they can't do yoga because they're not flexible. But they're missing the point. One of the reasons to practice yoga is to gain flexibility. The roots of yoga data back thousands of years. However, the practice has evolved over the years to become what it is today. Although a lot has changed, the essence of the practice is still preserved.  Anyone can practice yoga. There is a spectrum of practice ranging from seated meditation to breathing, to Pranayama, to being able to advance your practice to more difficult postures.  Yoga is the ancient practice of connecting the mind and body. It is a discipline based on a moral code. Practicing the physical side of yoga is one aspect and is what you see taught in gyms and studios. Treat your body as a vessel for your soul and respect it for improved physical and mental health. Serving yourself to be able to serve others. If you are out of shape, it can be challenging to take care of yourself and others.  If practiced regularly, yoga can offer these benefits:  <ul> <li>Increased flexibility and range of motion. </li> <li>Strength and length of muscles. </li> <li>Joint stability.</li> <li>Reduced anxiety. </li> <li>Increased lung capacity. </li> <li>Improved balance. </li> <li>All of the benefits of weight loss. </li> </ul> When you wake up is always a good time to practice. The evening is also good, as you're more flexible at the end of the day and you may have more of a sense of achievement.  You can practice yoga in the comfort of your own home with just a yoga mat, or you can sign up for a yoga class. The great thing about yoga is that you do not need equipment, so you can practice anywhere, even at your computer desk.  As always, consult with your health care clinician before starting any physical activity.  Try it. You just might like it.  Kay Kushwaha is a group fitness instructor at the Dan Abraham Healthy Living Center in Rochester, Minnesota. She teaches yoga basics and yoga combining Hatha and Vinyasa styles. Kay KushwahaPrimary Care in Rochester and KassonYogaPrimary Care in Rochester and KassonThe guidelines have been updated to include recommendations across the lifespan.&nbsp;<img src="/-/media/ech-media/images/widgets/people/multigenerationalfamilyeating.jpg?h=65&iar=0&w=100&sc_lang=en&hash=66BFF3E41110F9679B39639FE98E86E9" alt="MultigenerationalFamilyEating" width="100" height="65" DisableNVelocity="true" />New Dietary Guidelines for Americans11/14/2022 4:00 AM<img src="/-/media/ech-media/images/widgets/people/multigenerationalfamilyeating.jpg?h=205&iar=0&w=315&sc_lang=en&hash=F3B73E172CE84A17C88A980383DE85A3" alt="MultigenerationalFamilyEating" width="315" height="205" DisableNVelocity="true" />The <a rel="noopener noreferrer" rel="noopener noreferrer" href="https://www.dietaryguidelines.gov/" target="_blank">Dietary Guidelines for Americans</a> have been updated to include, for the first time, recommendations across the lifespan.  <a rel="noopener noreferrer" rel="noopener noreferrer" href="https://www.mayoclinic.org/biographies/hensrud-donald-d-m-d-m-s/bio-20053543" target="_blank">Dr. Donald Hensrud</a><a href="https://www.mayoclinic.org/biographies/hensrud-donald-d-m-d-m-s/bio-20053543">,</a> Executive and Development Health, says the dietary guidelines, which are updated every five years, are designed to give the best recommendations on what to eat and drink to promote health and prevent disease. One of the changes for this edition of the guidelines is focused on a lifespan approach from infancy to older adulthood. "We've known for quite some time that for the first six months of an infant's life, they should be fed exclusively human <a rel="noopener noreferrer" rel="noopener noreferrer" href="https://www.mayoclinic.org/healthy-lifestyle/infant-and-toddler-health/in-depth/breast-feeding/art-20047898?mc_id=us&utm_source=newsnetwork&utm_medium=l&utm_content=content&utm_campaign=mayoclinic&geo=national&placementsite=enterprise&cauid=100721" target="_blank">breast milk</a>," says Dr. Hensrud. "Another addition that people may not be aware of is that when foods are introduced to an infant around the age of 4 to 6 months, <a rel="noopener noreferrer" rel="noopener noreferrer" href="https://newsnetwork.mayoclinic.org/discussion/mayo-clinic-minute-peanut-allergy-prevention/?mc_id=us&utm_source=newsnetwork&utm_medium=l&utm_content=content&utm_campaign=mayoclinic&geo=national&placementsite=enterprise&cauid=100721" target="_blank">peanut-containing foods</a> can be added to the diet after checking with the infant’s health care provider. The evidence shows that by adding peanuts early in the diet, it may prevent allergies later on. Also, under the age of 2 years, no added sugars should be included in the diet of children. Added sugars do not provide any health benefit.  <iframe width="560" height="315" src="https://www.youtube.com/embed/apDOqMtKlbg" title="YouTube video player" frameborder="0" allow="accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture"></iframe> Key recommendations from the guidelines include: <ul style="list-style-type: disc;"> <li>For about the first 6 months of life, exclusively feed infants human milk. </li> <li>At about 6 months, introduce infants to nutrient-dense complementary foods. Introduce infants to potentially allergenic foods along with other complementary foods. </li> <li>From 12 months through older adulthood, follow a healthy dietary pattern across the lifespan to meet nutrient needs, help achieve a healthy body weight and reduce the risk of chronic disease.</li> <li>Limit foods and beverages higher in added sugars, saturated fat and sodium, and limit alcoholic beverages.</li> </ul> Dr. Hensrud says that before the guidelines are released, a scientific report on dietary guidelines is published. The dietary guidelines are then derived from this scientific report. "What many people who work in nutrition would have liked to have seen is a lower limit for added sugars and alcohol. This was included in the scientific report, but did not end up in the Dietary Guidelines," says Dr. Hensrud. "For example, the dietary guidelines recommend no more than 10% of calories as added sugars. But the scientific report recommended no more than 6%," he says. "Similarly, previous guidelines recommended up to no more than an average of two drinks per day for men. The scientific report recommended lowering this to one drink a day on average for both men and women. The Dietary Guidelines still recommend up to two drinks a day for men." Dr. Hensrud says the less added sugars in your diet, the better it will be. "We know that there is very little health benefit and many health risks from including too much added sugars in the diet. Sugars that are naturally present, such as in fruit, are fine to have in the diet."Primary Care in Rochester and KassonDietary GuidelinesPrimary Care in Rochester and KassonFind out about the common causes and recommended treatment.&nbsp;<img src="/-/media/ech-media/images/widgets/people/hippain.jpg?h=65&iar=0&w=100&sc_lang=en&hash=6A54A3F5C00E689584CAFF1EC72ED6F4" alt="HipPain" width="100" height="65" DisableNVelocity="true" />My hip hurts — What do I do?11/28/2022 4:00 AM<img src="/-/media/ech-media/images/widgets/people/hippain.jpg?h=205&iar=0&w=315&sc_lang=en&hash=361570C13FC515E92DEAAB76B5FF5715" alt="HipPain" width="315" height="205" DisableNVelocity="true" />Hip pain is a common complaint. It can be caused by problems involving the hip joint, the soft tissues around the joint, the pelvic joints or the back. Two common causes of pain are arthritis of the hip joint and bursitis, or inflammation of the jellylike cushion between the bones and the soft tissues of the hip. This is known as trochanteric bursitis. But how do you know what is causing your hip pain? Do you need to be seen by a health care professional? What can you do to treat the pain? The first step in finding the cause is to pay attention to your symptoms. Where do you feel the pain? What makes it worse — or better? Bursitis The main symptom of trochanteric bursitis is pain over the point of the hip, on the outside of the leg, which can extend down the outside of the thigh. At first, it may involve only a small area of the hip, be sharp and intense, but with time may spread and feel achier. Another thing you might notice is that lying on the hip at night makes it worse, causing you to roll over to ease the pain. Other things that can make it worse are squatting, stair-climbing and prolonged walking. It is more common in women, especially as they get older. Risk factors for developing bursitis include spine problems, injuries to the hip, differences in leg lengths, history of hip surgery and repeated stress to the hip joint that is related to activities. A physical examination often is sufficient for the diagnosis, although in certain situations, additional testing may be recommended. So if you think you have bursitis, what do you do? Avoid activities that cause or aggravate the pain. Application of a cold pack to the area can provide pain relief. Nonsteroidal anti-inflammatory drugs, commonly referred to as NSAIDs, can help with pain. Be sure to check with your clinician to see if it's safe for you to take these, especially if you have chronic medical conditions or take prescription medications. Try walking with a cane for a week or two on the side where you don't have pain. Exercise by focusing on stretching, strengthening and improving the flexibility of the hip muscles. If these things don't help, cortisone shots may be recommended. Surgery is rarely needed to treat this cause of hip pain. Arthritis Other pain that comes from the hip joint is most commonly related to arthritis. This occurs as a result of the loss of the cartilage that protects the space between the bone surfaces. These changes develop slowly. The pain comes on gradually and worsens with time. Unlike bursitis, stiffness is a common complaint along with the pain and loss of the ability to put on a sock, tie a shoe or do other activities that require bending at the hip joint. The stiffness may be worse in the morning or after sitting or resting. The pain differs because it often is felt in the groin rather than over the point of the hip and radiates to the knee or buttock. Occasionally, the hip may seem to lock or stick with a normal activity. The pain worsens with activity but is not affected by lying on the side of the painful hip. Risk factors for pain from arthritis include age, history of hip injury, excessive weight, a family history of hip arthritis and changes in the formation of the hip joint at birth. Like bursitis, a physical examination can be helpful in determining that arthritis is the cause of hip pain. An X-ray is often helpful to determine the extent of the arthritis. Treatment of hip pain due to arthritis is remarkably similar to bursitis and involves avoiding activities that aggravate the pain, exercises, using a cane and nonprescription medications, such as NSAIDs. Additional recommended treatments include the use of acetaminophen and weight loss, when appropriate. Cortisone injections into the hip joint can provide temporary relief. When hip arthritis results in uncontrolled pain or interferes with the ability to do normal activities, it is appropriate to consider hip replacement. <a href="http://communityhealth.mayoclinic.org/providers/denise-dupras-md">Denise Dupras, M.D., Ph.D.</a>, is a general internist in Community Internal Medicine, Geriatrics and Palliative Care at Mayo Clinic in Rochester. She completed her medical and doctoral degrees at Mayo Clinic Alix School of Medicine and her residency in internal medicine at Mayo Clinic in Rochester. Her interests include medical education, evidence-based medicine and care of LGBTQIA+ patients.Denise Dupras, M.D., Ph.D.Primary Care in Rochester and KassonHip PainPrimary Care in Rochester and KassonThe most effective way to prevent lung cancer is to stop smoking.&nbsp;<img src="/-/media/ech-media/images/widgets/randomimages/ech_smoking_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=F81C2F5C10F3581A4A5B28C907569E8F" alt="ECH_smoking_widget" width="100" height="65" DisableNVelocity="true" />Lung cancer awareness11/10/2022 4:30 AM<img src="/-/media/ech-media/images/widgets/randomimages/ech_smoking_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=98A6179A7F55406885E834734EB64A03" alt="ECH_smoking_widget" width="300" height="195" DisableNVelocity="true" />Each year in the United States, over 220,000 new cases of lung cancer are diagnosed and 140,000 people die from it. Lung cancer is the leading killer of both men and women. Lung cancer takes more lives than breast, colon and prostate cancer combined. Cigarette smoking is the leading cause of lung cancer and is associated with over 90% of all lung cancers. Despite advances in treatment, only 15% of all patients diagnosed with lung cancer will survive five years. The most effective way to prevent lung cancer is to stop smoking. Quitting smoking is difficult but made easier using a combination of medication and behavioral strategies. Medications that have been shown to be effective for smoking cessation are nicotine replacement therapy like nicotine patches, gum, lozenges, nasal spray or inhaler; bupropion and varenicline. The nicotine gum, lozenge and patch are available over the counter. The nicotine nasal spray, nicotine inhaler, bupropion and varenicline need to have a written prescription. Behavioral strategies that help people quit smoking include: <ul> <li>Picking a quit date.</li> <li>Engaging significant others and family members in support around the quit attempt.</li> <li>Removing all tobacco products from your environment. </li> <li>Understanding cues and triggers and developing strategies to address them. </li> </ul> Resources and tools to help you quit are available on the internet such as <a rel="noopener noreferrer" rel="noopener noreferrer" href="https://smokefree.gov/" target="_blank">smokefree.gov</a>. Ask your clinician about medication and additional counseling that can be obtained through our <a rel="noopener noreferrer" rel="noopener noreferrer" href="https://www.mayoclinic.org/departments-centers/nicotine-dependence-center/minnesota/overview" target="_blank">Nicotine Dependence Center</a>. If you smoke, lung cancer screening with low dose computed tomography (CT) can reduce your risk of dying from lung cancer. Ask your doctor about lung cancer screening. <a href="https://communityhealth.mayoclinic.org/providers/jon-ebbert-md/">Jon Ebbert, M.D.</a>, is a physician in Primary Care in Rochester and Kasson's Division of Community Internal Medicine. He is the medical director of <a rel="noopener noreferrer" href="https://intranet.mayo.edu/charlie/nicotine-dependence-center-rst/" target="_blank">Mayo Clinic's Nicotine Dependence Center</a> and chair of Community Internal Medicine's Division of Telehealth where he provides virtual visit care across Southeast Minnesota. Jon Ebbert, M.D.Primary Care in Rochester and KassonLung Cancer AwarenessPrimary Care in Rochester and KassonLiving with dementia is difficult and sometimes moving to memory care is necessary.&nbsp;<img src="/-/media/ech-media/images/widgets/elderly/ech_caregiver_stress_01_widget.jpg?h=65&iar=0&w=100&hash=5EA68E0BDAB984B76E1564A96472EF8C" alt="ECH_Caregiver_Stress_01_widget" width="100" height="65" DisableNVelocity="true" />Making the move to memory care11/17/2022 4:30 AM<img src="/-/media/ech-media/images/widgets/elderly/ech_caregiver_stress_01_widget.jpg?h=195&iar=0&w=300&hash=8B5430B510532665498CB9AC2463DEFE" alt="ECH_Caregiver_Stress_01_widget" width="300" height="195" DisableNVelocity="true" />Caring or a loved one with dementia can be physically and emotionally challenging. Many people want to stay in their home for as long as possible. Yet, living at home until the very end is not always feasible. When do you know if your loved one needs more care than you can provide?  As a nurse practitioner in both our nursing home and home-based care programs, I have journeyed with many families in this transition. Oftentimes, your loved one requires more physical care than you or your family can manage. They may need help getting to and from the bathroom. Your back may start to hurt at the end of the day from helping them bathe. We always worry when one elderly spouse is caring for another elderly spouse. When caring for your loved one puts you or your family at physical harm, seeking care elsewhere is appropriate.  For patients with dementia, oftentimes they begin to have emotional needs that are hard for loved ones to manage. They may begin wandering and leaving the home, which puts them at a high safety risk. They may start having verbal outbursts or yelling for no reason. These are not uncommon as dementia worsens. If you find yourself losing sleep, not eating well or your health worsens, it may be time to seek care for your loved one as a way to care for yourself.  There are many options for care in our community. Many assisted living facilities have attached memory care units. These units are usually locked. This means they have alarms in case your loved one tries to leave. Don't worry though. It's against fire code for them to be locked. All the doors can open, but they have passcodes to prevent the alarms from ringing.  Memory care units also have nursing assistants to provide bathing and dressing support to your loved one. Nursing staff will manage medications and monitor your loved one. They can still leave the unit for medical appointments or to visit family. You, as family, are always welcome to visit them.  Adult foster homes, or group homes, are another living idea in our town. These are residential homes that are modified to have 4 or 5 residents living in them. It has more of a family environment. Medications and basic needs are provided by staff, often the family who live at the home. They are a great alternative to assisted living/memory care.  Lastly, please know that any adjustment to a new living environment is difficult. People with dementia require extra time to adjust to change. It may take 2 weeks or 2 months for them to settle into their new "home." Having familiar objects around is helpful. Sometimes your presence is helpful, and sometimes it is not. Often, your loved one will want to leave when you leave. That is hard on you both. Don't take it personally. In time, the move gets easier on everyone. Your safety and the safety of your loved one is important.  <a href="https://communityhealth.mayoclinic.org/providers/natalie-mohammad-cnp/">Natalie Mohammad, APRN, C.N.P.</a>, is a nurse practitioner in Community Internal Medicine, Geriatrics and Palliative Care in Rochester, Minnesota. She cares for the elderly in our community, both in the Homebound and Skilled Nursing Facility practices. Natalie Mohammad, APRN, C.N.P.Primary Care in Rochester and KassonMemory CarePrimary Care in Rochester and KassonEach child is different, but these general age guidelines may help your decision.&nbsp;<img src="/-/media/ech-media/images/widgets/kids/boredkid.jpg?h=65&iar=0&w=100&sc_lang=en&hash=C9F8FC5FB0574A37604EAC3ADDE53BA8" alt="BoredKid" width="100" height="65" DisableNVelocity="true" />Is your child ready to stay home alone?11/3/2022 4:30 AM<img src="/-/media/ech-media/images/widgets/kids/boredkid.jpg?h=205&iar=0&w=315&sc_lang=en&hash=220E3C4A3C7BA6EC4252A22648C580F4" alt="BoredKid" width="315" height="205" DisableNVelocity="true" />With fall here and many children back in school, a common question I get in my pediatric practice is "when is my child old enough to stay home alone for a few hours after school?" This is not an easy question to answer. You have a lot to consider when evaluating your child's readiness to stay home alone.  Questions to ask include: <ul> <li>What is your child's age and maturity level?</li> <li>Does your child have any intellectual or psychological issues, mental health concerns or physical problems, such as an illness or a disability?</li> <li>How easily can you or an emergency contact be reached? Can your child reach emergency contacts by phone or in person when home alone? </li> </ul> Leaving children home alone involves some risk. The goal is to avoid situations that could put a child at risk physically or emotionally. Do whatever you can to lower these risks.  The ages shared here are general guidelines. To stay home alone, many children may need to be older than the ages in these guidelines. For some children, this decision depends on whether an adult will be nearby and whether the child will be caring for other children at home with them.  Here are general age guidelines to help you make your decision: <ul> <li>Under the age of 8 should never be left alone for any period of time. </li> <li>Ages 8 to 10 may be left alone for less than three hours, but should never be responsible for younger siblings. </li> <li>Ages 11 to 13 may be left alone for less than 12 hours. Often, children of this age should start with 2–3 hours and build up to longer periods of time based on their comfort and individual needs. </li> <li>Ages 14 to 15 may be left alone for less than 24 hours. </li> <li>Ages 16 to 17 may be left alone for a longer time if there is a plan in place about how to respond to an emergency. </li> </ul> It's a big responsibility for a child to stay home alone. With the appropriate preparation and thoughtful consideration, it can be a successful experience for your child. Do not hesitate to reach out to your child's primary care team for additional guidance, advice on how to prepare your child and recommendations surrounding this decision.  <a href="https://communityhealth.mayoclinic.org/providers/renee-breland-aprncnpms/">Renee Breland, APRN, C.N.P., M.S.</a>, is a certified pediatric nurse practitioner in Primary Care in Rochester and Kasson's Integrated Community Specialty Pediatric Attention-Deficit/Hyperactivity Disorder Clinic and a Community Pediatric and Adolescent general pediatric practitioner at Mayo Family Clinic Northeast in Rochester, Minn. Renee Breland, APRN, C.N.P., M.S.Primary Care in Rochester and KassonStaying Home AlonePrimary Care in Rochester and KassonWhen is it serious, and when should you see your clinician?<img src="/-/media/ech-media/images/widgets/people/ech_chronicpaingroup_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=97AA1F6517C647EC3262779A2EA9910A" alt="ECH_ChronicPainGroup_widget" width="100" height="65" DisableNVelocity="true" />My back hurts: Now what?12/1/2022 4:30 AM<img src="/-/media/ech-media/images/widgets/people/ech_chronicpaingroup_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=CAF44B59C5B4A4F3C28725495364E12A" alt="ECH_ChronicPainGroup_widget" width="300" height="195" DisableNVelocity="true" />If your back hurts, you're not alone. Back pain is one of the most common complaints and reasons patients seek medical attention. It's estimated that 80% of adults have back pain at some point in their lives. At any one time, up to 40% may be experiencing pain. But when is it serious, and when should you see a doctor?  Acute back pain Acute back pain lasts less than four weeks. There are many causes, which include:  <ul> <li>Sprains and strains, which are the most common cause. </li> <li>Degeneration of the discs between the bones of the spine or vertebra. </li> <li>Herniated or ruptured discs that can cause pain, as well as compress spinal nerves, leading to pain going into your legs, sometimes called sciatica. </li> <li>Spinal stenosis, or narrowing of the channel for the spinal cord. </li> <li>Irregularities of the spine, including scoliosis, or a sideways curve of the spine, and spondylolisthesis, which is overlapping of the vertebra. </li> </ul> When to seek medical attention While most acute back pain goes away, sometimes it's due to a serious condition. In these cases, you should seek medical attention. Signs or symptoms associated with the sudden onset of back pain that indicate something serious might be going on include: <ul> <li>Fever. </li> <li>Inability to control your bowel or bladder. </li> <li>Loss of strength or sensation in your legs. </li> <li>Daily use of prednisone. </li> <li>History of cancer, spine infection, osteoporosis or aortic aneurysm. </li> </ul> What to expect at your appointment If you do seek medical attention, here's what you can expect at your appointment:  <ul> <li>Your clinician will ask you questions about your past medical health, medications, activities and your current symptoms. </li> <li>A physical examination will assess your muscle strength and nervous-system function. Depending on these findings, laboratory testing and imaging may be ordered. </li> <li>Not everyone who has back pain needs X-rays of their back, and very few people need other studies, such as a CT scan, MRI or electromyography (EMG), a diagnostic procedure to assess the health of muscles and the nerve cells that control them. </li> </ul> <a href="https://communityhealth.mayoclinic.org/providers/denise-dupras-md">Denise Dupras, M.D., Ph.D.</a>, is a physician in Community Internal Medicine, Geriatrics and Palliative Care at Mayo Clinic in Rochester. She earned her medical and doctoral degrees at Mayo Clinic Alix School of Medicine and completed her residency in internal medicine at Mayo Clinic in Rochester. Her interests include medical education, evidence-based medicine and care of LGBTQIA+ patients. Denise Dupras, M.D., Ph.D.Primary Care in Rochester and KassonBack Pain Now WhatPrimary Care in Rochester and Kasson3 tips for what you can do at home to reduce pain and discomfort.&nbsp;<img src="/-/media/ech-media/images/widgets/people/ech_opioid-questions_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=EBD61833063628995B5774ABFED0F786" alt="ECH_opioid questions_widget" width="100" height="65" DisableNVelocity="true" />My back hurts: What do I do?12/22/2022 4:30 AM<img src="/-/media/ech-media/images/widgets/people/ech_opioid-questions_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=547BC434DCAEC3683200269BED93E504" alt="ECH_opioid questions_widget" width="300" height="195" DisableNVelocity="true" />The main cause of acute low back pain is strain or sprain. Sprains or strains are brought on by doing something you haven't done in a while, like planting the garden, raking the lawn, cleaning the garage, moving furniture or repeatedly lifting that growing grandchild you haven't seen in a while.  So what can you do at home to decrease the pain and discomfort. The last article <a href="https://communityhealth.mayoclinic.org/featured-stories/back-pain-now-what">"My back hurts: Now what?"</a> talked about when you should seek medical attention, but most of us won't need an office visit to start on a plan toward getting better.  Here are three key things you can do: <ol> <li>Remain active. There's good evidence that bed rest makes things worse. Stretching your back muscles will help maintain flexibility. Resuming normal activities and avoiding things that worsen the pain will put you on the road to recovery. But this is not the time to start strengthening your back muscles with new exercises. </li> <li>Treat the area with heat or cold. While not supported by strong evidence, heat or cold can provide relief of pain and tightness. Never sleep with a heating pad. Never place ice directly on your skin, which can cause burns or frostbite. </li> <li>Take over-the-counter pain relievers. Acetaminophen, aspirin, ibuprofen, naproxen or other nonsteroidal anti-inflammatory drugs (NSAIDs) can provide pain relief. Try taking them regularly, three to four times a day, for the first couple of days, to see if the pain lessens. As with any medication, make sure they're safe for you and don't interfere with any medication you are on, such as warfarin. </li> </ol> If after two weeks you aren't any better, or you develop signs or symptoms suggesting something serious is going on, it's time to seek medical attention.  <a href="https://communityhealth.mayoclinic.org/providers/denise-dupras-md">Denise Dupras, M.D., Ph.D.</a>, is a physician in Community Internal Medicine, Geriatrics and Palliative Care at Mayo Clinic in Rochester. She earned her medical and doctoral degrees at Mayo Clinic Alix School of Medicine and completed her residency in internal medicine at Mayo Clinic in Rochester. Her interests include medical education, evidence-based medicine and care of LGBTQIA+ patients. Denise Dupras, M.D., Ph.D.Primary Care in Rochester and KassonBack Pain What To DoPrimary Care in Rochester and KassonFollow these tips for parenting kids with food allergies.&nbsp;<img src="/-/media/ech-media/images/widgets/randomimages/glutenfree.jpg?h=65&iar=0&w=100&sc_lang=en&hash=55322B938342459BD7A22F4A2E419578" alt="GlutenFree" width="100" height="65" DisableNVelocity="true" />Growing up without gluten12/19/2022 4:30 AM<img src="/-/media/ech-media/images/widgets/randomimages/glutenfree.jpg?h=205&iar=0&w=315&sc_lang=en&hash=16D36294F562753F288EBBCBE32B2883" alt="GlutenFree" width="315" height="205" DisableNVelocity="true" /> My daughter was recently diagnosed with celiac disease. Celiac disease is more than a food allergy. Eating gluten causes an auto immune reaction within the body. In children, malabsorption can impair growth. Going gluten-free is the only "cure" for the disease. Living with a celiac kid is not unlike having a child with food allergies. As a parent, you need to be mindful of what they're eating and what they may be exposed to in their environment. Common food allergies include peanut, soy, dairy, eggs or tree nuts, like almonds, cashews and walnuts. Food allergies in kids can be hard. But with the challenge comes some fun. Over the past few months, I've learned some tips on how to raise my celiac kid while navigating child care needs, birthday parties and family gatherings.  Do your research Despite a large family history of celiac, I did my reading on the topic even before she was diagnosed. I had suspected her symptoms were celiac-related. Find reputable websites, such as <a rel="noopener noreferrer" rel="noopener noreferrer" href="https://celiac.org/" target="_blank">Celiac Disease Foundation</a>, <a rel="noopener noreferrer" rel="noopener noreferrer" href="https://www.raisingourceliackids.org/" target="_blank">ROCK – Raising our Celiac Kids</a> and <a rel="noopener noreferrer" rel="noopener noreferrer" href="https://www.mayoclinic.org/diseases-conditions/celiac-disease/symptoms-causes/syc-20352220" target="_blank">Mayo Clinic</a>. Visit your local library. Grab a few cookbooks while you're there so you can "try it before you buy it." Doing my own research made me a better-informed parent and gave me ideas on how to share this with others. Ask questions Often after a diagnosis of celiac disease, you will meet with a dietitian. Come prepared with your questions. I had specific questions I wanted answered, like: "Can my child still play with Play-Doh (which contains wheat)?" or "Do food labels need to say gluten-free, or can I just read the ingredients list?" Your child's health care clinician is always available to offer information and be a resource for you. He or she may even arrange a specialty visit with a gastroenterologist. Share your knowledge with others Child care providers need to know about any food allergies or health conditions your child has. Our day care provides meals. I request a copy of our child care provider's weekly meal plan so I can bring gluten-free options. If your child care center does not provide meals, then bringing food from home — that you know is allergen free — is even better. It's also important to share this with extended family and the parents of your child's friends. It's important that they know of any food restrictions at holiday meals or playtime. I always have gluten-free goodies in my child's bag when we visit friends — consider gluten-free granola bars, fruit snacks, fresh fruit or crackers. For child care events, I have a stash of gluten-free cookies they can substitute <a href="https://communityhealth.mayoclinic.org/providers/natalie-mohammad-cnp/">for birthday treats brought by other children. I also bought frozen, gluten-free doughnuts to have on hand for when other kids bring doughnuts to share.  </a> <a href="https://communityhealth.mayoclinic.org/providers/natalie-mohammad-cnp/">Have FUN </a> <a href="https://communityhealth.mayoclinic.org/providers/natalie-mohammad-cnp/">Yes, it can be overwhelming after a diagnosis of celiac disease — or any food allergy. Your child will notice the energy you display. If you dread grocery shopping or fixing food, he or she will know. When my child was diagnosed with celiac disease, I considered it a challenge to find the best cinnamon bread recipe so she no longer cried over missing the cinnamon bread at day care. It has been a great excuse for us to bake together. We are gluten-free gals on a mission to recreate our favorite recipes — gluten-free. This </a><a href="https://communityhealth.mayoclinic.org/providers/natalie-mohammad-cnp/">Gluten-Free Peanut Butter KISS Cookie</a><a href="https://communityhealth.mayoclinic.org/providers/natalie-mohammad-cnp/"> recipe is one of our favorites. </a> <a href="https://communityhealth.mayoclinic.org/providers/natalie-mohammad-cnp/"> I want my child to feel as "normal" as possible despite her celiac diagnosis. We are having fun by baking gluten-free treats together, and being prepared at day care and family gatherings. Doing my own research to feel knowledgeable and empowered has helped our family live with this diagnosis. Read more about celiac disease on the </a><a href="https://communityhealth.mayoclinic.org/providers/natalie-mohammad-cnp/">Mayo Clinic website</a><a href="https://communityhealth.mayoclinic.org/providers/natalie-mohammad-cnp/">.  </a> <a href="https://communityhealth.mayoclinic.org/providers/natalie-mohammad-cnp/">Natalie Mohammad, APRN, C.N.P.</a>, is a nurse practitioner in Community Internal Medicine, Geriatrics and Palliative Care. She is on a mission to recreate gluten-free recipes of all her favorite foods. She has mastered gluten-free bread, cutout Christmas cookies and blueberry dessert. Natalie Mohammad, APRN, C.N.P.Primary Care in Rochester and KassonGluten IntolerancePrimary Care in Rochester and KassonThese tips can help keep the holidays memorable, safe and healthy.&nbsp;<img src="/-/media/ech-media/images/widgets/kids/ech_christmassafety_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=729A802176B01786B981349A27AEB0FE" alt="ECH_ChristmasSafety_widget" width="100" height="65" DisableNVelocity="true" />Keeping your family safe in the bustling holiday season12/5/2022 4:30 AM<img src="/-/media/ech-media/images/widgets/kids/ech_christmassafety_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=C439AFD2D46053D9B79F664DE1CDEB14" alt="ECH_ChristmasSafety_widget" width="300" height="195" DisableNVelocity="true" />The glitter, magic, gifts and celebrations of the holidays fill children with excitement and wonder. But the season also comes with risks.  Check out these tips to ensure your holidays are memorable, safe and healthy.  Trees and decorations <ul> <li>If you have a real holiday tree, be sure the stand is always filled with water, so it doesn't dry out and pose a fire hazard. Artificial trees should be made from fire-retardant material. Tree stands should rest flat on the ground. </li> <li>Closely monitor children when they are assisting with decorations, especially when handling lighting, ornaments and breakable objects. Any decorations small enough to fit through a toilet paper tube can obstruct a small child's airway. Keep these ornaments higher on the tree so they are out of the reach of small hands. </li> <li>Holly berries, poinsettias and mistletoe are poisonous when eaten. Keep them away from kids and pets. </li> </ul> Lights and candles <ul> <li>Buy decorative lights with the UL mark, which certifies they've been tested to meet safety requirements. </li> <li>Use power strips with built-in circuit breakers. Avoid putting too many plugs into one electrical outlet. </li> <li>Keep cords out of the way or behind furniture, and insert outlet covers into any unused outlets. </li> <li>Kids and fire don't mix. Don't leave them alone in a room with lighted candles, matches, lighters, traditional or gas fireplaces, or any other flame or heat source. </li> </ul> Food safety <ul> <li>Many holiday traditions include special treats, foods and gatherings for meals. When you are preparing food for others, remember to wash your hands frequently — both before and during food preparation — and thoroughly cook all raw meats and wash raw vegetables to reduce the risk of foodborne illness. </li> <li>For more holiday food safety recommendations, <a rel="noopener" href="https://www.healthychildren.org/English/healthy-living/nutrition/Pages/Holiday-Food-Safety-Tips.aspx" target="_blank">check out these tips</a> from the American Academy of Pediatrics. </li> </ul> Toys and games <ul> <li>Choose age-appropriate toys and games. Be aware of hazardous toys. For younger kids, watch out for strings, long handles and small parts that can be removed. For older kids, be sure the parental controls are enabled for internet-capable devices. </li> <li>Avoid projectiles, such as guns or darts. </li> <li>Batteries shaped like disks, also known as button batteries, are tempting to small children. Check that batteries can't be easily removed. If you're worried your child may have eaten a button battery, seek immediate medical attention. </li> </ul> Winter fun <ul> <li>Dress kids for the weather, making sure their hands, feet and heads are covered. Utilize layers for extra warmth. </li> <li>When exposed to cold, be wary of a tingling sensation or loss of sensation in an extremity. This might be an early sign of frostbite, which is also referred to as frostnip. At temperatures below zero, frostbite can occur in as little as five to 30 minutes, depending on weather conditions. </li> <li>Encourage children to wear the correct safety gear for sledding, skiing, snowboarding, ice skating and other outdoor activities. Parents need to wear safety gear, too. </li> <li>If traveling by car, don't buckle kids in while wearing winter coats. Instead, cover them with blankets and coats over the seat belt. </li> <li>Follow safe-sleep recommendations. For infants, use a crib with a tight-fitted sheet and avoid piling on blankets. Instead, layer their clothing and consider a sleep sack. For older children, avoid pajamas with strings, and be sure footie bottoms of a child's pajamas are nonskid. </li> </ul> Holidays, health and travel No one wants to get sick or end up in quarantine over the holidays. Keep the whole family healthy by following these tips: <ul> <li>Vaccinate all eligible family members for COVID-19. The primary COVID-19 vaccine series is now approved for all people beginning at 6 months old. Bivalent booster doses, to be given after the primary series, are now available for adults and children over 5. In addition to getting vaccinated for COVID-19, <a rel="noopener" href="https://youtu.be/PJW-0ci0Vbg" target="_blank">get vaccinated for flu</a>, too. </li> <li>Avoid unnecessary travel if you are sick. Be tested for COVID-19 if you become sick before necessary travel. When traveling, consider wearing a mask in public. Check out the Centers for Disease Control and Prevention for more tips specific to travel in the era of the COVID-19 pandemic. </li> <li>Follow medication schedules and routines. Children should take their medications as prescribed by their health care clinician unless your clinician recommends a medication holiday. </li> </ul> <a href="https://communityhealth.mayoclinic.org/providers/paige-partain-md">Paige Partain, M.D.</a>, is a pediatrician in the Division of Community Pediatric and Adolescent Medicine at Mayo Clinic in Rochester. She practices at Mayo Family Clinic Northeast. Her areas of interest include preventive medicine and pediatric behavioral health, including attention-deficit/hyperactivity disorder, depression, anxiety and eating disorders. Paige Partain, M.D.Primary Care in Rochester and KassonSafe HolidayPrimary Care in Rochester and KassonThese tips can help soothe and protect your skin.&nbsp;<img src="/-/media/ech-media/images/widgets/skin/ech_bodycream_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=950E9EBE5E79493B835FF7340D31E721" alt="ECH_BodyCream_widget" width="100" height="65" DisableNVelocity="true" />Protect your skin from the winter woes12/29/2022 4:30 AM<img src="/-/media/ech-media/images/widgets/skin/ech_bodycream_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=625E168091BFED3BD9BFE7C225A0850E" alt="ECH_BodyCream_widget" width="300" height="195" DisableNVelocity="true" />Winter's harsh winds, cold temperatures and dry air can take a toll on your skin. But these tips can help protect and soothe your skin from three winter woes.  Dry home heating The heat in your home is as dry as the Sahara. Not only does your skin feel dry and itchy, you also may experience a dry throat and stuffy nose. The solution is adding humidity into the air with a freestanding humidifier or an in-furnace humidifier.  Here's a guide for determining ideal indoor winter humidity:  <table style="width: 100%; border-collapse: collapse;"> <tbody> <tr> <td style="width: 25%;"></td> <td style="width: 25%; border-style: solid; border-color: #91c2fa; background-color: #91c2fa; text-align: center;">Outdoor Temperature is:</td> <td style="width: 25%; border-style: solid; border-color: #91c2fa; background-color: #91c2fa; text-align: center;">Humidity Should Not Exceed:</td> <td style="width: 25%;"></td> </tr> <tr> <td style="width: 25%;"></td> <td style="width: 25%; border-style: solid; border-color: #91c2fa; text-align: center;">20–39 degrees</td> <td style="width: 25%; border-style: solid; border-color: #91c2fa; text-align: center;">40%</td> <td style="width: 25%;"></td> </tr> <tr> <td style="width: 25%;"></td> <td style="width: 25%; border-style: solid; border-color: #91c2fa; text-align: center;">10–20 degrees</td> <td style="width: 25%; border-style: solid; border-color: #91c2fa; text-align: center;">35%</td> <td style="width: 25%;"></td> </tr> <tr> <td style="width: 25%;"></td> <td style="width: 25%; border-style: solid; border-color: #91c2fa; text-align: center;">Zero–9 degrees</td> <td style="width: 25%; border-style: solid; border-color: #91c2fa; text-align: center;">30%</td> <td style="width: 25%;"></td> </tr> <tr> <td style="width: 25%;"></td> <td style="width: 25%; border-style: solid; border-color: #91c2fa; text-align: center;">10 below Zero–1 below Zero</td> <td style="width: 25%; border-style: solid; border-color: #91c2fa; text-align: center;">25%</td> <td style="width: 25%;"></td> </tr> <tr> <td style="width: 25%;"></td> <td style="width: 25%; border-style: solid; border-color: #91c2fa; text-align: center;">20 below Zero–9 below Zero</td> <td style="width: 25%; border-style: solid; border-color: #91c2fa; text-align: center;">20%</td> <td style="width: 25%;"></td> </tr> </tbody> </table> Keep in mind that if you can't add humidity back into the air, you can add humidity back to your eyes and sinus passages by using over-the-counter saline mists, sprays, gels and drops as directed.  Hot showers and baths While a hot shower on a chilly morning or a long soak in a hot tub after shoveling can feel good, your skin pays a big price. Hot water sucks the moisture form your body, and some bubble baths and bath salts can make it worse.  To protect your skin, follow these tips: <ul> <li>Turn down the temperature. Use warm rather than hot water. </li> <li>Minimize the use of drying soaps, and wash only the "pits, cracks and folds" instead of lathering up your entire body. </li> <li>Follow the three-minute rule: Apply a cream- or oil-based moisturizer within three minutes of stepping out of the bath or shower. </li> </ul> Moisturizers protect rather than repair your skin, so you want to apply ones that create a barrier to hold in moisture. Choose those that are cream rather than a lotion, or are oil- or petroleum-based, such as baby oil or a petroleum-based gel. For your face, look for creams that don't clog pores.  Don't forget your hands and feet, which can crack, peel and bleed during the winter. Rub creams or petroleum-based gels into your heels, hands and fingers.  Cold sunshine Although winter sun doesn't warm much, it hasn't lost its power to burn exposed skin. Apply sunscreen with a sun protection factor, or SPF, of at least 15 before going outside. Pay close attention to your face, hands, bare or bald spots on your scalp, and the tips and backs of your ears. And don't forget about sunscreen for your lips and sun protection for your eyes. For winter sports, give your face added protection with a coating of petroleum-based gel.  If you have dry, itchy patches that may peel or bleed — even when applying moisturizer — and these patches persist for longer than two to four weeks, you should have them evaluated by a member of your care team to make sure there is not a more serious underlying skin condition requiring treatment.  Lynne Lillie, M.D., is a family medicine physician with primary Care in Rochester and Kasson. She has been a practicing physician for over 20 years. Lynne Lillie, M.D.Primary Care in Rochester and KassonWinter Skin CarePrimary Care in Rochester and KassonValerie Kimball followed the footsteps of the health care professionals who touched her life.&nbsp;<img src="/-/media/ech-media/images/widgets/blooddonation/kimballvalerieblooddonation.jpg?h=65&iar=0&w=100&sc_lang=en&hash=E8FE5FC0DD2DE1F23CB414DB6A8DE94C" alt="KimballValerieBloodDonation" width="100" height="65" DisableNVelocity="true" />Need for blood sparks career at Mayo Clinic1/5/2023 4:30 AM<img src="/-/media/ech-media/images/widgets/blooddonation/kimballvalerieblooddonation.jpg?h=205&iar=0&w=315&sc_lang=en&hash=73C62B62552819DECE587DB5453B1F01" alt="KimballValerieBloodDonation" width="315" height="205" DisableNVelocity="true" />After experiencing chronic pain in her knee, Valerie Kimball finally decided it was time to get things checked out by her family doctor. A few tests and X-rays revealed that she had a form of osteosarcoma, a diagnosis that came on her 16th birthday. Her family was distraught over her diagnosis, but Valerie remembers feeling "16 and invincible." Valerie's treatment plan required chemotherapy, numerous blood transfusions, as well as a knee and partial femur replacement. Although Valerie lives with minor complications, she has been in remission for more than 20 years. And her story has come full circle. She's now a nurse in Hematology at Mayo Clinic in Rochester, Minnesota, working with a team that gives blood transfusions to patients receiving chemotherapy. Valerie says this career path seemed like a natural fit, following in the footsteps of so many health care professionals who had touched her life. One of her fondest memories from her medical journey is of her favorite nurse who went above and beyond to put a smile on Valerie's face, including sneaking in soda with a licorice straw. Looking back, it was this nurse who sparked Valerie's interest in her chosen career. When asked what she might say to a blood donor, Valerie's answer is simple, "THANK YOU." She added that the patients she sees face so many challenges through their treatments. Having blood products on hand to administer is one less thing for her, as a nurse, to worry about. As a patient, she also extends her gratitude for those who contributed to her medical recovery. If you would like to donate blood to help patients in the community, like Valerie, call the Mayo Clinic Blood Donor Program at <a rel="noopener noreferrer" href="tel:5072844475" target="_blank">507-284-4475</a> or contact the program <a href="mailto:mailto:donateblood@mayo.edu">via email</a>. Scheduling an appointment to donate blood is easy and helps to ensure that blood is available for a loved one or other patients in need. Be sure to watch for incentives by visiting the <a rel="noopener noreferrer" rel="noopener noreferrer" href="https://connect.mayoclinic.org/page/blood-donor-program/" target="_blank">Blood Donor Program blog</a>, the <a rel="noopener noreferrer" rel="noopener noreferrer" href="http://www.mayoclinic.org/donateblood" target="_blank">Minnesota Blood Donor Program website</a> or <a rel="noopener noreferrer" rel="noopener noreferrer" href="https://www.facebook.com/blooddonorcentermc?ref=br_tf" target="_blank">Facebook</a> page. Mayo Clinic Blood Donor Centers: Hilton Building, First Floor Monday — Friday, 6 a.m. to 4:30 p.m. Open until 7 p.m. every second Thursday of the month Saint Marys Campus Joseph Building, Main Floor M-86 Monday — Friday, 8 a.m. to 3 p.m.Primary Care in Rochester and KassonBlood Donation KimballPrimary Care in Rochester and KassonFollow these tips to ensure your child is riding safely and securely in your vehicle.&nbsp;<img src="/-/media/ech-media/images/widgets/kids/installcarseat.jpg?h=65&iar=0&w=100&sc_lang=en&hash=D2B793E4CF113C8870770985699F8722" alt="InstallCarSeat" width="100" height="65" DisableNVelocity="true" />5 tips for installing car seats1/30/2023 4:30 AM<img src="/-/media/ech-media/images/widgets/kids/installcarseat.jpg?h=205&iar=0&w=315&sc_lang=en&hash=DD0868CF27EC8042D6B8187A6421D3E6" alt="InstallCarSeat" width="315" height="205" DisableNVelocity="true" />Installing your child's new car seat can seem hard — but it's easier than you think. Follow the tips below to help you feel confident that your child is riding safely and securely in your vehicle. Always follow the manufacturer's instructions The two most important resources for correctly installing a child's car seat are the car seat instructions and your vehicle's owner's manual. Before installing the car seat, be sure to review each of these to learn how to best protect your child from injury in the event of a crash. Be sure to have them available to refer to during the installation process. In your vehicle's owner's manual, look for the "car seat installation" section. Here you will find detailed instructions on car seat placement, securing the car seat with the seat belt system, locating the vehicle's Lower Anchors and Tethers for Children (LATCH) system, LATCH weight limits, air bag precautions and safely securing other passengers near the child safety seat. The car seat instruction manual will have detailed instructions on installing using the various methods allowed by your vehicle manufacturer, securing your child in the car seat correctly, car seat weight and height limits, and harness and LATCH system weight limits. You also will find instructions, such as car seat expiration, infant carrier handle positions for vehicle transport, adjusting for the correct angle, cleaning, how to adjust the harness, use of lock-offs and more. Obey state laws All states and territories in the U.S. have child passenger safety laws for infants and children. Many of these vary by state. Evidence shows that state laws do result in more children being buckled up. Follow best practices Research has shown that best practices produce the most effective results and highest standards of protection. And sometimes, these require more than the state law. The safest way to transport your child is based on: <ul style="margin-top: 0in; list-style-type: disc;"> <li>Manufacturer's instructions. </li> <li>Child's age, weight and height. </li> <li>Child's cognitive and physical developmental level.</li> </ul> Best practice recommendations include: <ul style="margin-top: 0in; list-style-type: disc;"> <li>Children under the age of 1 and under 20 pounds should always ride in rear-facing car seats. </li> <li>Children ages 1 to 3 should ride in rear-facing car seats as long as possible — and, until they reach the upper height or weight limits according to the car seat manufacturer's instructions. </li> <li>When a child reaches the age of 4, if they still fit properly in the car seat with a harness, they should keep using that car seat until they reach the seat's upper limit for height and weight. </li> <li>Children should ride in a booster seat until the adult lap and shoulder belt fits properly. </li> <li>Children should not sit in the front seat until they're 13 years old, due to the force when an air bag deploys. </li> </ul> Seat placement does matter The safest place to ride for children younger than 13 is in the back seat. This is to protect them in head-on collisions. Additionally, front seats with an active front passenger air bag increases the risk of severe injury or death due to the force when the air bag deploys. Air bags, in combination with seat belts, are designed for adult protection. Be sure to familiarize yourself with the location of your vehicle's air bags. Keep in mind that rear-facing car seats should never be placed in front of an active air bag. Need assistance? Contact an expert If you have difficulty installing your child safety seat or have questions about placement in the vehicle, seek out a child passenger safety technician to help. The primary role of the technician is to educate on the correct selection, installation and use of car seats, booster seats and seat belts. Set up an appointment for one of our <a href="https://communityhealth.mayoclinic.org/classes-and-events">Car Seat Inspection Clinics</a>, or watch for health and safety fairs or community events in your area. When working with the technician: <ul style="margin-top: 0in; list-style-type: disc;"> <li>Be prepared to learn and be involved in the installation of your car seat.</li> <li>Plan ahead. If you are an expectant parent, schedule your appointment one to two months before your baby's due date. </li> <li>Know your child's height and weight and bring them along to the event. </li> <li>Try installing your car seat before arriving at the event. The technician can then review the installation and provide education as needed. </li> <li>Bring your car seat installation manual and vehicle owner's manual along. Your technician can review these to ensure you are using the proper position in the vehicle and that the car seat is appropriate for your child. </li> <li>Expect your meeting with the technician to take 30–45 minutes, depending on any issues with compatibility of the car seat and your car. It may take longer if you have more than one car seat or vehicle being checked. </li> <li>The technician will go through a series of questions about your current car seat to ensure it is appropriate for your child, is not expired and hasn't been recalled. Expect the technician to document his or her findings on a checklist. The technician also will discuss next steps, such as when to move to the next type of car seat, risks of bulky clothing, aftermarket products, safety in and around vehicles, and any other concerns you might have. </li> </ul> Nicole Guerton, M.S., is a master certified health education specialist at Mayo Clinic in Rochester's Level 1 Adult and Pediatric Trauma Center. She oversees the Injury and Prevention Programs, is certified as a child passenger safety technician and is a board-certified wellness coach.Nicole Guerton, M.S.Primary Care in Rochester and KassonCar Seat InstallationPrimary Care in Rochester and KassonTo prevent cervical cancer, get an HPV vaccination, don't smoke and get a Pap test and an HPV test.&nbsp;<img src="/-/media/ech-media/images/widgets/people/ech_cervicalcancer_01_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=2472EFB47377152C151A5E1D11399009" alt="ECH_CervicalCancer_01_widget" width="100" height="65" DisableNVelocity="true" />4 steps to prevent cervical cancer1/26/2023 4:30 AM<img src="/-/media/ech-media/images/widgets/people/ech_cervicalcancer_01_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=0D56C7547ED5A8F8F4740E6D337BD321" alt="ECH_CervicalCancer_01_widget" width="300" height="195" DisableNVelocity="true" />Every year, approximately 12,000 women in the U.S. are diagnosed with cervical cancer. However, this cancer is highly preventable, and women can significantly reduce their risk by following these steps:  Get an HPV vaccination. HPV is the most common sexually transmitted infection, with nearly 14 million Americans contracting it every year. In women, HPV can cause cervical cancer and other genital cancers. In all people, it can cause genital warts, as well as anal, head and neck cancers. While infection with HPV is extremely common, a vaccine can prevent it.  The Food and Drug Administration has approved a vaccine against nine types of HPV, including seven that cause 81% of cervical cancers and two that cause genital warts. Vaccination is recommended for people ages 9–25. However, the vaccine is approved up to age 45. Adults who are 27–45 should discuss possible benefits of HPV vaccination with their health care team.  Parents should ask their child's primary care clinician about the HPV-9 vaccination. It has an excellent safety record and is most effective when given to young people before they become sexually active.  In October 2015, the Centers for Disease Control and Prevention recommended that children 9–14 need only two doses if those doses are administered six months apart. To receive the same protection, teens and adults 15–45 require three doses over seven to eight months.  Don't smoke. Although there is no effective medical treatment for HPV infections, most people can eliminate the infection from their bodies before the virus develops precancerous or cancerous lesions. A strong immune system is important for fighting off HPV infections because the risk of cancer increases the longer HPV is present.  Smoking has been shown to limit the immune system's ability to eliminate HPV, which then increases the risk of cancers caused by HPV.  Get a Pap test and an HPV test. It can take years for HPV infections to cause cervical cancer. However, HPV and precancerous cervical changes can be detected with routine testing. Available screening tests, which include a Pap smear and an HPV test, can detect early precancerous changes so they can be treated before cancer develops. While previous guidelines recommended a yearly Pap test, current guidelines recommend that most women 21–65 should have cervical cancer screening every three to five years.  Cervical cancer screening guidelines continue to evolve as researchers learn more about HPV and how it causes cancer. Therefore, women should continue to talk with their primary care team about current recommendations.  <a href="https://communityhealth.mayoclinic.org/providers/matthew-meunier-md">Matthew Meunier, M.D.</a>, is a physician with women's health fellowship training in the Department of Family Medicine. He is a member of Primary Care in Rochester and Kasson, where he is the director of the Colposcopy Clinic, for women with abnormal Pap tests. Matthew Meunier, M.D.Primary Care in Rochester and KassonCervical CancerPrimary Care in Rochester and KassonPeople diagnosed with diabetes are at greater risk for this condition.&nbsp;<img src="/-/media/ech-media/images/widgets/medicalimages/ech_cataracts_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=9E84B7321DC6398671C645F2D59E0F50" alt="ECH_Cataracts_widget" width="100" height="65" DisableNVelocity="true" />Diabetic Retinopathy: More than meets the eye1/16/2023 4:30 AM<img src="/-/media/ech-media/images/widgets/medicalimages/ech_cataracts_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=63091FC346A73822344509F0123BCA3C" alt="ECH_Cataracts_widget" width="300" height="195" DisableNVelocity="true" />People who have been diagnosed with diabetes are at greater risk for eye disease and vision impairment due to a condition known as diabetic retinopathy. Diabetic retinopathy is the leading cause of blindness among adults in the U.S. In the initial stages of diabetic retinopathy, many people do not have any symptoms. Early recognition is vital because, if left untreated, it can progress to permanent vision changes and even blindness. What is it? Diabetic retinopathy occurs when high blood sugars damage the small blood vessels supplying blood flow to the retina. The retina is a layer of tissue along the back of the eye. It converts light to electrical signals. The electrical signals are transmitted to the brain via the optic nerve. The damage caused by elevated levels of blood sugar can disrupt these electrical signals to the brain, gradually resulting in vision loss. How to prevent diabetic retinopathy <ul style="list-style-type: disc;"> <li>Watch your blood sugar levels. </li> <li>Keep your blood pressure under control.</li> <li>Monitor your cholesterol levels.</li> <li>Get regular exercise — at least 150 minutes per week of moderate intensity activity. </li> <li>Eat a healthy well-balanced diet. Aim for 5-6 servings of fruits and vegetables, avoid concentrated sweets, limit processed foods and saturated fats.</li> </ul> When to start screening? People diagnosed with Type 1 diabetes should start formal diabetic eye examinations within five years of diagnosis. Individuals who are diagnosed with Type 2 diabetes, also referred to as adult-onset diabetes, should start screening at the time of diagnosis to ensure there are no signs of early diabetic retinopathy. After initial screening, patients with diabetes should have annual screening provided by an ophthalmologist or optometrist. Testing should include a comprehensive eye examination and dilation of the pupil. Photoscreening is another option that is available in most primary care settings. Photos of the retina are taken and reviewed by an optometrist or ophthalmologist for signs of retinopathy. Women with diabetes who are considering pregnancy should be screened before they become pregnant. After their pregnancy, the patient's health care team will determine how long screening should continue. How is diabetic retinopathy treated? Panretinal photocoagulation is a laser treatment that helps to reduce damage to the retinal blood vessels by stopping leaking vessels and destroying new growth of vessels. Alternatively, medications can be injected into the eye to treat leaky blood vessels. Conclusion Diabetic retinopathy is a common and preventable form of vision loss. If you have diabetes, keep your vision healthy this year by making healthy food choices, exercising regularly and ensuring your blood sugars are in range. And most importantly, make sure you get your annual screening exam for retinopathy. Let your primary care team know if you are struggling with any of these issues. We are here to help and want you to see into the future. <a href="https://communityhealth.mayoclinic.org/providers/kathryn-king-cnp">Katie King, APRN, C.N.P., M.S.N.</a>, is a nurse practitioner in Family Medicine at Mayo Family Clinic Southeast in Rochester. She has an interest in preventive care services and agrees with Ben Franklin that “An ounce of prevention is worth of pound of cure.” She enjoys being outside with her family and exercising with forward motion in the forms of cycling, jogging, walking and hiking.Katie King, APRN, C.N.P., M.S.N.Primary Care in Rochester and KassonDiabetic RetinopathyPrimary Care in Rochester and KassonHow can you recognize problem gambling in a loved one or yourself?<img src="/-/media/ech-media/images/widgets/activities/ech_gambling_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=225262B3FF3887F0BE86909DD5388FE5" alt="ECH_gambling_widget" width="100" height="65" DisableNVelocity="true" />Gambling: Has it become a problem?1/23/2023 4:30 AM<img src="/-/media/ech-media/images/widgets/activities/ech_gambling_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=A655AB598100E543AC74083C6BD8D301" alt="ECH_gambling_widget" width="300" height="195" DisableNVelocity="true" />Gambling can take many forms: heading to the casino, playing online poker, betting on fantasy sports teams, buying and trading on the stock market. Are you concerned that gambling has become a problem for a loved one — or yourself? Here are some things to look for if you suspect gambling is no longer a game but a disorder: <ul> <li>Spending increased time, money and attention. Gambling starts to get in the way of other activities like work, family and time with friends. Problem gamblers become preoccupied with it. Even when they're not gambling, they're thinking about it. </li> <li>Having difficulty controlling the urge to gamble. When they're away from it, problem gamblers suffer a form of withdrawal, feeling restless and irritable. They've repeatedly tried to quit but failed. </li> <li>Concealing their behavior. They may gamble online late at night or in a conference room at work. Problem gamblers may start manipulating shared and separate bank accounts and other financial institutions. </li> <li>Suffering losses due to gambling. This can include relationships, jobs and money. </li> <li>Relying on others to bail them out with loans to cover other expenses such as mortgages, bills, car payments, etc. </li> </ul> There's no one-size-fits-all reason gambling becomes a problem for some people. Studies have shown that it may run in families. And people who are impulsive, easily bored and who enjoy the "rush" may be more susceptible. Problem gamblers often experience three primary motivators to continue gambling.  <ul> <li>The positive "rush" or reward when they win.</li> <li>Gambling may reduce or distract from bad feelings such as depression, guilt, boredom and stress. </li> <li>The unpredictable nature of when a win will occur. Because gamblers will experience both wins and losses at an unpredictable rate, it can lead someone who is gambling to have the mindset that if they just play one more round or make one more bet, it might be a win. </li> </ul> When combined, these processes make this behavior difficult to change.  Our environment also makes it challenging to change. There are so many ways to access gambling, such as using cellphones and computers, and so many different options to bet on. Since a 2018 Supreme Court ruling opened the door for states to legalize sports betting, this practice has become legal in many states. Legalized sports betting, along with the notable increase in sports betting marketing and advertising campaigns, can make gambling even easier to access. Additionally, gambling often takes place where there's alcohol, which loosens the person's inhibitions even more.  Can gambling be treated? Yes, but it's a challenging addiction. Gamblers may only be seeking treatment, not because they want to change, but because they've suffered major negative consequences, such as the breakup of a marriage, legal problems or job loss due to their gambling.  The first step is to identify any underlying mood or anxiety disorder and treat it with medication or behavioral therapy. Behavioral techniques that are effective in treating gambling addiction include: <ul> <li>Creating barriers to gambling. This may include software that blocks access to websites, reducing privacy when using devices, providing the spouse or partner with full access to all bank accounts. </li> <li>Helping the individual redefine what gives them enjoyment. </li> <li>Working on impulse control. </li> <li>Incorporating both individual and group sessions. Organizations such as <a rel="noopener noreferrer" href="http://www.gamblersanonymous.org/ga/" target="_blank">Gamblers Anonymous</a> encourage recovering gamblers to share what has worked for them and to support each other. Creating a community with others brings gambling into the open. </li> </ul> Like drug or alcohol addiction, gamblers may need to make multiple attempts to quit before it sticks. They and their loved ones have to be patient. Treatment also is most effective when it involves the whole family.  An additional resources is the <a rel="noopener noreferrer" href="https://www.ncpgambling.org/help-treatment/national-helpline-1-800-522-4700/#:~:text=The%20National%20Council%20on%20Problem,help%20for%20a%20gambling%20problem" target="_blank">National Council on Problem Gambling</a> that also has a 24/7 helpline: <a rel="noopener noreferrer" href="tel:18005224700" target="_blank">1-800-522-4700</a>.  If you're concerned about the gambling of a loved one or yourself, contact your care team to take that first step toward breaking the grip gambling has on your life.  Anne Roche, Ph.D., and Alisson Lass, Ph.D., are clinical health psychology fellows in Primary Care in Rochester and Kasson's Division of Integrated Behavioral Health.  <a href="https://communityhealth.mayoclinic.org/providers/craig-sawchuk-phdlp">Craig Sawchuk, Ph.D., L.P.</a>, is a clinical psychologist in Primary Care in Rochester and Kasson's Division of Integrated Behavioral Health. He is the co-chair of Integrated Behavioral Health and co-chair of clinical practice in the Department of Psychiatry and Psychology at Mayo Clinic in Rochester. Anne Roche, Ph.D., Alisson Lass, Ph.D., Craig Sawchuk, Ph.D., L.P.Primary Care in Rochester and KassonGamblingPrimary Care in Rochester and KassonWatching championship competitions and games calls for snacks. Here's how to make them healthier — without sacrificing flavor.&nbsp;<img src="/-/media/ech-media/images/widgets/food/ech_healthyparty_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=CD5DD932641AC4ACB1DE1063FD2530BB" alt="ECH_healthyparty_widget" width="100" height="65" DisableNVelocity="true" />Game on! Healthy snacks for the big event1/19/2023 3:30 AM<img src="/-/media/ech-media/images/widgets/food/ech_healthyparty_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=05F990C5464766BB835A00FDEFDDAFF8" alt="ECH_healthyparty_widget" width="300" height="195" DisableNVelocity="true" />From the Super Bowl and the Winter Olympics to the Stanley Cup and March Madness, gathering with friends to watch the games calls for snacks. Here's how to add some tasty choices to the buffet without adding extra calories.  Skinny down recipes <ul> <li>Skip the fatty dips and spreads and try out some bean and legume recipes instead — like <a rel="noopener" href="https://www.mayoclinic.org/healthy-lifestyle/recipes/artichoke-spinach-white-bean-dip/rcp-20152939" target="_blank">Artichoke, Spinach and White Bean Dip</a> or <a rel="noopener" href="https://www.mayoclinic.org/healthy-lifestyle/recipes/roasted-red-pepper-hummus/rcp-20197743" target="_blank">Roasted Red Pepper Hummus</a>. </li> <li>Use oil-based rather than creamy dressings and sauces — and use sparingly. Serve dressings on the side.</li> <li>Choose fish and shellfish or lower-fat meats, such as chicken breasts or ground turkey.</li> <li>Even tortillas and crackers have lower-fat and salt options. Baked chips of all kinds tend to be lower in fat. Baking your own pita and tortilla crisps is a great choice, too.</li> </ul> Serve it on a stick <ul> <li>Serve fruit — from strawberries to melon balls — on a skewer with a side of nonfat fruit yogurt dip. It's a classic and adds color, as well as a bite of freshness.</li> <li>Slide a grape tomato, basil leaf and a square of pesto-dipped mozzarella cheese onto a skewer.</li> <li>Marinate veggie skewers of grape tomatoes, mushrooms, onion wedges, green, red or yellow peppers in low-fat Italian dressing, then grill.</li> </ul> Go crackers — and beyond <ul> <li>Look for whole-grain tortillas, pita bread, crackers, bruschetta.</li> <li>Make your own kale chips to add flavor and color to your snacks. </li> <li>Create your own homemade baked pita chips with your favorite herbs. </li> <li>Try <a rel="noopener" href="https://www.mayoclinic.org/healthy-lifestyle/recipes/fruit-salsa-n-sweet-chips/rcp-20049952" target="_blank">Fruit Salsa and Sweet Chips</a> instead of the traditional tomato-based salsa. </li> <li>Substitute thick slices of cucumber, big white radishes, apples or pears for crackers. Spread a cucumber with low-fat cream cheese mixed with horseradish, and top with a thin slice of ham on a toothpick. Pile olive tapenade on radish slices. Top apples or pears with a smear of chutney and a slice of smoked turkey.</li> </ul> Make it fun <ul> <li>Spread hummus on a plate, top with chopped olives mixed with a little nonfat Italian dressing and serve with pita crisps or sliced veggies. For basketball fans, arrange the olives in lines like those on a basketball.</li> <li>Jazz up classic deviled eggs with this recipe for <a rel="noopener" href="https://www.mayoclinic.org/healthy-lifestyle/recipes/avocado-deviled-eggs/rcp-20125131" target="_blank">Avocado Deviled Eggs</a>. </li> <li>Whip up a pitcher of fruit and spinach smoothies for a refreshing drink. </li> <li>If children will be in attendance, serve up some <a rel="noopener" href="https://www.mayoclinic.org/healthy-lifestyle/recipes/rainbow-ice-pops/rcp-20049997" target="_blank">Rainbow Ice Pops</a> for a refreshing snack. </li> <li>Set up a virgin bloody mary bar with a host of veggies for guests to build their own skewers. Choose a low-sodium tomato juice or bloody mary mix.</li> <li>Add fruit kabobs to tall glasses of flavored sparkling water.</li> </ul> Move it! <ul> <li>Work off a few calories by creating a cheerleading competition for halftime. Put your body into it and don't forget the pom-poms!</li> <li>Head to the garage and toss foam footballs or basketballs.</li> <li>Host a sledding or skating party before settling down to watch bobsledding, figure skating or hockey.</li> </ul> For more tips and recipes, Mayo Clinic offers recipes for an array of delicious, healthy <a rel="noopener" href="https://www.mayoclinic.org/healthy-lifestyle/recipes/snack-recipes/rcs-20077251" target="_blank">snacks</a> and <a rel="noopener" href="https://www.mayoclinic.org/healthy-lifestyle/recipes/appetizer-recipes/rcs-20075981" target="_blank">appetizers </a>that are perfect for game day or any day. For more tips and recipes, check out <a rel="noopener" href="https://www.myplate.gov/" target="_blank">MyPlate</a> or <a rel="noopener" href="https://healthysd.gov/category/nutrition/fruits-veggies-more-matters" target="_blank" title="Link opens in a new window">Fruits and Veggies – More Matters</a> and search "healthy snacks." Rose Prissel, M.S., R.D.N., L.D.,  is a recent Mayo Clinic retiree. She worked in pediatric and adult nutrition, with a focus on preventive care, sports nutrition and weight management.Rose Prissel, M.S., R.D.N., L.D.Primary Care in Rochester and KassonHealthy SnacksPrimary Care in Rochester and KassonFind out how to stabilize your mood with the foods you eat.&nbsp;<img src="/-/media/ech-media/images/widgets/food/superfoods.jpg?h=65&iar=0&w=100&sc_lang=en&hash=78956A3E1EB3056C3C1067651290FD42" alt="Superfoods" width="100" height="65" DisableNVelocity="true" />Foods that can boost your mood1/12/2023 4:30 AM<img src="/-/media/ech-media/images/widgets/food/superfoods.jpg?h=205&iar=0&w=315&sc_lang=en&hash=30DD345DE89C987885BD5E0195615138" alt="Superfoods" width="315" height="205" DisableNVelocity="true" />You've heard the buzz around gut health and how it can affect your mental health. It's true. Food can play a key role in helping you lift your mood and improve your outlook on life. While nutrition psychiatry is a relatively new field, studies are showing a direct correlation between diet and mood disorders, and there are quite a few things we can do foodwise to stabilize our moods. The science of how food affects our mood is based on how serotonin changes our brain chemistry. Serotonin is a neurotransmitter that's important for many things, including sleep regulation, mood and appetite. Ninety percent to 95% of our serotonin receptors are in the gut. Studies show that high-quality diets are correlated with feel-good hormones, such as serotonin and dopamine. Here is a list of foods that contain mood-boosting serotonin and dopamine: <ul> <li>Fruits and vegetables. </li> <li>Whole grains. </li> <li>Lean meats. </li> <li>Fish. </li> <li>Nuts and legumes. </li> <li>Low-fat dairy. </li> <li>Olive oil. </li> </ul> These foods are packed with mood-boosting nutrients, like zinc, folate, magnesium, potassium, vitamin C, fiber, iron, B vitamins and omega-3 fatty acids. All of these also are correlated with energy, clarity and improvements in anxiety and depressive disorders. The Mediterranean diet often is used as the primary example as a diet strategy that also can help improve mood. Studies show that poor diet quality or a diet that is primarily made up of high-fat, high-sugar, high-salt and processed foods is associated with increased feelings of anxiety and depression. This is because these foods typically don't contain enough of the nutrients our brain needs to help raise serotonin levels. Here are foods to eat in moderation: <ul> <li>Processed foods. </li> <li>Refined grains. </li> <li>Processed meats, red meats. </li> <li>Sugar-sweetened beverages. </li> <li>Sweets. </li> </ul> Key takeaway Remember, no single food or type of food is a cure-all. Talk to your primary care clinician if you think you are depressed. However, if the occasional blue mood disrupts your life, think about what you've been eating and incorporate these changes into your diet. Ellie Rautio is a Mayo Clinic dietetic intern. She earned her bachelor's degree in nutrition dietetics at the University of Nebraska-Lincoln.Ellie RautioPrimary Care in Rochester and KassonMood Boosting FoodsPrimary Care in Rochester and KassonCavities can lead to more complications than just a dental bill.&nbsp;<img src="/-/media/ech-media/images/widgets/kids/ech_babytooth_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=18F925CF516A7015F7C96331302EAED3" alt="ECH_babytooth_widget" width="100" height="65" DisableNVelocity="true" />Help your children to have healthy teeth2/15/2021 11:00 AM<img src="/-/media/ech-media/images/widgets/kids/ech_babytooth_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=333B6AC8C963222BC4B8F17EA98EA887" alt="ECH_babytooth_widget" width="300" height="195" DisableNVelocity="true" />Healthy teeth support your children's overall health. As a parent, you can prevent dental caries, also known as tooth decay, in your infants or children by brushing their teeth, starting at the first tooth and following the recommendations below.  Dental caries are the most common chronic infection disease in children. And they are 100% preventable. Early childhood caries are an aggressive form of dental caries in children 0 to 5. Dental caries affect 1 out of 5 children by age 5, and twice as many children from low-income families or minorities. In Minnesota 50% of third graders have at least one dental caries.  Why is oral health prevention important? Infants and children with dental caries can experience problems with pain and difficulty eating that leads to poor growth and severe, complicated infections. Children also can suffer from difficulty sleeping and poor self-esteem. More frequent school absences, or work absences for parents, and poor learning are consequences of untreated dental caries. Also, extensive and expensive preventable dental treatment if often needed to be performed under general anesthesia.  What can parents do to promote good oral health in their children?  To promote good oral health in their children, parents can:  <ul> <li>Brush their teeth twice a day with fluoridated toothpaste. Use a smear, like a grain of rice, in infants and children until their third birthday. Then after 3, use a pea-size amount. </li> <li>Keep a healthy diet with lots of fruits and veggies, and lots of water and milk. </li> <li>For infants, do not provide sippy cups with juice and do not feed in the middle of the night after 6 months. </li> <li>See a dentist by their first birthday or appearance of their first tooth. </li> <li>Have your health care provider or dentist apply fluoride varnish every three to six months to prevent caries. </li> </ul> Regular tooth brushing, especially before bedtime, is important to remove plaque and food debris, and for distributing fluoridated toothpaste. You should brush your children's teeth until they are at least 8 and supervise them for a while when they gain independence to brush on their own. It is best if you stand or sit behind your children when brushing their teeth. Your children should spit but not rinse after brushing to increase topical fluoride exposure.  It is important to find a dentist by the time your children's first tooth arrives or your children's first birthday. Your children's health care provider can help you find a dental home if needed and apply topical fluoride varnish after the first tooth and every three to six months until a dental home is established. Topical fluoride is the most efficient way to protect your children's teeth by making them healthier and stronger to prevent caries.  Remember, you can prevent caries and promote your children's overall health with healthy teeth. For more information, talk to your child's primary care provider or dentist.  Valeria Cristiani, M.D., is a pediatrician in Community Pediatric and Adolescent Medicine and a member of Primary Care in Rochester and Kasson. She co-chairs the Olmsted County Children's Oral Health Task Force and also is a member of the Minnesota Oral Health Coalition, a nonprofit group that supports oral health around the state. Valeria Cristiani, M.D.Primary Care in Rochester and KassonChildren Healthy Teeth 021521Primary Care in Rochester and KassonThese tips can save your family from significant harm.&nbsp;<img src="/-/media/ech-media/images/widgets/kids/babyelectriccord_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=E69430E678F07081E332177A15DD065B" alt="BabyElectricCord_widget" width="100" height="65" DisableNVelocity="true" />Keeping your family safe from electrical accidents2/8/2021 11:00 AM<img src="/-/media/ech-media/images/widgets/kids/babyelectriccord_widget.jpg?h=205&iar=0&w=315&sc_lang=en&hash=2589B73A314719F8FAA1C4B88B93FA37" alt="BabyElectricCord_widget" width="315" height="205" DisableNVelocity="true" />Electrical outlets and appliances are present in most homes. While they are necessary for many daily tasks, it is also important to be aware of the safety risks they present.  February is Electrical Safety Awareness Month, which makes it a good time to review some tips to keep your family safe: <ul> <li>Use safety plugs in outlets.  Cover unused electrical outlets with safety plugs that are not a choking hazard to small children. These safety plugs stop young children from being able to stick their fingers or other items into the outlet, which could cause an electric shock. </li> <li>Do not plug too many appliances into one outlet.  An outlet can become overloaded if too many items are trying to use power from it. You should only plug one large appliance, such as a refrigerator or dryer, into an outlet at a time. If you are worried that the outlet is becoming hot, schedule an appointment with a licensed electrician to review your home's electrical circuit. </li> <li>Check electrical cords for damage.  Damaged cords can cause electrical shock and fires. Check your cords regularly for signs of damage. If you notice that an electrical cord is fraying or cracking, replace it right away. </li> <li>Keep electrical appliances away from water.  Water and electricity do not mix. If an electrical appliance gets wet, it can cause an electrical shock. Make sure your appliances are dry and kept away from water sources. This is especially important in places like the kitchen or bathroom, where water is frequently used. </li> </ul> Following these tips will lower the risk of injury from electrical accidents.  If you are concerned about any outlets or appliances in your home, talk to a licensed electrician. Visit the American Academy of Pediatrics website for more <a rel="noopener noreferrer" rel="noopener noreferrer" href="https://www.healthychildren.org/English/safety-prevention/at-home/Pages/Home-Safety-Heres-How.aspx" target="_blank">home safety tips</a>.  <a href="https://communityhealth.mayoclinic.org/providers/anna-kellund-md/">Anna Kellund, M.D.</a>, is a pediatrician in the Division of Community Pediatric and Adolescent Medicine, which is part of Primary Care in Rochester and Kasson. She has special interests in undergraduate and graduate medical education. Anna Kellund, M.D.Primary Care in Rochester and KassonElectrical Safety 020821Primary Care in Rochester and KassonEarly involvement yields oodles of fun.&nbsp;<img src="/-/media/ech-media/images/widgets/kids/kidscooking_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=62B36A67DEDDA53D624FCFA49B6FC893" alt="KidsCooking_widget" width="100" height="65" DisableNVelocity="true" />Kids in the kitchen2/25/2021 4:00 AM<img src="/-/media/ech-media/images/widgets/kids/kidscooking_widget.jpg?h=205&iar=0&w=315&sc_lang=en&hash=415DC6FD1790594B2173AA5B19D9BFE3" alt="KidsCooking_widget" width="315" height="205" DisableNVelocity="true" />As a young child, I remember always wondering what was going on in the kitchen. It seemed to be the place to be, with all the commotion, sounds and smells.  One day, my dad propped me up on the counter beside him while cooking dinner, and I got to see firsthand what the fuss was all about. And I loved it.  From that day on, I was always in the kitchen — supervised, of course. I was the "official stirrer," mixing up everything from cookie batter to sauces on the stove. As I grew older, my responsibilities changed. I learned how to cut foods like a chef and make my grandmother's recipes.  If your kids are interested in cooking — even from an early age — involve them in the kitchen.  During the COVID-19 pandemic, you and your children may be spending more time at home. Instead of playing video games, get them in the kitchen. It's a place to bond, learn and create.  Start by involving your little sous-chef. It's also a great way to help your kids expand their food choices. The more children are involved in the process, the more likely they will want to try different foods other than pizza or chicken nuggets.  Here are a few guidelines for various ages and education levels:  <ul> <li>Toddlers with supervision  Younger children can help out in the kitchen. Being involved makes them feel as though they are part of something special. Give them the opportunity to do simple and safe tasks, such as pouring measured ingredients into a bowl. Allow them to watch and learn at the same time. </li> <li>Kindergarten and first graders with direct supervision  Ask them to measure items using a measuring cup, simultaneously developing great hands-on math skills; wash fruits and vegetables; and hand-mix items that are not sticky in a large bowl. </li> <li>Second and third graders with supervision  If you feel comfortable as a parent, this age group can try peeling vegetables, grating cheese and mixing sticky items in bowls. </li> <li>Fourth and fifth graders with supervision  Start using a can opener, stirring stovetop items, pounding chicken and scraping bowls. </li> <li>Sixth and seventh graders with limited supervision  If you feel comfortable as a parent, this age group can start using a knife and being more independent with cooking after instruction, and proving they are capable and safe. </li> </ul> Remember, children's skills will differ, so you will need to decide what you feel comfortable letting them try in the kitchen. Starting children at a young age can help them develop culinary skills that can last a lifetime. You might be surprised at what your children can do.  Amanda Halls, R.D.N., L.D., is a dietician at Mayo Clinic Health System in Lake City, Minnesota. Amanda Halls, R.D.N., L.D.Primary Care in Rochester and KassonKids In KitchenPrimary Care in Rochester and KassonThis ancient Chinese treatment can relieve symptoms for a wide range of conditions.&nbsp;<img src="/-/media/ech-media/images/widgets/medicalimages/ech_acupuncture_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=9F891180BDC886882D2FBB3FF746CB26" alt="ECH_acupuncture_widget" width="100" height="65" DisableNVelocity="true" />Is acupuncture appropriate for me?3/15/2021 4:30 AM<img src="/-/media/ech-media/images/widgets/medicalimages/ech_acupuncture_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=002C9CE0D00977963A418A66EF49763C" alt="ECH_acupuncture_widget" width="300" height="195" DisableNVelocity="true" />Acupuncture is a component of traditional Chinese medicine that originated more than 2,500 years ago. It involves inserting hair-thin needles into specific points along your body's energy meridians, called acupoints.  The philosophy behind traditional Chinese medicine focuses on maneuvers to balance life energy or Qi (pronounced "Chee"), which is considered vital to health and function, and often is described as blocked, depleted or in excess when disease-specific conditions and symptoms surface. This mechanism often is difficult to study, and exactly how it works is not fully understood.  The practice of acupuncture varies, depending on whether stimulation of the needles is manual or electrical, if ear acupuncture also is used, how long the needles are inserted, and the frequency of treatments.  How does acupuncture work to relieve pain?  According to the principles of the gate control theory of pain, inserting these needles stimulates pain fibers that close the pain gates in the central nervous system so the pain stimulus is not transmitted to the thalamus, which is located in the brain, and acts as the center for pain perception.  Biochemical evidence shows that acupuncture also increases the activity of the opioidergic system, releasing natural endorphins like serotonin, dopamine, neutrophins and nitric oxide, which may be effective in treating chronic pain and headache disorders.  What is acupuncture used to treat?  Acupuncture has been used for both acute and chronic health conditions. The goal is to promote and restore the balance of energy and improve overall health and well-being. The benefits of acupuncture can extend to a wide variety of conditions, including emotional disorders (anxiety, depression); neurological conditions, such as migraines or Parkinson's disease; or as a rehabilitation strategy for individuals who suffered a stroke.  It also can be beneficial for digestive issues, including nausea, vomiting, constipation, irritable bowel syndrome, and pain conditions due to injury or related to chronic inflammatory/degenerative disease, such as rheumatoid arthritis.  Acupuncture has been used for many women's health issues, such as hot flashes, gynecologic disorders and infertility. In addition, it has been beneficial for reducing fatigue and addictive behaviors, such as smoking. In terms of insurance coverage, Medicare now covers acupuncture for the indication of back pain. Otherwise, call your insurance provider to find out if your plan covers acupuncture for your condition.  Are there risks involved? Overall, the risks of acupuncture are very low if you are treated by a certified and experienced acupuncture practitioner. The needles are sterile and disposable to reduce infection risks. Possible side effects include minor issues, such as soreness or bruising at the needle sites. Injury may occur if the needles are pushed in too deeply (particularly in the lung), however this is extremely rare.  Before undergoing a treatment, let your practitioner know if you are pregnant, have a pacemaker or suffer from any bleeding disorders so your treatment may be designed to your specific needs in a safe manner.  Will it hurt? Acupuncture treatments should not be a painful experience. Initially, you may feel a small prick when the needle is inserted, but then you should feel a sensation of pressure, soreness, a deep ache or warmth when the needle is stimulated. This means it has made contact with the QI, the energy source. Typical treatments last from 20-30 minutes.  What should I experience/expect after the first treatment? Patients often report a general sense of relaxation and rejuvenation after an acupuncture treatment. The frequency of treatments and how long they last depends on the condition and individualized treatment plan that your practitioner will outline for you. Typically, chronic conditions may require more frequent and/or longer courses of treatment.  How do I find an acupuncture practitioner?  If you think acupuncture is an option for you, discuss it with your primary care provider and ask for a referral to one of Mayo Clinic's acupuncture specialists.  <a href="https://communityhealth.mayoclinic.org/providers/christina-chen-md/">Christina Chen, M.D.</a>, is an internal medicine physician, trained in geriatric medicine and acupuncture, and practices in the Division of Community Internal Medicine at Mayo Family Clinic Northwest in Rochester, Minnesota. She performs acupuncture through the Department of Integrative Medicine. Christina Chen, M.D.Primary Care in Rochester and KassonAcupuncture 031521Primary Care in Rochester and KassonThe Department of Clinical Genomics can help you understand your results.&nbsp;<img src="/-/media/ech-media/images/widgets/people/motherdaughtergranddaughter_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=074345EC6C3D6157349CDB69C53743F3" alt="MotherDaughterGranddaughter_widget" width="100" height="65" DisableNVelocity="true" />Do you have questions about your at-home genetic test results?3/8/2021 3:30 AM<img src="/-/media/ech-media/images/widgets/people/motherdaughtergranddaughter_widget.jpg?h=205&iar=0&w=315&sc_lang=en&hash=BA8339206F940DA915D77274E084DF37" alt="MotherDaughterGranddaughter_widget" width="315" height="205" DisableNVelocity="true" />Have you ever mailed off a saliva sample for genetic testing? Were you interested in learning about your ancestry, health traits or a genetic disease in your family? Do you have questions about these results or the testing you had done?  Direct-to-consumer (DTC) genetic testing, or at-home genetic testing, has increased tremendously in the last decade, often leaving people with many questions and reports that are difficult to understand.  Mayo Clinic <a rel="noopener noreferrer" href="https://www.mayoclinic.org/departments-centers/clinical-genomics/overview" target="_blank">Department of Clinical Genomics</a> is offering a new service to assist patients in better understanding their health-related, DTC genetic testing results.  If you already had a DTC genetic test and found it difficult to understand your report, ask your Mayo Clinic health care provider to refer you to the "DTC Results Review Clinic." Referred patients will be contacted by a Mayo Clinic genetics nurse who will gather information about your family health history, reasons for pursuing the DTC genetic test, and will request a copy of the DTC genetic test report for review. Patients then will be scheduled for a video visit with a certified genetic counselor. During the appointment, the genetic counselor will review the DTC genetic test report and discuss options for additional testing, if indicated. In some cases, a patient could be referred on for further evaluation and testing within the Department of Clinical Genomics, if indicated.  Mayo Clinic Department of Clinical Genomics is happy to help you navigate your DTC genetic test results. Primary Care in Rochester and KassonGenetic Test Results 030821Primary Care in Rochester and KassonFocusing on healthy lifestyle changes and not weight is the key.&nbsp;<img src="/-/media/ech-media/images/widgets/people/fatherdaughterkitchen.jpg?h=65&iar=0&w=100&sc_lang=en&hash=777159C93C4DAF3DAFB4CFCD7E8BD7C5" alt="FatherDaughterKitchen" width="100" height="65" DisableNVelocity="true" />Helping kids achieve a healthy weight during the pandemic3/11/2021 5:00 AM<img src="/-/media/ech-media/images/widgets/people/fatherdaughterkitchen.jpg?h=205&iar=0&w=315&sc_lang=en&hash=E2827CCEB9A3F592DB3CABD1FFE0EAF9" alt="FatherDaughterKitchen" width="315" height="205" DisableNVelocity="true" />Today, nearly 40% of American children are overweight or obese, compared to a 5% obesity rate in the 1970s. Being obese or overweight increases the risk of developing Type 2 diabetes, high blood pressure, high cholesterol and other chronic medical conditions that can begin as early as the teenage years and continue into adulthood. Not only does carrying extra weight affect health and quality of life, it also can affect mental well-being. Being overweight can lead to poor body image, low self-esteem, unhealthy weight control, bullying and depression. That's why your primary care provider may have addressed your child's weight during a well-child visit.  If you've had this discussion with your child's provider, you know there is a wealth of resources to help you — from nutrition information to healthy living programs just for kids. The trick is to apply that information at home. Here are some techniques and tips for creating an environment at home that benefits not just your child, but the entire family.  Staying on track during the pandemic. The COVID-19 pandemic presents new challenges to maintaining a healthy weight for children. Attending school online from home limits opportunities to play with friends, increases screen time and makes it harder to follow a schedule in the day. Having more access to snacks around the house can lead to mindless eating and weight gain. Everyone's busy schedules also can make it harder to enjoy mealtimes together. Here are some tips to stay on track:  <ul> <li>Designate certain times of the day to have family meals or snack time. </li> <li>Keep meals and snack time at the kitchen or dining room table, and not in front of screens. </li> <li>Stock up on healthier snacks and keep them in sight for children and adolescents to grab. </li> <li>Limit how many sweets and treats are in the household, whether you buy them or make them at home. </li> <li>Encourage kids and adolescents to take breaks from screens when possible and participate together in some form of physical activity or movement. </li> </ul> Make it a family affair. Any changes in eating and lifestyle will be good for everyone. Younger children rely on family members to provide their meals and snacks, so providing nutritious foods early can influence their decisions later in life as they transition to adolescence and adulthood. Having family meals at the dinner table is also a great opportunity to connect and enjoy time together.  Change the focus. Make the changes about healthy eating and activity rather than weight. Don't reward or punish kids with food. Shaming is not effective and may have the opposite effect on making positive behavior changes. Compliment your children on lifestyle changes, such as choosing to play outside over video games inside, rather than losing a few pounds.  Take action. Children learn fast, and they learn best by example. Decide on healthy habits you would like to create and get started step-by-step. Discuss the concrete benefits of these actions, such as fun with movement or good energy from eating a healthy meal or snack. Children are more likely to adopt these habits if they participate with family members.  Adopt new ways of eating. Some behaviors are known to promote weight gain, including skipping breakfast; eating meals in a restaurant or ordering takeout (which often have larger portions); eating too fast; eating in front of screens (like phones, computers, TV, etc.); eating less nutritious foods; and eating when you're not hungry. Positive eating habits include eating meals together; choosing more fruits and vegetables; eating at regular times; and preparing meals from scratch.  In short, every family is different in making healthy changes with food choices and activity. Just remember to take it one step at a time, notice immediate benefits to healthy habits, and have fun. Your primary care provider can be a good partner on the road to great health habits and can answer any questions you have along the way.  Kristine Penza, A.P.R.N., C.N.P., Tara Kaufman, M.D., and Michaeleen Burroughs, M.S., R.D.N., L.D., are members of the Primary Care in Rochester and Kasson Childhood Obesity Task Force. Eric DeAngelis and Sarah Dramstad are dietetic interns at Mayo Clinic in Rochester. The Childhood Obesity Task Force is committed to preventing and treating childhood obesity in primary care and community settings. Kristine Penza, A.P.R.N., C.N.P.; Tara Kaufman, M.D.; Michaeleen Burroughs, M.S., R.D.N., L.D.; Eric DeAngelis; Sarah DramstadPrimary Care in Rochester and KassonKids Healthy Weight 031121Primary Care in Rochester and KassonDiet and activity often help symptoms, but there are times when further evaluation is necessary.&nbsp;<img src="/-/media/ech-media/images/widgets/people/ech_ibs_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=6F4EE09EAE17434FD441FC2A7CFEDBCA" alt="ECH_IBS_widget" width="100" height="65" DisableNVelocity="true" />Constipation can affect people of all ages3/18/2021 4:00 AM<img src="/-/media/ech-media/images/widgets/people/ech_ibs_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=E904955D4700B0A67C01E8F45C0CBB51" alt="ECH_IBS_widget" width="300" height="195" DisableNVelocity="true" />Bowel movements are a fact of life that many of us take for granted until something goes wrong. Constipation is when someone has difficulty either because bowel movements are infrequent or become hard to pass.  What is normal? It is normal for people to have occasional constipation. Generally, we expect the average person to have at least three bowel movements per week. Normal bowel movements should be easy to pass without pain, straining or difficulty. Stools should be soft and not hard or lumpy.  What causes constipation? Common factors leading to constipation include dehydration, reduced activity and low-fiber diets. However, there is a long list of other causes, including medications and conditions such as hypothyroidism, and even certain cancers.  How is constipation treated? Treatment always depends on the cause. Generally, for occasional constipation, the first and most important treatment includes diet and activity. These changes can alleviate constipation and prevent it from returning.  Maintain regular activity throughout the day, from taking walks to more vigorous exercise. Keeping your body moving keeps your bowels moving, too.  Your diet should include a daily intake of high-fiber foods, such as fruits, vegetables, beans and whole grains. Some people choose to take over-the-counter fiber supplements.  Hydration is key, as it helps keep stool soft and moving easily through the digestive system. Make sure to sip on fluids throughout the day and with every meal.  Occasionally, people find benefit from over-the-counter laxatives, which come in many forms and can be effective. If changes in diet and activity are not enough, talk with your health care provider about whether this option is right for you.  When to be evaluated A sudden change in bowel habits that persists and does not improve with diet and activity should be evaluated. Bleeding and pain should not be ignored and need to be discussed with your health care provider.  <a href="https://communityhealth.mayoclinic.org/providers/michelle-duvall-md/">Michelle Duvall, M.D.</a>, is a family medicine physician in Primary Care in Rochester and Kasson. She practices at Mayo Family Clinic Northwest. Michelle Duvall, M.D.Primary Care in Rochester and KassonConstipationPrimary Care in Rochester and KassonHome INR results in ideal warfarin monitoring and convenience, but out-of-pocket costs vary.&nbsp;<img src="/-/media/ech-media/images/widgets/diabetes/ech_inr_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=FFF10D5E1826F4709AFC1B0241FDAB5B" alt="ECH_INR_widget" width="100" height="65" DisableNVelocity="true" />Find out if home INR testing is right for you3/22/2021 5:00 AM<img src="/-/media/ech-media/images/widgets/diabetes/ech_inr_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=2428EAB77A59A410D3658A6A9E18B4D2" alt="ECH_INR_widget" width="300" height="195" DisableNVelocity="true" />If you or a family member are taking a blood-thinning medication, like warfarin, for an indefinite period of time, the Primary Care Anticoagulation Clinic and the Mayo Clinic Store now offer a convenient option for testing INR (the time it takes for your blood to clot) at home. INR self-testing has been shown to provide effective control of warfarin anticoagulation. Patients also tend to have the lowest risk of either bleeding or clotting episodes.  Patients appropriate for this program are required to be on warfarin therapy for an indefinite period of time, such as for a mechanical heart valve, chronic atrial fibrillation or recurrent venous thromboembolism. They also should: <ul> <li>Be on warfarin for at least 30 days and show consistent anticoagulation control. </li> <li>Be able and willing to learn to perform the finger-stick test, which is a straightforward technique similar to that of glucose testing. Caregivers are welcome to learn, too. </li> <li>Demonstrate a consistent pattern of communicating with their health care team about their warfarin therapy. </li> </ul> Once patients are enrolled in the program, they will: <ul> <li>Visit with the anticoagulation nursing staff to establish the frequency of testing and reporting. </li> <li>Obtain the meter, supplies and training through the Mayo Clinic Store on the 17th floor of the Gonda Building at Mayo Clinic in Rochester, Minnesota. </li> <li>Test their INR weekly and report the results to the Anticoagulation Clinic every month, or earlier if a result is out of range. </li> </ul> In-home monitoring is available for patients who have commercial insurance, Medicare or other government-sponsored insurance. The actual amount will depend on the individual's insurance. The specifics of the plan, deductible and copay amounts all vary. It will be the patient's responsibility to contact his or her insurance carrier to know the exact amount of out-of-pocket cost. Our Anticoagulation Clinic staff will help by providing billing codes to interested patients.  For more information or to enroll in home INR testing, patients can contact the Anticoagulation Clinic's nursing staff or their primary care provider.  Thomas Jaeger, M.D., is the medical director of the Primary Care in Rochester and Kasson Anticoagulation Clinic. He is a consultant in the Division of Community Internal Medicine at Mayo Clinic practicing in the Baldwin Building. Thomas Jaeger, M.D.Primary Care in Rochester and KassonHome INR Testing 032221Primary Care in Rochester and KassonThis syndrome generally worsens as you age.&nbsp;<img src="/-/media/ech-media/images/widgets/people/rubbingleg_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=4EBF44A34BCE49EE667FE6EF26A8623B" alt="RubbingLeg_widget" width="100" height="65" DisableNVelocity="true" />I've got to move - Do I have restless leg syndrome?3/29/2021 4:30 AM<img src="/-/media/ech-media/images/widgets/people/rubbingleg_widget.jpg?h=205&iar=0&w=315&sc_lang=en&hash=9C4E61DEC6B238D220F30B66D78F3648" alt="RubbingLeg_widget" width="315" height="205" DisableNVelocity="true" />It is estimated that 5%–10% of people suffer from restless legs. But what is this condition and how do you know if you have it?  There are four main symptoms of restless legs:  <ul> <li>An uncomfortable feeling or urge to move your legs. </li> <li>Symptoms are usually worse at night. </li> <li>Symptoms come on with rest. </li> <li>Symptoms go away with moving your legs. </li> </ul> The condition is more common as you get older and in women. It can run in families, and can be associated with other conditions, including peripheral neuropathy, iron deficiency, kidney failure and spinal cord problems.  The symptoms can range from mild and not bothersome to severe to the point that it interferes with day-to-day functioning and sleep.  There isn't a test that makes the diagnosis of restless legs, but seeing a doctor is important to make sure there isn't another cause for your symptoms. Your doctor likely will perform a physical examination and order some basic tests.  Simple lifestyle changes may alleviate some of the symptoms, including:  <ul> <li>Soak in a warm bath and massage your legs</li> <li>Alternate the use of heat or cold packs</li> <li>Maintain a good sleep regimen</li> <li>Get active with moderate, regular exercise</li> <li>Avoid caffeine</li> </ul> Restless legs syndrome is not a curable disease. Once the diagnosis is made, there are many options for treatment. Replacement of iron is appropriate if there is iron deficiency, even if you aren't anemic. Treatment often focuses on increasing dopamine levels in the brain with medications that are often used for patients with Parkinson's disease. The primary disadvantage is that, over time, the dose will need to be increased to be effective. Another class of medications that affect calcium channels, which includes gabapentin, are effective for some patients. Other medications, such as opioids, muscle relaxants and sleep aids, are rarely used in the treatment of restless legs.  The bottom line is that if you feel like you just have to move your legs at the end of the day or when you are at rest and you get relief if you get up and walk around, it might be time to see your doctor and find out if you have restless legs syndrome.  <a href="https://communityhealth.mayoclinic.org/providers/denise-dupras-md/">Denise Dupras, M.D., Ph.D.</a>, is a general internal medicine physician in the Division of Community Internal Medicine at Mayo Clinic in Rochester, Minnesota. She completed her medical and doctoral degrees at Mayo Clinic Alix School of Medicine and her residency in internal medicine at Mayo Clinic in Rochester. Her interests include medical education and evidence-based medicine. Denise Dupras, M.D.Primary Care in Rochester and KassonRestless Leg SyndromePrimary Care in Rochester and KassonSnoring can be more serious than just a bother to your bed partner.&nbsp;<img src="/-/media/ech-media/images/widgets/people/ech_enoughsleep_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=FCF22AAFDC6A57CC21452E23B6980F2B" alt="ECH_enoughsleep_widget" width="100" height="65" DisableNVelocity="true" />Snoring and sleep apnea3/25/2021 5:00 AM<img src="/-/media/ech-media/images/widgets/people/ech_enoughsleep_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=5AA8583BF3718D6D2C143B1DD69A79AF" alt="ECH_enoughsleep_widget" width="300" height="195" DisableNVelocity="true" />Many people snore, but snoring also can be a sign of a serious condition known as obstructive sleep apnea. So when is it time to be concerned and contact your provider?  Sleep apnea is a condition where breathing repeatedly starts and stops. While it can be caused by a failure of the brain to tell the muscles to work (central sleep apnea), the more common cause is obstructive sleep apnea (OSA).  Symptoms of OSA include: <ul> <li>Loud snoring, enough to bother a bed partner</li> <li>Excessive sleepiness during the day, including falling asleep while driving, watching TV or working</li> <li>Stopping breathing during sleep, which is usually noticed by a bed partner</li> <li>Waking suddenly during the night with a gasping or choking sensation</li> <li>Morning headaches</li> <li>Problems with sleeping, including frequent awakening and difficulty falling or staying asleep</li> <li>Waking with a dry mouth or sore throat</li> </ul> Factors that increase the risk of OSA: <ul> <li>Age over 50</li> <li>Excess weight</li> <li>Thick neck</li> <li>Men or postmenopausal women</li> <li>Chronic nasal congestion</li> <li>Smoking</li> <li>High blood pressure</li> <li>Narrowed airway</li> </ul> Untreated OSA can increase a person's risk of car accidents, heart problems (including hear attacks and heart failure), high blood pressure, stroke, and complications after general anesthesia. It also may affect performance at work or in school.  Initial evaluation will include getting a history about sleep patterns and information from a bed partner. A physical examination will focus on your blood pressure, weight, heart, lungs, mouth and neck. Questionnaires are very helpful to assess your risk and need for additional testing. One of the most common questionnaires is the STOP-Bang, which can be used to screen patients and determine if additional testing is needed.  Treatment for OSA depends on the severity of the condition, but generally will include avoiding sedating medications, alcohol and weight loss if you're overweight. If it occurs when sleeping in certain positions, avoiding those positions at night may be enough. It also may include the use of devices, such as a CPAP, that can improve the quality and quantity of your sleep.  If you or your bed partner are bothered by your snoring, contact your primary care provider for a discussion and evaluation.  <a href="https://communityhealth.mayoclinic.org/providers/denise-dupras-md/">Denise Dupras, M.D., Ph.D.</a>, is a general internal medicine physician in the Division of Community Internal Medicine at Mayo Clinic in Rochester, Minnesota. She completed her medical and doctoral degrees at Mayo Clinic Alix School of Medicine, and her residency in internal medicine at Mayo Clinic in Rochester. Her interests include medical education and evidence-based medicine. Denise Dupras, M.D.Primary Care in Rochester and KassonSleep ApneaPrimary Care in Rochester and KassonThese tips can get a healthy meal on the table quickly.&nbsp;<img src="/-/media/ech-media/images/widgets/food/ech_kidcentric_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=4E902867D5737741159F8C1A9F506502" alt="ECH_KidCentric_widget" width="100" height="65" DisableNVelocity="true" />20 minutes to mealtime4/12/2021 5:00 AM<img src="/-/media/ech-media/images/widgets/food/ech_kidcentric_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=7770162C1B75BE46BCBA5A14E750491E" alt="ECH_KidCentric_widget" width="300" height="195" DisableNVelocity="true" />Spring is nature's "reboot" and a perfect time to refresh your meal plans. Spring into these habits to have healthier meals, and more time to meet spring and summer schedules. With a little planning and practice, you can cut mealtime prep to 20 minutes per night.  Piecing together a healthy, balanced meal To build healthy meals, focus on the food groups. Work to incorporate at least one choice from each of these food groups: <ul> <li>Vegetables</li> <li>Fruits</li> <li>Proteins</li> <li>Carbohydrates</li> <li>Dairy</li> </ul> Timesaving ideas Try these timesaving ideas: <ul> <li>Plan meals for the week and post the meal plan in a shared space. </li> <li>Designate time to prepare food for the week. </li> <li>Free up extra time with frozen foods. </li> <li>Find your sous-chef, and get help from family members or roommates. </li> <li>Add on to prepared foods or meal kits to make a larger, well-rounded meal. </li> <li>Plan and prepare simple recipes with fewer ingredients. </li> <li>Limit the types of cooking methods or utensils. One skillet or baking pan is often enough. </li> <li>Use a slow cooker, Instant Pot or sous vide (low temperature, long time) cooking methods. </li> <li>Double the recipe and freeze leftovers for a future meal. </li> <li>Preheat faster with air fryers and toaster ovens. </li> <li>Incorporate the same ingredients for different meals. </li> </ul> Quick meal ideas Try these quick meal ideas:  <ul> <li>Chicken fajitas with rice and beans  Cut chicken into strips and saute. Add chopped onions and peppers. Rinse and drain low-sodium canned black beans and heat in the microwave. Warm corn tortillas. Reheat rice from a batch previously prepared. Add ingredients like cheese, salsa and sour cream as condiments. </li> <li>Shrimp alfredo and Italian blend vegetables  Boil fettuccini noodles. Thaw shrimp in the refrigerator the day before. Cook shrimp and minced garlic in a pan. Add a jar of alfredo sauce to the pan to heat up. Microwave frozen veggies while the rest of the dinner finishes on the stove. </li> <li>Chicken summer salad  Start with leafy greens on each plate. Cook chicken in a pan. Slice strawberries, cucumbers and tomatoes while the chicken cooks. Add blueberries, walnuts, sliced strawberries, cucumber and tomatoes to each salad. Top salads with chicken. Add dressing and cheese, as desired. </li> </ul> Experience can save time The more experience you have with preparing a given meal, the more tips and tricks you will pick up in terms of efficiency. Keep recipes and ingredient lists for successful meals for your household. You'll soon have a healthy repertoire of tried-and-true "20 minutes to mealtime" menus to spring for.  Matthew McDavid is a dietetic intern at Mayo Clinic in Rochester, Minnesota.Matt McDavidPrimary Care in Rochester and Kasson20 minutes to mealtimePrimary Care in Rochester and KassonGlenn Modracek donates blood in honor of his wife.&nbsp;<img src="/-/media/ech-media/images/widgets/blooddonation/modracek_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=8DD5CE7E6ADF91BEC99C5EA20FD57B88" alt="Modracek_widget" width="100" height="65" DisableNVelocity="true" />Honoring loved ones while saving lives5/3/2021 4:30 AM<img src="/-/media/ech-media/images/widgets/blooddonation/modracek_widget.jpg?h=205&iar=0&w=315&sc_lang=en&hash=60923137F6D5020CD49776428B88FF0A" alt="Modracek_widget" width="315" height="205" DisableNVelocity="true" />Glenn Modracek, a dedicated blood donor, donates in honor of his wife, Sharon, who passed away on Nov. 27, 2019. He describes Sharon as having a one-of-a-kind personality, and he recalls her Mayo Clinic team of surgeons and specialists giving her the nickname "Tough Cookie." Sharon was born with congenital heart defects. In June 1956, she made history by being one of 15 patients to receive a new lifesaving surgery made possible with the invention of the heart-lung bypass machine at Mayo Clinic. She also was the first woman to give birth successfully after having that surgery.  Fifty-eight years after Sharon's heart surgery, she was due for a heart valve replacement. The surgery was deemed a success. But one hour later, Sharon's life was in peril as she endured a 33-minute Code Blue (medical emergency). A 75-day recovery followed.  Sharon had to learn how to breathe and walk again with the help of her loving family and the dedicated staff at Mayo Clinic. Her determination and Tough Cookie attitude allowed her to welcome her four great-grandchildren into the world over the next five years.  The ordeal had taken a toll on Sharon's lungs, however. A diagnosis of chronic obstructive pulmonary disease, combined with her congenital heart issues, was too much. With her characteristic grace and concern for others, Sharon made the courageous decision to stop her fight against the inevitable.  Glenn says he is forever grateful to the medical professionals who cared for his wife. These incredible men and women inspired "A Balancing Act," a painting that is now displayed at Mayo Clinic Hospital — Rochester, Saint Marys Campus.  How to donate blood For more information about donating blood in Rochester, Minnesota, call the Mayo Clinic Blood Donation Center at <a href="tel:5072844475">507-284-4475</a>, <a href="mailto:donateblood@mayo.edu">email the center</a>, or <a rel="noopener noreferrer" href="http://www.mayoclinic.org/donateblood" target="_blank">visit the center's webpage</a>. Primary Care in Rochester and KassonBlood Donation ModracekPrimary Care in Rochester and KassonLearn about available options that are easier to take.&nbsp;<img src="/-/media/ech-media/images/widgets/people/femalephysiciancounselingpatient.jpg?h=65&iar=0&w=100&sc_lang=en&hash=ED4290341EE9A3CF38720909E39D76EB" alt="FemalePhysicianCounselingPatient" width="100" height="65" DisableNVelocity="true" />Are you on a blood thinner?5/10/2021 5:00 AM<img src="/-/media/ech-media/images/widgets/people/femalephysiciancounselingpatient.jpg?h=205&iar=0&w=315&sc_lang=en&hash=B344B15FE7D13805BD0C4685A47A3CEE" alt="FemalePhysicianCounselingPatient" width="315" height="205" DisableNVelocity="true" />Direct-acting oral anticoagulants (DOACs) are a new group of medications used to treat or prevent blood clots. They represent a significant advancement in anticoagulant therapy. They have been available for several years. Over that time, these newer medications have been found to be safe and effective, and much easier to take.  Previously, warfarin (Coumadin) was the only medication in pill form available to thin the blood. While effective, warfarin requires regular monitoring, as its action is affected by many medications, acute illness and foods containing vitamin K. As a result, the blood can become too thick or too thin, which makes clotting or bleeding more likely.  Direct-acting oral anticoagulants are different in that their blood thinning actions are much more consistent. They require much less monitoring, and the dose does not need to be adjusted, making them much easier to take. On balance, they are somewhat safer and more effective than warfarin. Like any medicine that thins the blood, bleeding is a risk. However, when taken consistently, this risk is lessened.  Direct-acting oral anticoagulants cannot be used in some situations. For example, mechanical heart valves still require warfarin to be used for anticoagulation. For many patients, the primary concern to using direct-acting oral anticoagulants is the out-of-pocket cost, as these are new, brand-name medications with no generic equivalents. The cost to the patient will be determined by insurance coverage. Coupons may be available for those not enrolled in a Medicare Part D plan.  For most patients requiring oral anticoagulant therapy, direct-acting oral anticoagulants are a safe, effective and much more convenient treatment option. Your primary care provider can help determine if one of these medications is a good choice for you.  Thomas Jaeger, M.D., is medical director of the Primary Care in Rochester and Kasson Anticoagulation Clinic. He is a physician in the Division of Community Internal Medicine, practicing in the Baldwin Building. Thomas Jaeger, M.D.Primary Care in Rochester and KassonBlood ThinnersPrimary Care in Rochester and KassonThese habits are treatable, but it takes work.&nbsp;<img src="/-/media/ech-media/images/widgets/people/nailbiting.jpg?h=65&iar=0&w=100&sc_lang=en&hash=937E5C798A09123CD53B25D4ACF3350D" alt="NailBiting" width="100" height="65" DisableNVelocity="true" />What are body-focused repetitive behaviors and how are they treated?4/26/2021 5:00 AM<img src="/-/media/ech-media/images/widgets/people/nailbiting.jpg?h=205&iar=0&w=315&sc_lang=en&hash=12B3A6B256E22B683D768ED292C42878" alt="NailBiting" width="315" height="205" DisableNVelocity="true" />Picking at dry skin, biting a hangnail, twisting your hair — these are all common things people do when stressed or bored. They also can be nervous habits or ways to get rid of bodily imperfections.  Most of the time, these behaviors are infrequent, temporary and do not cause physical damage. However, for some people, skin picking, nail biting and hair pulling can become such a problem that they struggle to control these behaviors to the point where wounds do not heal, nails become ripped and bleed, and bald patches appear on the scalp.  What's in a name? Body-focused repetitive behaviors involve any self-grooming behavior that damages the body. The most common body-focused repetitive behaviors are skin picking, nail biting and hair pulling. These behaviors also go by a variety of names —trichotillomania, dermatillomania, factitial dermatitis, excoriation disease, neurotic excoriation, onychophagia, habit control disorder, impulse control disorder and obsessive-compulsive spectrum disorders, just to name a few.  How common are these behaviors? Up to 60% of the population may experience times in their life when they may get caught up in cycles of picking, biting and pulling behaviors. Approximately 1%-5% of people suffer with body-focused repetitive behaviors, which are recurring patterns of behavior that can be difficult to control. These behaviors often result in significant distress and may lead to serious health consequences.  Body-focused repetitive behaviors usually start in late childhood through the teenage years, and these behaviors can become a chronic, lifelong problem if left untreated. These behaviors are equally common among girls and boys in childhood, but they become much more frequent in females than males into adulthood. Body-focused repetitive behaviors also can occur, along with anxiety and mood disorders.  Types of body-focused repetitive behaviors Body-focused repetitive behaviors generally fall into one of two categories:  <ul> <li>Impulsive</li> </ul> The impulsive type tends to be automatic, with picking, biting or pulling often happening outside of one's awareness. It happens in a wide variety of situations, tends to be frequent and brief, and often comes out during times of boredom and stress, such as while watching TV, driving or working on the computer.  <ul> <li>Compulsive</li> </ul> The compulsive type tends to be deliberate and purposeful, such as getting in front of a mirror and looking for wiry hairs that need to be plucked out. These episodes also tend to happen in private settings, such as the bathroom or bedroom, and often occur during times of high stress. While compulsive behaviors happen less frequently, when they happen, they can last for much longer periods of time, increasing the likelihood of causing serious damage to skin, nails and hair. People who engage in compulsive repetitive behaviors also may use instruments, such as tweezers, clippers, pins and needles. Many people can have impulsive and compulsive features of their body-focused repetitive behaviors.  Treating body-focused repetitive behaviors with habit control therapy Body-focused repetitive behaviors are treatable conditions, but they take work. The most-effective behavioral intervention is called habit reversal therapy, which essentially involves trying to learn and strengthen new habits to reduce and offset the body-focused repetitive behaviors.  Habit reversal therapy generally involves four steps:  1. Awareness training During this phase, people monitor where, when, how often and how long they engage in body-focused repetitive behaviors. They also may rate their emotions and physical sensations before, during and after these episodes. Then they start to learn to pay attention to how their hands move when engaging in these behaviors to serve as an "early warning detection system." They also may place external reminders in high-risk environments, such as brightly-colored stickers on a computer monitor, to remind them to be more aware of their hands and the risk for engaging in body-focused repetitive behaviors.  2. Competing response training  During this stage, people learn and practice alternate behaviors that interfere with or disrupt the body-focused repetitive behavior. They may practice tensing and releasing muscles in their hands and fists, or fanning out their hands and fingers as a means of reducing tension. Some of the most-helpful competing responses involve fiddling with objects that have a unique texture, such as a nail file, pen or ridges on a coin. It is important to test out a variety of objects to find one that best holds their attention. The goal is to practice these competing habits several times per day in a wide variety of environments.  3. Increasing habit strength  During this phase, people deliberately go into the high-risk body-focused repetitive behavior environments and routinely practice their competing responses. Engaging in their competing responses several times per day for several minutes each time will help increase the strength of these alternate habits while weakening the body-focused repetitive behavior habit.  4. Overcorrection During this stage, people continue to work on increasing the strength of their competing responses. Any time they notice engaging in a body-focused repetitive behavior, they try to stop as best they can, estimate how long they were engaging in the behavior, and then immediately start practicing their competing responses for twice as long. For example, if a person was picking at the skin for about three minutes, then that person would practice their competing responses for six minutes. Doing so increases the likelihood that the competing responses now become the new, dominant habit as they start to become associated with these high-risk body-focused repetitive behavior environments.  Additional tips Body-focused repetitive behaviors can be difficult to treat, and these behaviors are often frustrating and embarrassing for the people who struggle with them.  Additional ideas to help manage body-focused repetitive behaviors include: <ul> <li> Increase social support. </li> </ul> It is good to have support from family members who notice the body-focused repetitive behaviors. Rather than criticizing or routinely telling people to stop, it is useful to work out a game plan where family members can help people be more aware of their hands, such as "Notice your hands," and encourage them to practice their competing responses. The compulsive type of body-focused repetitive behaviors can be private, so it can be helpful to ask a family member to check on people if they have been in their bathroom or bedroom for too long.  <ul> <li> Try blocking behaviors. </li> </ul> Sometimes it can be helpful to wear gloves, Band-Aids or hats to offset the likelihood of further damaging the body. However, these blocking behaviors tend to help only temporarily while working to increase the habit strength of their competing responses.  <ul> <li>Treat anxiety and depression. </li> </ul> Treating an underlying or co-occurring mental health condition also can reduce problems and impairments associated with body-focused repetitive behaviors. Working with a therapist to learn cognitive behavioral therapy, or meeting with a primary care provider or psychiatrist for medication management can improve one's mood and overall functioning. In some cases, effectively treating an anxiety or mood disorder can result in "self-correcting" the body-focused repetitive behavior.  <ul> <li>Work with a healthcare specialist.</li> </ul> Impulsive and compulsive body-focused repetitive behaviors place people at risk for chronic infections and further bodily damage. A referral to a healthcare specialist, such as a dermatologist, can help treat body-focused repetitive behaviors. Sometimes, underlying medical conditions that cause skin, nail and hair problems can be properly addressed, thereby reducing certain triggers for these behaviors.  Getting help Body-focused repetitive behaviors are treatable conditions. Talk with your primary care team about available treatment options. Gaining education on the nature and effective management of hair pulling, nail biting and skin picking is an important first step. <a rel="noopener noreferrer" href="https://www.bfrb.org/" target="_blank">The TLC Foundation for Body-Focused Repetitive Behaviors</a> is an excellent source that provides information, support and resources for these behaviors, including a locator to identify therapists who are trained in evidence-based, habit reversal therapy.  Additional self-help options include: <ul> <li> "Overcoming Body-Focused Repetitive Behaviors" (Mansueto, 2020)</li> <li> "Trichotillomania: An ACT Enhanced Behavior Therapy Workbook Approach" (Woods and Twohig, 2008) </li> </ul> Sydney Kelpin, Ph.D., and Olivia Bogucki, Ph.D., are clinical health psychology fellows in Primary Care in Rochester and Kasson. <a rel="noopener noreferrer" href="https://www.mayoclinic.org/biographies/sawchuk-craig-n-ph-d-l-p/bio-20085911" target="_blank">Craig Sawchuk, Ph.D.</a>, is a clinical psychologist in Primary Care in Rochester and Kasson and co-chairs the Division of Integrated Behavioral Health. Sydney Kelpin, Ph.D.; Olivia Bogucki, Ph.D.; Craig Sawchuk, Ph.D., L.P.Primary Care in Rochester and KassonBody Focused Repetitive BehaviorsPrimary Care in Rochester and KassonOmega-3 fatty acids are important for your health, but you may not need a supplement.&nbsp;<img src="/-/media/ech-media/images/widgets/medications/fish-oil-supplements.jpg?h=65&iar=0&w=100&sc_lang=en&hash=C3A4B5D695D513016F2C1A6A122DD22B" alt="Fish Oil Supplements" width="100" height="65" DisableNVelocity="true" />Answers to 5 questions about fish oil supplements4/15/2021 4:30 AM<img src="/-/media/ech-media/images/widgets/medications/fish-oil-supplements.jpg?h=205&iar=0&w=315&sc_lang=en&hash=28B426F706E849F7D06B93C25A06F6A1" alt="Fish Oil Supplements" width="315" height="205" DisableNVelocity="true" />The media is full of ads and recommendations for you to buy and take fish oil supplements to cure a list of health worries. But, are fish oil supplements really what you need?  What is fish oil? Fish oil is the fat, or oil, that comes from fish tissue. The reason you hear so much about it is because it is loaded with beneficial omega-3 fatty acids, specifically <span data-contrast="auto" class="TextRun SCXW75365123 BCX0" style="border:0px none #000000;color: #000000; opacity: 1; height: auto; width: auto; margin: 0px; padding: 0px; border-spacing: 0px; list-style-type: disc; list-style-image: none;">docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA). Your body cannot make these omega-3 fatty acids, so you must get them from food or supplements.  Omega-3 fatty acids are important for your muscles, specifically your heart muscle. They can reduce the risk of heart attacks; high cholesterol, particularly triglycerides; and high blood pressure. But more than that, omega-3 fatty acids play a role in brain function and inflammation. Being deficient in omega-3 fatty acids has shown to be associated with issues including cardiovascular disease, rheumatoid arthritis, depression and Alzheimer's disease.  Should you go and buy a bunch of fish oil supplements? While it's known that omega-3 fatty acids are good for you and being deficient is bad, taking high doses of fish oil supplements does not necessarily correlate to better health. In large studies examining the effects of fish oil supplements on health, the evidence was mixed.  These supplements did not appear to reduce the risk of heart attacks, strokes, or heart-related deaths in men and women. Moreover, there were some side effects, including bad breath and heartburn, and at high doses, an increased risk of bleeding. However, looking deeper, several specific groups benefited from fish oil supplements, and the exact dose of the supplement seemed to matter, as well.  Who benefits from taking fish oil supplements? As studies have shown, it is not a one-size-fits-all scenario. These studies showed that these specific groups may benefit from daily fish oil supplements: <ul> <li>Patients who eat less than 1.5 servings of fish a week or don't eat any fish. </li> <li>African American patients. </li> <li>Patients with high triglyceride levels, that is those patients whose triglyceride level is greater than 200 milligrams per deciliter. </li> </ul> If you are a member of one of the groups that benefits from fish oil supplements, how much should you take and when should you take it? The American Heart Association recommends that those who might benefit from fish oil supplements should take 1 gram per day of EPA plus DHA. Preferably this should come from consuming oily fish, but supplements can be considered. For patients with high triglycerides in particular, the American Heart Association concludes that a prescription fish oil supplement of 4 grams per day of EPA, or EPA + DHA, can be used to lower triglyceride levels.  It is recommended to take the supplement prior to your largest meal of the day if you can, as doing so will help mitigate the rise in triglycerides that occurs with the largest meal. As always, consult with your health care provider before starting a fish oil supplement.  What else can you do to lower your risk of heart disease? The best thing you can do to lower your risk of heart disease is lead a healthy lifestyle and consume a healthy diet. This means not smoking, eating at least five servings of fruits and vegetables daily, and getting moderate exercise for at least 150 minutes a week.  If you are a healthy person and at low or average risk for heart disease, you should eat at least two servings a week of fatty fish, such as salmon, tuna or herring. It is better to eat your omega-3 fatty acids in food rather than a supplement.  <a href="https://communityhealth.mayoclinic.org/providers/allison-ducharme-smith-md/">Allison Ducharme-Smith, M.D.</a>, is an internal medicine physician in Primary Care in Rochester and Kasson's Division of Community Internal Medicine, she practices at Mayo Family Clinic Northeast in Rochester. Her interests include preventive medicine, women's health, chronic disease management and medical education. Allison Ducharme-Smith, M.D.Primary Care in Rochester and KassonFish oil supplementsPrimary Care in Rochester and KassonIf you experience heartburn, these tips may help.&nbsp;<img src="/-/media/ech-media/images/widgets/people/heartburn_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=8E413AAA03362F972B1BA6976D5A4E5D" alt="Heartburn_widget" width="100" height="65" DisableNVelocity="true" />A user's guide to heartburn treatment4/19/2021 5:00 AM<img src="/-/media/ech-media/images/widgets/people/heartburn_widget.jpg?h=205&iar=0&w=315&sc_lang=en&hash=E13878F7780807C6316E82F5DBA6AF17" alt="Heartburn_widget" width="315" height="205" DisableNVelocity="true" />Heartburn is a burning pain often felt behind the breastbone in the middle of your chest. It occurs when stomach acid escapes into the esophagus, which is the tube that brings the food you eat to your stomach.  Where the esophagus meets the stomach is a rubber band like muscle that relaxes when you eat and then tightens again to keep the food and acid in the stomach. In some people, this muscle relaxes too much when a large meal is eaten, or when they lay down on a bed or couch. As a result, this muscle opens, allowing food or stomach acid to enter the esophagus and causing heartburn.  How is heartburn treated? Nonmedication and medication treatments are available: <ul> <li>Nonmedication treatment options  The first options used to correct heartburn are simple lifestyle changes, including: <ul> <li>Raising the head of your bed 4-6 inches. </li> <li>Wearing loose-fitting clothing. </li> <li>Eating smaller meals or eating meals two to three hours before laying down. </li> <li>Cutting back on alcohol and smoking. </li> <li>Avoiding trigger foods, such as caffeine, tomatoes, chocolate and onions. </li> <li>Losing weight. </li> </ul> </li> <li>Medication treatment options  Three classes of over-the-counter medications are used to treat heartburn: <ul> <li>Antacids, such as Tums or Maalox</li> <li>Histamine, or H2, blockers, such as Pepcid or Tagamet. </li> <li>Proton pump inhibitors, such as Protonix or Nexium. </li> </ul> </li> </ul> For as-needed symptoms, patients may find relief with antacids or histamine blockers. These medications are generally safe and well-tolerated when used as directed or under the direction of your health care provider. Proton pump inhibitors are more powerful medications that are used daily, and they can be used for more frequent symptoms or if other medications do not provide relief.  Should you tell your health care provider about these over-the-counter medications? You should notify your care team if you take any of these medications. Although many of these heartburn medications are available over the counter, they may interact with other medications you take. Some side effects are associated with long-term use of proton pump inhibitors, and your health care provider may need to perform additional monitoring.  Talk to your health care provider before taking both a proton pump inhibitor and histamine blocker together. If symptoms are severe enough to take multiple medications, you should see your health care provider to make sure it is simple heartburn and not a more severe issue. Taking both medications can increase the risk of gastrointestinal infection and decrease absorption of vitamins and calcium.  Is it time to stop your heartburn medication? You may need to stay on your proton pump inhibitor long term if:  <ul> <li>You have a history of ulcers, and frequently take medications like aspirin or ibuprofen — both nonsteroidal anti-inflammatory drugs. </li> <li>You have Barrett's esophagus (damage to the lower portion of the tube that connects the mouth and stomach). </li> </ul> If you have ben using one of these medications for many months or years for simple heartburn symptoms, it may be appropriate to discuss stopping the medication with your provider.  How can you discontinue these medications?  Medications such as Pepcid or Tums are only to be used as needed, and they can be stopped at any time. When someone has been taking a proton pump inhibitor for longer than three months, it is advised to slowly decrease the dose of the medication instead of quitting cold turkey.  The proton pump inhibitors have been shutting off your acid production, and quitting cold turkey would turn them all on at once, potentially causing an overproduction of acid. Slowly decreasing your daily amount by 50% every 1-2 weeks has been shown to be the best way to successfully taper off these medications.  Regina Haeflinger is a pharmacy student completing clinical rotations at Mayo Clinic. She will graduate from Creighton University in May. She enjoys educating patients and helping them understand their medications.  Laurel Lake, Pharm.D., is a pharmacist completing her residency training in ambulatory care at Mayo Clinic in Rochester.Regina Haeflinger, C.S.T., and Laurel Lake, Pharm.D., R.Ph.Primary Care in Rochester and KassonHeartburnPrimary Care in Rochester and KassonYou may not be aware of an allergy until you're stung.&nbsp;<img src="/-/media/ech-media/images/widgets/kids/bee-sting.jpg?h=65&iar=0&w=100&sc_lang=en&hash=ADCD799190A374CFC91D28FAC266F2DE" alt="Bee Sting" width="100" height="65" DisableNVelocity="true" />'Bee' prepared for insect stings5/27/2021 5:00 AM<img src="/-/media/ech-media/images/widgets/kids/bee-sting.jpg?h=205&iar=0&w=315&sc_lang=en&hash=86266FC0D119C1CE61A7C18581C60FFF" alt="Bee Sting" width="315" height="205" DisableNVelocity="true" />Summer's the season for gardening, playing outside, backyard picnics and just enjoying the outdoors. It's also the season of bee and other insect stings. About 5% of the population is allergic to insect stings, according to the American College of Allergy, Asthma & Immunology. But most people aren't aware of their allergy until they're stung.  Reactions to insect stings, including wasps, bees and hornets, range in severity from minor to potentially fatal. In most cases, bee and other stings are only annoying, causing a brief sharp pain, along with slight swelling and redness. Home treatment is all that's necessary to ease the pain.  But if you're allergic or get stung numerous times, a more severe reaction — anaphylaxis — can require emergency attention.  What happens when you're stung?  When you're stung, your immune system produces immunoglobulin E antibodies, which react to the venom injected by the insect. This reaction triggers your body's release of histamine and other chemicals that can cause severe responses, such as:  <ul> <li>Itching and hives throughout the body. </li> <li>Swelling of the throat and tongue. </li> <li>Difficulty breathing. </li> <li>Dizziness and nausea. </li> <li>Stomach cramps and diarrhea. </li> <li>Rapid fall in blood pressure, resulting in shock and possibly loss of consciousness. </li> </ul> Treating stings After any sting, remove the stinger using your fingernails or tweezers as soon as you can. It takes only seconds for the venom to enter your body. Then wash the sting area with soap and water.  If you notice a minor to moderate reaction, such as redness, warmth or swelling around the sting, apply a cold compress and take an over-the-counter oral antihistamine. You may want to apply hydrocortisone cream or calamine lotion to ease any symptoms.  If you have a more serious reaction to single or multiple bee stings, even if it's just one or two of the serious symptoms listed above, call 911.  Preventing stings These tips can reduce your risk of getting stung by bees, hornets and wasps: <ul> <li>Take care when drinking sweet beverages outside. Wide, open cups may be your best option because you can see if a bee is in them. Inspect cans and straws before drinking from them. </li> <li>Tightly cover food containers and trash cans. </li> <li>Clear away garbage, fallen fruit, and dog or other animal feces, as flies can attract wasps. </li> <li>Wear close-toed shoes when walking outside. </li> <li>Don't wear bright colors or floral prints, which can attract bees. </li> <li>Don't wear loose clothing, which can trap stinging insects between the cloth and your skin. </li> <li>When driving, keep your windows rolled up. </li> <li>Be careful when mowing the lawn or trimming vegetation, activities that might disturb a beehive or wasp nest. </li> <li>Have hives and nests near your home removed by a professional. </li> <li>If a few bees are flying around you, stay calm and slowly walk away. Swatting an insect may cause it to sting. </li> <li>If you are stung, or many insects start to fly around, cover your mouth and nose, and quickly leave the area. If you can, get into a building or closed vehicle. When a bee stings, it releases a chemical that attracts other bees. </li> </ul> If you've experienced an allergic reaction to a bee, wasp or hornet sting, you should talk with your health care provider or an allergy specialist about prevention and treatment options. This could include being prescribed an emergency medication, such as an epinephrine autoinjector, to use if stung. In more severe cases, allergy shots may be a long-term solution for you.  <a href="https://communityhealth.mayoclinic.org/providers/denise-dupras-md/">Denise Dupras, M.D., Ph.D.</a>, is a general internist in the Division of Community Internal Medicine in Rochester, Minnesota. She completed her medical and doctoral degrees at Mayo Clinic Alix School of Medicine and her residency in internal medicine at Mayo Clinic in Rochester. Her interests include medical education and evidence-based medicine. Denise Dupras, M.D., Ph.D.Primary Care in Rochester and KassonInsect StingsPrimary Care in Rochester and KassonThese tips can help you get and stay motivated.&nbsp;<img src="/-/media/ech-media/images/widgets/randomimages/impossible.jpg?h=65&iar=0&w=100&sc_lang=en&hash=D3B8E1A168227302256A445EA039D0F5" alt="IMpossible" width="100" height="65" DisableNVelocity="true" />What is motivation, and how do you find it?5/20/2021 5:00 AM<img src="/-/media/ech-media/images/widgets/randomimages/impossible.jpg?h=205&iar=0&w=315&sc_lang=en&hash=ADF590F64448C6B49CAC50153B5FB937" alt="IMpossible" width="315" height="205" DisableNVelocity="true" />Motivation is defined as the force to keep going even when things are tough. Finding motivation during a global pandemic can feel a lot like trying to find a cool glass of ice water in the middle of a desert.  A lack of motivation and energy is understandable to adults juggling households, careers, children, and distance learning — all while feeling more isolated and alone due to the ongoing pandemic. Children and teens facing distance learning, loss of extracurricular activities and social isolation are especially susceptible to decreased motivation.  No one can pretend these are normal times, and you cannot have the same expectations of yourself or your children during a pandemic.  There are strategies to improve motivation.  <ul> <li>Get creative.  Your brain craves new experiences, which seem far and few between. Boredom and disinterest make it harder to be motivated. Try performing tasks in a new way. Have a dance party while cleaning. Make the school and workday a competition. </li> <li>Create a routine that works for you.  Set aside the same time each day to do the tasks you dislike, such as doing homework or reviewing emails. Follow these tasks with more rewarding, enjoyable tasks. Use lists to keep yourself on track toward your goals. Break down tasks to smaller, achievable pieces. </li> <li>Set goals.  As a family or individually, motivation can come from an end goal and hopefully a pot of gold at the end. Identify potential obstacles and how you will overcome these. </li> <li>Set yourself up to succeed.  Think about your environment and consider whether it is motivating. Is your office or desk area a productive space? Do you need more natural light? Are there certain sites or apps you need to block on your computer while at work or school? </li> <li>Be realistic. Start with small achievable changes and build on them. It is a great goal to start running 5 miles a day, but lacing up your running shoes and walking around the block is an easier and healthier place to start. </li> <li>Partner up.  Find someone to be your motivation partner. What tasks will you be accountable for to them? Set aside time to check in or virtually complete tasks together. </li> <li>Determine what's important.  Find out what fills you up and do more of it. Complete this <a rel="noopener noreferrer" href="https://www.actmindfully.com.au/upimages/VALUED_Living_Questionnaire_-_adapted.pdf" target="_blank">values assessment</a> to identify what's important to you. </li> <li>Practice acceptance.  Some days you will not feel inspired or motivated. Acting as if everything should be easy will only make things worse. Acknowledge that this is hard for yourself and others. </li> </ul> Here are some specific strategies for kids: <ul> <li>Reward often and excessively. Internal rewards often don't kick in until adulthood. Teach kids that effort leads to satisfying results. Reward effort — not outcome. </li> <li>Encourage kids to do homework or virtual learning in new environments around your home. </li> <li>Find a homework buddy, even if kids are working on different homework. </li> <li>Agree on realistic expectations for kids' performance, behavior and productivity. </li> </ul> The secret to building motivation is no secret at all. The truth is that building motivation is about progress — not perfection. Try new things, especially when feeling exhausted or unmotivated. Create a support network. Celebrate every accomplishment, and do not be too hard on yourself or your children when you feel unmotivated.  Everyone is in this together. Remember the wise words of Confucius, "It doesn't matter how slow you go, as long as you don't stop." Hannah Mulholland, L.I.C.S.W., M.S.W., is a pediatric Integrated Behavioral Health and social work supervisor. She works with children and their families to develop skills to manage emotional and behavioral struggles.  John Mack, L.I.C.S.W., M.S.W., is an adult Integrated Behavioral Health social worker based in the Baldwin Building. He has eight years of experience working with people experiencing mental health challenges. Hannah Mulholland, L.I.C.S.W., M.S.W., and John Mack, L.I.C.S.W., M.S.W.Primary Care in Rochester and KassonMotivationPrimary Care in Rochester and KassonUnsure about donating organs for transplant? Don't let misinformation keep you from saving lives.&nbsp;<img src="/-/media/ech-media/images/widgets/medicalimages/organ-donation.jpg?h=65&iar=0&w=100&sc_lang=en&hash=513E60287ECBAC775AA4EA8544389C70" alt="Organ Donation" width="100" height="65" DisableNVelocity="true" />Don't let myths about organ donation confuse you4/8/2021 5:00 AM<img src="/-/media/ech-media/images/widgets/medicalimages/organ-donation.jpg?h=205&iar=0&w=315&sc_lang=en&hash=39DF020652F26C643051D43E524B6960" alt="Organ Donation" width="315" height="205" DisableNVelocity="true" />Over 100,000 people in the U.S. are waiting for an organ transplant.  Unfortunately, many may never get the call saying that a suitable donor organ — and a second chance at life — has been found. It's estimated that every day in the U.S. 20 patients die because of the lack of donor organs.  It can be hard to think about what's going to happen to your body after you die, let alone donating your organs and tissue. But being an organ donor is a generous and worthwhile decision that can be a lifesaver.  If you've never considered organ donation or delayed becoming a donor because of possible inaccurate information, here are answers to some common organ donation myths and concerns: Myth: If I agree to donate my organs, hospital staff won't work as hard to save my life.  Fact: When you go to the hospital for treatment, health care providers focus on saving your life — not somebody else's. You'll be seen by a health care provider whose expertise most closely matches your condition and who can give you the best care possible.  Myth: I won't really be dead when they sign my death certificate. Fact: Although it's a popular topic in the tabloids, people don't start to wiggle their toes after they're declared dead. People who have agreed to organ donation are given more tests at no charge to their families to determine that they're truly dead than are those who haven't agreed to organ donation.  Myth: Organ donation is against my religion. Fact: Organ donation is consistent with the beliefs of most major religions, including Roman Catholicism, Islam, most branches of Judaism and most Protestant faiths. If you're unsure of or uncomfortable with your faith's position on organ donation, ask a member of your clergy.  Myth: I'm under age 18. I'm too young to make this decision. Fact: Many states allow people who are younger than 18 to register as organ donors, but the final decision will remain the responsibility of your parents or legal guardian. Discuss your wish to become an organ donor with your family and ask for their consent. Keep in mind that children, too, are in need or organ transplants, and they usually need organs smaller than those an adult can provide.  Myth: An open-casket funeral isn't an option for people who have donated organs or tissues. Fact: Organ and tissue donation doesn't interfere with having an open-casket funeral. The donor's body is clothed for burial and treated with care and respect, so there are no visible signs of organ or tissue donation.  Myth: I'm too old to donate. Nobody would want my organs. Fact: There's no defined cutoff age for donating organs. The decision to use your organs is based on strict medical criteria — not age. Don't prematurely disqualify yourself. Let the doctor decide at the time of your death whether your organs and tissues are suitable for transplantation.  Myth: I'm not in the best of health. Nobody would want my organs or tissues.  Fact: Few medical conditions automatically disqualify you from donating organs. The decision to use an organ is based on strict medical criteria. It may turn out that certain organs are not suitable for transplantation, but other organs and tissues may be fine. Don't prematurely disqualify yourself. Only medical professionals at the time of your death can determine whether your organs are suitable for transplantation.  Myth: I'd like to donate one of my kidneys now, but I wouldn't be allowed to do that unless one of my family members is in need.  Fact: While that used to be the case, it isn't any longer. Whether it's a distant family member, friend or a complete stranger you want to help, you can donate a kidney through certain transplant centers. If you decide to become a living donor, you will undergo extensive questioning to ensure that you are aware of the risks and that your decision to donate isn't based on financial gain. You also will undergo testing to determine if your kidneys are in good shape and whether you can live a healthy life with just one kidney.  Myth: Rich and famous people go to the top of the list when they need a donor organ.  Fact: The rich and famous aren't given priority when it comes to allocating organs. It may seem that way because of the amount of publicity generated when celebrities receive a transplant, but they are treated no differently from anyone else. The reality is that celebrity and financial status are not considered in organ allocation.  Myth: My family will be charged if I donate my organs.  Fact: The organ donor's family is never charged for donation. The family is charged for the costs of all final efforts to save your life, and those costs are sometimes misinterpreted as costs related to organ donation. Costs for organ removal go to the transplant recipient.  Why you should consider organ donation Now that you have the facts, you can see that being an organ donor can make a big difference, and not just to one person. By donating your organs and tissue after you die, you can save or improve as many as 75 lives. Many families say that knowing their loved one helped save or improve other lives helped them cope with their loss.  It's especially important to consider becoming an organ donor if you belong to an ethnic minority. Minorities, including African Americans, Asians and Pacific Islanders, Native Americans, and Hispanics, are more likely than whites to have certain chronic conditions that affect the kidney's heart, lung, pancreas and liver.  Certain blood types are more prevalent in ethnic minority populations. Because matching blood type is usually necessary for transplants, the need for minority donor organs is especially high.  How to donate Becoming an organ donor is easy. You can indicate that you want to be a donor in these ways:  <ul> <li>Register with your state's donor registry. Most states have registries. Check the list at <a rel="noopener noreferrer" href="https://www.organdonor.gov/" target="_blank">organdonor.gov</a>. </li> <li>Designate your choice on your driver's license. Do this when you obtain or renew your license. </li> <li>Tell your family. Make sure your family knows your wishes regarding donation. </li> </ul> The best way to ensure that your wishes are carried out is to register with your state's organ donation registry, and include donor designation on your driver's license or state ID. Taking these steps legally authorizes your organ donation upon death.  If you have designated someone to make health care decisions for you if you become unable to do so, make sure that person knows that you want to be an organ donor. You also may include your wishes in your living will if you have one, but that might not be immediately available at the time of your death.  It's also important to tell your family that you want to be a donor. Hospitals seek consent from the next of kin before removing organs, although this is not required if you're registered with your state's donor registry or have donor designation on your driver's license or state ID card.  Used with permission of Mayo Foundation for Medical Education and Research, all rights reserved. Reference: Organ donation: Don't let these myths confuse you. (2019, April 11).  Retrieved from <a rel="noopener noreferrer" class="Hyperlink SCXW69267218 BCX0" href="https://www.mayoclinic.org/healthy-lifestyle/consumer-health/in-depth/organ-donation/art-20047529" target="_blank" style="color: inherit; background-color: #ffffff; margin: 0px; padding: 0px;">https://www.mayoclinic.org/healthy-lifestyle/consumer-health/in-depth/organ-donation/art-20047529</a>Primary Care in Rochester and KassonOrgan DonationPrimary Care in Rochester and KassonFind out how physical activity helps and where you can go for classes.&nbsp;<img src="/-/media/ech-media/images/widgets/elderly/elderlyexercise_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=3D143A741182544AF4105AFD250A79FC" alt="ElderlyExercise_widget" width="100" height="65" DisableNVelocity="true" />Physical activity as you age has many health benefits4/27/2021 5:00 AM<img src="/-/media/ech-media/images/widgets/elderly/elderlyexercise_widget.jpg?h=205&iar=0&w=315&sc_lang=en&hash=29C146BDE1FA0FA00C4A33F4272ABBCD" alt="ElderlyExercise_widget" width="315" height="205" DisableNVelocity="true" />Physical activity has many health benefits, including decreasing anxiety, improving balance, and improving sleep and overall health. Being active also reduces symptoms of depression, heart disease and chances of developing Type 2 diabetes.  Some options for activity classes in the community include:  Rochester Area Family YMCA The <a rel="noopener noreferrer" rel="noopener noreferrer" href="https://www.ymcanorth.org/locations/rochester_ymca" target="_blank">Rochester Area Family YMCA</a> is offering an evidence-based program for elderly adults called "Y's Enhance Fitness." Participants have noted these benefits:  <ul> <li>More energy. </li> <li>Better balance. </li> <li>Increase in upper and lower body strength. </li> <li>More flexibility and range of motion. </li> <li>Better sleep. </li> <li>More feelings of happiness. </li> <li>A sense of independence. </li> </ul> This program accommodates people who have arthritis, and it encourages activity. But the program makes sure that it doesn't hurt to exercise. Some activities can be performed with a chair for support if you have balance issues. The class can also help build social relationships between participants.  125 LIVE <a rel="noopener noreferrer" rel="noopener noreferrer" href="https://125livemn.org/" target="_blank">125 LIVE</a> in Rochester offers evidence-based classes to help seniors, including cancer survivors; yoga for multiple sclerosis patients; and "Rock Steady Boxing" and "PWR! Moves: Improved Neurological Function," two programs geared toward Parkinson's disease patients. Morning programs geared toward seniors also are offered.  Exercisabilities <a rel="noopener noreferrer" rel="noopener noreferrer" href="https://www.exercisabilities.org/senior-wellness/" target="_blank">Exercisabilities</a> is a local nonprofit organization with scholarships, reduced fee and affordable pricing available to help keep seniors fit. This fully accessible facility has advanced fitness equipment, such as functional electrical stimulation equipment, adaptive fitness equipment, treadmills and ellipticals. Some of their equipment is not available elsewhere in the community.  Exercisabilities also offers community-based physical and occupational therapy that focuses on neurologic diagnosis and advanced senior conditions. They offer community-based occupational therapy with the same focus.  <ul> <li>Individual Adaptive Personal Training (Therapeutic Health Promotion) This training involves personal trainers working with seniors suffering from neurologic conditions, arthritis, stroke, spinal cord injury, Parkinson's, cardiac conditions and more. Given the COVID-19 pandemic, they have changed group intervention focus to individualized services for safety. </li> <li>Additional senior wellness programming was available at Exercisabilities, but these programs are on hold due to COVID-19 including group-specialized, diagnosis-specific exercise safe programs; Stay Active and Independent; Parkinson's Wellness and Recovery; "Stroke Exercise" class; and A Matter of Balance. </li> </ul> Finally, Exercisabilities has a Medicare Diabetes Prevention program scheduled to begin on May 5, with a virtual option available. This program offers rolling referral acceptance by calling Exercisabilities at <a href="tel:5072597570">507-259-7570</a>, or having your provider fax a referral to 888-624-3107. This class is offered for free for any senior with any Medicare product who has a prediabetes diagnosis as confirmed by a body mass index of 25 or higher and an:  <ul> <li>HbA1C of 5.7%–6.4%. </li> <li>Fasting plasma glucose of 100–125 milligrams per deciliter. </li> <li>Two-hour plasma glucose after a 75-gram glucose load of 140–190 milligrams per deciliter. </li> <li>Previous diagnosis of gestational diabetes (not an allowed qualification for Medicare). </li> </ul> <a href="https://communityhealth.mayoclinic.org/providers/tara-kaufman-md/">Tara Kaufman, M.D.</a>, is a physician in the Department of Family Medicine at Mayo Clinic in Rochester, Minnesota. She practices at Mayo Family Clinic Southeast. Tara Kaufman, M.D.Primary Care in Rochester and KassonPhysical Activity AgingPrimary Care in Rochester and KassonThese tips can help you focus on a proactive diet.&nbsp;<img src="/-/media/ech-media/images/widgets/food/superfoods.jpg?h=65&iar=0&w=100&sc_lang=en&hash=78956A3E1EB3056C3C1067651290FD42" alt="Superfoods" width="100" height="65" DisableNVelocity="true" />Healthy food choices: 1 piece of the proactive health puzzle5/13/2021 4:30 AM<img src="/-/media/ech-media/images/widgets/food/superfoods.jpg?h=205&iar=0&w=315&sc_lang=en&hash=30DD345DE89C987885BD5E0195615138" alt="Superfoods" width="315" height="205" DisableNVelocity="true" />Scan the headlines of any popular fitness magazine, online health blog or social media platform, and you are bound to see "proactive health." Studies suggest that nearly two-thirds of people in the U.S. are making an effort to be proactive about their health. But what is the proactive health movement and how does eating well fit into this trend?  Proactive health movement is the public's increased interest in making changes in lifestyle habits and choices to live well and prevent disease. Being proactive about your health can include changes in diet, exercise, sleep hygiene, dental health and muscle strength and flexibility.  Choosing a healthy diet is one piece of proactive health. The public is being exposed to more channels via the internet and social media to learn about healthy foods and what that food can do for them. It is important to not get pulled into trendy or restrictive food habits, but rather consider food choices and habit changes that are backed by science.  Here are some tips for focusing on a proactive diet: <ul> <li>Eating a balanced diet. The Academy of Nutrition and Dietetics recommends consuming food from multiple food groups, including whole grains, lean protein, fiber-rich whole fruits and vegetables and low-fat dairy. Using the plate method, which divides up the plate to ensure appropriate portion sizes of different foods, can be a strategy to eat a balanced diet. </li> <li>Taking dietary supplements.  Individual nutrient needs vary depending on age and health conditions. Sometimes supplements are needed to fill a gap when someone cannot meet the need through diet. Discuss supplements with your health care team. </li> <li>Eating food with added functional benefits.  While the government has no legal definition for functional food, referring to the Nutrition Facts label and ingredients list can help determine if a food is a healthy choice. Functional foods include minimally processed, whole foods. A few examples include antioxidant-rich berries; fatty fish like salmon that are rich in omega-3; or unsalted, heart-healthy nuts. </li> <li>Supplementing diet with healthier foods.  A good first step is as easy as increasing your fruit and vegetable intake. You can start small. Adding just one serving — about one cup per day — is a great start. </li> <li>Eating superfoods.  A superfood is nutrient-dense, meaning they contain high volumes of protein, vitamins, minerals, or fiber in a portion. Examples include broccoli, which is rich in fiber and antioxidants, and low in calorie; oranges, which are high in fiber, vitamin C and potassium; and blueberries, which provide antioxidants and phytochemicals. </li> </ul> There are many pieces of the puzzle of proactive health to pursue. Healthy food choices for proactive health don't need to be flashy, restrictive or difficult to follow. When it comes to diet, choose a piece to work on — like more fruits and veggies — and see how it fits into your life.  Rachel Braun is a dietetic intern at Mayo Clinic in Rochester, Minnesota. Rachel BraunPrimary Care in Rochester and KassonProactive HealthPrimary Care in Rochester and KassonFollow these tips to save yourself a trip to your health care provider.&nbsp;<img src="/-/media/ech-media/images/widgets/people/gardeningfarming.jpg?h=65&iar=0&w=100&sc_lang=en&hash=21DA0E481E50242D29D4FAF6F421C27D" alt="GardeningFarming" width="100" height="65" DisableNVelocity="true" />Ergonomics for farm workers, gardeners6/17/2021 4:30 AM<img src="/-/media/ech-media/images/widgets/people/gardeningfarming.jpg?h=205&iar=0&w=315&sc_lang=en&hash=72EDDF55BDD90DE7F50944963EECFEAB" alt="GardeningFarming" width="315" height="205" DisableNVelocity="true" />Summer is here, and it's time to get in the fields and gardens. To avoid injuries and unwanted trips to your health care provider, take tips from ergonomics.  Ergonomics is the study of the "best fit" between workers and their job. The goal is to reduce injuries, and increase comfort and safety related to work. Work-related musculoskeletal injuries are caused by repeated gripping, lifting, bending, twisting, kneeling and squatting. These activities are common in farm workers and gardeners. Even activities that are harmless alone, such as stretching out an arm to grasp an object, can put a worker at risk of injury if repeated over time.  Some general principles can be use to reduce injuries related to farm work and gardening as it relates to hand work and lifting.  Consider these guidelines for hand work: <ol> <li>Avoid placing needed tools above shoulder height. </li> <li>Allow adequate recovery time between repeated activities and allow alternative activities to occur, such as alternating weeding with carrying heavy loads. </li> <li>Place items within 17 inches of yourself. </li> <li>Sit if possible. </li> <li>If you need to stand, use floor mats with workstations at the proper height. </li> <li>Have hand tools that are covered with a smooth, slip-resistant material, such as plastic or rubber, with a spring to keep an open position. </li> <li>When washing plants, include the use of mesh bags rather than hand-washing to avoid stooping, lifting and repeated gripping. </li> <li>Use standardized containers as much as possible to allow for easy stacking. </li> </ol> Consider these best practices for lifting: <ol> <li>Keep lifts between hand level and shoulder level and avoid lifting from the floor. </li> <li>Use handles on containers. </li> <li>Use dollies, palate trucks or utility carts. </li> <li>Keep bag or box weight below 50 pounds. </li> <li>Use lifting tools. </li> <li>Lift with your legs. </li> <li>Carry smaller loads. While this seems less efficient, it will allow you to avoid injury and needing to stop the work or activity. </li> </ol> For more safety tips for farm workers, visit <a rel="noopener noreferrer" href="https://www.cdc.gov/niosh/" target="_blank">The National Institute for Occupational Safety and Health website</a>.  Happy farming and gardening.  <a href="https://communityhealth.mayoclinic.org/providers/jon-ebbert-md/">Jon Ebbert, M.D.</a>, is a physician in Primary Care in Rochester and Kasson's Division of Community Internal Medicine. He is chair of Community Internal Medicine's Division of Telehealth and offers virtual visit care across Southeast Minnesota. Jon Ebbert, M.D.Primary Care in Rochester and KassonFarm Garden ErgonomicsPrimary Care in Rochester and KassonFind out when you should be seen for a headache.&nbsp;<img src="/-/media/ech-media/images/widgets/people/headache.jpg?h=65&iar=0&w=100&sc_lang=en&hash=8F90D3F4C846C5AC7032F61772E02DA9" alt="Headache" width="100" height="65" DisableNVelocity="true" />What should you do when your head hurts?6/21/2021 4:30 AM<img src="/-/media/ech-media/images/widgets/people/headache.jpg?h=205&iar=0&w=315&sc_lang=en&hash=AC5BECF76DFB518F61B9CA8D503AA736" alt="Headache" width="315" height="205" DisableNVelocity="true" />Of the hundreds of types of headaches, the four most common types are:  <ul> <li>Sinus  Sinus headaches cause pain in the face, sinuses, eyes, ears or forehead; congestion; itching and runny nose; fever; and swelling in the face. </li> <li>Tension  Tension headaches typically feel like a tight band or compression, without throbbing or sensitivity. </li> <li>Migraine  Migraine headaches tend to be throbbing and pounding, and associated with sensitivity to light, sound, smell and movement. </li> <li>Cluster  Cluster headaches tend to cause severe pain on one side of the head and occur off and on for weeks over the course of a few months. </li> </ul> How do you know what type of headache you have and when should you be seen? Is it serious, and do you need to go to the emergency department?  Most headaches will resolve on their own with over-the-counter pain relievers, time and rest. If the headache pattern is consistent with migraine or tension-type headache, and does not occur with the loss of vision, strength, coordination, walking or the ability to communicate, then a brain MRI or other brain scans are generally not needed or beneficial. You can manage these headaches and may not need or benefit from a visit with your primary care provider.  Any headache that persists or is associated with changes in your function of vision, communication, strength, coordination or walking should be evaluated urgently in a clinic or the emergency department.  If you are seen by your care team in Primary Care in Rochester and Kasson, keep in mind that they are directly connected to the Integrated Community Specialty — Neurology team. This team of specialists in the Baldwin building in Rochester is easily accessible to your care team at the time of your visit. The team can offer a specialty perspective and advice that may lead to a faster diagnosis and effective treatment. The team-based model and excellent collaboration may save you from added trips to the office to be seen.  Nathan Young, D.O., is a community general neurologist practicing in the Integrated Community Specialty — Neurology practice at Mayo Clinic in Rochester, Minnesota. He has special interests and focuses on headaches, particularly migraines, as well as general neurology. Nathan Young, D.O.Primary Care in Rochester and KassonHeadachesPrimary Care in Rochester and KassonThese tips can help ease the pain.&nbsp;<img src="/-/media/ech-media/images/widgets/people/kneepain.jpg?h=65&iar=0&w=100&sc_lang=en&hash=F88BCB39AA9CF187DD411BC28EA3E7E8" alt="KneePain" width="100" height="65" DisableNVelocity="true" />Living with knee arthritis and making the best of it6/7/2021 4:00 AM<img src="/-/media/ech-media/images/widgets/people/kneepain.jpg?h=205&iar=0&w=315&sc_lang=en&hash=FE0623241599B92AB1793EE113E7BC5C" alt="KneePain" width="315" height="205" DisableNVelocity="true" />Whether you like to play sports, play with your grandkids or take a walk with your loved one, if you have arthritis, you quickly become aware of how it affects your quality of life.  Arthritis is one of the most common conditions seen in primary care. Symptoms can include pain, loss of motion, stiffness, or difficulty walking or going up and down stairs. Pain can be mild to severe, affect daily activities, or increase the risk of falling.  Tips to improve joint health and decrease pain Here are some tips to improve joint health and decrease pain: <ul> <li>It's all about the load.  Your body weight is extremely impactful on your knees. Consider low-impact exercise. Be consistent with tolerable activities — cycling, swimming or walking. Physical therapists can help with exercises to work into a daily routine. Avoid high-impact activities like running. </li> <li>My knees give out.  Consider physical therapy and an assistive device. Examples include a cane, crutches, walking stick, or braces or sleeves. </li> <li>There is inflammation, too.  Arthritis creates an inflammatory response in the joint. Over-the-counter topical gels or oral pain relievers — if indicated by your medical provider — can improve pain and reduce swelling. </li> <li>What supplements can help?  While controversial, glucosamine has been suggested to improve pain and reduce the progression of arthritis. </li> <li>Is it time for a shot?  Many types of injections can supply temporary relief. Two common options are cortisone or viscosupplementation, a gel like fluid that acts as a lubricant. </li> <li>What's new?  Regenerative options, such as stem cell procedures — platelet-rich plasma or bone marrow aspirate concentrate — can be considered. Radiofrequency ablation, a nonsurgical procedure that uses heat to reduce the transmission of pain, is another choice to treat pain. </li> <li>What about surgery?  When you have tried everything and feel that conservative measures have failed, talk to your health care provider about an orthopedic consult. You may want to consider total or partial knee replacement, or other less-invasive surgeries. </li> </ul> Living with arthritis can be debilitating and prevent you from doing things you love to do. Talk to your health care provider about ways to improve your function and manage your pain.  Lori McGowan, P.A.-C., is a certified physician assistant in the Department of Orthopedic Surgery. She practices in the adult Integrated Community Specialties — Musculoskeletal Division at Mayo Clinic in Rochester, where she helps patients with hip, knee, shoulder, foot and ankle orthopedic conditions. Lori McGowan, P.A.-C.Primary Care in Rochester and KassonKnee ArthritisPrimary Care in Rochester and KassonLearn more about milk products made without the use of animal milk.&nbsp;<img src="/-/media/ech-media/images/widgets/beverages/milk-alternatives.jpg?h=65&iar=0&w=100&sc_lang=en&hash=48AFF1D5A69F2060CCEBC4EE473FD086" alt="Milk Alternatives" width="100" height="65" DisableNVelocity="true" />Should you consider a milk alternative? 6/28/2021 4:30 AM<img src="/-/media/ech-media/images/widgets/beverages/milk-alternatives.jpg?h=205&iar=0&w=315&sc_lang=en&hash=07E26FACAF8BA86474F31CD6950D19E1" alt="Milk Alternatives" width="315" height="205" DisableNVelocity="true" />Milk alternatives have become popular, and options and varieties are plentiful. Milk alternatives include any milk product that is made without the use of dairy, or animal, milk. Options include almond, cashew, soy, oat, coconut, rice, hemp and pea protein milk.  Why choose a milk alternative? People choose milk alternatives for many reasons, including:  <ul> <li>Allergy</li> <li>Intolerance</li> <li>Vegan diet</li> <li>Personal preference</li> </ul> When making the switch to a milk alternative, it's important to understand that nutrients offered in these options can vary from standard dairy milk. Be sure to look for varieties that offer nutrient content that meets your needs.  Be sure to consider: <ul> <li>Protein  A serving of cow's milk provides 8 grams of protein. Pea protein milk is a nondairy alternative that provides an equal amount of protein in a single serving, with soy milk coming in second at 7 grams of protein per serving. Other varieties offer much lower amounts of proteins per serving. </li> <li>Calcium  Cow's milk is a great source of calcium. Luckily, switching to a nondairy milk alternative will not sacrifice calcium, as many manufacturers fortify nondairy milk with calcium.</li> <li>Vitamin D  Both cow's milk and nondairy milk alternatives are fortified with vitamin D, so either option will help meet your needs. </li> <li>Sugars  When choosing a nondairy milk alternative, check for added sugars. Many nondairy milks come in sweetened varieties that are loaded with added sugars. Opting for a no-added-sugar or unsweetened version is best for overall health. </li> </ul> Trying a nondairy milk alternative might feel intimidating at first, but understanding how to incorporate it into your diet can make the switch feel less overwhelming.  Here are some tips for making the switch: <ul> <li>Add it to your cereal or oatmeal in the morning. </li> <li>Use it to make a smoothie with your favorite frozen fruit. </li> <li>Substitute at a 1–to–1 ratio for regular milk in baking. </li> <li>Use it to make things like homemade macaroni and cheese or a creamy alfredo sauce. </li> <li>Use it to make homemade mashed potatoes. </li> <li>Serve it as a beverage with any meal or snack, or add it to coffee in place of creamer. </li> </ul> Whether you're trying a nondairy milk alternative due to taste preference, dietary preference, allergies or intolerances, or to try something new, plenty of options are on the market to explore. Check the nutrition label to find a variety that best fits your nutrient needs and flavor preference. Then get creative with how you incorporate it in the kitchen.  Carly Herr is a dietetic intern at Mayo Clinic in Rochester, Minnesota. She is from Pittsburgh, and attended school at The Pennsylvania State University and University of Wisconsin-Green Bay. Her areas of interest include wellness and weight management. Carly HerrPrimary Care in Rochester and KassonMilk AlternativePrimary Care in Rochester and KassonLearn when your health care provider should evaluate your vaginal discharge.&nbsp;<img src="/-/media/ech-media/images/widgets/people/womanproviderhallway.jpg?h=65&iar=0&w=100&sc_lang=en&hash=C47AE392DF857FBBA17377A30C85E59D" alt="WomanProviderHallway" width="100" height="65" DisableNVelocity="true" />When you should be seen for vaginal discharge6/3/2021 4:30 AM<img src="/-/media/ech-media/images/widgets/people/womanproviderhallway.jpg?h=205&iar=0&w=315&sc_lang=en&hash=A3C595E2A12A212EA3D6CBF0968D4332" alt="WomanProviderHallway" width="315" height="205" DisableNVelocity="true" />Women commonly experience vaginal discharge. While regular and symptomless vaginal discharge can be normal, if the discharge changes, is associated with symptoms or occurs after a new sexual partner, you should be evaluated.  When to monitor vaginal discharge A regular amount of vaginal discharge is normal for most women. The average women has 2–3 tablespoons of discharge per day. This discharge is generally transparent to white in color, thick and odorless. Hormonal changes can increase or decrease the amount of vaginal discharge.  Vaginal discharge increases in women at menarche — the development of the menstrual cycle — and near the middle of one's menstrual cycle when ovulation occurs. This discharge typically increases in volume; is thicker; and is often described as stringy, stretchy or whitened, compared to baseline discharge.  Women can experience an increase or decrease in vaginal discharge during the perimenopause transition or with menopause. Use of hormonal contraceptives, including intrauterine contraception, also can change the amount of regular vaginal discharge.  When to be seen Any change from the normal discharge pattern described above should be considered abnormal and discussed with your health care provider. Abnormal discharge is characterized by a change in color, odor or the amount of vaginal discharge experienced.  If discharge is associated with vulvar — the external part of the female genitalia — or vaginal redness, swelling, masses or lesions, skin or mucosa changes, pain, itching, or other irritation, it should be evaluated. You also should be seen if the discharge occurs after a new sexual partner, and if pain occurs with intercourse — or bleeding occurs between menstrual periods, after intercourse or after menopause.  Abnormal discharge can be associated with an infection caused by a bacterium, fungus or protozoan. It also can be associated with sexually transmitted infections or certain medical conditions. Some common causes of abnormal vaginal discharge are:  <ul> <li>Bacterium, including bacterial vaginitis, chlamydia or gonorrhea</li> <li>Fungus, including candidiasis</li> <li>Protozoan, including trichomoniasis vaginitis</li> <li>Medical conditions: including genitourinary syndrome of menopause, desquamative inflammatory vaginitis, pelvic inflammatory disease, cervicitis or endometritis, dermatitis or a foreign body</li> </ul> If symptoms of abnormal discharge are present, you should be evaluated.  To prevent abnormal vaginal discharge:  <ul> <li>Avoid common vulvar and vaginal irritants, including scented soaps, creams or lubricants. </li> <li>Practice safe sex with condom use. </li> <li>Keep immunizations up to date. </li> <li>Control underlying medical conditions. </li> </ul> Be sure to contact your primary care provider if you notice any abnormal changes.  <a href="https://communityhealth.mayoclinic.org/providers/danielle-olaughlin-pac/">Danielle O'Laughlin, P.A.-C., M.S.</a>, is a physician assistant in Primary Care in Rochester and Kasson's Division of Community Internal Medicine. She is the team lead of the Primary Care Obstetrics and Gynecology Clinic and is the Clinical Skills co-director of the Mayo Clinic Physician Assistant Program. Danielle O'Laughlin, P.A.-C.Primary Care in Rochester and KassonVaginal DischargePrimary Care in Rochester and KassonEnjoy the fair with these healthy choices.&nbsp;<img src="/-/media/ech-media/images/widgets/food/fairfoods.jpg?h=65&iar=0&w=100&sc_lang=en&hash=988CF72BE3D686A3F81FB31A8F79B193" alt="FairFoods" width="100" height="65" DisableNVelocity="true" />Smart summer fair food choices7/1/2021 4:30 AM<img src="/-/media/ech-media/images/widgets/food/fairfoods.jpg?h=205&iar=0&w=315&sc_lang=en&hash=E2CA90939EAF395987E75A2D99BB4D12" alt="FairFoods" width="315" height="205" DisableNVelocity="true" />The warmer weather brings with it many opportunities to get active and enjoy time outside. However, many summer events with their variety of tasty and high-calorie foods present a challenge for people trying to lose weight. One such challenge is navigating foods at the local fair. Enjoying time outside at the fair with family and friends shouldn't interfere with your weight-loss goals. Check out the tips below for some ideas on ways to enjoy the fair and make smarter food choices. Alternative food and beverage choices to enjoy at the fair include: <ul style="list-style-type: disc;"> <li>Swap the fried blooming onion for roasted corn on the cob.</li> <li>Substitute a fried turkey leg with a chicken or steak kebab with veggies.</li> <li>Replace sodas, lemonades and limeades with water.</li> <li>Select simple snacks like popcorn or nuts over mashup foods like chili cheese fries.</li> <li>Choose smaller portions of your favorite treats like ice cream.</li> </ul> Other suggestions to help prevent you from overeating at the fair include: <ul style="list-style-type: disc;"> <li>Eat a well-rounded, nutritious meal before you go.</li> <li>Stay hydrated with water.</li> <li>Pick one or two snack items that you will most enjoy and stick with those.</li> <li>Try sharing a portion with a family member or friend to prevent overeating. </li> <li>Plan ahead for your next meal so that you know what you'll eat when you leave the fair. </li> <li>Set a budget for food and do not exceed it.</li> </ul> Remember, it's OK to treat yourself to your favorite fair snack, but planning ahead, watching your portions and being mindful with your selections will ensure that you stick to your health and nutrition goals while enjoying the local fair. Sarah Dramstad, Eric Deangelis and Carly Herr are dietetic interns at Mayo Clinic in Rochester. Sarah Dramstad, Eric Deangelis, Carly HerrPrimary Care in Rochester and KassonFair FoodsPrimary Care in Rochester and KassonMaintaining a healthy gut reduces the risk of some diseases.&nbsp;<img src="/-/media/ech-media/images/widgets/food/fermentedfoodsampler.jpg?h=65&iar=0&w=100&sc_lang=en&hash=CA156DF4740833A48FE572E267173C20" alt="FermentedFoodSampler" width="100" height="65" DisableNVelocity="true" />Building a healthy gut microbiome7/12/2021 4:30 AM<img src="/-/media/ech-media/images/widgets/food/fermentedfoodsampler.jpg?h=205&iar=0&w=315&sc_lang=en&hash=0CE84F954D57777856919274A7A66B57" alt="FermentedFoodSampler" width="315" height="205" DisableNVelocity="true" />Your gastrointestinal tract is made up of trillions of microorganisms that make up the gut microbiome. These microorganisms can be generally classified as healthy or unhealthy.  Gut health can be defined by a normal composition of the microbiome, adequate digestion and absorption of food, the absence of gut illnesses, and an effective immune status. Emerging research is helping the medical world understand more about the gut microbiome, suggesting that the microbiome can be altered by what is eaten.  This is important because when the gut microbiome is not balanced, disease risk is higher. A gut rich in healthy bacteria can reduce the risk of inflammatory diseases, such as inflammatory bowel disease and irritable bowel syndrome, as well as obesity and colon cancer.  How to build a healthy gut microbiome Foods that help create a healthy gut microbiome are prebiotics and fiber, and probiotics and fermented foods. High-fiber diets containing prebiotics and probiotics promote a healthy gut microbiome. In contrast, diets high in fast food, sugar, processed foods and excessive alcohol can decrease gut health.  Try to include these foods in your diet:  <ul> <li>Fiber and prebiotics  These are nondigestible substances that feed healthy gut bacteria. Sources include fruits, vegetables, legumes and grains. For example, include foods such as artichokes, asparagus, bananas, barley, beans, berries, chicory root, flax, garlic, leafy greens, oatmeal, onion, rye and wheat in your diet.</li> <li>Fermented foods and probiotics  These bacteria feed off of fiber and prebiotics, and aid in digestion. Sources include buttermilk, fermented vegetables, kefir, kimchi, kombucha, miso, sauerkraut, sourdough, tempeh and yogurt with live cultures. </li> </ul> These foods may not be appropriate for everyone. Talk with your dietitian to see if they are right for you.  Rachel Waletzko is a dietetic intern at Mayo Clinic in Rochester. She is from northern Minnesota and graduated from the University of Minnesota Twin Cities. Her areas of interest are pediatrics and ICUs. Rebecca WaletzkoPrimary Care in Rochester and KassonHealthy Gut MicrobiomePrimary Care in Rochester and KassonMany over-the-counter and herbal products can interact with prescriptions and raise your blood pressure.&nbsp;<img src="/-/media/ech-media/images/widgets/medications/herbalmedications.jpg?h=65&iar=0&w=100&sc_lang=en&hash=58647E2D4AC681103A7B91AC564B9DAE" alt="HerbalMedications" width="100" height="65" DisableNVelocity="true" />Do you have high blood pressure?7/19/2021 4:30 AM<img src="/-/media/ech-media/images/widgets/medications/herbalmedications.jpg?h=205&iar=0&w=315&sc_lang=en&hash=689FBA9316D5671A0A60B57E43884E5B" alt="HerbalMedications" width="315" height="205" DisableNVelocity="true" />Consumers purchase many over-the-counter and herbal products each year. While they tend to think about these products as being safe, side effects can occur. When combined with a prescription, these products can worsen or cause new side effects, or lessen the response of that prescription. Prescriptions for hypertension, or high blood pressure, are one example of medications that can be affected by over-the-counter and herbal products. Considering that nearly half of adults in the U.S. have hypertension or are taking a prescription for hypertension, it's important to be mindful of these potential interactions. Several over-the-counter products have been shown to increase blood pressure, even when used as labeled. For example, nonsteroidal anti-inflammatory drugs used to treat pain, such as ibuprofen (Advil or Motrin) or naproxen sodium (Aleve) can increase blood pressure, as can decongestants to treat colds, such as pseudoephedrine (Sudafed) and phenylephrine (Sudafed-PE and Neo-Synephrine). Look for these ingredients in many other combination products for colds. Herbal products also can increase blood pressure, including ginkgo, ephedra, licorice, caffeine, saw palmetto and St. John's wort. Other herbal products that can contribute to increased blood pressure include arnica, bitter orange, blue cohosh, dong quai, guarana and yohimbine. If you've been told you have high blood pressure or are using a prescription to treat high blood pressure, talk to a member of your health care team before starting herbal or over-the-counter products to ensure they're safe for you. It's important to check the ingredient list on herbal and other over-the-counter products you take. Since many herbal products have not been well-studied, it may be difficult to predict the exact effects on blood pressure. Further, some products can lower blood pressure, increasing the risks of side effects. If you decide to start an over-the-counter or herbal product, you're encouraged to closely monitor your blood pressure to watch for changes. Laurel Lake, Pharm.D., R.Ph., is a pharmacist completing her residency training in ambulatory care at Mayo Clinic in Rochester.Laurel Lake, Pharm.D., R.Ph.Primary Care in Rochester and KassonHerbal Medications High Blood PressurePrimary Care in Rochester and KassonYou'll probably hear whining, but unplugging can give family time a boost.&nbsp;<img src="/-/media/ech-media/images/widgets/people/ech_media_plan_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=CEFCC780D5FB4A890DA11B564E454547" alt="ECH_media_plan_widget" width="100" height="65" DisableNVelocity="true" />Unplugging your family: Tips to make it work7/29/2021 4:30 AM<img src="/-/media/ech-media/images/widgets/people/ech_media_plan_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=F2239560D5E7930177959DDE50053097" alt="ECH_media_plan_widget" width="300" height="195" DisableNVelocity="true" />Are you worried that screen time has run amok in your family? If so, you're not alone. During the COVID-19 pandemic, most children and families increased their screen time due to things like social distancing and distance learning. Many families have lamented the challenges that this time brought, with technology being the only safe mode for many children to socialize with peers and continue their education. As society is starting to return to previous routines this summer, many families are thinking about having a technology reset. Nearly 50% of teens feel addicted to mobile devices, and 59% of parents worry their kids are addicted to mobile devices, according to a survey by <a rel="noopener" href="https://www.commonsensemedia.org/" target="_blank">Common Sense Media</a>. And it's no wonder. Using a mobile device activates the pleasure sensors in our brain, which means they make us feel good.  To put media use in perspective, the American Academy of Pediatrics' guidelines for young children are:  <ul style="list-style-type: disc;"> <li>Before age 2 No digital media, except for video chatting.</li> <li>Ages 2–5 Limit to one hour per day of high-quality programming and watch it with them.</li> <li>Ages 5 and up Two hours or less per day.</li> </ul> So what can parents do? Here are some tips for managing family device use and even unplugging for a while this summer: <ul style="list-style-type: disc;"> <li>Start with yourself.  How many times per day do you turn to your phone? Being aware of your habits can help you be a better role model. Resist the urge to bring your phone to bed, check email whenever you have a few minutes of downtime or glance at the screen instead of watching your kids jump in the pool, shoot baskets or dance around the living room. </li> <li>Create a family media plan.  Bring the family together and design a media plan, complete with goals and rules that everyone can buy into. It also will help you as a parent determine the role you want media to play in your family. The American Academy of Pediatrics' <a rel="noopener" href="https://healthychildren.org/English/Pages/default.aspx" target="_blank">healthychildren.org</a> has created a <a rel="noopener" href="https://www.healthychildren.org/English/fmp/Pages/MediaPlan.aspx?_gl=1*tbuy8n*_ga*NjYxMjA4MjUzLjE3MjI5MzczMjY.*_ga_FD9D3XZVQQ*MTcyMjkzNzMyNi4xLjAuMTcyMjkzNzMyNi4wLjAuMA.." target="_blank" title="Link opens in a new window">step-by-step form</a> in English and Spanish to help you customize a plan for your family overall and each child. </li> <li>Stick to the plan. Be prepared. A device-free dinner, holiday or Sunday afternoon is going to generate a symphony of whines and moans. Remind your family that the plan was agreed on by everyone, and it applies to everyone — even the grown-ups. </li> <li>Fill the device gap. Simply unplugging isn't the point. It's about breaking free of these electronic babysitters, to connect with friends, spend time together as a family and savor alone time. Spend that time talking, making pizza from scratch, playing games, going for a walk, doing puzzles, planning a "someday" trip, rediscovering favorite toys, making a scrapbook, volunteering together. The device-free options are limited only by your imagination. </li> <li>Reap the benefits.  There are sound reasons for putting down the phone. Cyberbullying is real. So is texting while driving, which is illegal in Minnesota. Kids — and grown-ups — need to learn how to interact face to face with people. This is something that will serve them well in the workplace and life. And, remember, it's OK to be bored. Boredom encourages creativity, resiliency, imagination and problem-solving, which are all indispensable skills for a successful life. </li> </ul> <a rel="noopener" href="http://communityhealth.mayoclinic.org/providers/angela-mattke-md" target="_blank">Angela Mattke, M.D.,</a> is a general pediatrician in the Division of Community Pediatric and Adolescent Medicine at Mayo Clinic in Rochester. She is host of Mayo Clinic's interactive Facebook Live show and podcast called, <a rel="noopener" href="https://www.facebook.com/search/top/?q=%40askthemayomom" target="_blank">"#AskTheMayoMom</a>," where she discusses and answers audience questions about common pediatric health topics. You can follow her on Twitter at <a rel="noopener" href="https://twitter.com/DrAngelaMattke" target="_blank">@DrAngelaMattke</a>. For more information about pediatric health topics, follow <a rel="noopener" href="https://twitter.com/search?q=mayoclinickids&src=typd" target="_blank">@mayoclinickids</a> on Twitter. Angela Mattke, M.D.Primary Care in Rochester and KassonUnplugging FamilyPrimary Care in Rochester and KassonIf you're itching, one of these unwelcome guests may be causing your symptoms.&nbsp;<img src="/-/media/ech-media/images/widgets/skin/ech_itch_01_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=07F20E31B39CEEE303932291DF625FB7" alt="ECH_Itch_01_widget" width="100" height="65" DisableNVelocity="true" />Bedbugs, scabies and lice - oh my!8/30/2021 4:30 AM<img src="/-/media/ech-media/images/widgets/skin/ech_itch_01_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=3432E4E0ABE8AC6A6D5103B3CE880FAD" alt="ECH_Itch_01_widget" width="300" height="195" DisableNVelocity="true" />Bedbugs, scabies and lice love people since people are their main source of food and lodging. If you've been experiencing uncommon itching — not from mosquito or other summer insect bites — you may want to check your family, yourself and your surroundings for signs of bedbugs, scabies or lice. If you think they're the culprits, alert your care team before you come to the clinic, so your care team can help you most effectively.  Learn more about bedbugs, scabies and lice:  Bedbugs <img alt="ECH_BedBug_01_widget" src="/-/media/ech-media/images/widgets/skin/ech_bedbug_01_widget.jpg?h=130&w=200&sc_lang=en&hash=662F3B00DC11F8FB2743B8C38ECB7C7E" style="height: 130px; width: 200px; float: right;" />These small, flat insects feed solely on the blood of people and animals while they sleep. Bedbugs are reddish-brown in color and wingless, and they are about the size of Lincoln's head on a penny. They can live several months without a blood meal.  Bedbugs can be found everywhere from homes to five-star hotels. They hide during the day in places such as seams of mattresses, box springs, bed frames, headboards, dresser tables, inside cracks or crevices, behind wallpaper, or other clutter or objects around a bed. Bedbugs have been shown to be able to travel more than 100 feet in a night, but they tend to live within 8 feet of where people sleep.  Bedbugs don't spread disease, but their bites can be annoying. In some cases, these bites can cause an allergic reaction. The best way to treat a bite is to avoid scratching the area, apply antiseptic creams or lotions, and take an antihistamine.  If you think you have a bedbug infestation, contact your landlord or professional pest control company with experience treating bedbugs. Learn more on <a rel="noopener noreferrer" rel="noopener noreferrer" href="https://www.mayoclinic.org/diseases-conditions/bedbugs/symptoms-causes/syc-20370001" target="_blank">Mayo Clinic's website</a>.  Scabies <img alt="ECH_Scabies_01_widget" src="/-/media/ech-media/images/widgets/skin/ech_scabies_01_widget.jpg?h=130&w=200&sc_lang=en&hash=D1F5D3427E7C0C367E5BD07685E8B42E" style="height: 130px; width: 200px; float: right;" />Scabies is caused by the human itch mite burrowing into the upper layer of the skin, where it lives and lays its eggs. The most common symptoms of scabies are intense itching and a pimplelike rash. Learn more on Mayo Clinic's website.  If you suspect you have scabies, contact your care team. To get an accurate diagnosis, they probably will have you come to the clinic to have a small area inspected and tested. If you are infected, they'll typically give you a prescription for a scabicide that kills the mites and eggs. No over-the-counter remedies have been tested and approved for human use. The infected person, as well as family members and sexual partners, should be treated.  Lice <img alt="ECH_Lice_01_widget" src="/-/media/ech-media/images/widgets/randomimages/ech_lice_01_widget.jpg?h=130&w=200&sc_lang=en&hash=A9B89AF7723941A2168AD1984A0B415D" style="height: 130px; width: 200px; float: right;" />Lice are parasites that feed on human blood. The three types of lice are head lice, body lice and pubic (crabs) lice.  Since head lice is particularly an issue with school starting, here's what you should know.  <ul> <li>In the U.S., head lice infestation is most common among children in child care, elementary school and the household of infested children. </li> <li>Head lice move by crawling. They can't hop or fly. </li> <li>They spread by direct contact with the hair of an infested person. </li> <li>Although not common, head lice can spread through contact with clothing, such as hats, scarves, coats or other personal items, including combs, brushes or towels. </li> </ul> Head lice have three stages: nit (egg), nymph and adult. The lice and nits are found almost exclusively on the scalp, particularly around and behind the ears and near the neckline at the back of the head. You can find more information on <a rel="noopener noreferrer" rel="noopener noreferrer" href="https://www.mayoclinic.org/diseases-conditions/lice/symptoms-causes/syc-20374399" target="_blank">Mayo Clinic's website</a>. If you suspect a head lice infestation, contact your care team. Your child's school also may have a head lice protocol that you will need to follow.  They are not life-threatening Bedbugs, scabies and lice are unpleasant, but they're not life-threatening and don't reflect on the cleanliness of your home or your belongings. Use the links above or visit the Centers for Disease Control and Prevention website for more in-depth information. Don't hesitate to call your care team for specific questions or concerns.  <a rel="noopener noreferrer" rel="noopener noreferrer" href="http://www.mayoclinic.org/biographies/franz-walter-b-iii-m-d/bio-20053435" target="_blank">Walter Franz, III, M.D</a>., is a physician in Primary Care in Rochester and Kasson's Department of Family Medicine. He has practiced in the Baldwin Building since 1982. Walter Franz, III, M.D.Primary Care in Rochester and KassonBedbugs Scabies LicePrimary Care in Rochester and KassonKeep these tips in mind as you begin your school shopping.&nbsp;<img src="/-/media/ech-media/images/widgets/kids/ech_backpack_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=DEAEE2721A038A3D22CD695D7C3ACC38" alt="ECH_backpack_widget" width="100" height="65" DisableNVelocity="true" />Choosing the best school backpack8/9/2021 5:30 AM<img src="/-/media/ech-media/images/widgets/kids/ech_backpack_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=DA91966D41F1762A593F01C513C1D1AF" alt="ECH_backpack_widget" width="300" height="195" DisableNVelocity="true" />As parents and kids hit the stores for back-to-school shopping, a new backpack often tops the list. But there's more to look for in a backpack than fun graphics or trendy colors.  Keep these tips in mind to minimize stress and strain on your child's body:  Consider backpack basics.  Choose a backpack that is lightweight and has: <ul> <li>Wide, padded shoulder straps. Narrow straps can dig into shoulders, causing pain and restricting circulation. </li> <li>Two shoulder straps. Single, cross-body straps can't distribute the weight evenly. </li> <li>A padded back to protect against sharp edges of objects inside the pack and increase comfort. </li> <li>A waist strap to distribute the weight of a heavy load more evenly. </li> </ul> Bigger is not better.  The upside of a big backpack is that there's lots of room for stuff. The downside is there's lots of room for stuff. And that stuff can overload a child.  Everyone has seen tiny kids bent forward under the weight of a backpack that's too large. The American Academy of Orthopaedic Surgeons says that ideally a filled backpack should not exceed 15%–20% of a child's body weight. In addition to causing back and shoulder pain, a backpack that's too heavy can put a child off balance, such as when going up or down stairs.  Check the fit. Adjust shoulder straps and tighten the waist strap so the backpack lies close to the body and holds the pack 2 inches above the waist.  Wear it correctly. Always use both shoulder straps, since slinging it over one shoulder can cause muscle strain.  Organize. Use all the compartments to distribute weight and make things easier to find. Put heavier items, such as books and water bottles, close to the center of the child's back.  Other good ideas.  Kids should stop at their school locker often, if possible, so they don't have to carry all the books needed for a day. When bending down, kids should use their knees and not bend at the waist. Consider a rolling backpack, if the school allows them, but be aware this could present a tripping hazard for your child or others.  Don't ignore symptoms. Parents, don't ignore your child's complaints about back or shoulder pain, which may be caused by a backpack that's too heavy or improper form in carrying it. For questions about backpack safety, check out the <a rel="noopener noreferrer" href="https://www.healthychildren.org/English/safety-prevention/at-play/Pages/Backpack-Safety.aspx" target="_blank">American Academy of Pediatrics' Healthy Children website</a> or ask your child's primary care provider.  <a href="http://communityhealth.mayoclinic.org/providers/nusheen-ameenuddin-md">Nusheen Ameenuddin, M.D.</a>, is a pediatrician in the Division of Community Pediatric and Adolescent Medicine in Rochester. She has a strong interest in child advocacy and media effects on children. She is vice chair of the national American Academy of Pediatrics' Council on Communications and Media and on the board of the Minnesota chapter of the American Academy of Pediatrics. She also is director of the Pediatric Resident Continuity Clinic. Nusheen Ameenuddin, M.D.Primary Care in Rochester and KassonChoosing A BackpackPrimary Care in Rochester and KassonWhile there is no cure for Lou Gehrig's disease, some treatments can help you live more comfortably.&nbsp;<img src="/-/media/ech-media/images/widgets/people/legweakness.jpg?h=65&iar=0&w=100&sc_lang=en&hash=6FB99E4827BD7B176130E24C461D610A" alt="LegWeakness" width="100" height="65" DisableNVelocity="true" />Living with Lou Gehrig's disease8/19/2021 4:30 AM<img src="/-/media/ech-media/images/widgets/people/legweakness.jpg?h=205&iar=0&w=315&sc_lang=en&hash=78E107D70DD3DF6D3F1ABC9F65820F43" alt="LegWeakness" width="315" height="205" DisableNVelocity="true" />A patient recently presented complaining of a variety of symptoms, including muscle cramps, hoarseness, difficulty with swallowing and choking when he eats, and generalized back pain with slowness of his walking. He was 83 and had multiple medical problems, so it was easy enough to attribute his symptoms to medications, known lumbar spine disease, and his age. Extensive testing did not reveal the cause of his symptoms.  Over the next six months, he developed more difficulty with swallowing, hoarseness and generalized weakness, which impaired his walking. When muscle twitches developed in his arms, trunk and tongue at six months, further evaluation confirmed the diagnosis of Lou Gehrig's disease, which is also known as amyotrophic lateral sclerosis, or ALS.  ALS symptoms? Signs and symptoms of ALS vary from person to person but can include:  <ul> <li>Difficulty walking or performing normal daily activities. </li> <li>Tripping and falling. </li> <li>Weakness in your legs, feet or ankles. </li> <li>Hand weakness or clumsiness. </li> <li>Slurred speech. </li> <li>Trouble swallowing. </li> <li>Muscle cramps or twitching in your arms, shoulders or tongue. </li> <li>Inappropriate crying, laughing or yawning. </li> <li>Cognitive and behavioral changes. </li> </ul> ALS often starts in the hands, feet or limbs, and then spreads. As the disease progresses, nerve cells are destroyed, and people with ALS become weaker. Pain is not usually a symptom of ALS, whether early or in later stages.  What causes ALS? Established risk factors for ALS include:  <ul> <li>Heredity Of people with ALS, 5%–10% inherited it. The children of people with inherited, or familial, ALS have a 50-50 chance of developing the disease. </li> <li>Age  Risk increases with age, but ALS occurs most common between the ages of 40 and the mid-60s. </li> <li>Gender  Slightly more men than women are diagnosed with ALS before age 65. The sex difference disappears after age 70. </li> <li>Genetics  Genetic variations might make people more susceptible to ALS, even in patients without the familial ALS. </li> </ul> Environmental factors that might trigger ALS include: <ul> <li>Smoking  Smoking is the only likely environmental risk factor. The risk seems to be greatest for women, particularly after menopause. </li> <li>Environmental toxin exposure  Some evidence suggests that exposure to lead or other substances might be linked to ALS. At this time, no single agent or chemical has consistently been associated. </li> <li>Military service  While studies indicate that military personnel are at higher risk, it is unclear what the specific trigger is. </li> </ul> Is there a treatment or cure for ALS? While ALS cannot be cured, some treatments can slow its progression, prevent complications and treat symptoms to allow people to live more comfortably and independently.  When should you be seen? If you are concerned that you're developing symptoms of ALS or a family member is developing symptoms, contact your primary care provider. Your provider will review your family medical history, and your signs and symptoms, and work with you to get you the care you need.  <a href="https://communityhealth.mayoclinic.org/providers/denise-dupras-md/">Denise Dupras, M.D., Ph.D.</a>, is a physician in the Division of Community Internal Medicine at Mayo Clinic in Rochester, Minnesota. She completed her medical and doctoral degrees at Mayo Clinic Alix School of Medicine, and her residency in internal medicine at Mayo Clinic. Her interests include medical education and evidence-based medicine. Denise Dupras, M.D., Ph.D.Primary Care in Rochester and KassonLou Gehrigs DiseasePrimary Care in Rochester and KassonGood nutrition promotes optimal health and aging.&nbsp;<img src="/-/media/ech-media/images/widgets/food/ech_cooking_for_two_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=9CB9474F1F1FDAB5833B71DDD6D519E3" alt="ECH_cooking_for_two_widget" width="100" height="65" DisableNVelocity="true" />Nutrition for life's next stage9/2/2021 4:30 AM<img src="/-/media/ech-media/images/widgets/food/ech_cooking_for_two_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=6A47FA178365DA0E22F83B21CD0AB728" alt="ECH_cooking_for_two_widget" width="300" height="195" DisableNVelocity="true" />Eating well is important for all stages of life. Special considerations that affect eating as you age include living situations, routines, appetites and food preferences. As you approach life's next stage, it's important to make sure your body gets the essential vitamins and minerals recommended to promote optimal health and aging.  Different foods provide different vitamins and minerals, so picking a variety of foods at mealtimes will help ensure a proper balance of important nutrients. To meet nutritional needs, aim to pick foods from at least three food groups at each meal.  Here are some the nutrients especially important in healthy aging:  Vitamin D Vitamin D helps maintain bone health as you age. Your body needs more than it did when you were younger. Sources of vitamin D include fatty fish, like salmon, as well as eggs and fortified foods and beverages, like milk and yogurt.  Try to include a fatty fish once or twice per week in place of red meat. Make your soup or oatmeal with low-fat milk instead of water.  Calcium Calcium helps the body maintain healthy bones and teeth. Try to aim for three servings of calcium-rich foods per day. Sources include low-fat or fat-free dairy products, dark green leafy vegetables, soybeans, and calcium-fortified foods.  Add a cup of low-fat or fat-free milk as a beverage at lunch or dinner. Consider yogurt or a low-fat cheese as an afternoon snack.  Vitamin B12 Vitamin B12 is important for healthy nerves and helps prevent a type of anemia that can lead to weakness and fatigue. Good sources of vitamin B12 include meat, fish, poultry, milk and fortified breakfast cereals.  Shop for a cereal that has been fortified with vitamin B12. Include a serving of meat at least once per day.  Potassium Potassium helps support proper kidney and heart function, muscle contraction and nerve function. Getting enough potassium helps support a healthy blood pressure.  Potassium is found in many foods, and it is especially high in plant foods. Good sources include fruits, vegetables, lentils, kidney beans, nuts, milk, yogurt and meat.  Aim to include a side of fruit or vegetables at every meal. Include a plant-based protein like lentils or kidney beans once or twice per week in place of meat.  Fiber Fiber helps support regular bowel movements and lowers the risk for heart disease and Type 2 diabetes. Good sources of fiber include whole-grain breads and cereals, beans, lentils, and whole varieties of fruits and vegetables.  Make it a goal to chew your fruits and veggies whole instead of drinking them in the form of juice. Look for the whole-grain labeling on the front of the packaging and choices that offer at least 2-3 grams of fiber per serving.  Additional guidance A nutritionist can offer additional guidance specific to your needs and preferences. It may seem challenging, but it can be fun and inviting to consider changing up your food choices in the next stage of life.  Carly Herr is a dietetic intern at Mayo Clinic in Rochester, Minnesota. She is from Pittsburgh, and she attended The Pennsylvania State University and University of Wisconsin-Green Bay. Her areas of interest include wellness and weight management. Carly HerrPrimary Care in Rochester and KassonAging and NutritionPrimary Care in Rochester and KassonThese five tips can help keep your baby safe and healthy.&nbsp;<img src="/-/media/ech-media/images/widgets/kids/childsafety.jpg?h=65&iar=0&w=100&sc_lang=en&hash=F91D54D22989BEB9A3F319B1DEA41102" alt="ChildSafety" width="100" height="65" DisableNVelocity="true" />Tips for keeping your baby safe9/27/2021 4:30 AM<img src="/-/media/ech-media/images/widgets/kids/childsafety.jpg?h=205&iar=0&w=315&sc_lang=en&hash=FC0DB6BFFEB7FA1CD6C9E4FB331D1D54" alt="ChildSafety" width="315" height="205" DisableNVelocity="true" />From the moment you see that little heartbeat on the screen, your life changes. Your new goal is to keep this little human safe and happy. There is no shortage of advice available — from online blogs to well-meaning family and friends. But all that advice can be confusing at best and dangerous at worst.  Here are five simple tips you can use to keep your baby safe:  Provide safe sleep. Providing safe sleep is key to taking care of your little bundle of joy.  Key things to remember are: <ul> <li>Put your baby to sleep on his or her back. </li> <li>Your baby should sleep in his or her own flat sleep space. </li> <li>It is best to keep your baby in your room until 6 months of age, or even better, 1 year. </li> <li>Keep your baby's space clear. That means no cute fluffy blankets, stuffed animals or crib bumper. </li> <li>Once your little one starts rolling, stop swaddling his or her arms. Then he or she can freely use his or her arms to reposition if needed. </li> <li>Give your little one a pacifier, which can decrease the risk of sudden infant death syndrome, or SIDS. </li> </ul> Check your home environment. Your little one is growing and developing quickly. As he or she becomes mobile, be sure your house is safe.  This means: <ul> <li>Installing safety gates. </li> <li>Moving chemicals, sharp knives and dangerous products up and out of reach. </li> <li>Installing drawer and cabinet locks, and electrical outlet covers. </li> <li>Removing any small pieces a little explorer could choke on. </li> <li>Draining any water — even if just a few inches — from buckets or bathtubs to prevent drowning. </li> </ul> It can help to crawl around at baby level to see any hazards that are around.  Ride safely. Install a rear-facing car seat for your little one to ride in. Ensure it is installed correctly and tightly in the vehicle. The instruction manual that comes with the car seat is a valuable resource.  Always buckle up, even if only going a short distance. When you buckle your little one, the clip should be at the nipple line, and the belt should be tight — so tight you can't pinch the fabric with your fingers. During the winter, it is important to not put your child in a bulky coat or snowsuit while in the car. The bulky clothing can compress in a crash leaving the straps too loose to restrain your child. This can lead to increased risk of injury.  Take care of yourself. It is important to make time for your own health, both mental and physical. Babies cry — sometimes a lot.  It can be difficult to cope if you are overwhelmed. This can lead to decreased bonding or even harming your baby.  It is especially important to watch for any signs of postpartum depression, such as feeling worthless, not enjoying hobbies, or in serious cases, wanting to harm yourself or your baby. Know that postpartum depression is not your fault, and your health care team can help you.  Keep an open line of communication with your care team. Keep your well-child appointments on schedule. These appointments make sure your baby is growing and developing appropriately, and that's when immunizations are provided to keep your family safe.  Always ask your health care team any questions you have. Millions of things can come up when raising your child, and your health care team is here to help and support you, and your little one.  Enjoy every moment you have with your little one and take simple steps to keep your little one safe. A great resource for more information on safety, growth and parenting is <a rel="noopener noreferrer" href="http://healthychildren.org" target="_blank">healthychildren.org</a>, a parent-friendly resource from the American Academy of Pediatrics. Remember, you are doing a great job and the best parent for your little one is you.  Erika Short, APRN, C.N.P., D.N.P., is a nurse practitioner in Community Pediatric and Adolescent Medicine in Rochester, and practices in the Baldwin building. Erika Short, APRN, C.N.P., D.N.P.Primary Care in Rochester and KassonBaby Safety 2021Primary Care in Rochester and KassonWatch for unusual symptoms that do not resolve.&nbsp;<img src="/-/media/ech-media/images/widgets/kids/childhoodcancer.jpg?h=65&iar=0&w=100&sc_lang=en&hash=9F52B2BAF9A3512F3C2A12C2181FE0FE" alt="ChildhoodCancer" width="100" height="65" DisableNVelocity="true" />Childhood cancer: What to watch for9/16/2021 4:30 AM<img src="/-/media/ech-media/images/widgets/kids/childhoodcancer.jpg?h=205&iar=0&w=315&sc_lang=en&hash=854A0599B9A7752239CA89CAC05ED69F" alt="ChildhoodCancer" width="315" height="205" DisableNVelocity="true" />September is Childhood Cancer Awareness Month, a time to honor the strength and courage of children affected by cancer. About 10,500 children in the U.S. under 15 will be diagnosed with cancer this year, according to the American Cancer Society.  Cancer is the second leading cause of death in children 1–15. Advances in cancer treatments, however, have brought the five-year survival rate of childhood cancers from 58% in the mid-1970s to 84% today.  Unlike adult cancers, which are often linked to unhealthy lifestyles, most cancers in children occur because of DNA changes that happen in early life, even before birth. What causes these DNA changes is not always known.  The most common cancers in children are:  <ul> <li>Leukemia — blood or bone marrow cancer, 28% of childhood cancers. </li> <li>Brain and spinal cord tumors, 26% of childhood cancers. </li> <li>Lymphomas — tumor of lymph nodes, other lymph tissue and bone marrow. </li> <li>Neuroblastoma — tumor of early fetal nerve cells, usually in infants and young children .</li> <li>Wilms tumor — a type of kidney tumor, usually in children ages 3–4. </li> <li>Bone cancer, including osteosarcoma and Ewing sarcoma — usually in teens. </li> <li>Retinoblastoma — a cancer of the eye, usually in children around age 2. </li> <li>Rhabdomyosarcoma — a type of muscle tumor. </li> </ul> Cancers in children can be hard to recognize because the early symptoms are like those of other common illnesses or injuries.  Symptoms can include: <ul> <li>Fever. </li> <li>Fatigue. </li> <li>A new lump or swelling.</li> <li>Pain.</li> <li>Limping.</li> <li>Sudden headaches with vomiting.</li> <li>Eye or vision changes. </li> <li>Unexplained weight loss. </li> <li>Excessive bruising. </li> </ul> If your child has unusual symptoms that aren't going away, talk to their health care provider.  Leslie Kummer, M.D., M.P.H., is a pediatrician in the Division of Community Pediatric and Adolescent Medicine at Mayo Clinic in Rochester. She practices at Mayo Family Clinic Northwest, and has special interests in newborn care, early childhood development, and community-based health interventions. Leslie Kummer, M.D., M.P.H.Primary Care in Rochester and KassonChildhood CancerPrimary Care in Rochester and KassonLength of time — not taste, smell or look of food — is the best way to determine if leftovers are still safe to eat.&nbsp;<img src="/-/media/ech-media/images/widgets/food/ech_leftovers_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=254BD8472B33CB7BE1400481BA4B7575" alt="ECH_leftovers_widget" width="100" height="65" DisableNVelocity="true" />How long can you safely keep leftovers in the refrigerator?9/23/2021 4:30 AM<img src="/-/media/ech-media/images/widgets/food/ech_leftovers_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=BF4714498F4B8C2B4F0C91BDCF9D5ACC" alt="ECH_leftovers_widget" width="300" height="195" DisableNVelocity="true" />From leftovers in your lunch to planning a meal for family and friends, keeping food safe is important. Food poisoning — also called foodborne illness — is caused by harmful germs, such as bacteria, in contaminated food. Because bacteria typically doesn't change the taste, smell or look of food, you can't tell whether it's dangerous to eat. So if in doubt, throw it out.  Fortunately, proper cooking and food handling can prevent most cases of food poisoning.  To practice food safety:  <ul> <li>Quickly refrigerate perishable foods, such as meat, poultry, fish, dairy and eggs. </li> <li>Don't let food sit more than two hours at typical room temperature or more than one hour at temperatures above 90 F. </li> <li>Uncooked foods, such as cold salads or sandwiches, also should be eaten or refrigerated promptly. </li> </ul> Your goal is to reduce the time a food is in the "danger zone" — between 40 F and 140 F — when bacteria can quickly grow.  If you're going on a picnic or hosting a cookout, you should:  <ul> <li>Keep cold foods in a cooler with ice or frozen gel packs until ready to serve. </li> <li>To preserve quality and safety, consider resting a container or plate of cold items on a bed or bowl of ice. </li> <li>Have a separate cooler for drinks since this cooler will be opened more frequently and affect the temperature. </li> </ul> For more tips check out <a rel="noopener noreferrer" rel="noopener noreferrer" href="https://www.fda.gov/food/buy-store-serve-safe-food/handling-food-safely-while-eating-outdoors" target="_blank">Handling Food Safely While Eating Outdoors</a> from the Food and Drug Administration.  While you shouldn't use slow cookers to reheat food, you can use them to maintain the temperature of foods that are already hot. Keep your food at or above 140 F, usually on the low temperature setting. Tip: This is an option when you're feeding a large group and need to keep hamburgers or meat from the grill hot.  Leftovers can be kept for three to four days in the refrigerator. After that, the risk of food poisoning increases. If you don't think you'll be able to eat leftovers within four days, freeze them immediately. When ready to eat leftovers, reheat them on the stove or in a conventional oven or microwave until the internal temperature reaches 165 F.  Katherine Zeratsky, R.D.N., L.D., has worked for Mayo Clinic in Rochester for more than 20 years. Her areas of interest range from wellness nutrition to pediatrics.  <a rel="noopener noreferrer" href="https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/expert-answers/food-safety/faq-20058500?utm_" target="_blank">This article</a> was reprinted with permission from Mayo Foundation for Medical Education and Research. All rights reserved. Katherine Zeratsky, R.D., L.D.Primary Care in Rochester and KassonLeftover Food SafetyPrimary Care in Rochester and KassonIt's important to share your information for personalized health care recommendations.&nbsp;<img src="/-/media/ech-media/images/widgets/lgbtqi/lgbtqiahandsheart.jpg?h=65&iar=0&w=100&sc_lang=en&hash=39CF998DD6C4342A6DE0FE5D7A764F36" alt="LGBTQIAhandsheart" width="100" height="65" DisableNVelocity="true" />LGBTQIA+ patients: Help your provider get to know you9/30/2021 4:30 AM<img src="/-/media/ech-media/images/widgets/lgbtqi/lgbtqiahandsheart.jpg?h=205&iar=0&w=315&sc_lang=en&hash=2560BA7172F8D44FECE856F877E39DCF" alt="LGBTQIAhandsheart" width="315" height="205" DisableNVelocity="true" />Mayo Clinic is committed to providing an inclusive and welcoming health care environment for LGBTQIA+ (Lesbian, Gay, Bi-sexual, Transgender, Queer, Intersex, Asexual and Other) patients and their families who seek medical care.  While sex is determined at birth, many factors contribute to how people feel about themselves. Gender identity refers to how people see themselves, whether that is more female or male, or a combination of the two. Identity can be expressed by how people dress and act. Another aspect is sexuality; who people are attracted to; and whether that attraction is to a man, a woman, both or neither.  To provide the best possible care, including preventive services, it is important for your health care provider to know who you are. While it can be difficult to discuss issues surrounding your gender identity, sexual attraction and activity, this information is important for your provider to asses your health care risks and provide care that's individualized for you.  Here are a few tips to get started: <ul> <li>Your discussions are confidential and protected by law, so you can feel safe disclosing sensitive information. </li> <li>Your provider may not know how you want to be addressed, whether it's the name or pronoun you prefer, and the same is true for your partner or anyone accompanying you to a visit. It's OK to correct your provider. The awkward moment will pass. </li> <li>Remember that providing this information allows your care team to personalize the recommendations for the most appropriate care to ensure your health and well-being. </li> </ul> The Fenway Institute provides a free resource, "<a rel="noopener noreferrer" href="http://www.lgbthealtheducation.org/publication/dadt/" target="_blank">Do Ask, Do Tell</a>," which may be useful when talking with your care team.  <a href="http://communityhealth.mayoclinic.org/providers/denise-dupras-md">Denise Dupras, M.D., Ph.D.</a>, is a general internist in Community Internal Medicine at Mayo Clinic in Rochester. She completed her medical and doctoral degrees at Mayo Clinic Alix School of Medicine and her residency in internal medicine at Mayo Clinic in Rochester. Her interests include medical education, evidence-based medicine and care of LGBTQIA+ patients. Denise Dupras, M.D., Ph.D.Primary Care in Rochester and KassonLGBTQIA Patient CarePrimary Care in Rochester and KassonSimple activities like taking walks, playing games and using a computer can improve your brain fitness.&nbsp;<img src="/-/media/ech-media/images/widgets/elderly/ech_seniorvitalitygroup_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=6CE74C44036825FF593CE8F199F73EEB" alt="ECH_SeniorVitalityGroup_widget" width="100" height="65" DisableNVelocity="true" />Staying mentally fit as you age9/20/2021 4:30 AM<img src="/-/media/ech-media/images/widgets/elderly/ech_seniorvitalitygroup_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=6D4A99C1A7B8448529E4BBE03CD93948" alt="ECH_SeniorVitalityGroup_widget" width="300" height="195" DisableNVelocity="true" />Just like your body, your brain gets out of shape if you don't exercise it. And just like keeping your body fit, keeping your brain fit doesn't require anything fancy.  Here's what you can do to maintain your mental edge as you age:  Exercise your body Any exercise that gets your heart pumping and your lungs huffing and puffing is good for your brain. Go for a walk, climb the stairs, dance, swim, cross-country ski, work in the yard, or take a fitness class. It's not important what you do, but rather that you do it and do it regularly.  The rule of thumb is at least 30 minutes five times a week. But you also can move in smaller doses more often, which can make it easier to work movement into your everyday life.  Exercising lowers your blood pressure and reduces cholesterol, both of which can affect the blood vessels feeding your brain. Some research also has found that exercise can slow shrinking of the brain, which to some degree happens naturally with age. When more advanced, this shrinkage can be associated with conditions like Alzheimer's dementia.  Make your brain work As with physical exercise there's no best activity to keep your mind sharp. Use the computer; do crossword, number or jigsaw puzzles; play cards and other games; knit; build something in your woodshop; read; brush up on your high school French; or discuss current events with a friend.  A recent Mayo Clinic study found that people 70 or older with no cognitive issues who used a computer, completed craft projects, took part in social activities and played games had a lower risk of developing mild cognitive impairment. Researchers followed nearly 2,000 cognitively normal participants for an average of four years. They discovered that taking part in these "brain games" one to two times a week reduced the risk of mild cognitive impairment by:  <ul> <li>Computer use: 30%. </li> <li>Craft projects: 28%. </li> <li>Social activities: 23%. </li> <li>Playing games: 22%. </li> </ul> Get social With age, it's easy to become isolated as friends or family members move or pass away. Humans are social creatures, and human brains fare better when connected with others. You can get a double dose of brain stimulation by going for a morning walk with a neighbor, taking a group exercise class, joining a book club, volunteering, singing in the church choir, or playing cards or other games regularly with a group.  Choose something you enjoy Whatever it is you do to stay mentally fit, choose something you enjoy, not only to make it easier to stay with, but also to enrich your life.  <a href="https://communityhealth.mayoclinic.org/providers/brandon-verdoorn-md/">Brandon Verdoorn, M.D.</a>, is a geriatrician in the Division of Community Internal Medicine at Mayo Clinic in Rochester. He completed his medical degree at Mayo Clinic Alix School of Medicine, and his residency in internal medicine and fellowship in geriatric medicine at Mayo Clinic in Rochester. His interests include geriatric medical education and primary care for frail, elderly patients. Brandon Verdoorn, M.D.Primary Care in Rochester and KassonMental Fitness 2021Primary Care in Rochester and KassonYou know your body best, so if something feels off, talk with your provider.&nbsp;<img src="/-/media/ech-media/images/widgets/people/ech_ovarian_cancer_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=770B659F646FBB5B1B3F1073AA81F498" alt="ECH_ovarian_cancer_widget" width="100" height="65" DisableNVelocity="true" />Listen to your body to detect ovarian cancer9/9/2021 4:30 AM<img src="/-/media/ech-media/images/widgets/people/ech_ovarian_cancer_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=C62B05AC4CCE6F11625E6AA2481669D6" alt="ECH_ovarian_cancer_widget" width="300" height="195" DisableNVelocity="true" />Ovarian cancer is the fifth most common cancer in women, accounting for 3% of cancer in women. One in 70 women will develop ovarian cancer. The typical age of diagnosis is between 55 and 65. Ovarian cancer is most often diagnosed in the later stages, and it's associated with vague symptoms. Symptoms can include: <ul> <li> Abdominal bloating. </li> <li> Increased abdominal girth. </li> <li> Nausea or vomiting. </li> <li> Indigestion.</li> <li> Anorexia (loss of appetite). </li> <li> Feeling full after eating a small amount of food. </li> <li> Weight loss. </li> <li> Pelvic pressure. </li> <li> Cramping. </li> <li> Back pain. </li> <li> Vaginal bleeding. </li> <li> Urinary frequency or urgency. </li> <li> Change in bowel habits. </li> <li> Fatigue. </li> <li> Pain during intercourse. </li> <li> Leg swelling. </li> </ul> The risk for developing ovarian cancer is associated with several factors. The most common factor is advancing age. Women with a history of infertility and infertility treatment (assisted reproductive technology), endometriosis and postmenopausal hormone therapy are at a slightly increased risk. Women at the greatest risk are those with known heritable genetic conditions, including the BRCA 1 or BRCA 2 breast cancer genes and hereditary nonpolyposis colorectal cancer, also known as Lynch syndrome. The risk for ovarian cancer increases three to six times for women with: <ul> <li> A diagnosis of premenopausal breast cancer under 40. </li> <li> A diagnosis of breast cancer under 50. </li> <li> A close relative ― grandparent, parent, sibling or child ― with breast or ovarian cancer diagnosed at any age. </li> <li> A first-degree relative ― mother, sister or daughter ― with ovarian cancer.</li> <li> A family history of breast cancer under 50 in two or more close relatives. </li> <li> A family history of ovarian cancer diagnosed at any age. </li> <li> Ashkenazi Jewish heritage. </li> </ul> No guidelines for ovarian cancer screening are available for the general population. To reduce their risk, most women simply need to follow a healthy lifestyle and recommended wellness principles: <ul> <li> Weight Achieve and maintain a normal body weight with a body mass index of 19–24. </li> <li> Exercise Take part in 30 minutes or more of a moderate intensity activity five to seven days per week, with 10,000 steps per day. </li> <li> Diet Consume a low-fat diet that is more plant-based than animal-based, with minimal processed food. </li> <li> Sleep Aim for seven to nine hours of sleep per night. </li> <li> Stress Take time to recharge and reduce your stress. </li> <li> Substance exposure Stop all use of tobacco products, avoid or stop vaping, avoid or stop drug use, and consume little to no alcohol. </li> </ul> For women with an increased risk, a heritable genetic conditions consult and testing are the first steps. For women with the aforementioned heritable genetic conditions, individualized screening may include laboratory testing for CA-125, which looks for certain proteins in your blood, and a pelvic ultrasound. Other recommendations for procedures that reduce risk include surgical removal of the uterus, one or both breasts, one or both ovaries, and/or one or both fallopian tubes. Body self-awareness is key to maintenance of good health. Listen to your body and be aware of symptoms. Early detection of ovarian cancer is key to the best possible outcome. If something is off, contact your provider. <a href="https://communityhealth.mayoclinic.org/providers/marcia-obrien-md/">Marcia O'Brien, M.D.</a>, is a physician in the Department of Family Medicine at Mayo Clinic in Rochester. She practices the full spectrum of family medicine, including hospital medicine, newborn nursery and obstetric care at Mayo Family Clinic Northeast.Marcia O'Brien, M.D.Primary Care in Rochester and KassonOvarian Cancer 2021Primary Care in Rochester and KassonThis challenge brings lifesaving blood donations to patients in need.&nbsp;<img src="/-/media/ech-media/images/widgets/blooddonation/blooddonationmillerlouden.jpg?h=65&iar=0&w=100&sc_lang=en&hash=5D03B55C0B89460FBFA83DE76E0A72B6" alt="BloodDonationMillerLouden" width="100" height="65" DisableNVelocity="true" />Pints for Preemies Blood Donation Challenge to be held through Nov. 1710/11/2021 4:30 AM<img src="/-/media/ech-media/images/widgets/blooddonation/blooddonationmillerlouden.jpg?h=205&iar=0&w=315&sc_lang=en&hash=3738D6A8B004FBC2B2AF91B1AB6CBA6F" alt="BloodDonationMillerLouden" width="315" height="205" DisableNVelocity="true" />The Pints for Preemies Blood Donation Challenge helps those smallest patients in need. Hannah Miller, a labor and delivery nurse, knows the importance of blood donation all to well. But it was not until her pregnancy that she would see the benefits firsthand.  At just 12 weeks pregnant, Hannah began to have complications with a subchorionic hemorrhage, which is bleeding under one of the membranes that surrounds the baby inside the uterus. Due to her complications, Hannah was admitted to the hospital when she was 17 weeks pregnant. She needed seven blood transfusions to stay pregnant long enough to bring her son to viability. Her son, Louden Miller was born prematurely at 24 weeks, weighing just 1 pound, 7 ounces.  During his six-month stay in the Neonatal ICU, Louden needed eight blood transfusions. After 135 days in the Neonatal ICU, Louden gave his dad the best birthday gift: He was discharged to head home for the first time. Louden is now a thriving and happy 18-month-old.  Pictured with Louden are his Neonatal ICU beads that represent each trial he was faced with during his stay. They are symbols of hope, strength, courage and healing.  Pints for Preemies Blood Donation Challenge information In honor of World Prematurity Day, the Mayo Clinic Blood Donor Program will host the Annual Pints for Preemies Blood Donation Challenge. This year's goal is to bring in more lifesaving blood donations and raise awareness of World Prematurity Day on Nov. 17.  The challenge runs through Nov. 17. To participate, simply stop in at the front desk at one of the Mayo Clinic Blood Donor Program's two donation locations and fill out a challenge sheet: <ul> <li>Hilton Building  This location is on the first floor is open weekdays from 6 a.m. to 4:30 p.m. You can reach this location at <a href="tel:5072844475">507-284-4475</a>. </li> <li>Joseph M-86 This location on the Saint Marys Campus is open weekdays from 8 a.m. to 3 p.m. You can reach this location at <a href="tel:5072554359">507-255-4359</a>.</li> </ul> How to donate Call to schedule an appointment at one of the two locations listed above. For more information about donating blood, call the Mayo Clinic Blood Donor Program at <a href="tel:5072844475">507-284-4475</a> or <a href="mailto:mailto:donateblood@mayo.edu">email the program</a>. Learn more by visiting the <a rel="noopener noreferrer" href="http://www.mayoclinic.org/donateblood" target="_blank">Mayo Clinic Blood Donor Program website</a>. Primary Care in Rochester and KassonBlood Donation Miller LoudenPrimary Care in Rochester and KassonYou may be experiencing pandemic anger, or 'panger.'<img src="/-/media/ech-media/images/widgets/people/frustration.jpg?h=65&iar=0&w=100&sc_lang=en&hash=3DB97D6973D583553F0B508C67AB8227" alt="Frustration" width="100" height="65" DisableNVelocity="true" />Are you experiencing frustration with the COVID-19 pandemic?10/4/2021 4:30 AM<img src="/-/media/ech-media/images/widgets/people/frustration.jpg?h=205&iar=0&w=315&sc_lang=en&hash=5E9B855C373FB0328C4C3075501A3482" alt="Frustration" width="315" height="205" DisableNVelocity="true" />Have you noticed increased experiences of frustration, agitation or anger throughout the course of the COVID-19 pandemic? If so, you're not alone.  Research has shown that many people are experiencing anger. The pandemic anger, or "panger," is real.  If this experience is familiar to you, you know that anger can become exhausting over time. And you might be interested in learning about different ways to cope.  What is anger? Anger is a universal human emotion. In its most basic form, anger's primary purpose is to motivate action. That's really important. But many of the things done in response to anger, such as yelling, ruminating or shutting down, can be less than helpful. And these actions can negatively affect physical and mental health, and relationships.  So what can you do?  Below, you'll find some ideas that may help you respond intentionally and effectively to "panger" rather than simply reacting:  Step back and observe.  Take a deep breath and pay attention to what's happening in the moment without judging or evaluating your experience.  Oftentimes, anger feels too overwhelming. If you can step back, you can notice that experiencing anger has many parts. People experience anger in their own way.  Take a moment to reflect on what your anger typically looks like:  <ul> <li>Thoughts  Thoughts and emotions are closely related. What thoughts indicate you're becoming angry? You may notice thoughts such as "This isn't fair" or "How dare they," or "I'm so tired of this." Try to observe your thoughts coming and going like clouds in the sky rather than thinking of thoughts as absolute truths that must be immediately acted on. </li> <li>Emotions  A variety of other emotions can come with anger. For example, you may be feeling hurt, fear, embarrassment or frustration before you notice anger itself. Be specific in labeling your <a rel="noopener noreferrer" rel="noopener noreferrer" href="http://atlasofemotions.org/" target="_blank">emotions</a>. </li> <li>Physical sensations  Where do you notice anger in your body, such as as tightening of the chest or clenching of the jaw or fists, or feeling hot? </li> <li>Urge to act  Before taking action, you may notice an action urge, or impulse. For example, you may notice the urge to scream or run away. </li> </ul> Try imagining what your "panger" might look like in physical form. Would it be big or small? What color would it be? What shape? Where would it be located in your body? Would it make noise? Would it be loud or soft? Imagining a physical "anger monster" might help you notice and observe your anger rather than being caught up in it.  Simply slowing down and observing anger in these ways can make it seem less overwhelming and can help create space between your anger and what you do next.  Allow 'panger' to be present. As humans, we often try to avoid or get rid of unpleasant internal experiences, including thoughts, emotions and memories. This is natural and even makes a lot of sense in the short term, but it doesn't always work well in the long term. With anger, the tendency to avoid can result in various automatic reactions that aren't always helpful and may even lead to an increase in anger over time.  For example, though lashing out at someone may make you feel better in the moment, it doesn't often help in the long term and may even make you feel worse, such as feeling guilty for yelling at your children or co-worker. Similarly, shutting down and suppressing anger or frustration often leads to an increase in its intensity over time — what you might think of as "the beach ball effect." That is the more you push the beach ball down under the water, the bigger and stronger it becomes when it explodes up.  Listen to anger's message about what you value. Choosing to allow anger, and associated thoughts, emotions, physical sensations and urges, to be present without automatically trying to avoid or get rid of them creates freedom and flexibility to choose effective and meaningful actions. It's important to note that accepting anger is an active choice, not a passive resignation. It does not mean you're accepting the situation that may have led to anger or that you're giving up on what you care about. It means you're choosing to put energy toward effective action rather than focusing solely on trying to control the uncontrollable.  If you listen closely, painful emotions, like anger, often connect with a message about something or someone you really care about or value. If you didn't care, it wouldn't hurt. And of course, most humans are hurting in the context of the global pandemic. "Panger" makes sense.  Choose your effective action.  Once you've slowed down to listen to the message anger may have for you, choose your next effective action. You may not be able to control what others say and do, or even what you think and feel, but you can control how you respond.  For example: <ul> <li>Anger about pandemic-related travel and social distancing restrictions might carry the message that you really care about your family and friends. You miss spending time with them. You may choose to explore new, creative and safer ways to connect with loved ones, such as walking together outside or scheduling a Zoom game night. </li> <li>Anger about racial health disparities related to COVID-19 may point to how much you value equitable health care policies and practices. Anger can help motivate you to take part in values-based actions, which could range from getting involved in advocacy efforts to giving yourself time to rest and recharge. </li> <li>Frustration with stress or exhaustion, or burnout at work, may be associated with the importance of self-care. This message may cue you to make time, no matter how small, to take part in restful, grounding or enjoyable activities. </li> <li>Agitation toward those who may not agree with your views and the importance of public health measures, such as COVID-19 vaccinations, may indicate that you value the health and wellness of the global community. This may lead you to focus on public health education efforts and modeling the Center for Disease Control and Prevention's recommendations. </li> </ul> It is important to note that everyone has unique and individually chosen values, and the actions that align with these values likely look different across people and situations. It's all about exploring the message that anger may have for you and choosing actions based on what you care about most.  If you feel like anger or other strong emotions are significantly and negatively affecting you, consider seeking out psychotherapy services from a professional who uses evidence-based treatments such as cognitive behavioral therapy or acceptance and commitment therapy.  Here are helpful resources if you need help managing your "panger": <ul> <li><a rel="noopener noreferrer" rel="noopener noreferrer" href="https://store.samhsa.gov/sites/default/files/d7/priv/anger_management_workbook_508_compliant.pdf" target="_blank">Substance Abuse and Mental Health Services Administration: Anger Management for Substance Use Disorder Mental Health Clients Workbook</a>. </li> <li><a rel="noopener noreferrer" href="http://www.adaa.org" target="_blank">Anxiety & Depression Association of America</a>. </li> <li><a rel="noopener noreferrer" href="http://www.abct.org" target="_blank">Association for Behavioral and Cognitive Therapies</a>. </li> <li><a rel="noopener noreferrer" href="http://www.abct.org" target="_blank">Psychology Today</a>. </li> </ul> Anne Roche, Ph.D., and Sydney Kelpin, Ph.D., are clinical psychology fellows in Primary Care in Rochester and Kasson's Division of Integrated Behavioral Health at Mayo Clinic. <a rel="noopener noreferrer" rel="noopener noreferrer" href="http://www.mayoclinic.org/biographies/sawchuk-craig-n-ph-d-l-p/bio-20085911" target="_blank">Craig Sawchuk, Ph.D.</a>, is a clinical psychologist in Primary Care in Rochester and Kasson's Division of Integrated Behavioral Health. He is the co-chair of Integrated Behavioral Health and co-chair of Clinical Practice within the Department of Psychiatry and Psychology at Mayo Clinic in Rochester. Anne Roche, Ph.D.; Sydney Kelpin, Ph.D.; Craig Sawchuk, Ph.D.Primary Care in Rochester and KassonPandemic AngerPrimary Care in Rochester and KassonFollow these tips to limit your sugar intake.&nbsp;<img src="/-/media/ech-media/images/widgets/food/sugartypes.jpg?h=65&iar=0&w=100&sc_lang=en&hash=6494B954528C9651804232FFA88418ED" alt="SugarTypes" width="100" height="65" DisableNVelocity="true" />Is sugar sweet or scary?10/7/2021 4:30 AM<img src="/-/media/ech-media/images/widgets/food/sugartypes.jpg?h=205&iar=0&w=315&sc_lang=en&hash=0C3ACF2A234BE56C21167D55EA61E7B9" alt="SugarTypes" width="315" height="205" DisableNVelocity="true" />When you think of sugar, you might think of sweets and treats, and sugary beverages like soda and energy drinks. However, sugar can be added to sauces, condiments — like ketchup, salad dressings, crackers, soups, commercially processed breads, and even "reduced-fat" versions of foods. Added sugars are often used to enhance the taste or texture of food.  But not all sugar is bad, as your body prefers sugar as its main energy source.  It's important to distinguish added sugars with naturally occurring sugars. On a Nutrition Facts label, check out the added sugars listed under the total sugars. The total sugars include natural and added sugars.  Naturally occurring sugars are found in:  <ul> <li>Dairy products, such as cow's milk, yogurts and some cheeses. </li> <li>Fruits. </li> <li>Vegetables. </li> <li>Whole grains. </li> </ul> If you can, stick with the foods listed above that contain naturally occurring sugars, as they often provide other nutrients like protein, fiber, vitamins, minerals and antioxidants.  Here's what you can do to limit how much added sugar is in your diet: <ul> <li>Choose water or plain and unflavored low-fat milk, or milk alternative beverages first. </li> <li>Dilute 100% fruit juice with water. </li> <li>Pick plain unsweetened yogurt and add fresh or frozen fruit on top. </li> <li>Swap out sweetened applesauce for unsweetened applesauce. </li> <li>Instead of flavored oatmeal packets, add your own cinnamon or fruit to plain oatmeal. </li> <li>Have fun by baking your own bread or mixing your own salad dressings with spices and herbs. </li> <li>Throw in trail mix or dried fruit instead of candy for a sweet and savory treat. </li> <li>Mix in stickers, pencils or glow sticks to pass out for Halloween. You won't graze on those candies if they're not sitting around the house. </li> </ul> The American Heart Association recommends added sugar to be no more than 150 calories per day for men, or about 9 teaspoons or 36 grams, and 100 calories per day for women, or about 5 teaspoons or 24 grams. Don't worry, you can still enjoy those Halloween treats. Just don't trick yourself into eating a whole bucket at once. Sarah Dramstad is a dietetic intern at Mayo Clinic studying to be a dietitian. She is a Vermont native and completed her bachelor's degree in dietetics at the University of New Hampshire. She enjoys working in inpatient and outpatient settings and working with diverse populations. Sarah DramstadPrimary Care in Rochester and KassonSugar Sweet ScaryPrimary Care in Rochester and KassonLearn which foods on your grocery list increase and decrease inflammation.&nbsp;<img src="/-/media/ech-media/images/widgets/food/fruitrainbow.jpg?h=65&iar=0&w=100&sc_lang=en&hash=E905D9F224C838C1E5BD161352DB4B61" alt="FruitRainbow" width="100" height="65" DisableNVelocity="true" />Want to ease chronic inflammation? Start with your grocery list11/4/2021 4:30 AM<img src="/-/media/ech-media/images/widgets/food/fruitrainbow.jpg?h=205&iar=0&w=315&sc_lang=en&hash=96C56D4DC411E6F9F8C49A5889243FD4" alt="FruitRainbow" width="315" height="205" DisableNVelocity="true" />Flip through a magazine or scroll through your news feed, and you'll probably see a story about anti-inflammatory foods. But why is inflammation bad, and what does food have to do with it?  Inflammation is a part of the body's normal response to infection or injury. It's when damaged tissue releases chemicals that tell white blood cells to start repairing. But sometimes inflammation is low-grade, spreads through the body and is chronic.  Chronic inflammation can damage the body. It can play a role in the buildup of plaque in your arteries, increasing your risk of heart disease and stroke. It's also associated with a higher risk of cancer, diabetes and other chronic conditions.  How food can hurt or help The choices you make at the grocery store can affect the inflammation in your body. While scientists are still unraveling how food affects inflammatory processes, they know a few things:  <ul> <li>Some foods, like processed sugars, release inflammatory messengers that can raise the risk of chronic inflammation. </li> <li>Other foods, like fruits and veggies, help the body fight against oxidative stress, which can trigger inflammation. </li> <li>Foods that are anti-inflammatory tend to be the same foods that can keep you healthy in other ways. </li> </ul> Add more of these foods to your grocery list Choosing foods to reduce chronic inflammation has layers. Specific components in food work together to reduce inflammation. That's why no one food makes your diet anti-inflammatory. It's the sum of the foods you eat every day.  Overall, eat a rainbow of fruits, veggies, whole grains and legumes — all of which have the anti-inflammatory nutrients that your body needs. Fresh, simple ingredients are best, since over processing can significantly change the nutritional content of foods.  You can start building an anti-inflammatory grocery list by choosing:  <ul> <li>Deep orange, yellow and red, and dark green foods, such as pumpkin, sweet bell peppers, tomatoes, carrots, kale, spinach, Swiss chard, arugula and endive. </li> <li>Cruciferous vegetables such as broccoli, cauliflower and cabbage. </li> <li>Onions. </li> <li>Citrus fruits, such as oranges, grapefruit and pomelos. </li> <li>Whole grains, such as wheat, oats, rye, buckwheat, millet, quinoa and brown rice. </li> <li>Plant-based proteins, including dried beans, lentils, lentil pasta and soy. </li> <li>Nuts and seeds, including walnuts and almonds, and seeds like chia, flax and hemp. </li> <li>Spices and herbs, including ginger, garlic, turmeric, cardamom, black pepper, cinnamon and rosemary. </li> <li>Beverages such as water, herbal and green teas, and coffee. </li> </ul> Trim these foods from your list Gradually reduce inflammation-promoting foods from your daily meals by trimming these foods from your grocery list, while trying some alternatives: <ul> <li>Refined carbs, such as white bread, rice, pasta and pastry. Try mixing white and brown rice, white and whole-wheat pasta, or sweet with unsweetened cereal. </li> <li>Fried foods, such as french fries, chips and donuts. Bake your own french fries with the skin, try kale chips or use an air fryer. </li> <li>Sugar-sweetened sodas, fruit drinks, sweetened teas and flavored coffees. Replace with sparkling mineral water, infused water, unsweetened tea and coffee. </li> <li>Processed meats, such as hot dogs, sausage, brats and red meat. Try <a rel="noopener noreferrer" rel="noopener noreferrer" href="https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/meatless-meals/art-20048193" target="_blank">meatless meals</a> or use meat as a side dish rather than a main dish. </li> </ul> Building meals with your new grocery list These ideas can help you start building meals with anti-inflammatory foods:  <ul> <li>Breakfast Start the day with oatmeal with berries, an apple or a fruit smoothie. </li> <li>Lunch  Toss together a <a rel="noopener noreferrer" rel="noopener noreferrer" href="https://www.mayoclinic.org/healthy-lifestyle/recipes/bean-salad-with-balsamic-vinaigrette/rcp-20049640" target="_blank">salad</a> of dark greens, colorful fruits and vegetables, topped with beans and nuts or seeds. </li> <li>Dinner  Fill half your plate with <a rel="noopener noreferrer" rel="noopener noreferrer" href="https://www.mayoclinic.org/healthy-lifestyle/recipes/braised-kale-with-cherry-tomatoes/rcp-20049864" target="_blank">colorful vegetables</a>, a quarter in whole grains and the other quarter with a <a rel="noopener noreferrer" rel="noopener noreferrer" href="https://www.mayoclinic.org/healthy-lifestyle/recipes/black-bean-burgers-with-chipotle-ketchup/rcp-20049605" target="_blank">lean protein</a>. </li> </ul> Foods aren't the only way you can reduce inflammation in the body. Boost the results of your diet by maintaining a healthy body weight, since weight loss on its own is anti-inflammatory. Also, get in 30 minutes of daily physical exercise and manage stress.  Rose Prissel, M.S., R.D.N., L.D., is a dietitian in Primary Care in Rochester and Kasson. She works in pediatric and adult nutrition, focusing on preventive care, sports nutrition and weight management. Rose Prissel, M.S., R.D.N., L.D.Primary Care in Rochester and KassonChronic InflammationPrimary Care in Rochester and KassonThis report from an expert brings out the facts.&nbsp;<img src="/-/media/ech-media/images/widgets/medications/covidvaccine_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=0C8BB93F5A8E906BFEC519170FC46D3D" alt="COVIDvaccine_widget" width="100" height="65" DisableNVelocity="true" />Understanding COVID-19 and vaccinations11/2/2021 4:30 AM<img src="/-/media/ech-media/images/widgets/medications/covidvaccine_widget.jpg?h=205&iar=0&w=315&sc_lang=en&hash=F3FB1C547B39A9D41AA8FF40A40E7B89" alt="COVIDvaccine_widget" width="315" height="205" DisableNVelocity="true" />Dr. Gregory Poland is head of the Mayo Clinic Vaccine Research Group. He has spent the past 40 years studying vaccines, their development and use to prevent disease. He has been the chair or member of every committee at the federal level involved with vaccine decision-making.  He recently gave a virtual presentation to provide an update on COVID-19, what is known about the virus, how containment of the COVID-19 pandemic is progressing, and the role of vaccinations for adults and children. A lot of misinformation is circulating about COVID-19 vaccines. Dr. Poland cleared the air to ensure everyone had correct facts. He also addressed misunderstandings and misinterpretations.  Here is a brief summary of his presentation: Facts about the pandemic <ul> <li>No one thing will end the COVID-19 pandemic. People will continue to need to wash their hands, maintain distance from others, avoid being around those who are sick or exposing others when they are, wear a mask at times, and get vaccinated for COVID-19. </li> <li>Hospitals are full. Even though these facilities have protective gear for doctors, nurses and others who work there, hospital personnel are getting tired, and more staff are needed in hospitals. </li> <li>Children are getting sick. In September, 250,000 became ill with COVID-19, and some of them died. </li> <li>Those who choose not to get vaccinated for COVID-19 are much more likely to become serious ill, be hospitalized, and die of COVID-19 than those who get vaccinated. </li> <li>The new delta variant is much more contagious than the original alpha version of COVID-19. One sick person can spread the infection to up to six to eight other people. </li> </ul> Facts about the vaccine <ul> <li>No vaccine in history has ever been studied as much as the COVID-19 vaccines. </li> <li>Pfizer's COVID-19 vaccine has full Food and Drug Administration approval now, not just emergency use authorization. </li> <li>Vaccines do best in blocking COVID-19. They are less effective at blocking infection. While you can get infected with COVID-19, you generally do not get seriously ill, and it decreases your risk of dying from COVID-19. </li> <li>Every vaccine has side effects, but if you balance the benefits of getting vaccinated with COVID-19 against the side effects, the benefits outweigh the generally mild side effects. </li> </ul> The bottom line is that everyone is in this together, and the only way to end this pandemic is for everyone to do his or her part. While people can exercise their freedom to choose whether to be vaccinated, they are choosing not only for themselves, but for others. Unvaccinated people continue to be sources of infections, allowing COVID-19 to continue developing new variants.  You can listen to Dr. Poland's full presentation below: <iframe width="560" height="315" src="https://www.youtube.com/embed/jkmcGEM3Jj8" title="YouTube video player" frameborder="0" allow="accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture"></iframe> <a href="https://communityhealth.mayoclinic.org/providers/denise-dupras-md">Denise Dupras, M.D., Ph.D.</a>, is a general internist in Primary Care in Rochester and Kasson's Division of Community Internal Medicine. She completed her medical and doctorial degrees at Mayo Clinic Alix School of Medicine, and her residency in internal medicine at Mayo Clinic in Rochester. Her interests include medical education and evidence-based medicine. Denise Dupras, M.D.Primary Care in Rochester and KassonCOVID19 FactsPrimary Care in Rochester and KassonEpilepsy has many causes, and the real cause is not always known.&nbsp;<img src="/-/media/ech-media/images/widgets/medicalimages/epilepsy.jpg?h=65&iar=0&w=100&sc_lang=en&hash=16C337EF326F6F0D7488280CF1F2C30A" alt="Epilepsy" width="100" height="65" DisableNVelocity="true" />What is epilepsy?11/22/2021 4:30 AM<img src="/-/media/ech-media/images/widgets/medicalimages/epilepsy.jpg?h=205&iar=0&w=315&sc_lang=en&hash=C6A86AA1EEC08C4B70313DB818AE620D" alt="Epilepsy" width="315" height="205" DisableNVelocity="true" />Human brains are like computers in that there are electrical signals. When these signals become disrupted or overactive, a seizure can occur. Seizures occur in roughly 1 in 10 people.  Epilepsy is a neurological condition that causes recurrent seizures or increases the risk of recurrent seizures. Approximately 65 million people around the world have epilepsy. In the U.S., 1 in 26 people will develop epilepsy at some point.  What causes epilepsy? A single seizure can occur due to severe illness, high fever, infection, stroke, drug use, medication overdose, significant head injury, or alcohol withdrawal.  Epilepsy can be caused by an inherited tendency, a genetic cause; abnormality in brain development from birth; brain injury; stroke; dementia; or due to residual brain damage from previous brain infection, such as meningitis or encephalitis. However, the cause of epilepsy is not known in 6 of 10 people.  Can epilepsy be prevented? Other than minimizing risk for head injury be wearing a helmet when appropriate and taking care of your health to minimize the risk of stroke, you cannot prevent epilepsy.  In someone who is diagnosed with epilepsy, it is important to avoid missing doses of anti-seizure medication and avoid sleep deprivation. It is also important to not consume excessive amounts of alcohol or use illicit drugs.  How is epilepsy treated? People with epilepsy need to take an anti-seizure medication regularly to reduce the chance of a seizure. Two-thirds of people with epilepsy can control their seizures with medication.  Some people will develop epilepsy that is difficult to treat, and more than one anti-seizure medication may be required to control seizures. Epilepsy surgery or the need for an implanted device to control seizures is also needed sometimes.  Can someone with epilepsy lead a healthy life? Most people with epilepsy will lead normal lives, and you will not know by looking at them that they have epilepsy. People with epilepsy can perform a variety of jobs. However, people with epilepsy generally cannot be an airline pilot or a truck driver.  If you're struggling with epilepsy, be sure to talk to your care team about treatment options.  <a rel="noopener noreferrer" rel="noopener noreferrer" href="https://www.mayoclinic.org/biographies/truitt-karen-a-d-o/bio-20502485" target="_blank">Karen Truitt, D.O.</a>, is a Mayo Clinic neurologist. She practices in Integrated Community Specialties — Neurology and Spine Center in Rochester, Minnesota. She has a procedural practice at Mayo Clinic Health System in Red Wing. She completed her neurology residency at Mayo Clinic in Rochester followed by a clinical neurophysiology fellowship with emphasis on electroencephalography in epilepsy. Karen Truitt, D.O.Primary Care in Rochester and KassonEpilepsyPrimary Care in Rochester and KassonPrimary Care labs in Rochester and Kasson will offer point of care INR testing beginning Tuesday, Oct. 26.&nbsp;<img src="/-/media/ech-media/images/widgets/medicalimages/inrtest.jpg?h=65&iar=0&w=100&sc_lang=en&hash=53FA622DC5DC7ECC197C16098149F956" alt="INRtest" width="100" height="65" DisableNVelocity="true" />New locations for anticoagulation blood test10/25/2021 5:14 AM<img src="/-/media/ech-media/images/widgets/medicalimages/inrtest.jpg?h=205&iar=0&w=315&sc_lang=en&hash=C499A856C0D33E630B7ABE3B039B26FD" alt="INRtest" width="315" height="205" DisableNVelocity="true" />Beginning Tuesday, Oct. 26, all Primary Care labs in Rochester and Kasson will offer point of care INR testing to Anticoagulation patients. Patients will be able to choose any of these laboratories for blood tests: <ul style="list-style-type: disc;"> <li>Baldwin Laboratory, 221 Fourth Ave. SW, Rochester.</li> <li>Mayo Family Clinic Kasson Laboratory, 411 West Main St., Kasson.</li> <li>Mayo Family Clinic Northeast Laboratory, 3041 Stonehedge Drive NE, Rochester.</li> <li>Mayo Family Clinic Northwest Laboratory, 4111 West Frontage Road Hwy 52 NW, Rochester.</li> <li>Mayo Family Clinic Southeast Laboratory, 4544 Canal Place SE, Rochester.</li> </ul> Ample free parking is available at each location, except the Baldwin Building. At the Baldwin Building, patients can use metered street parking, or the Baldwin Ramp at 221 Fourth Ave. SW for a fee. Patients are asked to call the Anticoagulation Appointment Line at <a href="tel:5075388650">507-538-8650</a> to schedule or make changes to appointments for point of care blood tests and follow up with their Anticoagulation Care Team after each test. Patients can also talk to their Anticoagulation Care Team, including about medication dosing, through video visits. Video visits help the Anticoagulation Care Team visually assess overall physical health and provide the best possible care recommendations.    After Oct. 26, Mayo Clinic Express Care South will no longer provide point of care blood tests. This location is tentatively scheduled to reopen for acute care patients later this year.Primary Care in Rochester and KassonINR TestingPrimary Care in Rochester and KassonIf you're thinking about transitioning to a vegetarian diet, follow these tips to ensure you get the nutrients you need.&nbsp;<img src="/-/media/ech-media/images/widgets/food/vegetariangrill.jpg?h=65&iar=0&w=100&sc_lang=en&hash=E2834E6875FC4640ECC56E8CB5C99930" alt="VegetarianGrill" width="100" height="65" DisableNVelocity="true" />Considering the move to a vegetarian diet?11/18/2021 4:30 AM<img src="/-/media/ech-media/images/widgets/food/vegetariangrill.jpg?h=205&iar=0&w=315&sc_lang=en&hash=16F998E9774049B6DBB6DED52437888F" alt="VegetarianGrill" width="315" height="205" DisableNVelocity="true" />While following a vegetarian diet is a healthy way of eating, you need to consider how to get the appropriate nutrients. It's also important to remember that a vegetarian diet is not necessarily a weight-loss diet. Rather, it's a healthy lifestyle choice.  With a little planning, a vegetarian diet can meet the needs of people of all ages, including children, teenagers, and pregnant or breastfeeding women. It's important to include a variety of foods while not relying too heavily on processed foods. Processed foods can be higher in calories, sugar, fat and sodium. The types of vegetarian diets, and what foods are included and excluded, differ: <ul> <li>Lacto-vegetarian This diet excludes meat, fish, poultry and eggs, as well as foods that contain them. Dairy products, such as milk, cheese, yogurt and butter, are included.</li> <li>Ovo-vegetarian This diet excludes meat, poultry, seafood and dairy, but it allows eggs.</li> <li>Lacto-ovo vegetarian This diet excludes meat, fish and poultry, but it allows dairy products and eggs.</li> <li>Pescatarian This diet excludes meat, poultry, dairy and eggs, but it allows fish.</li> <li>Vegan This diet excludes meat, poultry, fish, eggs and dairy, and all foods that contain these products.</li> <li>Semivegetarian (or flexitarian) This primarily plant-based diet includes dairy, eggs and poultry, and fish on occasion or in small quantities.</li> </ul> When moving to a vegetarian diet, remember these key nutrients in your meals: <ul> <li>Calcium This nutrient keeps your bones strong and prevents fractures. Milk and dairy products are highest in calcium. Dark green vegetables when eaten in sufficient quantities provide calcium, as well. Consider calcium-enriched and fortified products, as well.</li> <li>Vitamin D This nutrient is important for bone health, immune function and reduction of inflammation. Vitamin D is added to milk, some soy and rice milk, and some cereals. It's naturally found in mushrooms exposed to ultraviolet light.</li> <li>Vitamin B-12 This vitamin is necessary to produce blood cells and prevent anemia. Dairy and eggs are good sources. Vegans and older adults who may have more difficulty absorbing vitamin B-12 may require fortified foods or vitamin supplements.</li> <li>Protein This nutrient helps maintain healthy skin, bones, muscles and organs. Eggs and dairy products are good sources, but you don't need to eat large quantities of these foods to meet your needs. Soy products, legumes, lentils, seeds, nuts and whole grains are also good sources of protein.</li> <li>Omega-3 fatty acids They are especially important for heart health and during pregnancy. Excluding fish and eggs can decrease the amount of omega-3 your body requires. While canola oil, soy oil, walnuts, ground flaxseed and soybeans are good sources of plant-based omega-3, the body uses them less efficiently.</li> <li>Iron and zinc Iron is a crucial component of red blood cells. Because iron isn't as easily absorbed from plant sources, the recommended intake of iron is almost double if you receive your iron from plant sources, such as dried beans and peas, lentils, enriched cereals, whole-grain products, dark leafy green vegetables and dried fruit. Zinc also is not easily absorbed from plant sources, such as whole grains, soy products, legumes, nuts and wheat germ. Legumes and cheese are good options to fulfill your zinc requirements.</li> <li>Iodine This is a component in thyroid hormones, which helps regulate your metabolism, growth and function of key organs. Plant-based diets are typically low in iodine. Adding just one-fourth of a teaspoon of iodized salt a day provides a significant amount of iodine.</li> </ul> Whichever diet you decide on, it's important to choose a variety of healthy plant-based foods, such as whole fruits and vegetables, legumes and nuts, and whole grains. At the same time, be sure to cut back on less healthy choices, such as sugar-sweetened beverages, fruit juices, overly processed foods and refined grains. Be sure that whatever diet you choose includes the nutrients you need to stay healthy. For more information, talk to your health care team or request a referral to a dietician to learn more. Katherine Zeratsky, R.D.N., L.D., is a dietitian who has worked for Mayo Clinic in Rochester for more than 20 years. Her areas of interest range from wellness nutrition to pediatrics.Katherine Zeratsky, R.D.N., L.D.Primary Care in Rochester and KassonVegetarian DietPrimary Care in Rochester and KassonA lack of sleep can affect athletic and academic performance.&nbsp;<img src="/-/media/ech-media/images/widgets/teens/ech_teensleeping_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=EB60C64CD2791A51C59041375E84AB20" alt="ECH_teenSleeping_widget" width="100" height="65" DisableNVelocity="true" />Add sleep to your student athlete's training regimen12/27/2021 4:00 AM<img src="/-/media/ech-media/images/widgets/teens/ech_teensleeping_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=F2C2CB52B9C819F5A932994842032786" alt="ECH_teenSleeping_widget" width="300" height="195" DisableNVelocity="true" />Life as a student athlete is busy. Full school days, practices, games, homework and social life make for a full schedule. Sleep often gets overlooked when scheduling the day, but this can come at a price.  A lack of quality sleep can negatively affect your student's academic and athletic performance. Your child is experiencing an important period of physical, mental and emotional maturation. Sleep is vital to optimize healthy growth and development during this time.  Here's how I respond to some of the common questions that student athletes and their parents ask me about sleep:  What the benefits of sleep? Research has extensively described the benefits of sleep. In athletes, getting enough quality sleep has been demonstrated to improve mood, energy levels, and physical and cognitive performance; speed up recovery; improve immune function; and reduce likelihood of injury.  Adequate sleep has been shown to improve academic performance, which should be the top priority for student athletes. Getting enough quality sleep — in addition to practice, training and proper nutrition and hydration — is a vital part of achieving a student athlete's peak athletic performance. From an injury prevention standpoint, some studies have shown that even getting a single additional hour of sleep can greatly reduce injury risk.  Sleep is also important in regulating several physiologic functions, including immune function and energy storage. Sleep deprivation has been shown to decrease glycogen storage, which is one way the body stores energy for intense, prolonged physical activity.  How much sleep should an athlete get? The amount of sleep each athlete needs varies, since some need more than others to perform at their peak. However, most high school athletes should get a minimum of eight to 10 hours of sleep per night, with younger athletes needing even more. In addition to getting adequate sleep, it's also important that sleep is high-quality.  I heard napping was bad for teenagers. Is this true? Not all napping is bad. Rather, naps have been shown to be beneficial if done appropriately, since they can provide a physical and mental boost. A daytime nap can reduce sleep debt, and improve your energy, alertness and memory — and even reaction time and performance. Limit naps to about 30 minutes, and they shouldn't be done too late in the day, since prolonged naps or napping too late in the day can interfere with nighttime sleeping.  If athletes are excessively sleeping during the day, they're probably not getting adequate restorative nighttime sleep. Excessive daytime sleepiness also can be a symptom of depression in children, so alert your child's primary care provider if you're noticing a pattern of increased daytime sleepiness or other signs or symptoms of depression.  Is it OK if my athlete snores? Snoring should not be brushed aside or ignored. Snoring can be a sign of a sleep disorder, such as obstructive sleep apnea. If your athlete consistently snores, you should discuss this with your primary care provider to see if an evaluation by a sleep medicine specialist would help.  What should I do if my athlete has trouble sleeping?  Sleep difficulties can occur for various reasons. Some student athletes have a difficult time falling asleep, while others may have trouble staying asleep or wake up frequently at night. Certain medical conditions can cause sleep issues, but most of these issues can be addressed by optimizing your sleep hygiene.  Improving sleep includes practices such as:  <ul> <li>Having a consistent bedtime routine, including going to bed and waking up at consistent times every day. </li> <li>Creating a relaxing and soothing environment, such as bathing before bed, playing soothing music or meditating. </li> <li>Making the room cool, dark and quiet. White noise or fans help some people sleep. </li> <li>Avoiding cellphones and other screen time at least one to two hours before bed. This artificial light can be stimulating and suppress your brain's melatonin production, which is an important hormone involved in your body's sleep-wake cycle. </li> <li>Avoiding heavy meals or exercise within two hours of bedtime, which can make it more difficult to fall asleep. Hunger also affects sleep, so try having a light snack before bedtime, if you're hungry. </li> <li>Avoiding caffeine late in the day, including coffee, soda, tea, energy drinks and chocolate. </li> </ul> If sleep problems persist despite these recommendations, consider discussing your student athlete's sleep with their primary care provider.  <a href="https://communityhealth.mayoclinic.org/providers/luke-radel-md/">Luke Radel, M.D.</a>, is a physician in Primary Care in Rochester and Kasson's Division of Community Pediatric and Adolescent Medicine. He is board-certified in pediatrics and sports medicine. Dr. Radel volunteers as the team physician for the John Marshall High School football team. He was named a pediatric sports medicine "Top Doctor" in Minnesota Monthly in 2020 and 2021. He has experience treating youth, collegiate and professional athletes. Luke Radel, M.D.Primary Care in Rochester and KassonAthlete SleepPrimary Care in Rochester and KassonCat scratch or bite? Talk to your care team.&nbsp;<img src="/-/media/ech-media/images/widgets/kids/kittenbite.jpg?h=65&iar=0&w=100&sc_lang=en&hash=AF560D8C262720E0F8567D076BC4B3D3" alt="KittenBite" width="100" height="65" DisableNVelocity="true" />When kitty turns tiger, take it seriously12/30/2021 4:30 AM<img src="/-/media/ech-media/images/widgets/kids/kittenbite.jpg?h=205&iar=0&w=315&sc_lang=en&hash=46DC0C60B97B2715035BAEDD1B0D10F8" alt="KittenBite" width="315" height="205" DisableNVelocity="true" />Just beneath the coat of your Kitty lies a tiger waiting to pounce. House cats are biologically designed to be efficient hunters and complete with the tools they need — sharp claws and teeth for grabbing and killing prey. Unfortunately, sometimes that "prey" is their human's hands, face or feet.  It doesn't take much for Kitty to turn tiger. A game that gets out of hand or being overexcited, frightened by another animal or startled by a noise can trigger their predator response, and the claws come out. (Even declawed cats usually still have a full set of back claws in working order.) If you're a victim of a cat bite or scratch, take is seriously to avoid becoming infected with cat-scratch disease (CSD).  What is CSD? It's an infection caused by being bitten, scratched or having an open wound licked by a cat carrying a bacterium called Bartonella henselae. About 40% of cats carry this bacterium at some time in their lives, although most never show signs of illness. Kittens younger than one year are more likely to be infected and spread the germ, since they often bite and scratch as they play and learn how to attack prey.  How do cats get infected? Cats can pick up the bacterium from flea bites and getting flea droppings into their wounds. They also can become infected by fighting with other cats that are infected.  How do you know if you have CSD? About 3 to 14 days after the bite or scratch, a mild infection can set in. The affected area may look swollen and red with round, raised lesions and possibly, pus. It also may feel warm or painful. The infected person may have a fever, headache, poor appetite and be excessively tired. As the infection progresses, lymph nodes closest to the original scratch or bite can become swollen, tender or painful.  Although rare, CSD can cause serious complications, affecting the brain, eyes, heart or other internal organs. These rare complications, which may require intensive treatment, are more likely to occur in children younger than 5 years old and people with weakened immune systems.  How is CSD treated? Wash bites and scratches well with soap and running water. Keep an eye on the wounds and contact your care team if you develop any symptoms of infection. You may need to be treated with antibiotics.  How can it be prevented? Protect your cat by keeping it indoors and make sure it has regular veterinary care. But as every cat owner knows, scratches and nips happen. That's why it's important for everyone to learn how to play safely with them, such as using toys for "prey" rather than your hands, holding them correctly and realizing that your Kitty has the heart of a tiger.  <a href="https://communityhealth.mayoclinic.org/providers/denise-dupras-md/">Denise Dupras, M.D., Ph.D.</a>, is a general internist in Community Internal Medicine, Geriatrics and Palliative Care at Mayo Clinic in Rochester. She completed her medical and doctoral degrees at Mayo Clinic Alix School of Medicine and her residency in internal medicine at Mayo Clinic in Rochester. Her interests include medical education, evidence-based medicine and care of LGBTQIA+ patients. Denise Dupras, M.D., Ph.D.Primary Care in Rochester and KassonCat Scratch Disease 2022Primary Care in Rochester and KassonWatch for symptoms and talk to your care provider for help.<img src="/-/media/ech-media/images/widgets/elderly/elderlydepression.jpg?h=65&iar=0&w=100&sc_lang=en&hash=0B951CC763EDD69327315509923BEB9A" alt="ElderlyDepression" width="100" height="65" DisableNVelocity="true" />Depression in the elderly population12/22/2021 1:30 PM<img src="/-/media/ech-media/images/widgets/elderly/elderlydepression.jpg?h=205&iar=0&w=315&sc_lang=en&hash=927E0E63094C23458D7C13572FA23EF8" alt="ElderlyDepression" width="315" height="205" DisableNVelocity="true" />The COVID-19 pandemic has increased stress for everyone, which has increased discussions about mental health.  More frequent discussions about mental health is one thing positive that has come from the pandemic. This change is notable due to a long history of stigma attached to talking about mental health. However, this does not mean everyone is comfortable starting a conversation or openly discussing depression and mental health. Older generations may still feel uncomfortable with this. But everyone is still at risk for depression during such uncertain times.  What are common signs or symptoms of depression? Depression, while more common as people age, is not a normal part of aging. Reasons for increased depression in the elderly include effects of chronic health conditions, physical limitations and the loss of loved ones. While everyone will feel down at times, if these feelings last weeks to months, it may suggest depression.  Common symptoms of depression include:  <ul> <li>Feeling sad, hopeless, helpless or guilty. </li> <li>Loss of interest in once enjoyable activities. </li> <li>Decreased energy.</li> <li>Difficulty sleeping. </li> <li>Irritability. </li> <li>Moving or talking more slowly. </li> <li>Thoughts of death or suicide. </li> </ul> What can be done if someone is experiencing depression symptoms? First, if a person is having thoughts of suicide or self-harm, or expresses thoughts of suicide or self-harm, reach out for help immediately. Seeking emergency care and making sure the person is not alone must be the first step.  Over the last year and a half, isolation has been a big factor affecting mental health. The elderly have borne the brunt of this.  It is important to remain respectful of others when talking about mental health. Just reaching out, and providing socialization and talking, can be a good start. Making regular contact and extending a hand to involve them in activities can build on this.  Evidence suggests that psychotherapy, or talk therapy, as well as antidepressant medications can help. Primary care providers are sensitive to the effects of antidepressants and side effects in the elderly. They pay careful attention to medication selection and dosing to ensure they are well-tolerated. They also will watch for interactions with other medications. These should not be barriers to considering and discussing medications with one's health care provider. Therapy and medications are often used together.  Is there anything that can reduce the risk for depression? Taking regular care of one's self and maintaining social contact can be beneficial in maintaining good mental health.  These are some reasonable steps to focus on:  <ul> <li>Get regular exercise. </li> <li>Maintain a regular sleep regimen. </li> <li>Eat a healthy diet. </li> <li>Keep socially active, even if just with a phone call or video chat during the pandemic. </li> <li>Stay active with hobbies. </li> </ul> Many elder care programs have options that provide low-cost or free phone calls with volunteers to provide another source of contact during this time. This often provides a nice resource to those who might not feel comfortable talking to family. Technology has made counseling services by video chat available to many in their own home, as well.  Continue to watch out for others. Know that many around you might be struggling. A kind and supportive word is never wrong to offer.  <a href="https://communityhealth.mayoclinic.org/providers/kyle-mckenzie-md/">Kyle McKenzie, M.D.</a>, is an internal medicine physician and geriatrician in Primary Care in Rochester and Kasson's Division of Community Internal Medicine, Geriatrics and Palliative Care. His primary focus is care for the geriatric population and specifically working with those in long-term care settings. He is medical director for several skilled nursing facilities in surrounding communities, including Dodge Center, Hayfield, Pine Island and Plainview, Minnesota. Kyle McKenzie, M.D.Primary Care in Rochester and KassonElderly DepressionPrimary Care in Rochester and KassonYou can now use your Mayo Clinic App to check in for most Mayo Clinic appointments.&nbsp;<img src="/-/media/ech-media/images/widgets/randomimages/cellphone1.jpg?h=65&iar=0&w=100&sc_lang=en&hash=A0E60303FE65FA091E7983D7B0054BEB" alt="CellPhone1" width="100" height="65" DisableNVelocity="true" />New way to check in for your appointment: Mobile Appointment Check-In12/2/2021 4:30 AM<img src="/-/media/ech-media/images/widgets/randomimages/cellphone1.jpg?h=205&iar=0&w=315&sc_lang=en&hash=1EA5A4D755DB057EFAB68B16A96E3F2E" alt="CellPhone1" width="315" height="205" DisableNVelocity="true" />You can now use your Mayo Clinic App to check in for most Mayo Clinic appointments. This new feature, Mobile Appointment Check-In, lets you tell Mayo Clinic staff that you've arrived for your appointment and are ready to be seen.  To use mobile appointment check-in, you'll need a Patient Online Services account and the Mayo Clinic App. If you need to create an account, visit <a rel="noopener noreferrer" href="https://onlineservices.mayoclinic.org/content/staticpatient/showpage/patientonline" target="_blank">mayoclinic.org/onlineservices</a> and select "Create account." Be sure to have your Mayo Clinic number handy as you'll need that when completing the account creation form. If you need to download the free Mayo Clinic App, go to your App Store and search for "Mayo Clinic." Start at home The best way to use Mobile Appointment Check-in is to start at home. Log in to the Mayo Clinic App as early as seven days prior to an in-person appointment and complete PreCheck-In. You may be asked to answer some questionnaires or update insurance information. This is often easier to do at home where you have access to the information you'll need to answer these questions.  Arriving at Mayo Clinic Mobile Appointment Check-In can begin as early as 30 minutes prior to your appointment. You should be at Mayo Clinic when you start check-in. This makes it easier for staff to reach out to you if they have questions or if you have questions for them. To check in from the Mayo Clinic App:  <ul> <li>Log in to the Mayo ClinicApp. </li> <li>Find your appointment. You'll see the words, "I'm Here" by the appointment. </li> <li>Tap "I'm Here."</li> <li>Follow the onscreen prompts. </li> </ul> In some cases, you may be asked to talk to a Mayo Clinic staff member. If you haven't completed PreCheck-In, you'll be asked to complete that before you check in.  In many cases, you'll be asked to go to a waiting area and wait for your name to be called. This means you're checked in for your appointment. No need to use the kiosk or go to the desk. Mayo staff knows you've arrived and will call you when your provider is ready to see you.  Helpful hints Make sure you have the most recent version of the Mayo Clinic App on your phone. You can update it by going to the App Store or using your phone to set up automatic updates.  If you have location services turned on for the Mayo Clinic App, you may receive notifications on your device to check in for your appointment when you are near your appointment location. You'll also need to complete PreCheck-In on the same device you use for Mobile Appointment Check-In to take advantage of these notifications.  View the <a rel="noopener noreferrer" href="https://mssvideoupload.mayo.edu/media/Using%20Mobile%20Appointment%20Check-In/1_7pa7hs0r" target="_blank">Mobile Appointment Check-In Using the Mayo Clinic App video</a> to see how this new feature works. To help you remember how to use this feature, you can <a rel="noopener noreferrer" href="https://mcforms.mayo.edu/mc0600-mc0699/mc0684-205.pdf" target="_blank">print out this card</a> or ask a Mayo Clinic staff member for a copy. Primary Care in Rochester and KassonMobile Appointment CheckinPrimary Care in Rochester and KassonA slow cooker can save time at the end of the day.&nbsp;<img src="/-/media/ech-media/images/widgets/food/slowcookermeals.jpg?h=65&iar=0&w=100&sc_lang=en&hash=C9BFB201C1A66DE28DF895976A6D72B9" alt="SlowCookerMeals" width="100" height="65" DisableNVelocity="true" />How to make your kitchen equipment work for you12/20/2021 4:30 AM<img src="/-/media/ech-media/images/widgets/food/slowcookermeals.jpg?h=205&iar=0&w=315&sc_lang=en&hash=1A145CCDC8880B91F73A1B5940ACA395" alt="SlowCookerMeals" width="315" height="205" DisableNVelocity="true" />Imagine coming home from a long day at work to be welcomed by a meal that is already prepared or requires less than 30 minutes of hands-free time. Many would consider that a dream come true.  While few people have the luxury of a private chef, it's likely that you own a well-loved slow cooker. Or maybe you've recently acquired one of the newer must-have pieces of equipment, a pressure cooker. These appliances seem to promise the world. However, they can become forgotten pieces of equipment when it comes to making nutritious meals.  Let slow cookers and pressure cookers do the work of preparing meals for you. They allow you to set it and forget it or reduce the amount of time needed to prepare food.  Preparing meals ahead of time can help you plan nutritious meals throughout the week. You also can try batch cooking where you make several portions at once and consume these portions within three to five days.  Batch cooking is ideal for:  <ul> <li>Grains, such as brown rice or steel-cut oatmeal. </li> <li>Proteins, such as beans, poultry, beef, fish and lentils. </li> <li>Vegetables, such as carrots, broccoli, beets, green beans, corn, potatoes and squash. </li> <li>Whole meals with multiple food groups, including soups and stews. </li> </ul> Consider these tips and tricks: <ul> <li>For slow cookers, use a liner to make clean up a breeze. </li> <li>Use the ingredients you have on hand, including frozen and canned ingredients. </li> <li>Start simple with a few ingredients and work up to recipes with more ingredients. </li> <li>Prepare plain ingredients to allow flavors to be unique for each meal by adding various spices, herbs and citrus juices. </li> <li>Include different food groups — grains, vegetables, proteins, dairy and fruits — such as oatmeal made with milk and served with diced apples and walnuts. </li> </ul> Starting to use slow cookers or pressure cookers may take some adjustment, but once you get into the groove, they can help support a healthy lifestyle. If you're struggling with ideas, check out <a rel="noopener noreferrer" href="https://www.mayoclinic.org/healthy-lifestyle/recipes/slow-cooking-recipes/rcs-20200545" target="_blank">Mayo Clinic's slow cooking recipes</a> for inspiration or visit other websites.  Kelly Sommer, RDN, is a dietetic intern at Mayo Clinic in Rochester. She grew up in Southeast Minnesota and studied at University of Wisconsin-Stevens Point. Her areas of interest are nutrition through the life span and sustainability. Kelly Sommer, RDNPrimary Care in Rochester and KassonSlow Cooker MealsPrimary Care in Rochester and KassonThese over-the-counter medications may help.<img src="/-/media/ech-media/images/widgets/medications/otccoldflucovidmeds.jpg?h=65&iar=0&w=100&sc_lang=en&hash=F7632FF2116E00E3599124F33D4CE659" alt="OTCcoldfluCOVIDmeds" width="100" height="65" DisableNVelocity="true" />Options for relieving cold, flu and COVID-19 symptoms1/27/2022 4:30 AM<img src="/-/media/ech-media/images/widgets/medications/otccoldflucovidmeds.jpg?h=205&iar=0&w=315&sc_lang=en&hash=41594029723A54611A5205796C428C7C" alt="OTCcoldfluCOVIDmeds" width="315" height="205" DisableNVelocity="true" />As cold and flu season is underway and COVID-19 continues in a series of waves, you may be in search of over-the-counter products to combat your symptoms. However, it's important to take steps to determine which medication is the correct choice for you.  First, read the medication label so you are aware of each ingredient. Many over-the-counter brands have different products that contain various ingredients. For example, what's the difference between Mucinex DM and Mucinex Sinus-Max? Mucinex DM contains dextromethorphan, a cough suppressant, and guaifenesin, which thins and looses mucus. On the other hand, Mucinex Sinus-Max contains acetaminophen, a pain reliever; dextromethorphan, guaifenesin; and phenylephrine, a nasal decongestant. Do you need each of these ingredients? Are you already taking acetaminophen for pain or fever? What about a separate nasal decongestant?  Second, talk with your health care team to determine if the product is safe to take with your prescription medications and current health conditions, or if you may be pregnant.  To help with the above steps, here are the main medication categories:  Antihistamines Antihistamine treat a runny nose by blocking the effects of a substance called histamine. However, not all antihistamines have the same effects. The older class of antihistamines includes medications such as chlorpheniramine (Chlor-Trimeton), diphenhydramine (Benadryl) and doxylamine (Vicks NyQuil, Tylenol Cold and Cough Nighttime). These medications are known to cause drowsiness and are often used in nighttime formulations to aid with sleep. Older adults, and people taking medications that cause dizziness, drowsiness or balance issues, should use these antihistamines with caution.  On the other hand, newer antihistamines, such as cetirizine (Zyrtec), loratadine (Claritin), levocetirizine (Xyzal) or fexofenadine (Allegra) are often considered to be safer options, as they do not tend to cause drowsiness and interact with fewer medications.  In addition to treating a runny nose, antihistamines can reduce swelling and congestion in the nasal passages and improve postnasal drip, the mucus in the nose or sinuses that drains into the throat. Postnasal drip is one of the most common causes of long-lasting cough.  Cough suppressants Cough is a common symptom of a cold, flu or COVID-19. However, COVID-19 typically presents with a dry cough rather than a productive cough with mucus. Although antihistamines and decongestants can help treat a cough by decreasing nasal congestion and postnasal drainage, other medications are designed to target a cough.  Dextromethorphan, often labeled as "DM" on medication labels, works on the part of your brain responsible for the cough reflex and disrupts the communication between your brain and the nerves that cause a cough. If using a liquid formulation of this medication, make sure to use the dosing cup that is provided with the bottle to ensure you are taking an accurate dose. Dextromethorphan is sold under the brand name Delsym or commonly found in combination products like Robitussin DM. If you have diabetes, purchase sugar-free options to avoid raising your blood sugar. If you take medications that affect serotonin levels to treat depression, such as sertraline (Zoloft), fluoxetine (Prozac) or venlafaxine (Effexor), dextromethorphan may enhance the effect of your medication and should be used with caution. This combination may lead to a rare, serious side effect called serotonin syndrome. If you experience confusion, heavy sweating, diarrhea, rapid heart rate, vomiting or muscle spasms, contact your health care provider or seek medical attention immediately.  Guaifenesin, a common ingredient in Mucinex or Robitussin, acts by loosening and thinning mucus in the airways to relieve congestion in acute or chronic coughs. However, guaifenesin does not suppress a cough itself. Also, adequate hydration is required to loosen and thin mucus.  Decongestants A stuffy or congested nose may present with a cold, flu or COVID-19. Common decongestants include pseudoephedrine or phenylephrine, often labeled as "PE." These decongestants work by narrowing blood vessels, which temporarily relieves nasal congestion. However, they also can increase blood pressure in people with high blood pressure. Therefore, patients with hypertension, ischemic heart disease or kidney disease should use these medications with caution. When comparing these two medications, pseudoephedrine is more effective than phenylephrine. Pseudoephedrine does not require a prescription. However, it is placed behind the counter at pharmacies and requires a photo ID to purchase it.  In addition to oral options, decongestants are also available as nasal sprays, including oxymetazoline, which is sold under the brand names of Afrin and Vicks Sinex. This option can relieve congestion with less of an effect on blood pressure. Oxymetazoline should be used for a maximum of three days. Otherwise, it can lead to rebound nasal congestion, which means the nasal congestion can recur or worsen.  Natural or homeopathic products Although homeopathic products may be marketed to relieve the symptoms of colds or the flu, the evidence for their safety and effectiveness is lacking. Because there is little evidence to support their use, it is usually best to avoid them.  There is also limited evidence for the use of other natural products, such as vitamin C, echinacea, zinc and ginseng. Vitamin C has been studied for years as a possible treatment for colds. Studies have demonstrated little to no benefit for preventing or treating the common cold. Echinacea also has been shown to have minimal benefits and may only shorten cold symptoms by about a half-day. Similarly, zinc lozenges or syrup have been shown to reduce the length of a cold by one day, especially when taken within 24 hours of the first signs and symptoms of a cold. Studies with ginseng have concluded that there is not enough evidence for its use. North American ginseng may be effective in shortening the duration of colds when taken preventatively for eight to 16 weeks. If you are considering one of these products, it is important to talk to your health care provider to avoid drug interactions. For example, ginseng may reduce the effects of warfarin.  Other natural products, such as honey — alone or mixed with chamomile tea or lemon — may help relieve your cough and loosen chest congestion.  Pain, headache or fever Acetaminophen (Tylenol) can be used to treat a fever, pain or headache. It is recommended to take 500 milligrams every four hours as needed or 1,000 milligrams every six hours as needed. You should not take more than 3,000 milligrams in a 24-hour period. If you have a liver condition, confirm your maximum recommended dose with your health care provider.  Ibuprofen (Advil or Motrin) also can be used to treat a fever, pain or headache. The recommended dose is 200 to 400 milligrams every four to six hours as needed. The maximum dose is 1,200 milligrams in a 24-hour period. You should avoid ibuprofen if you have kidney disease, coronary heart disease, heart failure, or a history of a gastric ulcer or gastric surgery.  Other important considerations If you have cold, flu or COVID-19 symptoms, stay home from school or work to avoid spreading these germs. If you are experiencing COVID-19 symptoms, get tested and appropriately quarantine if you receive a positive result.  Washing your hands frequently with soap and water or using hand sanitizer is important to prevent the spread of these illnesses. If you need to cough or sneeze, use a tissue to cover your mouth and nose. If you do not have a tissue, cough or sneeze into your elbow — not your hands. Remember to immediately wash your hands after blowing your nose, coughing or sneezing.  Protect yourself and others from the spread of the flu and COVID-19 by receiving your annual flu shot and the appropriate series of the COVID-19 vaccine, including the booster dose.  If your symptoms last for more than a week, or if you develop a fever, rash or persistent headache, contact your health care provider for further evaluation.  Danielle Hess, Pharm.D., R.Ph., is a pharmacy resident at Mayo Clinic in Rochester, Minnesota. Danielle Hess, Pharm.D., R.Ph.Primary Care in Rochester and KassonCold Flu Covid Symptom ReliefPrimary Care in Rochester and KassonThese exercises are easy to fit into a busy day, and they reinvigorate you.&nbsp;<img src="/-/media/ech-media/images/widgets/activities/ech_fab5_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=574FB78E71244E646453E2B84FDD2D95" alt="ECH_fab5_widget" width="100" height="65" DisableNVelocity="true" />5 fab exercises to get you moving at work, home1/17/2022 4:30 AM<img src="/-/media/ech-media/images/widgets/activities/ech_fab5_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=552D869C30ED7D6470F52C4E2914D749" alt="ECH_fab5_widget" width="300" height="195" DisableNVelocity="true" />Not having enough time to exercise is one of the top reasons people give up on their resolution to get in better shape. But there's a solution that helps you blend exercise into a busy day, all while making you more productive at work.  As a wellness physical therapist, people often tell me they simply don't have enough time to get a workout in during the week because of their busy work schedules. But lack of time shouldn't be an obstacle. Every bit of physical activity counts. You don't necessarily have to always get to the gym.  To show you how easy it is to get moving at work, I've developed a program called the "Fab 5." These are five simple exercises you can do in the office or at home to reinvigorate yourself. A lot of studies have shown us that once people get up, move and get active, they're more productive.  It can take as few as five minutes to do chair squats, desk or countertop pushups, chair pushups, toe raises and lunges. Not only do the exercises count as a resistance training workout, they also can be the key to getting the blood flowing to overcome the midday lull.  They're simple and easy to do in a small area, and these exercises can be a wonderful way to reenergize you. Here's how to do the Fab 5:  The squat <img alt="SquatSmall" src="/-/media/ech-media/images/widgets/activities/squatsmall.jpg?h=231&w=200&hash=7C631814EFFE6F4837C51F96177C7DF062CA94E3&sc_lang=en" style="height: 231px; width: 200px; float: left; padding: 10px;" class="img-responsive">Stand tall with your feet shoulder-width apart.  Bend your knees, setting your hips back with your chest upright and the weight in your heels. Return to a standing position and repeat 10 to 12 times.  Tip: Don't let your knees come together   <hr>  Desk pushups <img alt="DeskPushupSmall" src="/-/media/ech-media/images/widgets/activities/deskpushupsmall.jpg?h=231&w=200&hash=59A8749AE98BF6B638FB3598AC0F5CE06492C769&sc_lang=en" style="height: 231px; width: 200px; float: left; padding: 10px;" class="img-responsive">Stand next to a table or desk, leaning onto straightened arms for support.  Bend your elbows, slowly lowering yourself into a pushup position. Then push your body back up away from the table and repeat 10 to 12 times.  Tip: Make sure to keep your back straight. Don't let your hips sag.    <hr>  Chair pushups <img alt="ChairPushupSmall" src="/-/media/ech-media/images/widgets/activities/chairpushupsmall.jpg?h=231&w=200&hash=C01486F95998C22642A5F81B628A2755B2235AEC&sc_lang=en" style="height: 231px; width: 200px; float: left; padding: 10px;" class="img-responsive">Sit upright in a chair with your hands resting on the armrests.  Straighten your arms, lifting your body off the chair. Hold briefly. Then lower yourself down and repeat 10 to 12 times. Tip: Make sure to use a sturdy chair, and use your legs to balance, as needed. Don't shrug your shoulders during the exercise.  <hr>  Toe raises <img alt="ToeRaiseSmall" src="/-/media/ech-media/images/widgets/activities/toeraisesmall.jpg?h=231&w=200&hash=B3F51408527B009AF2C7792C6F77CCA7BBAAEA41&sc_lang=en" style="height: 231px; width: 200px; float: left; padding: 10px;" class="img-responsive">Begin in a standing position.  Rise up onto your toes, hold briefly, then lower back down, shifting your weight to the heels and lifting the balls of your feet off the ground. Repeat 10 to 12 times.  Tip: Make sure to maintain an upright posture and use a chair or desk to help you balance as needed.  <hr>  The lunge <img alt="LungeSmall" src="/-/media/ech-media/images/widgets/activities/lungesmall.jpg?h=231&w=200&hash=6E55079E1D72098590830FBFB4DE88C3285DFC10&sc_lang=en" style="height: 231px; width: 200px; float: left; padding: 10px;" class="img-responsive">Stand upright with your hands resting on your hips and your feet shoulder-width apart.  Keeping your trunk upright, step backward with your right leg, and lower your body toward the ground into a lunge position. Carefully return to the starting position. Repeat with the left leg. Repeat 10 to 12 times.  Tip: Keep your trunk steady. Don't let the knee in front collapse inward or move forward past your toes as you lunge.  <hr>  Watch the "Fab 5 Exercises to Get You Moving" video posted to the <a rel="noopener noreferrer" href="https://newsnetwork.mayoclinic.org/discussion/mayo-clinic-minute-fab-5-exercises-to-get-you-moving/" target="_blank" style="font-size: 1.6rem;">Mayo Clinic Minute</a>: <iframe width="560" height="315" src="https://www.youtube.com/embed/T0_QWyAelWI" frameborder="0"></iframe> Danielle Johnson, M.S., P.T., is a wellness physical therapist at the Mayo Clinic Healthy Living Program in Rochester, Minn. She specializes in combining physical therapy with whole-body wellness and integrating fundamental and natural movement patterns, as well as practical and playful movement, into daily experiences. Danielle P. Johnson, M.S., P.T.Primary Care in Rochester and KassonGet Moving ExercisesPrimary Care in Rochester and KassonPlease adhere to this safety measure to help protect our community.&nbsp;<img src="/-/media/ech-media/images/widgets/people/momchildmasked.jpg?h=65&iar=0&w=100&sc_lang=en&hash=4E1B352442A9A81312BD6A317875E940" alt="MomChildMasked" width="100" height="65" DisableNVelocity="true" />Patients and visitors are required to wear face masks while on Mayo Clinic property12/8/2021 12:24 PM<img src="/-/media/ech-media/images/widgets/people/momchildmasked.jpg?h=205&iar=0&w=315&sc_lang=en&hash=DACEDC4C01597E366FB3FA6DBEB947E4" alt="MomChildMasked" width="315" height="205" DisableNVelocity="true" />For your own safety and for the safety of your care team and others, all patients and visitors are required to wear a face mask while on Mayo Clinic property. Masks should be well-fitting and worn over the nose and mouth. If you do not have an <a rel="noopener noreferrer" href="https://www.mayoclinic.org/patient-visitor-guide/preparing-for-your-visit/covid-19-acceptable-face-masks" target="_blank">appropriate mask</a>, you will be given one so we can continue to provide your care. Unless directed by a provider, masks must always remain on. This includes in the lobby, while moving between appointments and buildings, and when in the exam room as you wait to be seen (even if alone). Before arriving for an appointment, check the <a rel="noopener noreferrer" href="https://www.mayoclinic.org/covid-19" target="_blank">Mayo Clinic COVID-19 page</a> for updates and any visitor limitations. These can change based on local data and community transmission levels. In addition to mandatory masking, patients and visitors will proceed through a checkpoint upon entering, and social distancing will be expected throughout the campus. Please adhere to these safety measures to help protect our community. If you have questions about wearing a mask for your visit, contact your Mayo Clinic location before arriving on site. Watch: <a rel="noopener noreferrer" href="https://mssvideoupload.mayo.edu/media/Mask+on%2C+Mask+up%2C+Mask+Always/1_wcgpaxoc" target="_blank">Mask Up, Mask On, Mask Always</a>  <iframe id="kaltura_player" src="https://cdnapisec.kaltura.com/p/1825021/sp/182502100/embedIframeJs/uiconf_id/29327221/partner_id/1825021?iframeembed=true&playerId=kaltura_player&entry_id=1_wcgpaxoc&flashvars[streamerType]=auto&flashvars[localizationCode]=en&flashvars[leadWithHTML5]=true&flashvars[sideBarContainer.plugin]=true&flashvars[sideBarContainer.position]=left&flashvars[sideBarContainer.clickToClose]=true&flashvars[chapters.plugin]=true&flashvars[chapters.layout]=vertical&flashvars[chapters.thumbnailRotator]=false&flashvars[streamSelector.plugin]=true&flashvars[EmbedPlayer.SpinnerTarget]=videoHolder&flashvars[dualScreen.plugin]=true&flashvars[hotspots.plugin]=1&flashvars[Kaltura.addCrossoriginToIframe]=true&&wid=1_sxab8dxp" width="400" height="285" allow="autoplay *; fullscreen *; encrypted-media *" sandbox="allow-forms allow-same-origin allow-scripts allow-top-navigation allow-pointer-lock allow-popups allow-modals allow-orientation-lock allow-popups-to-escape-sandbox allow-presentation allow-top-navigation-by-user-activation" frameborder="0" title="Kaltura Player"></iframe>Primary Care in Rochester and KassonMask On Mask UpPrimary Care in Rochester and KassonThe Mayo Clinic Blood Donor Center is conducting mobile blood drives once again. Find out how you can be involved.&nbsp;<img src="/-/media/ech-media/images/widgets/blooddonation/blooddonormobileprogram.jpg?h=65&iar=0&w=100&sc_lang=en&hash=22EDF44D0FAA2575D8DA41D2FCC6B836" alt="BloodDonorMobileProgram" width="100" height="65" DisableNVelocity="true" />Mayo Clinic Blood Donor Center needs your help1/13/2022 4:30 AM<img src="/-/media/ech-media/images/widgets/blooddonation/blooddonormobileprogram.jpg?h=205&iar=0&w=315&sc_lang=en&hash=DE1855F082D568CF7D8EF89CDAF2F96C" alt="BloodDonorMobileProgram" width="315" height="205" DisableNVelocity="true" />Nearly two years ago, James Stubbs, M.D., former chair of the Division of Transfusion Medicine, said that Mayo Clinic's need for blood donors during the COVID-19 pandemic was a marathon, not a sprint. Well, the marathon continues.  The need for blood is as great as the beginning of the COVID-19 pandemic. More importantly, a consistent blood supply is needed.  While whole blood may last for 42 days, platelets only last five. Thankfully, with the growing COVID-19 vaccination rate, the Mayo Clinic Blood Donor Center is excited to go out into the community again to boost the blood supply through mobile blood drives.  That is where you come in.  You can choose to donate blood at one of the locations at Mayo Clinic in Rochester:  <ul> <li>Hilton Building, first floor, downtown  This location is open weekdays from 6 a.m. to 4:30 p.m., and it's open until 7 p.m. every second Thursday of the month. </li> <li>Joseph Building, main floor, M-86, Saint Marys Campus  This location is open weekdays from 8 a.m. to 3 p.m.</li> </ul> Or you can become a mobile blood drive ambassador, and host a blood drive at your church, school, community center or workplace. By hosting a mobile blood drive, you are benefiting your community as you come together to help save lives.  The Mayo Clinic Blood Donor Center cannot do this on its own, so you're asked to join the marathon. The center is in it for the long run.  If you're interested in hosting a mobile blood drive, call the Mayo Clinic Blood Donor Center at <a href="tel:5072844475">507-284-4475</a>, or <a href="mailto:mailto:donateblood@mayo.edu">email the center</a>. To meet social distancing guidelines, the Mayo Clinic Blood Donor Center will limit appointments each day to sustain inventory while ensuring donor safety.  Mayo Clinic patients depend on the generosity of blood donors. Scheduling an appointment to donate blood helps ensure that blood is available for patients in need.  For more information about donating blood in Rochester, call the Mayo Clinic Blood Donor Center at <a href="tel:5072844475">507-284-4475</a>, or <a href="mailto:mailto:donateblood@mayo.edu">email the center</a>. You also can <a rel="noopener noreferrer" rel="noopener noreferrer" href="https://www.mayoclinic.org/blood-donor-program/minnesota" target="_blank">visit the center's webpage</a> for more information. Primary Care in Rochester and KassonMobile Blood DonationPrimary Care in Rochester and KassonHere are three tips for coping in the telework age.&nbsp;<img src="/-/media/ech-media/images/widgets/people/teleworkcoping.jpg?h=65&iar=0&w=100&sc_lang=en&hash=25117541883124CEA3CC3E084CDCB408" alt="TeleworkCoping" width="100" height="65" DisableNVelocity="true" />Is telework working for you?1/10/2022 4:30 AM<img src="/-/media/ech-media/images/widgets/people/teleworkcoping.jpg?h=205&iar=0&w=315&sc_lang=en&hash=0197338F767E47DA14694ADBA634352D" alt="TeleworkCoping" width="315" height="205" DisableNVelocity="true" />Telework has become common during the COVID-19 pandemic. Approximately 71% of people whose work responsibilities could be completed remotely are teleworking, according to data from the <a rel="noopener noreferrer" href="https://www.pewresearch.org/" target="_blank">Pew Research Center</a> published near the end of 2020.  Of course, not all career paths allow for telework. For example, health care workers providing direct patient care may not have a telework option. Also, data indicate that lower-income workers and people with less than a college education are less likely to telework.  Overall, however, the pandemic has significantly altered the landscape of the workforce, and many people are wondering how to best navigate the new normal of teleworking.  First, it's important to pay attention to the potential advantages and disadvantages of telework. This gives you the best chance to get full benefit form the positives of telework and cope with the challenges.  Some potential advantages of teleworking include flexibility in hours, greater work-life balance, potential cost savings, and shorter or no commute time. These benefits may help explain why data indicate that over half of people whose work can be done remotely report that they would like to continue teleworking, even after the COVID-19 pandemic.  On the other hand, disadvantages of telework can include feeling less connected with co-workers, struggling with motivation, feeling isolated or lonely, and having difficulty getting away from work at the end of the day. Also, telework may present specific challenges for certain groups. For example, teleworkers with children are more likely to report interruptions while teleworking.  Although it's not known exactly how teleworking affects mental health, what is known is that changes in day-to-day routines and ongoing uncertainties of the pandemic could affect emotional well-being. Studies show that symptoms of depression, anxiety, trauma and insomnia have increased during the pandemic.  Here are three healthy ways to cope with some of the challenges of teleworking and maintain your well-being:  <ol> <li>Keep track of how you are doing.  Pay attention to how you're feeling throughout the day. Sitting in front of a screen for hours on end can be draining. Be intentional about checking in with your body and mind, and ask yourself "What do I need right now?" Maybe it's a glass or water, a stretch or simply a deep breath. Try to allow yourself to refuel throughout the day, even in small ways. When the workday is over, try to create a purposeful shift away from your desk or computer to create a boundary for yourself between work and home. This may look like taking a brief walk at the end of your workday to unwind before transitioning to your evening activities. </li> <li>Find creative ways to connect with others.  If you're feeling disconnected from co-workers, be intentional about making time to socialize throughout the workday. For example, you could schedule a 15-minute break for each of you to take a walk around your own block while chatting on the phone. Consider using workplace services, such as Microsoft Teams or Skype for Business, to stay connected about projects or schedule a brief daily Zoom check-in. Outside of work, make time to schedule safe activities with friends and family. Different things will help different people enhance feelings of connection. Experiment with what may work for you. </li> <li>Communicate regularly with your supervisor or manager.  The shift to telework is relatively new to most, leaders included. Talk with your supervisor or manager about things you each see as working well, areas for improvement, and opportunities for adjustment or advancement in the workplace. Be open and honest about your experience and ideas, and receptive to feedback and trying new things. </li> </ol> The shift to telework at the beginning of the COVID-19 pandemic was sudden and swift. Even months later, people are adjusting to the changes of the telework world. Following these tips can help you continue to adapt and promote overall well-being.  Sometimes you may need additional help and support during times of stress. Talk to your primary care provider if you are struggling. Together, you can review potential treatment options. Most mental health providers and clinics offer in-person and teletherapy visits.  Visit the <a rel="noopener noreferrer" href="https://adaa.org/" target="_blank">Anxiety & Depression Association of America</a> or <a rel="noopener noreferrer" href="https://www.abct.org/" target="_blank">Association for Behavioral and Cognitive Therapies</a> websites for information on evidence-based treatments for depression, anxiety, trauma and insomnia, and find a therapy location near you.  Anne Roche, Ph.D., and Sydney Kelpin, Ph.D., are clinical psychology fellows, and <a rel="noopener noreferrer" href="https://www.mayoclinic.org/biographies/sawchuk-craig-n-ph-d-l-p/bio-20085911" target="_blank">Craig Sawchuk, Ph.D., L.P.</a>, is a clinical psychologist in Primary Care in Rochester and Kasson's Division of Integrated Behavioral Health at Mayo Clinic in Rochester, Minnesota. Anne Roche, Ph.D.; Sydney Kelpin, Ph.D.; Craig Sawchuk, Ph.D., L.P.Primary Care in Rochester and KassonTelework CopingPrimary Care in Rochester and KassonWinter coats and snowsuits can compress in a crash and leave the harness straps too loose.&nbsp;<img src="/-/media/ech-media/images/widgets/kids/ech_carseatwinter_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=AAE55E007FB021E3C424A785D4957EE0" alt="ECH_CarSeatWinter_widget" width="100" height="65" DisableNVelocity="true" />Bulky winter wear and car seat safety don't mix1/20/2022 4:30 AM<img src="/-/media/ech-media/images/widgets/kids/ech_carseatwinter_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=F79E639A78110B5AC127C925EAD8E22E" alt="ECH_CarSeatWinter_widget" width="300" height="195" DisableNVelocity="true" />When winter winds blow, babies and kids are bundled in snuggly coats and snowsuits. While they keep children warm, the <a href="https://www.aap.org/" target="_parent">American Academy of Pediatrics</a> warns they also can interfere with car seat safety. That's because bulky clothing can compress in a crash and leave the straps too loose to restrain your child. And that leads to increased risk of injury.  Ideally, dress your baby in thinner layers, and wrap a coat or blanket around them over the buckled harness straps. Oh, and dressing in thinner layers, with a coat at hand, applies to parents, too.  Follow these tips from <a rel="noopener noreferrer" rel="noopener noreferrer" href="https://www.healthychildren.org/English/safety-prevention/on-the-go/Pages/Winter-Car-Seat-Safety-Tips.aspx" target="_blank">healthychildren.org</a> to keep your little ones warm, as well as safely buckled in their car seats:  <ul> <li>Store the carrier portion of infant seats inside the house.  A room-temperature car seat will reduce the loss of your child's body heat once he or she is in the cold car. </li> <li>Plan ahead and take extra time.  Consider warming your car before getting the child inside. Also, extra time may be needed for travel on winter roads. </li> <li>Dress your child in thin layers.  Start with close-fitting layers on the bottom, like tights, leggings and long-sleeved bodysuits. Then add pants and a warmer top, like a sweater or thermal knit shirt. Your child can wear a thin fleece jacket over the top. In very cold weather, long underwear is also a warm and safe layering option. In general, infants should wear one more layer than adults. If you have on a hat and a coat, your infant will probably need these, as well as a blanket. </li> <li>Pull on hats, mittens, and socks or booties.  These help keep kids warm without interfering with car seat straps. </li> <li>Tighten the straps of the car seat harness.  Even if your child looks snuggly bundled up in the car seat, multiple layers may make it difficult to tighten the harness enough. If you can pinch the straps of the car seat harness, it needs to be tightened to fit snugly against your child's chest. </li> <li>Use a car seat cover, or coat or blanket, over the straps.  You can add a blanket or coat atop the harness straps or add a car seat cover. Remember that nothing thick or bulky should ever go underneath your child's body or between the body and the harness straps. Be sure to leave your baby's face uncovered to avoid trapped air and suffocation. Keep in mind that the top layer should be removable so your baby doesn't get too hot after the car warms up. </li> <li>Remember, if an item such as a car seat cover didn't come with the car seat, it hasn't been crash-tested.  It may interfere with car seat safety, so be cautious what is purchased, as some items may be considered unsafe. </li> </ul> Taking a few minutes to follow these tips can help you travel with peace of mind.  <a rel="noopener noreferrer" href="https://communityhealth.mayoclinic.org/providers/david-soma-md/" target="_blank">David Soma, M.D.</a>, is a pediatrician in Primary Care in Rochester and Kasson's Division of Community Pediatric and Adolescent Medicine.  Tammy Schmit, R.N., is the ambulatory nurse manager in Primary Care in Rochester and Kasson's Division of Community Pediatric and Adolescent Medicine. David Soma, M.D., and Tammy Schmit, R.N.Primary Care in Rochester and KassonWinter Car Seat SafetyPrimary Care in Rochester and KassonIt's official - the flu season is here. So get a flu shot and follow these steps.&nbsp;<img src="/-/media/ech-media/images/widgets/people/ech_flu2018_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=9223C3438369B726A49D5286CC81D905" alt="ECH_flu2018_widget" width="100" height="65" DisableNVelocity="true" />4 steps for staying healthy during flu season1/13/2020 5:00 AM<img src="/-/media/ech-media/images/widgets/people/ech_flu2018_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=1E19B3D4BBC7BDECE17EA1F90EBBC715" alt="ECH_flu2018_widget" width="300" height="195" DisableNVelocity="true" />While the best prevention is getting an influenza (flu) vaccine, there are other steps you can take to prevent infection and stay healthy:  <ol> <li>Wash your hands often. Clean hands are key to helping prevent the transfer of infection from others to you. Soap up, rinse off and dry your hands throughout the day. Do this especially before eating, drinking and after using the toilet. Here's the best technique: Wet your hands and scrub with soap for at least 20 seconds; rinse and dry thoroughly. Use skin moisturizers during the winter to avoid chapping and skin breakdown. </li> <li>Get enough sleep. Every night, make sure you're getting the sleep you need to recover from the day. Studies show that weekend "catch up" sleep doesn't make up for getting enough sleep during the week. </li> <li>Stay hydrated. Drink water throughout the day. Your water needs increase during the winter when furnaces dry out the air in our homes and offices. </li> <li>Avoid touching your eyes, nose and lips during the day. Even though you're washing your hands, soap and water can only do so much to remove germs. Your eyes, nose and lips are direct entry points for germs. </li> </ol> What if you do get sick? <ul> <li>Stay home and get better! <ul> <li>Don't take your illness to work, school or other activities. </li> <li>Take the time you need to recuperate. </li> </ul> </li> <li>Get medical attention. <ul> <li>If your fever lasts more than three days or your illness runs more than 10 days. </li> <li>Right away if you develop difficulty breathing, you're unable to stay hydrated, you experience dizziness, or you suffer severe pain in the chest or abdomen. </li> </ul> </li> <li>Cover your coughs and sneezes.  <ul> <li>Use a tissue to cover your mouth and nose when you cough or sneeze, and then throw the tissue away in a waste basket. </li> <li>If you don't have a tissue handy, cough or sneeze into the crook of your elbow. </li> <li>Be sure to wash your hands with soap and water after coughing or sneezing. </li> </ul> </li> <li>Wear a mask. <ul> <li>If you're sneezing and coughing and making a visit to the clinic, ask for a mask at the desk. </li> <li>For health care providers, wear a mask if you're seeing a patient who's coughing and sneezing. </li> </ul> </li> </ul> <a href="https://communityhealth.mayoclinic.org/providers/robert-jacobson-md/">Dr. Robert M. Jacobson</a> is a primary care pediatrician in Primary Care in Rochester's Division of Community Pediatric and Adolescent Medicine and the medical director of the Immunization Program for Primary Care in Southeast Minnesota. Robert M. Jacobson, MDPrimary Care in Rochester and KassonHealthy During Flu SeasonPrimary Care in Rochester and KassonIf eating healthier, managing your weight or being more active is on your to-do list for 2020, these apps and online tools can help keep you on track.&nbsp;<img src="/-/media/ech-media/images/widgets/people/ech_patient-online-services_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=75765F86DE4681A347F1A21823DD601C" alt="ECH_Patient Online Services_widget" width="100" height="65" DisableNVelocity="true" />e-Tools for a healthier new year1/30/2020 4:30 AM<img src="/-/media/ech-media/images/widgets/people/ech_patient-online-services_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=4B12761D8666DC6DCD8B5E385C910758" alt="ECH_Patient Online Services_widget" width="300" height="195" DisableNVelocity="true" />Monitoring, whether it's jotting notes in a pocket notebook or logging onto an online or app-based tool, can help keep your New Year's weight or activity goals on track. Tracking isn't a magical fix, but it can be a good place to start as you adopt better lifestyle habits. You may want to track your progress as you undertake your journey, but once you get more established in new habits, use it as a tool now and then to check your progress or help you back onto the path.  Journaling Keeping a food/activity journal uses self-awareness to better understand and change behaviors. It can build confidence for long-term success. Here are some tips to help you get started: <ul> <li>Choose the format that works best for you: paper and pen, sticky notes, charts, etc.</li> <li>For weight loss, be accurate about what, when and where you're eating — including snacks, condiments, beverages and portion sizes — even if you didn't stick to your plan. </li> <li>For activity, be accurate about what you're doing and for how long (time/distance). Even a comment on intensity, say on a scale of one to 10, can build awareness and motivation for future fitness. </li> <li>Jot your notes right after eating or activity. </li> <li>Review your journal to see how you're doing compared to your goals. </li> </ul> Online tools/apps You might find an app easier, more convenient and fun to track your weight loss or activity progress. Online tools and apps can also boost your motivation, discipline, accountability and remind you when it's time to celebrate. No matter what website or mobile app you use, make sure it:  <ul> <li>Uses nutritional databases from a reliable source</li> <li>Is easy to use and gives you the information you're looking for</li> <li>Clearly labels food items entered by other users</li> <li>Is compatible with your smart phone and computer devices</li> </ul> We've selected a few, based on their quality, reliability and user reviews. They're available on both iPhone and Android platforms; many are free.  Weight management <a rel="noopener noreferrer" rel="noopener noreferrer" href="https://www.noom.com/#/" target="_blank">Noom®</a> <ul> <li>Uses a psychology-based approach to create healthy habits through behavior changes</li> <li>Helps you set weight-loss goals and see progress</li> <li>Logs your exercise</li> <li>Cost: Monthly plan starts at $59, annual membership is $199</li> </ul> <a rel="noopener noreferrer" rel="noopener noreferrer" href="http://www.fooducate.com/" target="_blank">Fooducate©</a><a href="http://www.fooducate.com/" target="_blank"></a> <ul> <li>Calorie and exercise tracker</li> <li>Community support</li> <li>Barcode scanning option </li> </ul> <a rel="noopener noreferrer" rel="noopener noreferrer" href="https://www.myfitnesspal.com/" target="_blank">MyFitnessPal©</a> <ul> <li>Has QR barcode scanner to use while shopping</li> <li>Tracks major nutrients</li> <li>Analyzes recipes</li> </ul> <a rel="noopener noreferrer" rel="noopener noreferrer" href="https://www.loseit.com/" target="_blank">Lose It!©</a> <ul> <li>Tracks food and exercise</li> <li>Set reminders to log meals and snacks</li> <li>Maintains your favorite foods and typical service sizes</li> <li>Search food via barcode scanner or snap picture of food for tracking</li> </ul> <a rel="noopener noreferrer" rel="noopener noreferrer" href="https://www.myplate.gov/" target="_blank" title="Opens in new browser window">MyPlate Calorie Counter™</a> <ul> <li>For weight gain, weight loss or maintenance</li> <li>Eight-week meal plan and shopping list</li> <li>Active community for support and motivation</li> <li>Short workouts</li> <li>Tracks caloric intake and diet plans</li> <li>Analyzes recipes</li> <li>Individualized exercise development component</li> </ul> Activity/exercise <a rel="noopener noreferrer" rel="noopener noreferrer" href="https://runkeeper.com/" target="_blank">Runkeeper®</a> <ul> <li>Tracks your distance, time, speed, elevation, calories burned</li> <li>Helps you analyze your training patterns</li> <li>Provides motivational audio feedback from the Voice Coach</li> </ul> <a rel="noopener noreferrer" rel="noopener noreferrer" href="https://www.jefit.com/" target="_blank">JEFIT Workout Planner</a><a href="https://www.jefit.com/" target="_blank"></a> <ul> <li>Detailed workout programs</li> <li>HD video exercise instruction</li> <li>Tools to log and track your workouts</li> </ul> <a rel="noopener noreferrer" rel="noopener noreferrer" href="https://www.nike.com/us/en_us/c/nike-plus/training-app" target="_blank">Nike Training Club</a> <ul> <li>More than 185 free instructor-led workouts</li> <li>Daily "Picks For You" personalized workout recommendations based on your requirements and ability, along with your routine</li> <li>As you train with the app, recommendations become more personal</li> </ul> <a rel="noopener noreferrer" rel="noopener noreferrer" href="https://www.mypacer.com/" target="_blank">Pace Pedometer & Step Tracker</a> <ul> <li>Tracks your activities</li> <li>Provides support and motivation from its community</li> <li>Provides challenges, personalized fitness plans, guided workouts</li> </ul> <a rel="noopener noreferrer" rel="noopener noreferrer" href="https://apps.apple.com/us/app/strava-run-ride-swim/id426826309" target="_blank">Strava: Run, Ride Swim</a> <ul> <li>Monitors your distance, pace, speed, elevation and calories burned</li> <li>Provides monthly challenges</li> <li>Swim option only available on Apple products, running/cycling available on all platforms</li> </ul> Rose Prissel, MS, RDN, LD, is a dietitian at Mayo Clinic working in pediatric and adult nutrition, with a focus on preventive care, sports nutrition and weight management.  Michaeleen Burroughs, MS, RDN, LD, has worked in Primary Care in Rochester/Kasson in Family Medicine for 20 years. She currently helps patients at Mayo Family Clinics Northwest, Southeast and Kasson, and Baldwin Family Medicine and Community Pediatric and Adolescent Medicine (CPAM). Her areas of interest are diabetes and child and adult weight management. Rose Prissel, MS, RDN, LD, and Michaeleen Burroughs, MS, RDN, LDPrimary Care in Rochester and KassonHealthy You eToolsPrimary Care in Rochester and KassonWinter coats and snowsuits can compress in a crash and leave the straps too loose.&nbsp;<img src="/-/media/ech-media/images/widgets/kids/ech_carseatwinter_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=AAE55E007FB021E3C424A785D4957EE0" alt="ECH_CarSeatWinter_widget" width="100" height="65" DisableNVelocity="true" />Bulky winter wear and car seat safety don't mix2/18/2020 11:00 AM<img src="/-/media/ech-media/images/widgets/kids/ech_carseatwinter_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=F79E639A78110B5AC127C925EAD8E22E" alt="ECH_CarSeatWinter_widget" width="300" height="195" DisableNVelocity="true" /><div class="OutlineElement Ltr SCXW247129167 BCX0" style="color: #000000; margin: 0px; padding: 0px;"> When winter winds blow, we bundle babies and kids in snuggly coats and snowsuits. While they keep children warm, the <a rel="noopener noreferrer" class="Hyperlink SCXW247129167 BCX0" href="https://www.aap.org/en-us/Pages/Default.aspx" target="_blank" style="color: inherit; margin: 0px; padding: 0px;">American Academy of Pediatrics</a> (AAP) warns they can also interfere with car seat safety. That’s because bulky clothing can compress in a crash and leave the straps too loose to restrain your child, leading to increased risk of injury.  </div> <div class="OutlineElement Ltr SCXW247129167 BCX0" style="color: #000000; margin: 0px; padding: 0px;">   </div> <div class="OutlineElement Ltr SCXW247129167 BCX0" style="color: #000000; margin: 0px; padding: 0px;"> Ideally, dress your baby in thinner layers and wrap a coat or blanket around them over the buckled harness straps. Oh, and dressing in thinner layers, with a coat at hand, applies to parents, too. </div> <div class="OutlineElement Ltr SCXW247129167 BCX0" style="color: #000000; margin: 0px; padding: 0px;">   </div> <div class="OutlineElement Ltr SCXW247129167 BCX0" style="color: #000000; margin: 0px; padding: 0px;"> Follow these tips from the AAP to keep your little ones warm, as well as safely buckled in their car seats: </div> <div class="SCXW247129167 BCX0" style="color: #000000; margin: 0px; padding: 0px;"> <div class="ListContainerWrapper SCXW247129167 BCX0" style="margin: 0px; padding: 0px;"> <ul class="BulletListStyle1 SCXW247129167 BCX0" role="list" style="margin: 0px; padding: 0px;"> <li data-leveltext="" data-font="Symbol" aria-setsize="-1" data-aria-posinset="1" role="listitem" data-aria-level="1" class="OutlineElement Ltr SCXW247129167 BCX0" style="margin: 0px 0px 0px 24px; padding: 0px;"> Store the carrier portion of infant seats inside the house. A room-temperature car seat will help reduce the loss of your child's body heat once they’re in the cold car. </li> <li data-leveltext="" data-font="Symbol" aria-setsize="-1" data-aria-posinset="2" role="listitem" data-aria-level="1" class="OutlineElement Ltr SCXW247129167 BCX0" style="margin: 0px 0px 0px 24px; padding: 0px;"> Dress your child in thin layers. Start with close-fitting layers on the bottom, like tights, leggings and long-sleeved bodysuits. Then add pants and a warmer top, like a sweater or thermal-knit shirt. Your child can wear a thin fleece jacket over the top. In very cold weather, long underwear is also a warm and safe layering option. In general, infants should wear one more layer than adults. If you have on a hat and a coat, your infant will probably need a hat, coat and blanket. </li> <li data-leveltext="" data-font="Symbol" aria-setsize="-1" data-aria-posinset="3" role="listitem" data-aria-level="1" class="OutlineElement Ltr SCXW247129167 BCX0" style="margin: 0px 0px 0px 24px; padding: 0px;"> Pull on hats, mittens and socks or booties. These help keep kids warm without interfering with car seat straps. If your child is a thumb sucker, consider half-gloves with open fingers or keep an extra pair or two of dry mittens handy, since wet mittens are cold mittens. </li> <li data-leveltext="" data-font="Symbol" aria-setsize="-1" data-aria-posinset="4" role="listitem" data-aria-level="1" class="OutlineElement Ltr SCXW247129167 BCX0" style="margin: 0px 0px 0px 24px; padding: 0px;"> Tighten the straps of the car seat harness. Even if your child looks snuggly bundled up in the car seat, multiple layers may make it difficult to tighten the harness enough. If you can pinch the straps of the car seat harness, it needs to be tightened to fit snugly against your child's chest.  </li> <li data-leveltext="" data-font="Symbol" aria-setsize="-1" data-aria-posinset="5" role="listitem" data-aria-level="1" class="OutlineElement Ltr SCXW247129167 BCX0" style="margin: 0px 0px 0px 24px; padding: 0px;"> Use a coat or blanket over the straps. You can add a blanket over the top of the harness straps or put your child's winter coat on backwards (over the buckled harness straps) after he or she is buckled up. Some parents prefer products such as poncho-style coats or jackets that zip down the sides so the back can flip forward over the harness. Keep in mind that the top layer should be removable so your baby doesn't get too hot after the car warms up. </li> </ul> </div> </div> <div class="SCXW247129167 BCX0" style="color: #000000; margin: 0px; padding: 0px;"> <div class="ListContainerWrapper SCXW247129167 BCX0" style="margin: 0px; padding: 0px;"> <ul class="BulletListStyle1 SCXW247129167 BCX0" role="list" style="margin: 0px; padding: 0px;"> <li data-leveltext="" data-font="Symbol" aria-setsize="-1" data-aria-posinset="1" role="listitem" data-aria-level="1" class="OutlineElement Ltr SCXW247129167 BCX0" style="margin: 0px 0px 0px 24px; padding: 0px;"> Remember, if an item, such as a seat cover, didn’t come with the car seat, it hasn’t been crash tested and may interfere with car-seat safety. Never use sleeping bag inserts or other stroller accessories in the car seat. </li> </ul> </div> <div class="OutlineElement Ltr SCXW247129167 BCX0" style="margin: 0px; padding: 0px;">   </div> <div class="OutlineElement Ltr SCXW247129167 BCX0" style="margin: 0px; padding: 0px;"> Read <a rel="noopener noreferrer" class="Hyperlink SCXW247129167 BCX0" href="https://www.healthychildren.org/English/safety-prevention/on-the-go/Pages/Winter-Car-Seat-Safety-Tips.aspx" target="_blank" style="color: inherit; margin: 0px; padding: 0px;">more tips</a> from the AAP for keeping your child warm and safe in the car. </div> <div class="OutlineElement Ltr SCXW247129167 BCX0" style="margin: 0px; padding: 0px;">   </div> <div class="OutlineElement Ltr SCXW247129167 BCX0" style="margin: 0px; padding: 0px;"> <a class="Hyperlink SCXW247129167 BCX0" href="https://communityhealth.mayoclinic.org/providers/david-soma-md" rel="noreferrer noopener" style="color: inherit; margin: 0px; padding: 0px;">Dr. David Soma</a> is a pediatrician in Primary Care in Rochester/Kasson’s Division of Community Pediatric and Adolescent Medicine (CPAM). </div> </div> <div class="OutlineElement Ltr SCXW247129167 BCX0" style="color: #000000; margin: 0px; padding: 0px;">   </div> <div class="OutlineElement Ltr SCXW247129167 BCX0" style="color: #000000; margin: 0px; padding: 0px;"> Tammy Schmit, RN is the ambulatory nurse manager in Primary Care in Rochester/Kasson’s Division of Community Pediatric and Adolescent Medicine (CPAM).  </div>Dr. David Soma and Tammy Schmit, RNPrimary Care in Rochester and KassonCar Seat Winter WearPrimary Care in Rochester and KassonLearn about DVT: What it is, what causes it and how it can be treated and prevented.&nbsp;<img src="/-/media/ech-media/images/widgets/medicalimages/ech_deepveinthrombosis_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=90B5E8DF486ACEDA688004857F5C4CBD" alt="ECH_DeepVeinThrombosis_widget" width="100" height="65" DisableNVelocity="true" />FAQs: What is deep vein thrombosis?3/12/2020 2:30 AM<img src="/-/media/ech-media/images/widgets/medicalimages/ech_deepveinthrombosis_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=4C1C151BA0ABB2319B24C9F8EA3318F7" alt="ECH_DeepVeinThrombosis_widget" width="300" height="195" DisableNVelocity="true" />Every once in a while, deep vein thrombosis (DVT) makes the news when someone develops it on an airplane, often with serious effects on their health. But what is it and how can you avoid developing it?  What is deep vein thrombosis? DVT is a condition where a clot forms in the veins of our legs, deep inside the muscles. It can develop if you have certain medical conditions that affect how your blood clots. DVT can also happen if you don't move for a long time, such as after surgery or an accident, when you're confined to bed or sit too long when flying or driving.  This condition can be very serious because blood clots in your veins can break loose, travel through your bloodstream, lodge in your lungs and block blood flow, causing a pulmonary embolism. It's not all that common, though, affecting only about 3% of individuals.  DVT can be confused with other conditions, including superficial thrombophlebitis and even a strain of your calf muscle. With superficial thrombophlebitis, the area has tenderness, often redness and warmth just under the surface of the skin. While the superficial clots are more obvious, they're much less serious than clots with DVT.  What are the symptoms? The symptoms of DVT can be subtle. One leg, but not both, may swell over the course of a few days. This swelling is more prominent than what we all experience to some extent as the day progresses. There may be some discomfort, but it's harder to pinpoint.  How is DVT diagnosed?  If someone has new, unexplained pain or swelling of a single leg, DVT is a possibility. An evaluation should be scheduled promptly, within a day, if possible. Determining the cause of leg symptoms, whether pain or swelling, requires direct examination. This exam usually includes diagnostic testing, typically an ultrasound. In some instances, a clot is discovered as a result of testing done for other reasons.  What is the treatment? In almost all cases, treatment of DVT requires blood-thinning medication, which falls into two categories:  <ul> <li>Newer blood thinners. These are convenient, don't require injections and are somewhat safer, but they can be expensive. </li> <li>Warfarin, pill form. Warfarin is still used routinely but it requires five or more days of heparin injections, as well as regular testing to monitor effectiveness. Even patients consistently taking the same dose of warfarin might have thinner and thicker clotting depending on diet, acute illness or other medications, so warfarin requires regular monitoring. Monitoring is done through the Primary Care in Rochester Anticoagulation Clinic pharmacy and nursing staff. </li> </ul> What happens after treatment? Once you receive treatment for DVT, you'll need to:  <ul> <li>Check with your doctor regularly to see if your treatment needs to be modified. If you're taking warfarin (Coumadin®, Jantoven®), you'll need a blood test to see how well your blood is clotting. </li> <li>Take your blood thinners as directed. If you've had DVT, you'll be on blood thinners for at least three to six months. </li> <li>Watch for excessive bleeding, which can be a side effect of taking blood thinners. Talk to your doctor about activities that could cause you to bruise or get cut, since even a minor injury could become serious if you're taking blood thinners. </li> <li>Move. If you've been on bed rest because of surgery or other factors, the sooner you get moving, the less likely blood clots will develop. </li> </ul> How can DVT be prevented? The best treatment for DVT is preventing it from occurring. Here are some things you can do:  <ul> <li>Avoid sitting still.  <ul> <li>If you've had surgery or been on bed rest for other reasons, try to get moving as soon as possible. </li> <li>If you're sitting for a while, don't cross your legs, which can hamper blood flow. </li> <li>If you're traveling a long distance by car, stop every hour or so and walk around. </li> <li>If you're on a plane, stand or walk occasionally. If you can't do that, exercise your lower legs. Try raising and lowering your heels while keeping your toes on the floor, then raising your toes with your heels on the floor. </li> </ul> </li> <li>Make lifestyle changes. Lose weight and quit smoking. </li> <li>Exercise. Regular exercise lowers your risk of blood clots, which is especially important for people who sit a lot or travel frequently. </li> </ul> <a href="https://communityhealth.mayoclinic.org/providers/thomas-jaeger-md/">Dr. Thomas Jaeger</a> is a consultant in Primary Care in Rochester/Kasson's Division of Community Internal Medicine, and is the Medical Director of the Primary Care Anticoagulation Clinic. Thomas Jaeger, MDPrimary Care in Rochester and KassonDeep Vein ThrombosisPrimary Care in Rochester and KassonWhether to take an herbal supplement depends on your health and health needs.&nbsp;<img src="/-/media/ech-media/images/widgets/medications/ech_herbal_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=A289EC64100EF1E7A3945A9D6D316942" alt="ECH_herbal_widget" width="100" height="65" DisableNVelocity="true" />Taking herbal supplements: Should I or shouldn't I?2/17/2020 2:30 AM<img src="/-/media/ech-media/images/widgets/medications/ech_herbal_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=EF9CF0CFE4D3E4F1DB714BE10F632F36" alt="ECH_herbal_widget" width="300" height="195" DisableNVelocity="true" />Cannabidiol (CBD), St. John's wort, echinacea, ginkgo and garlic. You can find these herbal remedies in the vitamin aisle of any pharmacy, discount store and even your local supermarket. Many claim they will help with health problems using the "gentle, natural action" of herbs.  Studies have shown that some herbal supplements are safe and effective. Effectiveness of others hasn't been proven, and some have been shown to be harmful. Natural does not always mean safe.  Herbs may be popular, but are they for you? That depends on the herb and your health needs. If you're thinking about using herbal supplements, this advice may help:  <ul> <li>Talk to your health care provider about herbal supplements you're considering before you start taking them to make sure they're safe for you. This is especially important for higher-risk patients including those who are:  <ul> <li>Pregnant or breastfeeding</li> <li>Having surgery</li> <li>Younger than 18 or older than 65</li> </ul> </li> <li>Learn about the herbal products you're thinking about using from a trusted medication source, such as <a rel="noopener noreferrer" rel="noopener noreferrer" href="https://www.mayoclinic.org/" target="_blank">Mayo Clinic</a> (search herbal supplements) or <a rel="noopener noreferrer" rel="noopener noreferrer" href="https://naturalmedicines.therapeuticresearch.com/" target="_blank">The Natural Medicines Comprehensive Database</a>. </li> <li>Read the label and never take more than the recommended dosage. </li> <li>Keep track of what and how much you take. Report your herbals to your health care provider to have an up-to-date and accurate medication list. </li> <li>Start taking only one type of supplement at a time so you can determine if it's effective for you. </li> <li>Don't expect immediate results and beware of claims that sound too good to be true. </li> <li>Be cautious about the herbal supplements manufactured or purchased outside the United States, where regulations may not be in place for safety. </li> </ul> It may not be easy to separate fact from fiction when evaluating herbal remedies. To choose the best herbal brands, look for standardized herbal extracts. USP Verified on the label means that the product:  <ul> <li>Contains the ingredients shown on the label</li> <li>Contains the amount or strength of ingredients stated</li> <li>Will dissolve effectively so your body can absorb the ingredients</li> <li>Meets requirements for limits on contaminants</li> </ul> Amanda Davis, PharmD, RPh, is a pharmacist in Primary Care Rochester/Kasson. Amanda Davis, PharmD, RPhPrimary Care in Rochester and KassonHerbal Supplements 2020Primary Care in Rochester and KassonLearn why this diet is so popular and if it might be right for you.&nbsp;<img src="/-/media/ech-media/images/widgets/food/ech_mediterraneandiet_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=3BB61E92249FA79F90E2C31B8A5F48B9" alt="ECH_MediterraneanDiet_widget" width="100" height="65" DisableNVelocity="true" />'Testing the waters' of the Mediterranean diet2/27/2020 2:30 AM<img src="/-/media/ech-media/images/widgets/food/ech_mediterraneandiet_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=91E82C99E85B26CDAE2EE61E8ED80F9E" alt="ECH_MediterraneanDiet_widget" width="300" height="195" DisableNVelocity="true" />The Mediterranean diet. You've heard about it in the news, read about it on the internet and maybe you have a friend who's raved about it. What makes this diet so popular and is it right for you? These FAQs can give you answers as you consider "testing the waters" of this heart-healthy eating plan.  What's the Mediterranean diet?  This diet, which is really a lifelong eating style, blends the basics of healthy eating with the traditional flavors and cooking methods of the Mediterranean. Interest in it began in the 1960s as data started showing that coronary heart disease caused fewer deaths in countries bordering the Mediterranean Sea than in the U.S. and northern Europe. More studies backed up these findings.  Here are the basics of eating the Mediterranean way:  <ul> <li>Daily consumption of vegetables, fruits, whole grains and healthy fats</li> <li>Weekly intake of fish, poultry, beans and eggs</li> <li>Moderate portions of dairy products</li> <li>Limited intake of red meat</li> <li>Sharing meals and enjoying a glass of red wine with family and friends</li> <li>Being physically active</li> </ul> What are healthy fats? Healthy fats are a mainstay of the Mediterranean diet. They're eaten instead of less healthy fats, such as saturated and trans fats, which contribute to heart disease. Healthy fats include:  <ul> <li>Olive oil. Primary source of added fat. Lowers total cholesterol, as well as LDL or "bad" cholesterol. </li> <li>Nuts, seeds. Contain monounsaturated fat. </li> <li>Fatty fish. Mackerel, herring, sardines, water-packed albacore tuna, salmon and lake trout are rich in omega-3 fatty acids, a type of polyunsaturated fat that may reduce inflammation in the body. Omega-3 fatty acids also help decrease triglycerides, reduce blood clotting and decrease the risk of stroke and heart failure. </li> </ul> What about wine? If you've ever been to countries like France, Italy or Spain, you know that wine is a feature of their daily meals. The Mediterranean diet allows red wine in moderation:  <ul> <li>Women: One 5-ounce serving per day. </li> <li>Men: No more than two 5-ounce servings per day. </li> <li>Remember these recommendations are limits per day — not an average per week. </li> </ul> Do I have to give up snacks? Snacks — small amounts of food eaten between meals — can be part of the Mediterranean diet. Tasty and satisfying treats of fruit, whole grains, veggies, nuts and seeds follow the Mediterranean eating plan. Here are some easy ideas: air-popped popcorn, peanut butter and celery, veggies with toasted red pepper hummus, cottage cheese or Greek yogurt with berries, tomato slices/olives/whole wheat bread drizzled with olive oil or up to 14 almonds.  How do I get started? If you'd like to test the waters of the Mediterranean diet, here are some steps for taking the plunge:  <ul> <li>Eat more fruits and vegetables. Aim for seven to 10 servings a day of fruit and vegetables. Fill up to half your place with fruit and veggies. Meet your servings my choosing fruits and veggies as snacks. </li> <li>Opt for whole grains. Switch to whole-grain bread, cereal and pasta. Experiment with other whole grains, such as bulgur and faro. </li> <li>Use those healthy fats. Olive oil is a good replacement for butter when cooking. Instead of putting butter or margarine on bread, try dipping it in flavored olive oil. </li> <li>Eat more seafood. Eat fish twice a week: fresh or water-packed tuna, salmon, trout, mackerel and herring are healthy choices. Grilled fish is delicious and simple to prepare. Avoid deep-fried fish. </li> <li>Reduce red meat. Substitute fish, poultry or beans for meat. If you eat meat, make sure it's lean and keep portions small. </li> <li>Enjoy some dairy. Drink a glass of low-fat milk with one meal a day, eat low-fat Greek or plain yogurt and small amounts of a variety of cheeses. </li> <li>Spice it up. Herbs and spices boost flavor and lessen the need for salt. </li> <li>Do watch your portions. Too much of even a healthy food can add pounds. For example, nuts have good health benefits, but it's easy to eat more than 1,000 calories in one sitting. Stick to a small handful — 1-1.5 ounces — of nuts per day. That means the 30-ounce tub of nuts form Costco should last a person an entire month! A good source for learning about portions is <a rel="noopener noreferrer" rel="noopener noreferrer" href="https://www.myplate.gov/" target="_blank">MyPlate.gov</a>. </li> <li>Do move more! Diet and movement work together for overall health, stress reduction, better sleep and personal enjoyment. </li> </ul> Need some meal ideas? Here are a few:  <ul> <li>Breakfast: whole grain hot cereal and a banana; whole-grain English muffin, almond butter and a grapefruit; shredded wheat, skim milk, blackberries</li> <li>Lunch: two quinoa cakes, low-fat cottage cheese, fresh pineapple; turkey chili, blackberries, whole-wheat cracker thins; baked cod, mixed veggie salad, large peach</li> <li>Dinner: cooked chicken and asparagus tossed with penne, side salad of veggies and greens with balsamic dressing; five butternut squash ravioli tossed with braised kale and cherry tomatoes and a dash of olive oil, roasted Brussels sprouts; grilled chicken, wild rice pilaf with cranberries and walnuts, steamed broccoli</li> </ul> Check out more <a rel="noopener noreferrer" rel="noopener noreferrer" href="https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/mediterranean-diet-recipes/art-20046682" target="_blank">recipes and ideas</a> from Mayo Clinic.  The Mediterranean diet is a delicious and healthy way to eat for life, not just as a "quick fix". Many people who switch to this style of eating say they'll never eat any other way.  Michaeleen Burroughs, MS, RDN, LD, has worked win Primary Care in Rochester/Kasson in Family Medicine for 20 years. She currently helps patients at Mayo Family Clinics Northwest, Southeast and Kasson, Baldwin Family Medicine and Community Pediatric and Adolescent Medicine (CPAM). Her areas of interest are diabetes and child and adult weight management. Michaeleen Burroughs, MS, RDN, LDPrimary Care in Rochester and KassonMediterranean DietPrimary Care in Rochester and KassonThis fall, Minnesota will be enforcing the school rule requiring meningococcal vaccine.&nbsp;<img src="/-/media/ech-media/images/widgets/teens/ech_menb_01_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=3DFFA956D402EACA6CFAA54850B58DED" alt="ECH_MenB_01_widget" width="100" height="65" DisableNVelocity="true" />High-school students: Get the meningococcal vaccine!3/5/2020 3:30 AM<img src="/-/media/ech-media/images/widgets/teens/ech_menb_01_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=B36C94B826491B0D46B990EBA52B56DA" alt="ECH_MenB_01_widget" width="300" height="195" DisableNVelocity="true" />Before school starts in the fall, Minnesota school rules call for all senior high school students to receive two doses of the meningococcal ACWY (Menactra®, Menveo®) vaccine. This vaccine prevents sudden death and loss of limb from a rapid-onset bacterial infection caused by meningococcus. Teens ages 11 through 20 are at increased risk. One dose of the vaccine is due when students are 11 to 12 years old; the second dose is due when they're 16. The vaccine dose lasts about five years.  If you've heard or been told that your teen should wait to get the second dose until they're closer to age 18, this is not correct and has never been a recommendation. The increased risk begins at 11 or 12 years of age and decreases after the first year out of high school.  Mayo Clinic recommends all its patients get these doses when they are due. Nurses and providers work hard to catch teens up at non-preventive care visits. Mayo Clinic also provides nurse-only visits to get any shots that are due. Mayo Clinic Express Care offers this vaccine, as well.  Parents can ask for their teens' vaccination records by calling their care team or through their teen's Patient Online Services portal. This is an exception to the privacy rules that restrict other access. The vaccines will appear in the portal as MCV4 (Menactra), MCV4 (Menveo) or MCV4 (Unspecified). If your teen got the vaccine elsewhere, the vaccine might show up as MenACWY.  Until this fall, Minnesota State Law didn't require schools to enforce the need for the 16-year-old dose. Schools won't admit seniors who haven't received the vaccine. Seniors will need to get the vaccine, or, if the parents refuse, turn in a conscientious-objection form.  This vaccine is different from the optional MenB vaccine that Mayo doesn't recommend routinely. We do make the MenB vaccine available for those 16 to 23 years of age who request it.  Both vaccines are well covered by commercial insurance, so there's no out-of-pocket expense, and provided free of charge through Minnesota Vaccines for Children.  <a href="https://communityhealth.mayoclinic.org/providers/robert-jacobson-md/">Dr. Robert M. Jacobson</a> is a pediatrician in Primary Care in Rochester/Kasson's Division of Community Pediatric and Adolescent Medicine (CPAM) and medical director of the Primary Care Immunization Program. Robert M. Jacobson, MDPrimary Care in Rochester and KassonMeningococcal VaccinePrimary Care in Rochester and KassonThis learned skill can reduce stress, energize us and find connection to our inner selves and others.&nbsp;<img src="/-/media/ech-media/images/widgets/people/ech_mindfulness_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=EBFCB0BCDFB03FF23895721E6D89CEB8" alt="ECH_Mindfulness_widget" width="100" height="65" DisableNVelocity="true" />Why mindfulness is good for your health3/23/2020 2:30 AM<img src="/-/media/ech-media/images/widgets/people/ech_mindfulness_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=0ED71A296541BAFECC7D15FA57EDCA2B" alt="ECH_Mindfulness_widget" width="300" height="195" DisableNVelocity="true" />I'm sitting in an ashram, humming "om" all day, and finding perfect bliss. Is that mindfulness? Well, yes — and no. There's a lot of "buzz" these days about the benefits of mindfulness, and the numerous ways to practice it. So what exactly is mindfulness, and why are we so focused on it in health care?  We have technology at our fingertips, and we can connect with friends or acquaintances with the tap of a finger. Media allows us to be in touch with people more than any other time in history. We know making these connections are good for our health, but why does it seem like the world is spinning so quickly, and our minds seem to be racing all the time? How do we slow the racing brain and allow ourselves to feel more through both body and mind?  What is mindfulness? In the rush of modern life, we tend to lose touch with the peace that's available to each of us in each moment. We'd all love to experience this joyful state of mind and well-being. Mindfulness is the path to connection, to that state of well-being, and it's a learned skill. Once learned, these skills can point you toward a calm state of being when you need it most; when your feeling down, stuck, overwhelmed or stressed, or whenever you want to feel good, energized and enthusiastic about life.  Mindfulness helps overcome stress, energizes the mind, develops focused attention, gives guidance to dissolve unhealthy habits and manage sickness and pain. Through practice, we can find inner joy, focus on priorities, find insight and wisdom, and grow in closeness to ourselves and others.  In The Joy Compass, Donald Altman, a former Buddhist monk, shares the importance of calibrating the mental tools of awareness: attention and intention. He writes that, "Mindfulness is the awakening of possibility." With mindfulness, you bring a sense of openness and acceptance to what is happening in the moment through the body and mind.  Mindfulness is intentional, present-focused and nonjudgmental. Our brains have built-in "negativity bias" that prompts us to automatically look for danger or threat. Mindful attention can help you retrain your brain and body to choose joyful thoughts, which leads the physical body to follow by slowing down and becoming more calm. If you can focus on pleasant and productive activities, you'll be more healthy in the physical body.  How to learn, practice mindfulness Thich Nhat Hanh, a mindfulness leader, tells us that a smile on our face relaxes hundreds of muscles in our body. And studies have shown that when we flex our facial muscles into expressions of joy, we produce positive effects on our nervous system that stimulate real joy.  So why not take a few minutes each day to slow down your brain, reduce some of the "fight or flight" chemicals, recharge in a peaceful manner and focus on stillness pointing toward joy.  Here are some simple examples for practicing mindfulness:  For mental energy: <ol> <li>Light a candle.</li> <li>Sit with a straight back, relax and be aware of the candle.</li> <li>Notice the colors and light.</li> <li>When your mind wanders, bring your attention back to the candle.</li> <li>Keep focused on the candle for about 10 minutes. </li> </ol> For calm: <ol> <li>Sit quietly in a chair, hands on lap, feet on floor. </li> <li>Straighten your back. </li> <li>Stay still for three minutes. </li> <li>Breathe in and out gently, while feeling the presence of your body. </li> <li>While staying upright, let your body relax. </li> </ol> For creativity: <ol> <li>If you're feeling scattered, get up and dance with arms outstretched for about 10 minutes. </li> <li>Move the body slowly in different directions. </li> <li>Feel the flow of energy as you move the parts of your body. </li> <li>Keep the flow going for the full 10 minutes. </li> </ol> Mindfulness and meditative practices take time to develop. Start off with a few minutes each day, and work on building up your mindfulness stamina over time. Some people have also found apps to be helpful to support their practice. Good apps for mindfulness and medication are: Calm, Personal Zen and Mindfulness Coach.  Marcia Johnson, LICSW, is a social worker/therapist in Integrated Behavioral Health (IBH) at Primary Care Clinic Southeast and has worked for 20 years in psychiatry and behavioral health at Mayo Clinic in Rochester. She runs groups for senior vitality, as well as cognitive behavior therapy (CBT) for depression and anxiety.  <a rel="noopener noreferrer" href="https://www.mayoclinic.org/biographies/sawchuk-craig-n-ph-d-l-p/bio-20085911" target="_blank">Craig Sawchuk, PhD, LP</a>, is a clinical psychologist in Primary Care in Rochester/Kasson and also co-chairs the Division of Integrated Behavioral Health and Professionalism. Marcia Johnson, LICSW, and Craig Sawchuk, PhD, LPPrimary Care in Rochester and KassonMindfulness 2020Primary Care in Rochester and KassonThese 4 tips can help you make the call about going to work or school.&nbsp;<img src="/-/media/ech-media/images/widgets/people/ech_cold_coping_widget.jpg?h=66&iar=0&w=100&sc_lang=en&hash=040470695D398664BACA2B4C91BF8940" alt="ECH_cold_coping_widget" width="100" height="66" DisableNVelocity="true" />To go or stay? Deciding what to do when you're sick2/20/2020 5:00 AM<img src="/-/media/ech-media/images/widgets/people/ech_cold_coping_widget.jpg?h=195&iar=0&w=293&sc_lang=en&hash=347D77AB33260D77874ACCC0BC4E57BA" alt="ECH_cold_coping_widget" width="293" height="195" DisableNVelocity="true" />Oh, it's only a cold. My fever's just a little high. People are counting on me. My child has an algebra test they shouldn't miss. I don't feel THAT bad.  Who hasn't had these mental debates when they're sick? But how do you decide if you're too sick to go to work or if you should keep your child home from school? These four tips should help: Tip #1: Listen to your body. The same chemicals that tell the immune system to rush in and fend off invading viruses also tell us to slow down and rest. but we often tune out the messages our stuffy nose and aching body are sending us until we're so sick we can't get out of bed.  Tip #2: If you have flu-like (influenza) symptoms (high fever, cough, chills, body aches), stay home for at least 24 hours after your temperature returns to normal — that's without taking anything to reduce your fever. However, if you're a health care worker who has contact with stem cell transplant patients in a protective environment, you should stay home for one week once your temperature is normal.  Think you have the flu? Rather than head to the clinic, just stay home. Only those with very severe symptoms, are pregnant, have a chronic disease or are in contact with someone at high risk for the flu need to see a health care provider. Those younger than one year of age or older than 65 may also need to be checked out. With some rest and self-care measures at home, the average healthy person can expect to get better within a week, although symptoms of a dry cough may last for several weeks.  When you do head back to work or school, cover your coughs and sneezes, wash your hands and avoid close contact with others who might be sick, since you're still recuperating.  Tip #3: If you have tummy troubles — vomiting and/or diarrhea — don't go to work or school until 24 hours after the last episode.  Tip #4: If you have a cold — and feel up to spending the day at work (see Tip #1) — it's okay to go, as long as you take precautions to protect your co-workers. Wash and/or sanitize your hands frequently, avoid touching others, cover your coughs and sneezes and consider wearing a mask. Keep in mind that some over-the-counter cold remedies can slow your reaction time or make you drowsy.  <a href="https://communityhealth.mayoclinic.org/providers/jason-ogrady-md/">Dr. Jason O'Grady</a> is the medical director of Mayo Family Clinic Kasson. He practices full-spectrum Family Medicine, including obstetrics and office-based procedures. Jason O'Grady, MDPrimary Care in Rochester and KassonStay Home When SickPrimary Care in Rochester and KassonThe need for blood doesn't stop, even for a pandemic.&nbsp;<img src="/-/media/ech-media/images/widgets/people/ech_blooddonatino.jpg?h=65&iar=0&w=100&sc_lang=en&hash=AAD8880FD40F44431160B264CD030D85" alt="ECH_BloodDonatino" width="100" height="65" DisableNVelocity="true" />Blood Donation: It's a marathon, not a sprint4/23/2020 2:30 AM<img src="/-/media/ech-media/images/widgets/people/ech_blooddonatino.jpg?h=195&iar=0&w=300&sc_lang=en&hash=DD7FDD3176A8A017921A4A8610182812" alt="ECH_BloodDonatino" width="300" height="195" DisableNVelocity="true" />As the Mayo Clinic Blood Donor Program prepares for the impact of the COVID-19 pandemic, we're asking all well and healthy people to consider donating blood.  Our need is a marathon, not a sprint, according to Dr. James Stubbs, division chair of Transfusion Medicine. During the past couple of weeks, we've seen the sprint, with a great response from donors. We do need blood now, but we'll also need it in the coming months. While whole blood lasts for 42 days, platelets only last five.  That's why we're currently encouraging all donors to schedule their appointments for a week or two out, since we need to ensure our blood supply stays at adequate levels. That's the marathon.  If you're interested in donating blood, call <a href="tel:5072844475">507-284-4475</a> to schedule an appointment. To make sure we're following social distancing guidelines, the Mayo Clinic Blood Donor Program will limit appointments each day to sustain inventory and ensure our donors' safety.  Here's where and when you can donate: <ul> <li>Hilton Building, First Floor Monday — Friday, 6 a.m. to 4:30 p.m. Open until 7 p.m. every second Thursday of the month</li> </ul> <ul> <li>Saint Marys Campus Joseph Building, Main Floor M-86 Monday — Friday, 8 a.m. to 3 p.m.</li> </ul> Mayo Clinic patients depend on the generosity of blood donors. Scheduling an appointment to donate blood helps ensure that blood is available for a loved one or other patients in need. For more information about donating blood in Rochester, Minnesota, call <a href="tel:5072844475">507-284-4475</a> or contact us via <a href="mailto:donateblood@mayo.edu">email</a>. You can also visit our <a href="https://www.mayoclinic.org/blood-donor-program/minnesota">web page</a> for more information. Katy Maeder, Donor ServicesPrimary Care in Rochester and KassonBlood Donation COVIDPrimary Care in Rochester and KassonThese tips can help you manage the stress brought on by the coronavirus pandemic.&nbsp;<img src="/-/media/ech-media/images/widgets/randomimages/ech_anxiousstress_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=3397B437630AC35AB56E7A9B55BE97A8" alt="ECH_AnxiousStress_widget" width="100" height="65" DisableNVelocity="true" />COVID-19 stressing you out?4/6/2020 2:00 AM<img src="/-/media/ech-media/images/widgets/randomimages/ech_anxiousstress_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=EAF76395508562518DDF917E06CE4592" alt="ECH_AnxiousStress_widget" width="300" height="195" DisableNVelocity="true" />Since the World Health Organization named the COVID-19 virus a global pandemic, stress levels are increasing all around us. Some of the main contributors include: <ul> <li>Uncertainty</li> <li>Information overload</li> <li>Disruptions in daily routines</li> </ul> Stress is a normal, healthy human response. It's also motivating. That means it helps us:  <ul> <li>Be more aware of our surroundings</li> <li>Get ready to take action</li> <li>Plan and prepare for the future</li> </ul> Some common ways our body and mind show stress include:  <ul> <li>Emotionally. Anxiety, fear, irritability, sadness</li> <li>Physically. Sleep problems, tension, fatigue</li> <li>Thinking. Worry, rumination, racing thoughts</li> <li>Behaving. Avoidance, social withdrawal, excessive checking, seeking reassurance</li> </ul> Always keep in mind that what goes up does come down. Stressful times do come and go. When things are feeling more uncertain, try to focus on those things you can control. Here are active steps you can take to manage stress brought on by the COVID-19 outbreak.  Maintain healthy habits An important first step is keeping a daily schedule. Setting up healthy habits and routines can help boost your mood and energy levels: <ul> <li>Make sleep a priority. Get up and go to bed at routine times each day. Make sure that you're getting adequate, restful sleep. Sleeping too little or too much tends to cause problems. </li> <li>Be physical. Plan 30 minutes of physical activity, walking or exercise each day. Mix and match your exercises for variety. Try to get outside every day for fresh air. </li> <li>Eat well. Nourish your body with foods that support your health: fruits, vegetables, healthy fats, whole grains, fish, lean meats, beans and legumes. These foods give longer-lasting energy. Keep yourself hydrated by drinking plenty of water. </li> <li>Care for yourself. Start each day be showering and getting dressed. This will help wake up your brain. Stay engaged with personally meaningful activities. Be productive and keep up with daily chores. Set reminders if you need to take any medications.</li> </ul> Making a plan can be helpful for structuring your daily schedule. Focus on a few tasks that are most important to you rather than changing your whole routine. Calendars and reminders can help you set up and stick to a daily schedule.   Stay connected and disconnected Stay connected with family members, friends and other social supports who reliably build you up. During times when social distancing is recommended, rely on virtual options, such as phone, text and video messaging. Keeping up with our social network is essential to our well-being Set limits on social media and the news. Choose a trusted news source. Staying informed is helpful, but at some point, it can be too much of a good thing. It's important to disconnect from information overload during the day. Try scheduling 15-30 minutes twice a day to stay up to date on the latest events. Know that it's okay to disconnect if you feel your stress level rising.  Relax, relax, relax Consider all the ways you can relax and manage stress, such as breathing deeply, practicing mindfulness or meditation, listening to music, reading a book or watching something that makes you laugh. Make a list of your options and put it where you can see it. Building in small amounts of relaxation throughout the day can help bring your stress level down. Worries force you to focus inward on distressing thoughts. Mindfulness helps you learn how to change your focus to the environment around you:  <ul> <li>When you're mindful, you don't fight with your thoughts. </li> <li>You learn how to direct your attention, awareness and thoughts back to the present moment. </li> <li>Mindfulness is about focus. You focus only on what is happening right now with intention and purpose, without judgment. </li> <li>When you're being mindful, you're present in the moment and accept the moment as it is. </li> </ul> Keep your thinking in check Worry is common during times of stress. Worry can change our thinking in three ways: <ul> <li>Catastrophizing (thinking the worst)</li> <li>Overestimating the likelihood of bad things happening</li> <li>Underestimating our ability to cope</li> </ul> The more anxious we get, the less flexible our thinking becomes. Keep in mind:  <ul> <li>The most catastrophic outcomes tend to be the least likely to happen. </li> <li>The least catastrophic outcomes tend to be the most likely to happen. </li> </ul> If you find yourself caught up in cycles of worry, practice this exercise for more flexible thinking. Start by writing down five worries. Next, directly challenge these thoughts by writing answers to these questions:  <ul> <li>What is another, less bad way to look at this situation?</li> <li>What is the actual likelihood that these worries will happen?</li> <li>What objective evidence do I have for these worries?</li> <li>What objective evidence do I have against these worries?</li> <li>How have I coped with situations like this in the past? </li> </ul> It's important to write out these thoughts; it helps you train your brain to be more flexible.  Mind your manners Be patient. Be kind. Be helpful. As stress goes up, our tolerance can go down. Do what you can to be a positive influence on others. Work together as a team. Think about ways you can help those who may be in need — give to the food pantry or participate in donating blood.  Take reasonable precautions Keep up to date with your local health authorities or the <a rel="noopener noreferrer" href="https://www.cdc.gov/" target="_blank">Centers for Disease Control and Prevention (CDC)</a> about appropriate steps for handwashing, disinfecting surfaces and using face masks. Avoid going above and beyond recommended precautions. Take stock of what you have at home and keep a shopping list of what you actually need. Don't go overboard with purchasing too many things you feel you might need at some point in the future.  Final thoughts Time and experience will help move things from being uncertain to being more certain. Know your limits. Keep track of your overall stress level and those things that are helpful for relieving it. If you find you're having difficulties coping, reach out to your health care team for resources and to discuss additional treatment options. Dr. Olivia Bogucki is a clinical health psychology fellow in Primary Care in Rochester/Kasson.  <a rel="noopener noreferrer" href="https://www.mayoclinic.org/biographies/sawchuk-craig-n-ph-d-l-p/bio-20085911" target="_blank">Dr. Craig Sawchuk</a> is a clinical psychologist in Primary Care in Rochester/Kasson and co-chairs the Division of Integrated Behavioral Health. Olivia Bogucki, PhD, and Craig Sawchuk, PhD, LPPrimary Care in Rochester and KassonCOVID StressPrimary Care in Rochester and KassonThese tips can help you find creative ways to keep everyone calm, healthy and engaged while everyone's home.&nbsp;<img src="/-/media/ech-media/images/widgets/people/ech_media_plan_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=CEFCC780D5FB4A890DA11B564E454547" alt="ECH_media_plan_widget" width="100" height="65" DisableNVelocity="true" />'I'm bored!': Keeping kids occupied, active during COVID-19 outbreak3/24/2020 7:30 AM<img src="/-/media/ech-media/images/widgets/people/ech_media_plan_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=F2239560D5E7930177959DDE50053097" alt="ECH_media_plan_widget" width="300" height="195" DisableNVelocity="true" />You're doing your part to help contain the spread of COVID-19 (coronavirus) by keeping the kids at home. But as parents and other caregivers are discovering, the novelty of not going to school, being with friends and engaging in sports is wearing off for their kids. Across America, parents already are hearing the dreaded, "I'm bored!" and seeing teens turn into social media zombies.  What's a parent to do? The American Academy of Pediatrics offers some tips for finding creating ways to keep everyone calm, healthy and engaged in constructive work and play.  <ul> <li>Make a plan. Talk with your kids about what your daily structure will be for getting up, meals, telework, schoolwork and breaks to relax, play and connect. </li> <li>Use social media for good! Check in with neighbors, friends and loved ones. If schools are closed, find out if there are ways to help students who need meals or internet access for at-home learning. Set up video chats to stay in touch. </li> <li>Select what your child watches. Use trusted sources to find positive content, such as <a rel="noopener noreferrer" rel="noopener noreferrer" href="https://www.commonsensemedia.org/" target="_blank">Common Sense Media</a>, which as been compiling lots of ideas for families hunkering down right now. Use media together.</li> <li>Bring your child to "work". For parents working from home, this is a chance to show kids a part of what you do. Encourage imaginative "work" play as for a Take Your Child to Work Day without ever leaving home. </li> <li>Search out podcasts and audiobooks. These are great ways to keep children's minds engaged while parents get things done. </li> <li>Go offline. Take walks outside, play board games, read together, have family dance parties, bake, make crafts, teach your child a new skill such as knitting or carpentry. Share your ideas with other families. </li> <li>Engage with your community — from a distance. Invite families who live around you to join in activities — at a safe distance. Some ideas: concerts or dance parties in your own front yard, sing-alongs, sidewalk chalk art galleries that walkers can enjoy. </li> </ul> Activity resources <ul> <li><a rel="noopener noreferrer" rel="noopener noreferrer" href="https://www.pbs.org/parents" target="_blank">PBS Kids</a>. Geared toward preschoolers, PBS Kids sends out a daily newsletter with show and activity ideas. </li> <li><a rel="noopener noreferrer" rel="noopener noreferrer" href="https://new.artsmia.org/" target="_blank">Minneapolis Institute of Art (Mia)</a>. Tour the museum's artwork online. </li> <li><a rel="noopener noreferrer" rel="noopener noreferrer" href="https://new.artsmia.org/" target="_blank">Walker Art Center</a>. Take a virtual tour of the Walker's Sculpture Garden and its art collections.</li> <li><a rel="noopener noreferrer" rel="noopener noreferrer" href="https://mcm.org/" target="_blank">Minnesota Children's Museum</a>. Check out the resources for parents and caregivers. </li> <li><a rel="noopener noreferrer" rel="noopener noreferrer" href="https://new.smm.org/" target="_blank">Science Museum of Minnesota</a>. SMM is building a library of resources to help families explore science at home.</li> <li>Wildlife cams. Want to watch what wildlife does when it's home? Search "wildlife cams" in your computers browser. Start with <a rel="noopener noreferrer" rel="noopener noreferrer" href="http://history.mayoclinic.org/tours-events/mayo-clinic-peregrine-falcon-program.php" target="_blank">Mayo Clinic's Falcon Cam</a> or the <a href="https://www.nationaleaglecenter.org/eaglewatch-cam/" target="_parent">National Eagle Center's Eagle Cam</a>. </li> <li><a rel="noopener noreferrer" rel="noopener noreferrer" href="https://www.facebook.com/events/cincinnati-zoo-botanical-garden/home-safari-facebook-lives/2915534028492292/" target="_blank">Home Safari Live</a>. Join this Facebook event every day at 2 p.m. CDT or watch the video later. From the Cincinnati Zoo and Botanical Garden. </li> <li><a rel="noopener noreferrer" rel="noopener noreferrer" href="https://www.healthychildren.org/English/ages-stages/preschool/nutrition-fitness/Pages/Motor-Activity-and-Self-Play.aspx" target="_blank">Active games</a>. From Simon Says to Duck, Duck, Goose the games will delight pre-schoolers, as well as their older sibs. </li> <li><a rel="noopener noreferrer" rel="noopener noreferrer" href="https://kids.nationalgeographic.com/" target="_blank">NatGeo for Kids</a>. Learn about geography and fascinating animals. </li> <li><a rel="noopener noreferrer" rel="noopener noreferrer" href="https://kids.nationalgeographic.com/" target="_blank">Storyline Online</a>. Movie stars read favorite stories to kids. </li> <li><a rel="noopener noreferrer" rel="noopener noreferrer" href="https://kids.nationalgeographic.com/" target="_blank">Fun Brain</a>. Games for reading and math skills for grades K through eight. </li> </ul> Despite the challenges — and worries —this can also be a time for your family to start new traditions, try new experiences, discover new activities and even look back on in years to come as a special time for all of you.  <a href="https://communityhealth.mayoclinic.org/providers/nusheen-ameenuddin-md/">Dr. Nusheen Ameenuddin</a> is a pediatrician with Primary Care in Rochester/Kasson's Division of Community Pediatric and Adolescent Medicine (CPAM). She has a strong interest in child advocacy and media effects on children. She serves as chair of the national American Academy of Pediatric's (AAP) Council on Communications and Media and is on the board of the Minnesota chapter of the AAP. She also holds a master's in Public Health and serves as director of the Pediatric Resident Continuity Clinic. Dr. Nusheen AmeenuddinPrimary Care in Rochester and KassonKeeping Kids OccupiedPrimary Care in Rochester and KassonThese tips can help calm and inform them - and you.&nbsp;<img src="/-/media/ech-media/images/widgets/kids/ech_youngboywindow_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=69E195E19A4E645F3D2D39FD0FACCEA8" alt="ECH_YoungBoyWindow_widget" width="100" height="65" DisableNVelocity="true" />Helping your kids cope with coronavirus3/17/2020 3:03 AM<img src="/-/media/ech-media/images/widgets/kids/ech_youngboywindow_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=5472435767AE99545075DB0B58FE8FF3" alt="ECH_YoungBoyWindow_widget" width="300" height="195" DisableNVelocity="true" />The coronavirus (COVID-19) has become a source of daily conversation. It can be a scary time for kids, and you may be wondering how to support and help them understand what's happening. These tips can help you help your kids cope through this experience.  Define terms about COVID-19. Kids are hearing about it all the time. Take time to sit down with your child to define what COVID-19 is, using language appropriate for their development. Start by asking your child, "What do you think coronavirus or COVID-19 is?" This gives you an understanding of what they know, think they know or how they interpret the illness. As you talk, here's how you can help explain the situation: <ul> <li>Coronavirus or COVID-19 is a virus. A virus is so tiny, you can't see it, and it can cause a person's body to feel sick. The reason you are hearing so much about this virus, is because it's one our world hasn't seen before. Every day we're learning about it and ways to stop it from spreading through research. Experts around the world are working hard every day to learn about this virus and how to keep people safe. </li> <li>Most people who have COVID-19 say they have a cough, fever, chills (feeling cold) and body aches. The most common way the virus can enter a person's body is from their hands — and then touching their mouth or their eyes. That's why it's important to wash your hands often, especially before touching your mouth or your eyes. </li> <li>When people have coronavirus, or possibly have come in contact with others who have the illness, they're being asked to remain in quarantine. Quarantine means to stay in your house and not be in places or spaces with people other than your family.</li> <li>To help prevent coronavirus from spreading, we're being asked to social distance ourselves from one another. This means when we're outside our home, we shouldn't come into close contact with others. Pretend there is a bike separating you and the person you are standing by. Keep that distance away from people other than your family. Right now, instead of giving high fives, fist bumps or hugs to people outside your family, we can smile and wave to say hello. </li> </ul> Control your child's access to news and social media about coronavirus. Explain to your child there are many conflicting resources about the virus, so you're going to monitor and limit their access to external media for now. Reassure them you'll share any new information you learn that they should know. As a caregiver, use reliable sources such as the <a rel="noopener noreferrer" href="https://www.cdc.gov/coronavirus/2019-nCoV/index.html" target="_blank">Centers for Disease Control</a>, <a rel="noopener noreferrer" href="https://www.who.int/" target="_blank">World Health Organization</a>, <a rel="noopener noreferrer" href="http://mayoclinic.org" target="_blank">Mayo Clinic</a>, your state health department, communication from your school district, etc., to gather your facts. Be aware of your child's presence when watching or listening to the news. Even though they may not appear to be paying attention, they may be listening and internalizing the information they hear.  Explain the importance of good hand washing. Bring your child to a sink and practice washing your hands together. Show them how to "create tiny bubbles" by rubbing their hands back and forth and how to get the soap between all spaces, even to the ends of their fingers. Encourage your child to sing an entire song such as "Happy Birthday" twice while they wash their hands, so they can be sure they're spending enough time getting their hands clean.  <ul> <li>Hang a sign, such as "Welcome home. Please remember to wash your hands", on your front door. This reminds them to wash their hands when they get home. </li> <li>Remind them to wash before meals, after blowing their nose, coughing or sneezing. </li> </ul> When events are being canceled, explain how this will help prevent the spread of coronavirus. Young children may see canceling an event, a family vacation, school, going to the movies, etc., as a result of something they've done wrong. Explain that the reason you're not able to attend the event is to help prevent the spread of coronavirus, especially with large groups of people. If it's an option, share with your child future plans to attend the event after you know it's safe for everyone.  Remind your child when they're under someone else's care, to listen to them. It's important to tell them to follow directions and instructions from those who are responsible for them when you're not there, such as a grandparent, a daycare provider or teacher. Directions they give, such as practicing good handwashing, social distancing, covering your mouth with your sleeve when you cough or sneeze, are practices to protect them and keep them safe. Create new home routines as a family. Setting up and keeping routines help kids predict what's planned, allowing them to feel in control. Use a white board or paper to display a daily schedule at home. Explain that if social distancing continues to be encouraged, the new norm is going to be staying at home. Identifying clear expectations for the day will support and encourage kids to feel accomplished and like they're helping. When making a schedule, consider activities, such as wake-up/bedtime, meals, school/learning, exercise/outdoor, play and household responsibilities.  PLAY, PLAY, PLAY. Kids learn and process through play. Take advantage of being asked to stay home/social distance, to engage together as a family. Play games, play with toys, put together puzzles, read books, listen to/play music, dance, take family hikes and work on an art project together. For evening times, establish family fun nights, such as movie nights, cooking nights, game nights and ice cream nights. Even though being stuck at home may seem out of the norm, consider this an opportunity for your family to make good memories.  Connect with loved ones and friends with electronic devices. <ul> <li>During social isolation, call or FaceTime grandparents, aunts and uncles, cousins and friends you normally would engage with. This will help children not feel as isolated as they maintain and build relationships with their loved ones. </li> <li>Set up a virtual playdate with your child's friend. Kids can be fulfilled from watching others play. Children can also engage in the same activity by virtually playing with each other, also known as parallel play. </li> <li>Virtual connections are also a way to support their social development through interacting with others. </li> </ul> If your child becomes sick, reassure them. Remind them you, or someone who is caring for them, will keep a close watch on their body at all times. Reassure them you'll be in close contact with your medical provider if you feel medical advice is needed, and that the doctor or nurse will give instructions to help you care for them.  If your child hears of a friend or a loved one who becomes infected with coronavirus, reassure them. Let them know the friend or loved one has received medical advice, and they are being told how to help their body during their illness. As a family, send the person who is recovering a note through the mail. You could have your child draw a picture or write a story to add to your note. This lets them know you're thinking about them and a way for your child to feel they're helping their loved one or friend by bringing joy into their day.  Be honest with your kids. As a parent, it may go against your instinct to tell the truth because at times you may feel what you are sharing may cause fear, worry, anxiety or sadness. Being honest with your child and telling them you're going to be honest, builds trust between you. Remind them you'll keep them posted and update them when information changes or new information arises about coronavirus. This way, as new information comes up, they're hearing it from you.  Have these conversations daily: <ul> <li>This will give them the chance to ask you questions or help them process their concerns. </li> <li>Let your child know how you feel about COVID-19 to validate how they're feeling. You may feel challenged because of your own questions, concerns or worries. </li> <li>It's important to let your child know that you're following the guidance of our leaders. </li> <li>Remind them we're all doing things to help prevent the spread of the virus and to help keep our bodies safe. </li> </ul> As a caregiver, you are your child's biggest support and advocate. You have the ability to make a significant difference on how your child copes through this ever-changing experience.  Jennifer Rodemeyer, MA, CCLS, is a certified child life specialist and child life manager at Mayo Clinic Children's Center.  Jennifer Rodemeyer, MA, CCLSPrimary Care in Rochester and KassonKids CoronavirusPrimary Care in Rochester and KassonA clean kitchen helps protect your family from foodborne illness.&nbsp;<img src="/-/media/ech-media/images/widgets/randomimages/ech_kitchencleaning_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=9306950FE8B18A23EB0822A71A1EA05E" alt="ECH_KitchenCleaning_widget" width="100" height="65" DisableNVelocity="true" />When spring cleaning, don't forget the kitchen5/11/2020 5:00 AM<img src="/-/media/ech-media/images/widgets/randomimages/ech_kitchencleaning_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=CD913DC1F28A6E33EECBD884F0A99667" alt="ECH_KitchenCleaning_widget" width="300" height="195" DisableNVelocity="true" />If you're shaking off winter doldrums with a burst of spring cleaning, don't forget the kitchen. Spring's a great time to target harmful bacteria that can lurk on kitchen surfaces and in your refrigerator. A clean kitchen helps protect you and your family from foodborne illness, but keeping food safe isn't just for spring — it should be a year-round practice. Remember, everything that touches food should be clean.  Here are some cleaning tips for making your kitchen and meals safer:  <ul> <li>Counters. They may look clean, but bacteria can hide anywhere. So clean surfaces thoroughly with hot water and soap. Then disinfect/sanitize with a strong chlorine bleach solution, if appropriate for the surface, or a disinfectant kitchen cleaner.  <ul> <li>The <a rel="noopener noreferrer" rel="noopener noreferrer" href="https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/disinfecting-your-home.html" target="_blank">CDC recommends</a> using a strong bleach solution of four teaspoons of bleach per quart of water or five tablespoons (1/3 cup) per gallon. </li> <li>Remember, never mix bleach with ammonia or other cleaners. Also, more bleach is not better. Let the solution stand on the surface for several minutes, then rinse with cold water and air dry or pat dry with fresh paper towels. Bleach solutions can lose their effectiveness over time, so discard any unused solution after one week. </li> </ul> </li> <li>Kitchen towels and sponges. These provide a moist environment for bacteria to grow. Consider using paper towels instead, and toss them when you're done. If you use cloth towels, wash them often in the hot cycle of your washing machine, If you use kitchen sponges, replace them frequently. </li> <li>Kitchen sink and drain. Food particles get trapped in the drain and disposal, creating a perfect place for bacteria to thrive. Clean your kitchen sink, drain and disposal once a week with warm water and soap. Disinfect your drain and disposal by pouring in that bleach solution you made for the counters. </li> <li>Microwaves. These workhorses of the kitchen often get overlooked in day-to-day cleaning. But you can give it a good cleaning with just a few steps: <ul> <li>Heat a microwave-safe bowl filled with water on high for approximately four minutes. </li> <li>Carefully remove the bowl; use hot water and dish soap to wipe down the inside. Dry with a fresh paper towel. </li> </ul> </li> <li>Cutting boards. Wash them in hot, soapy water after each use; then rinse and air or pat dry with clean paper towels.  <ul> <li>To sanitize your cutting boards, use a solution of one tablespoon unscented, liquid chlorine bleach per gallon of water. Flood the surface with the bleach solution and allow it to stand for several minutes; then rinse and air or pat dry with clean paper towels. </li> <li>Non-porous acrylic, plastic, glass and solid wood boards can be washed in a dishwasher, although laminated boards may crack or split. Even plastic boards wear out over time. Once cutting boards become very worn or develop hard-to-clean grooves, replace them. </li> </ul> </li> <li>Refrigerator. For general food safety, check that the temperature in your fridge is set below 40°F. Clean it weekly to get rid of spills, bacteria, mold and mildew that could contaminate foods.  <ul> <li>Manufacturers recommend against using chlorine bleach, solvent cleaning solutions or abrasives because they can damage seals, gaskets and linings. </li> <li>Clean inside surfaces with hot water and soap. Rinse with a damp cloth; dry with a clean cloth. </li> </ul> </li> </ul> A clean kitchen is just one part of food safety and reducing food waste. How you handle and monitor food also plays a big role.  <ul> <li>Wash your hands. It's your first line of protection.  <ul> <li>To do the job properly, wet hands with warm, running water. Apply soap and rub your hands together vigorously to make lather and scrub all surfaces. Continue for 20 seconds (sing "Happy Birthday" two times), then dry thoroughly with a clean towel. </li> <li>In the kitchen, wash your hands before and after handling food, such as uncooked eggs or raw meat, poultry or fish and their juices. If something takes you away from the kitchen, wash your hands again before returning to food prep. </li> </ul> </li> <li>Wash fruits and veggies — but not meat, poultry or eggs! <ul> <li>As you cut or peel fruits and veggies, any bacteria on the outside can spread to the inside. This includes onions, bananas, oranges, pineapple and more. </li> <li>Washing raw meat and poultry can actually spread any bacteria, because juices may splash onto and contaminate your sink and countertops. Commercial eggs are washed before they're sold, so no need to wash them at home. </li> </ul> </li> <li>Toss or keep? To minimize food waste: <ul> <li>Check your fridge regularly to be sure you use foods before they spoil. </li> <li>Once a week, make it a habit to throw out or compost foods that shouldn't be eaten. </li> <li>There's an app for that! Questions about shelf-life of food and kitchen safety? Want to get alerts about food safety recalls? You can download a free app from the USDA and FDA: <a rel="noopener noreferrer" rel="noopener noreferrer" href="https://www.foodsafety.gov/keep-food-safe/foodkeeper-app" target="_blank">The FoodKeeper</a>. </li> </ul> </li> </ul> Want to learn more? Here are some good resources:  <ul> <li>USDA Meat and Poultry Hotline at 1-888-MPHotline (1-888-674-6854). TTY 1-800-256-7072. </li> <li><a rel="noopener noreferrer" rel="noopener noreferrer" href="http://www.fightbac.org/" target="_blank">FightBAC!®</a> website</li> <li><a rel="noopener noreferrer" rel="noopener noreferrer" href="http://www.foodsafety.gov/" target="_blank">Gateway to Government Food Safety Information</a></li> <li><a rel="noopener noreferrer" rel="noopener noreferrer" href="https://www.fda.gov/food/consumers/people-risk-foodborne-illness" target="_blank">People at risk for foodborne illness</a></li> </ul> Rose Prissel, MS, RDN, LD, is a dietitian at Mayo Clinic working in pediatric and adult nutrition, with a focus on preventive care, sports nutrition and weight management. Rose Prissel, MSN, RDN, LDPrimary Care in Rochester and KassonKitchen Spring CleaningPrimary Care in Rochester and KassonCaffeine gives us a lift, but is it good for us?&nbsp;<img src="/-/media/ech-media/images/widgets/beverages/ech_caffeine_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=EAA3871645318255190077B946F1D0FC" alt="ECH_Caffeine_widget" width="100" height="65" DisableNVelocity="true" />Caffeine: Friend or foe?4/30/2020 5:00 AM<img src="/-/media/ech-media/images/widgets/beverages/ech_caffeine_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=662EE7E17A9015CB42FDD1E18C52BB29" alt="ECH_Caffeine_widget" width="300" height="195" DisableNVelocity="true" />With the current pandemic, it's the small joys that are so important to get through the day. For millions of Americans, the quality of the day often hinges on that morning cup of coffee, evening spot of tea or soda at lunch. While these beverages may give us a lift or soothe our souls during these troubled times, is the caffeine they contain good for us? There's a lot of information out there; these FAQs may help you sort it out.  Is caffeine good for anything? It's not just in your head. In healthy adults, caffeine can temporarily improve your ability to think and even help with headaches. Beyond this, we're not sure it does much else that's good. For instance, you may have read about caffeine making you live longer and protecting you against disease, like Parkinson's, but the jury is still out on this.  How much is too much? It appears that 400 milligrams of caffeine per day is safe, if you're a healthy adult. This is about the same as three to four cups of coffee, four to six cups of tea, eight cans of soda or two energy drinks. Most products should let you know how much caffeine is in them.  How do I know if I'm having problems from caffeine? Sometimes it can be hard to know, but there are a lot of symptoms that show evidence your body may not be liking caffeine — irritability, insomnia, feeling nervous, urinary urgency and headache are bothersome symptoms of caffeine. However, caffeine can cause more serious issues, such as elevated blood pressure and dangerous heart rhythm problems.  Who shouldn't drink caffeine? Children have plenty of energy, which is a clue they don't need any more! People with insomnia should avoid caffeine. If you have certain heart problems, caffeine poses risks, so ask your doctor about consuming caffeine. For women who are pregnant, modest caffeine use seems to be okay, but limiting it to about 200 milligrams per day is recommended.  How should I cut down? Stopping cold-turkey won't hurt you, but it may not feel good. You'll likely have a headache, feel run down and be a bit crabby for a few days! Another is the go-slower route: <ul> <li>So you know your starting point, write down how much caffeine you consume every day. </li> <li>Then slowly decrease the amount. For example, drink one less cup of coffee for a week. </li> <li>Switch to decaf! Almost all the great-tasting beverages you love have a caffeine-free or caffeine-reduced version. </li> </ul> The current pandemic has limited us in a lot of ways, and the small joys in life really are important right now. For healthy adults, caffeine in moderation can be an ally to help us get through the day. However, be vigilant for problems and have a plan ready to cut down.  And, don't forget to wash your hands! <a href="https://communityhealth.mayoclinic.org/providers/luke-hafdahl-md/">Dr. Luke Hafdahl</a> is a consultant and assistant professor in Primary Care in Rochester/Kasson's Division of Community Internal Medicine (CIM). He has a particular interest in medical education.Dr. Luke HafdahlPrimary Care in Rochester and KassonCaffeinePrimary Care in Rochester and KassonDonated breast milk helped her preemie baby, so she made a donation in turn.&nbsp;<img src="/-/media/ech-media/images/widgets/people/ech_mohammad.jpg?h=65&iar=0&w=100&sc_lang=en&hash=B0DA02A6F3ABFC22D863A3101A9FA62A" alt="ECH_Mohammad" width="100" height="65" DisableNVelocity="true" />Mom pays it forward by donating breast milk5/18/2020 5:00 AM<img src="/-/media/ech-media/images/widgets/people/ech_mohammad.jpg?h=195&iar=0&w=300&sc_lang=en&hash=0A6E0A5ACA6B533AC83FCEE43EFE8379" alt="ECH_Mohammad" width="300" height="195" DisableNVelocity="true" />When Natalie Mohammad's daughter Safia was born six weeks premature, she required a feeding tube so she could gain strength and coordination before nursing on her own. But Natalie's milk hadn't come in yet, so the Neonatal Intensive Care Unit (NICU) turned to donated breast milk.  "It was wonderful," she says. "She needed donor breast milk for nine to 10 days, every three hours around the clock." As soon as she could, Natalie, a nurse practitioner in Community Internal Medicine in Primary Care in Rochester/Kasson, began pumping and then her own milk was used to feed Safia.  Once Safia was able to stay awake long enough, Natalie would breast feed her, but she was so small that she only needed a small portion of what Natalie was producing every day. So, Mom continued pumping and freezing her excess supply. "I had a big stash in the freezer that I didn't need," Natalie says. "She preferred mom and wouldn't take a bottle, so I decided to donate the surplus to the Breast Milk Depot at Primary Care Southeast Clinic." Natalie found the process "Super easy. Once you go through the screening process, they supply you with instructions on how to store your milk, containers for freezing and labels. You take it right to the clinic. The nurses were always very sweet and thanked me every time." Now two, Safia is healthy and thriving, thanks to the start she got from donated breast milk. "If you have extra milk, instead of letting it go to waste, think about donating it," Natalie says. "It goes to a good place and helps premature babies just like Safia." The Breast Milk Depot at Mayo Family Clinic Southeast in Rochester is still accepting donations during the COVID-19 pandemic. If you're a lactating mother who has extra milk or have experienced the loss of a child and are interested in donating, here's how: <ul> <li>Set up a verbal interview by contacting the donor coordinator, Heidi Baudhuin, by <a href="mailto:">email</a> or by phone (<a href="tel:18778915347">1-877-891-5347</a>). </li> <li>Fill out a written questionnaire; there also will be a form for your health care provider to complete. </li> <li>Arrange for a blood test. You'll receive a screening kit in the mail. You'll need to take it to Mayo Family Clinic Southeast to have your blood drawn. Please call the clinic at <a href="tel:5072938590">507-293-8590</a> to find out how blood tests are being handled. </li> <li>You blood will be screened for HIV, hepatitis B and C, HTLV and syphilis. </li> <li>If you qualify to donate, congratulations! When you're ready to make a donation, call <a href="tel:5072938590">507-293-8590</a> and ask for the charge nurse at the Southeast Clinic before dropping off your milk to make sure someone will be available to accept it. Drop-off hours are 8:30 a.m. to 4 p.m., Monday through Friday. </li> </ul> Thank you for your part in giving babies like Safia the best start in life possible. Natalie Mohammad, APRN, CNPPrimary Care in Rochester and KassonDonate Breast MilkPrimary Care in Rochester and KassonDuring social distancing, try these creative ways to get physical activity in your own home.&nbsp;<img src="/-/media/ech-media/images/widgets/activities/ech_soupcanslunges_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=EB8BBE91A7F765D6BFFD7E6F2266C0BD" alt="ECH_SoupCansLunges_widget" width="100" height="65" DisableNVelocity="true" />From soup cans to laundry lunges5/21/2020 5:00 AM<img src="/-/media/ech-media/images/widgets/activities/ech_soupcanslunges_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=739599F4250D5759A74FBCD2313644A0" alt="ECH_SoupCansLunges_widget" width="300" height="195" DisableNVelocity="true" /><div class="OutlineElement Ltr SCXW147661252 BCX0" style="color: #000000; background-color: #ffffff; margin: 0px; padding: 0px;"> Now that you are finding new ways to work, home school your children and social distance, we are sure you also are finding that you are less active and more tired. Since you cannot hop over to your local gym, how about trying some creative ways to get physical activity in your own home? </div> <div class="OutlineElement Ltr BCX0 SCXW147661252" style="color: #000000; background-color: #ffffff; margin: 0px; padding: 0px;">   </div> <div class="OutlineElement Ltr BCX0 SCXW147661252" style="color: #000000; background-color: #ffffff; margin: 0px; padding: 0px;"> The <a href="https://healthyliving.mayoclinic.org/home.php">Mayo Clinic Healthy Living Program</a> experts have put together some <a href="/-/media/ech-media/documents/soupcanslaundrylunges_hlp.PDF?sc_lang=en&hash=C3F9D25945D28EAAC3264BBFA81643B5">simple tips</a> to help you adjust to stay-at-home orders, travel restrictions, work-from-home settings, fitness center closures, social distancing, uncertainty and stress.  </div> <div class="OutlineElement Ltr BCX0 SCXW147661252" style="color: #000000; background-color: #ffffff; margin: 0px; padding: 0px;">   </div> <div class="OutlineElement Ltr BCX0 SCXW147661252" style="color: #000000; background-color: #ffffff; margin: 0px; padding: 0px;"> Take a moment to try them out – and get the whole family involved! </div>Primary Care in Rochester and KassonHome Physical Activity OptionsPrimary Care in Rochester and KassonThe new social media place to be for teens isn't Facebook.&nbsp;<img src="/-/media/ech-media/images/widgets/teens/ech_teensocialmedia_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=4371A5D156A44EA57619D5B4C492DFA1" alt="ECH_TeenSocialMedia_widget" width="100" height="65" DisableNVelocity="true" />Keeping up with teens' social media trends4/27/2020 9:00 AM<img src="/-/media/ech-media/images/widgets/teens/ech_teensocialmedia_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=0FF3D79D91B052379544ECF3DCCE90A9" alt="ECH_TeenSocialMedia_widget" width="300" height="195" DisableNVelocity="true" />During the COVID-19 pandemic, everyone is turning even more to social media to stay connected with friends, family and coworkers. That's especially true for teens. Do you know where they're "hanging out"? Teens, since time began, have wanted to be where their friends are. Nothing's changed there. While Facebook used to be the place to be, new platforms like TikTok along with older ones like Snapchat and Tumblr, are claiming their attention. Remember, teens typically don't just have one platform, but a portfolio of go-to- social media. If you're not familiar with what your teen is using, check these out: <ul> <li><a href="https://www.tiktok.com/en/" target="_parent">TikTok</a>. All the rage, this platform features 30-second videos created by users. They run the gamut from showing off dance moves to making art to adorable pets to how-tos for just about anything. School teachers and pediatricians are jumping onto TikTok to get out the message about a lesson, vaccinations or social distancing. </li> <li><a rel="noopener noreferrer" rel="noopener noreferrer" href="https://www.snapchat.com/" target="_blank">Snapchat</a>. It's all about photos, adding artwork and playing games. Originally, the posts only lasted for a set amount of time, now they can be saved and shared. Users can create "streaks," almost like the old-fashioned chain letter, but no one wants to break the streak, which makes it especially hard for parents trying for a social media holiday. </li> <li><a rel="noopener noreferrer" rel="noopener noreferrer" href="https://www.tumblr.com/" target="_blank">Tumblr</a>. Through user-created blogs on any topic under the sun, from silly jokes to poems, users connect with others who share their interests. If teens aren't able to find a community in real life, Tumblr is one place they can find one online. </li> <li><a rel="noopener noreferrer" rel="noopener noreferrer" href="https://www.instagram.com/" target="_blank">Instagram</a>. While this photo-focused app has been around a while, it's still popular. But what you see on your teen's public Instagram posts might not be all they're sharing. They may have created a "finsta", or "fake Insta", a private Instagram account that's only open to a select group of friends outside the view of parents. </li> </ul> Social media is a tool that's neither good nor bad. But it's very powerful. It can encourage social behavior, activism, finding a cause that means something to your child, or connecting with a community that shares their interests, which can be a huge plus for kids who feel marginalized in any way. Social media also can lead to cyberbullying, sexting, revenge porn, and more, that can ruin their reputation now and into their professional adult life.  It's recommended that pediatricians talk about internet and social media use at every well-child visit, starting when kids reach middle school.  <ul> <li>Message for parents: If you allow your child to have social media, even if it's just text or email, you should have your child's user names and passwords for devices, sites and apps. This can be negotiated as kids near 18. </li> <li>Message for teens: Everything you put online, even if you think it's private, becomes public. If you wouldn't put it on a bulletin board at school, don't put it on social media. One of the reasons your parents should be involved, is so that if anything you've received bothers you or is inappropriate, you can take it to them. They can take a screenshot and alert the authorities, if necessary. </li> <li>Message for both: Cell phones and screens shouldn't be in your room. Putting it in another room, especially when you're ready for bed, creates separation and reduces the pressure to respond. And it lets you get the sleep you need. </li> </ul> <a rel="noopener noreferrer" rel="noopener noreferrer" href="https://www.screenagersmovie.com/" target="_blank">Screenagers</a> is a documentary that focuses on teens’ use of social media. Currently, it’s only available for community showings, in order to stimulate discussion. Here’s where you can find information for <a rel="noopener noreferrer" rel="noopener noreferrer" href="https://www.screenagersmovie.com/host-a-screening/" target="_blank">hosting a showing</a>.        Talk with your kids about social media use and stay engaged with them about it. It's your role as a parent to encourage what's good about these platforms and protect your teen from what's bad. If you'd like your pediatrician to start the discussion, just ask.     <a href="https://communityhealth.mayoclinic.org/providers/nusheen-ameenuddin-md/">Dr. Nusheen Ameenuddin</a> is a pediatrician with Primary Care in Rochester/Kasson's Division of Community Pediatric and Adolescent Medicine (CPAM). She has a strong interest in child advocacy and media effects on children. She serves as chair of the national American Academy of Pediatrics (AAP) Council on Communications and Media and is on the board of the Minnesota chapter of the AAP. She also holds master's degrees in Public Health and Public Administration and serves as director of the Pediatric Resident Continuity Clinic. Dr. Nusheen AmeenuddinPrimary Care in Rochester and KassonTeens Social MediaPrimary Care in Rochester and KassonBesides dairy, which foods provide a significant dose of calcium? There's good news: there are ample options, even if you don't do dairy.<img src="/-/media/ech-media/images/widgets/food/ech_calcium_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=4E8AD62F91B39851B45170C775660831" alt="ECH_calcium_widget" width="100" height="65" DisableNVelocity="true" />How can I add calcium to my diet?6/8/2020 4:00 AM<img src="/-/media/ech-media/images/widgets/food/ech_calcium_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=A4B901A9BE456E469489480DEBE51546" alt="ECH_calcium_widget" width="300" height="195" DisableNVelocity="true" />As many of us know, milk is a good source of calcium. But what if you're on a dairy-free diet? Or just don't like milk? Can you still get your daily recommended amount of calcium?  Absolutely! Calcium is found naturally in many foods, and food manufacturers also add it to some food products. The foods best known for calcium are milk, cheese and yogurt. In addition, calcium supplements are another option available to meet calcium needs.  Calcium is known to be beneficial for bone health. However, did you know that calcium keeps your heart muscle pumping and regulates muscle contraction and much more? A diet with adequate calcium helps keep your bones strong, nerves functioning, and heart beating. Just how much you need depends on your age. And remember, like most minerals, there are drawbacks to overdoing calcium.  Recommended dietary allowances (RDAs) for calcium by age/gender <ul> <li>0-6 months: 200 mg</li> <li>7-12 months: 260 mg</li> <li>1-3 years: 700 mg</li> <li>4-8 years: 1,000 mg</li> <li>9-18 years: 1,300 mg</li> <li>19-50 years: 1,000 mg</li> <li>51-70 years: 1,000 mg for men and 1,200 mg for women</li> <li>71+ years: 1,200 mg</li> </ul> New labels on foods and supplements now state the amount of calcium a product provides, as well as the % Daily Value (DV). The daily values are reference amounts of nutrients to consume or not exceed.  But what if you're avoiding dairy? Try to incorporate some of these other calcium-rich foods in your diet: <ul> <li class="Paragraph SCXW21232953 BCX0" paraid="1923339244" paraeid="{ee5b8415-9157-40db-8352-ca288646fcfd}{74}" style="color: windowtext; background-color: transparent; padding: 0px;">These fish varieties, as long as bones are consumed: <ul> <li class="Paragraph SCXW21232953 BCX0" paraid="1923339244" paraeid="{ee5b8415-9157-40db-8352-ca288646fcfd}{74}" style="color: windowtext; background-color: transparent; padding: 0px;">Canned sardines. Check the label to be sure they're canned in oil, bones included. </li> <li class="Paragraph SCXW21232953 BCX0" paraid="1923339244" paraeid="{ee5b8415-9157-40db-8352-ca288646fcfd}{74}" style="color: windowtext; background-color: transparent; padding: 0px;">Canned pink salmon with bones.</li> </ul> </li> <li class="Paragraph SCXW21232953 BCX0" paraid="1923339244" paraeid="{ee5b8415-9157-40db-8352-ca288646fcfd}{74}" style="color: windowtext; background-color: transparent; padding: 0px;">Check the label on these foods to know how much calcium is in a serving: <ul> <li class="Paragraph SCXW21232953 BCX0" paraid="1923339244" paraeid="{ee5b8415-9157-40db-8352-ca288646fcfd}{74}" style="color: windowtext; background-color: transparent; padding: 0px;">Calcium-fortified soy, almond, oat, and rice milk</li> <li class="Paragraph SCXW21232953 BCX0" paraid="1923339244" paraeid="{ee5b8415-9157-40db-8352-ca288646fcfd}{74}" style="color: windowtext; background-color: transparent; padding: 0px;">Calcium-fortified orange juice</li> <li class="Paragraph SCXW21232953 BCX0" paraid="1923339244" paraeid="{ee5b8415-9157-40db-8352-ca288646fcfd}{74}" style="color: windowtext; background-color: transparent; padding: 0px;">Tofu made with calcium sulfate</li> <li class="Paragraph SCXW21232953 BCX0" paraid="1923339244" paraeid="{ee5b8415-9157-40db-8352-ca288646fcfd}{74}" style="color: windowtext; background-color: transparent; padding: 0px;">Calcium-fortified cereals and English muffins</li> </ul> </li> <li class="Paragraph SCXW21232953 BCX0" paraid="1923339244" paraeid="{ee5b8415-9157-40db-8352-ca288646fcfd}{74}" style="color: windowtext; background-color: transparent; padding: 0px;">Greens. Turnip and collard greens and kale all pack a calcium-rich punch.</li> <li class="Paragraph SCXW21232953 BCX0" paraid="1923339244" paraeid="{ee5b8415-9157-40db-8352-ca288646fcfd}{74}" style="color: windowtext; background-color: transparent; padding: 0px;">Beans. Garbanzo, kidney, navy and boiled green soybeans are another good option. </li> <li class="Paragraph SCXW21232953 BCX0" paraid="1923339244" paraeid="{ee5b8415-9157-40db-8352-ca288646fcfd}{74}" style="color: windowtext; background-color: transparent; padding: 0px;">Veggies: Like cooked broccoli, Chinese cabbage, edamame and acorn squash. </li> <li class="Paragraph SCXW21232953 BCX0" paraid="1923339244" paraeid="{ee5b8415-9157-40db-8352-ca288646fcfd}{74}" style="color: windowtext; background-color: transparent; padding: 0px;">Papaya, dried figs and oranges</li> </ul> Who's at higher risk for calcium deficiency? If you fall into one of these categories, you should monitor your calcium intake closely. <ul> <li class="Paragraph SCXW21232953 BCX0" paraid="1923339244" paraeid="{ee5b8415-9157-40db-8352-ca288646fcfd}{74}" style="color: windowtext; background-color: transparent; padding: 0px;">Adolescent girls — especially athletes</li> <li class="Paragraph SCXW21232953 BCX0" paraid="1923339244" paraeid="{ee5b8415-9157-40db-8352-ca288646fcfd}{74}" style="color: windowtext; background-color: transparent; padding: 0px;">Postmenopausal women</li> <li class="Paragraph SCXW21232953 BCX0" paraid="1923339244" paraeid="{ee5b8415-9157-40db-8352-ca288646fcfd}{74}" style="color: windowtext; background-color: transparent; padding: 0px;">Individuals who are lactose intolerant or have a dairy allergy</li> <li class="Paragraph SCXW21232953 BCX0" paraid="1923339244" paraeid="{ee5b8415-9157-40db-8352-ca288646fcfd}{74}" style="color: windowtext; background-color: transparent; padding: 0px;">Elderly</li> <li class="Paragraph SCXW21232953 BCX0" paraid="1923339244" paraeid="{ee5b8415-9157-40db-8352-ca288646fcfd}{74}" style="color: windowtext; background-color: transparent; padding: 0px;">Those with decreased ability to absorb calcium due to certain digestive diseases (such as celiac disease)</li> <li class="Paragraph SCXW21232953 BCX0" paraid="1923339244" paraeid="{ee5b8415-9157-40db-8352-ca288646fcfd}{74}" style="color: windowtext; background-color: transparent; padding: 0px;">Vegans</li> </ul> How to help improve calcium absorption <ul> <li class="Paragraph SCXW21232953 BCX0" paraid="1923339244" paraeid="{ee5b8415-9157-40db-8352-ca288646fcfd}{74}" style="color: windowtext; background-color: transparent; padding: 0px;">Vitamin D promotes absorption of calcium from the intestine. This helps to build and maintain strong bones. </li> <li class="Paragraph SCXW21232953 BCX0" paraid="1923339244" paraeid="{ee5b8415-9157-40db-8352-ca288646fcfd}{74}" style="color: windowtext; background-color: transparent; padding: 0px;">Consume your calcium throughout the day. </li> </ul> Even though bone health is the most prominent health reason to consume adequate calcium, remember that the majority of your cells need calcium to survive. Now you know of several calcium options to consider — even if you avoid dairy. Be well! Rose Prissel, MS, RDN, LD, is a dietitian at Mayo Clinic working in pediatric and adult nutrition, with a focus on preventive care, sports nutrition and weight management.Rose Prissel, MS, RDN, LDPrimary Care in Rochester and KassonCalciumPrimary Care in Rochester and KassonSara Sedivy weighs in on emotions felt by grievers and their loved ones.&nbsp;<img src="/-/media/ech-media/images/widgets/people/ech_grief_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=351BBB2847C91EDCF7C59E8E0DAE1791" alt="ECH_grief_widget" width="100" height="65" DisableNVelocity="true" />How can you help others - and yourself - deal with grief?6/29/2020 10:00 AM<img src="/-/media/ech-media/images/widgets/people/ech_grief_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=2B6C01171C13E4A72AC6715BC60E6D1E" alt="ECH_grief_widget" width="300" height="195" DisableNVelocity="true" />Grief. It's such a simple word for that painful and complicated process when there is significant change or loss in our lives.  One might surmise that since grief and loss are part of the human condition, we should naturally know how to help others who are grieving. The reality is that many people have difficulty knowing how to help a friend, family member or colleague who is suffering a loss.  First, it's important to remember that grieving is natural and an individual experience; there's no right or wrong way to grieve. Here are some responses and attitudes that demonstrate what someone who is actively grieving may be feeling: <ul> <li>I know it's difficult to see me hurting, but someone I love is gone and I am going to hurt for a while. </li> <li>Crying is a healthy reaction to grief, I need to feel my feelings as they come. </li> <li>Keep me connected to others — even if I don't respond, please send emails, call/text, invite me to lunch, send cards. It helps to know you care. </li> <li>Please don't try to compare my loss to yours. </li> <li>I am not going to "find closure" or "get over it" — but, in time, I will heal. </li> <li>Sadness and joy can coexist; when I laugh one day it doesn't mean that I won't cry the next. </li> <li>Grief can be a roller coaster ... some days I can conquer mountains and other days I can't get myself to shower. </li> <li>Please don't tell me to stay strong. To me that means, don't show emotion. </li> <li>Memories and stories are important to my healing. Please talk about my child, partner, sibling, grandchild or parents ... I will let you know if it's too much. </li> <li>Avoid platitudes such as "he/she is in a better place now". </li> <li>I may need more rest, be more needy, have less to give. Grief is draining and exhausting. </li> <li>Grief knows no timeline. It takes as long as it takes. </li> </ul> When someone you care about is grieving, you may be afraid of saying the wrong thing or feel you are intruding on their privacy. Don't let your discomfort prevent you from reaching out. Here are some tips to help: <ul> <li>Understand the grieving process: There is no right or wrong way to grief; grief may involve extreme emotions and behavior; there is no timetable. </li> <li>Know what to say: While you may worry about what to "say" — it's actually more important to "listen". </li> <li>Offer practical assistance: Offer to shop for groceries or run errands; drop off a family meal; offer to assist with funeral arrangements, housework, child/pet care; or just be there to show your support. </li> <li>Provide ongoing support: Grieving doesn't stop when the funeral is over. Continue your support over the long haul. </li> <li>Watch for signs of depression: It's common to feel depressed, confused, and disconnected during grief, but if the symptoms don't fade over time (or they get worse), it may be a sign that this has evolved into a more serious problem. </li> </ul> Remember, grief can occur following any change — such as the loss of a job or position change, life-transition periods (kids leaving for college, getting married), relationship ending, or social distancing. Check out these resources if you or someone you know could use some extra support: <ul style="list-style-type: disc;"> <li><a rel="noopener noreferrer" rel="noopener noreferrer" href="https://thegrieftoolbox.com/" target="_blank">Grief Toolbox</a></li> <li>What is grief? (<a rel="noopener noreferrer" rel="noopener noreferrer" href="http://www.mayoclinic.org/" target="_blank">www.mayoclinic.org</a>)</li> </ul> This quote from Days of Healing, Days of Joy by Earnie Larsen and Carol Larsen Hegarty is a good reminder to live by.  "So life has given us some dents. Dents are neither soft spots in our characters that should make us ashamed, nor saber scars that should make us proud. They are simply evidence that we have been alive for a while. Attending to our grief (sic) offers us the chance to learn from our dents, to accept them as new spaces for growth." Sara Sedivy, MA, LP, is a psychologist in Primary Care in Rochester and Kasson's Division of Integrated Behavioral Health (IBH). For the past 21 years, she has practiced at Mayo Family Clinic Kasson and Baldwin Primary Care.Sara Sedivy, MA, LPPrimary Care in Rochester and KassonGrief 2020Primary Care in Rochester and KassonInterpreters are available to assist with in-person, video, or telephone visits.&nbsp;<img src="/-/media/ech-media/images/widgets/people/ech_interpreter_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=9219FF5F4FB7BF854C43485E861E5846" alt="ECH_Interpreter_widget" width="100" height="65" DisableNVelocity="true" />Interpreters at Mayo Clinic - What are the options?5/28/2020 5:00 AM<img src="/-/media/ech-media/images/widgets/people/ech_interpreter_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=A35393072ED661C58AE078E03809832B" alt="ECH_Interpreter_widget" width="300" height="195" DisableNVelocity="true" />In the various interactions between patients and their health care teams, clear and complete communication is vital. It is important that providers get an accurate and complete picture of each patient's concerns, and patients also need to be fully 'heard' and understood, as well as to comprehend fully the recommendations they receive from providers.  In a country where many health care providers speak only English, patients who have limited English proficiency, defined as those who speak English less than very well, may require an interpreter for adequate communication with their health care teams. Interpreters serve a critical role in facilitating communication between two parties, not only in terms of language, but also in cultural terms. Their role is to convey the message accurately without adding, modifying, or deleting information.  At Mayo Clinic, interpreters are available at no cost to assist with communication between health care providers and patients whose primary language is not English. Experienced medical interpreters attend appointments with patients (in-person or virtually), translate patient education materials, and offer other assistance as needed, including helping communicate appointment details and deliver test results to patients. Patients are usually asked to indicate if they need an interpreter at the time appointments are scheduled, which helps ensure that appropriate planning is done prior to the visit to facilitate the availability of an interpreter.  Mayo Clinic offers appointments for patients in person, via video or phone. Interpreters are available to assist with each of these types of visits. While family members may be willing to assist with interpretation for the patient, best practices indicate that having a trained medical interpreter who is familiar with medical terminology is the ideal standard. Adequate communication is irreplaceable in the healing relationship between providers and health care teams.  <a href="https://communityhealth.mayoclinic.org/providers/jane-njeru-mbchb/">Dr. Jane Njeru</a> is a general internist in Primary Care in Rochester/Kasson's Division of Community Internal Medicine (CIM). She completed her medical school training at the University of Nairobi, Kenya, and her residency in Internal Medicine at Mayo Clinic in Rochester. Her interests include developing interventions to reduce health disparities, with special focus on patients with limited English proficiency, immigrants and refugees. Dr. Jane NjeruPrimary Care in Rochester and KassonInterpreter ServicesPrimary Care in Rochester and KassonThese tips can help you restore your balance and replenish your energy.&nbsp;<img src="/-/media/ech-media/images/widgets/activities/ech_yogaocean_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=012DF30F8D2086AE4D2B88B043B2EA78" alt="ECH_YogaOcean_widget" width="100" height="65" DisableNVelocity="true" />Restorative exercises in times of stress6/4/2020 5:00 AM<img src="/-/media/ech-media/images/widgets/activities/ech_yogaocean_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=F118BCFF369C62FA288C9CCDF3949372" alt="ECH_YogaOcean_widget" width="300" height="195" DisableNVelocity="true" />This is an unusual time for all of us. Many of us are spending more time at home than ever before. Our schedules and routines have been thrown out the window. We are navigating through an ever-changing situation resulting in chronic low-level stress.  If you are using this opportunity to really make progress on staying steady with your exercise program, good for you! Exercise challenges our systems by breaking them down, in a sense, to elicit a physiologic response of reinforcing strength for the next challenge. An equally important, yet often overlooked factor in this equation is the anabolic, or "building up" effect.  Sara Mansfield, MS, wellness assessment specialist in the <a rel="noopener noreferrer" rel="noopener noreferrer" href="https://healthyliving.mayoclinic.org/" target="_blank">Healthy Living Program</a> offers <a href="/-/media/ech-media/documents/restorativeexercises.pdf?sc_lang=en&hash=42DAC44334813010A77655F2A99948C7">these tips</a> for what you can do at home to help restore your balance and replenish your energy. Primary Care in Rochester and KassonRestorative ExercisesPrimary Care in Rochester and KassonIt's important to know what's normal and what warrants further evaluation.&nbsp;<img src="/-/media/ech-media/images/widgets/people/ech_cervicalcancer_01_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=2472EFB47377152C151A5E1D11399009" alt="ECH_CervicalCancer_01_widget" width="100" height="65" DisableNVelocity="true" />Vulvar and vaginal health: What's normal and what's not?6/11/2020 4:30 AM<img src="/-/media/ech-media/images/widgets/people/ech_cervicalcancer_01_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=0D56C7547ED5A8F8F4740E6D337BD321" alt="ECH_CervicalCancer_01_widget" width="300" height="195" DisableNVelocity="true" />The health of the vulva, or external portion of the female genitalia, and the vagina are important components in a women's overall health; however, often women are embarrassed or afraid to mention new or concerning symptoms. It's important to know what symptoms can be normal and what symptoms warrant further evaluation with your health care team.  It's normal to have some vaginal discharge, called physiologic discharge. The average woman has 2 to 3 tablespoons of discharge per day. This discharge is often transparent to white, thick, odorless and without irritating symptoms. Hormonal changes, such as during ovulation, contraceptive use, or menopause, can alter this discharge and may increase or decrease the amount or consistency of the discharge.  Abnormal discharge that may indicate an underlying medical condition can present with a change in color, odor or amount of discharge. Vulvar or vaginal skin changes including redness, itching, burning, pain, urinary symptoms, incontinence, ulcers, masses, or a bulge warrant further evaluation. Evaluation is also recommended if there is any abnormal menstrual bleeding, such as bleeding between periods, after intercourse or after menopause.  In order to maintain vulvar and vaginal health it is recommended to wash the vulva with warm water only. You should wear underwear with a wide fit that are white and made with a cotton material. Underwear should be washed in very hot water and with half the amount of laundry soap compared to other loads. Avoid hand washing underwear and wearing thong-fitting underwear. It is recommended that you sleep without underwear or wear loose clothing to bed.  Avoid common vulvar and vaginal irritants such as soaps, scented pads and tampons, spermicides, lubricants, sprays, dyes, fragrances, softeners, bleach, bubble bath, shampoo, hot tubs, chlorine, over-the-counter prescriptions, shaving, douching, oral sex, and over cleansing.  Be sexually responsible — utilize condoms and be screened for sexually transmitted infections. It is also important to limit alcohol and tobacco use, which can decrease sexual function and arousal. Be sure to follow guideline recommendations for Pap smear screening and vaccinations, and report any new or concerning symptoms to your health care team.  <a href="https://communityhealth.mayoclinic.org/providers/danielle-olaughlin-pac/">Danielle O'Laughlin, PA-C, MS</a>, is a physician assistant and assistant professor in Primary Care in Rochester and Kasson's Division of Community Internal Medicine (CIM). She serves as the team lead of the Primary Care Obstetrics and Gynecology Clinic and is the clinical skills co-director of the Mayo Clinic Physician Assistant Program. Danielle O'Laughlin, PA-C, MSPrimary Care in Rochester and KassonVulvar Vaginal HealthPrimary Care in Rochester and KassonMeet Avery and find out how blood donation saved her life.&nbsp;<img src="/-/media/ech-media/images/widgets/blooddonation/ech_blooddonationavery_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=33DF393504D2EA4225AF9A286EA10CD8" alt="ECH_BloodDonationAvery_widget" width="100" height="65" DisableNVelocity="true" />A blood recipient's story: Avery7/16/2020 10:00 AM<img src="/-/media/ech-media/images/widgets/blooddonation/ech_blooddonationavery_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=20FD44E1168403915C6C95B0CF42EDAC" alt="ECH_BloodDonationAvery_widget" width="300" height="195" DisableNVelocity="true" />Little Avery's mother, Bethany, began to worry when the three year old seemed constantly exhausted. Her "mother's intuition" moved her to pay a visit to their local emergency room to see what was wrong. The staff ended up drawing Avery's blood twice, because her hemoglobin levels were so low that they thought someone had made a mistake in the reading. They immediately sent Avery on to the Mayo Clinic in Rochester.  On September 11, 2017, Avery was diagnosed with B-cell acute lymphoblastic leukemia. "I will never forget that day. Hearing a diagnosis such as this is every parent's worst nightmare," Bethany shares. Immediately Avery's medical team began treating her with blood transfusions, and Bethany was amazed at just how quickly her daughter's energy level would rebound and her coloring would improve after each unit of blood product she received.  "The thought of what an amazing and selfless thing giving blood is never really crossed my mind. These people who donated blood for my daughter had nothing to gain except knowing they had done something to help someone," Bethany recalls.  Currently Avery is in remission. Hopefully her two-and-a-half year treatment plan will be completed at the end of this year. "Before she was diagnosed, she loved to ride her bike with her friends, but she could only go about a block and then would cry, because her friends were so far ahead of her. I remember the first time she got back on her bike after the blood-transfusion treatments, she had all the energy in the world. It was really amazing to see that!" How to donate For more information about donating blood in Rochester, Minnesota, call <a href="tel:5072844475">(507) 284-4475</a> or email <a href="mailto:donateblood@mayo.edu">donateblood@mayo.edu</a>. Or visit our webpage at <a rel="noopener noreferrer" href="http://www.mayoclinic.org/donateblood" target="_blank">http://www.mayoclinic.org/donateblood</a>.Primary Care in Rochester and KassonBlood Donation AveryPrimary Care in Rochester and KassonLearn more about elbow pain, home treatment options, and when to be seen.&nbsp;<img src="/-/media/ech-media/images/widgets/medicalimages/ech_elbowpain_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=2F248891FA9E3681F8AE5776C64952EC" alt="ECH_ElbowPain_widget" width="100" height="65" DisableNVelocity="true" />Epicondylitis: Getting back to moving7/27/2020 5:00 AM<img src="/-/media/ech-media/images/widgets/medicalimages/ech_elbowpain_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=F1970D1DB6F41D6886FAC2F14E8F19E8" alt="ECH_ElbowPain_widget" width="300" height="195" DisableNVelocity="true" />As the weather is warming up and people are becoming more active, overuse injuries can be more common. A frequent complaint following overuse or repetitive action is elbow pain.  The best way to understand this elbow pain is that there are two main muscle groups in the forearm that control the actions of the wrist and fingers.  <ul> <li> Bending the wrist and fingers uses the muscles that attach on the epicondyle on the inside (medial) of your elbow.  </li> <li>Bringing the wrist up and straightening the fingers uses muscles that attach on the bony prominence (epicondyle) on the outside or thumb side (lateral) of the elbow.</li> </ul> Repeatedly moving your wrist and/or fingers in the same motion or activity can cause inflammation and irritation over the epicondyle, resulting in pain. Common causes of epicondylitis include: golfing, tennis, painting, cooking, gripping tools, or riding a bike. Most often the pain starts slowly over weeks to months. The pain is generally worse with activity, may radiate towards your hand, and result in the feeling of some weakness with use of the hand.  Most people improve with home treatments. Initial treatments include:  <ul> <li>Rest. Avoid any activity that worsens your symptoms. </li> <li>NSAIDs. If you tolerate and are approved to take anti-inflammatories such as ibuprofen, they can help decrease the pain and inflammation. Tylenol can help with the pain but does not have the NSAIDs added benefit of being anti-inflammatory. </li> <li>Bracing. Using an elbow counter brace during activity can take pressure off the irritated area. </li> <li>Ice. Ice massage to the painful area can decrease pain and inflammation. </li> </ul> If after a few weeks your symptoms are still not improving, contact your provider for further evaluation and consideration of additional treatment options.  Some things to remember as you return to activities:  <ul> <li>Start slowly. </li> <li>If symptoms redevelop, stop and restart treatment. </li> </ul> Chelsea Harstad, PA-C, is a physician assistant in Mayo Clinic in Rochester's Department of Orthopedics. She focuses on the care of patients with complex shoulder reconstruction and shoulder tendon transfers. Chelsea Harstad, PA-CPrimary Care in Rochester and KassonEpicondylitisPrimary Care in Rochester and KassonHome remedies work to relieve the itch to scratch.<img src="/-/media/ech-media/images/widgets/skin/ech_mosquitobite_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=646EFCF36BCD1B9A2981F52BD99A1C45" alt="ECH_mosquitobite_widget" width="100" height="65" DisableNVelocity="true" />Easing the itch of mosquito bites7/23/2020 5:00 AM<img src="/-/media/ech-media/images/widgets/skin/ech_mosquitobite_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=84DCDAF4908851BF8C0AF29972188A60" alt="ECH_mosquitobite_widget" width="300" height="195" DisableNVelocity="true" />There are millions of mosquitoes swarming this summer, sucking blood and leaving itchy, red bumps on the skin. Mosquitoes are pesky parasites that leave bites that can be unbearably itchy. So what's the best way to cope with this summertime nuisance? The best way to keep mosquito bites to a minimum is to:  <ul> <li>Use repellent sprays or wipes containing DEET, picardin or oil of lemon eucalyptus, a plant-based option</li> <li>Avoid outdoor activities between dusk and dawn when skeeters are most active</li> <li>Repair any tears in window and door screens and camping gear</li> <li>Use mosquito netting over strollers and cribs or when sleeping outdoors</li> </ul> If you do get a bite, why does it itch? Mosquitoes deposit saliva in our skin when they bite us. Our bodies react to the saliva, causing a bump, which usually clears up on its own in a few days, but can cause unbearable itching in the meantime.  Some of the tried-and-true home remedies for treating mosquito bites work well to calm down bites, including calamine lotion, over-the-counter hydrocortisone cream and even a cold compress.  These remedies sooth and quiet the intense burning and inflammation we feel in our skin. But while it's not always easy, it's also important to not scratch them. Why? If we scratch bites hard enough, it can break the skin. Then there's a chance of developing a bacterial infection.  Although using insect repellent and other prevention tips can reduce your chances of being bit, getting at least one skeeter bite this summer is almost inevitable. When you do, let time and home remedies work their magic. And don't scratch! Learn more about <a rel="noopener noreferrer" href="https://www.mayoclinic.org/diseases-conditions/mosquito-bites/symptoms-causes/syc-20375310?mc_id=us&utm_source=newsnetwork&utm_medium=l&utm_content=content&utm_campaign=mayoclinic&geo=national&placementsite=enterprise&cauid=100721" target="_blank">mosquito bites</a> or watch this short video featuring Dr. Summer Allen.  <iframe width="560" height="315" src="https://www.youtube.com/embed/m4iapNcv8-Q" frameborder="0"></iframe> <a rel="noopener noreferrer" href="https://communityhealth.mayoclinic.org/providers/summer-allen-md" target="_blank">Dr. Summer Allen</a> is a primary care physician in Primary Care in Rochester and Kasson's Department of Family Medicine. She previously served as medical director of Patient Experience for the Mayo Clinic Health System, Southeast Minnesota region. Her practice covers the full spectrum of family medicine with an obstetrical practice that focuses on patient education and women's health. Her research interests include understanding how to engage patients, improve their experience and health care delivery innovation. Dr. Allen is involved in the Knowledge Education Research (KER) unit at Mayo Clinic to better understand the impact of minimally disruptive medicine and shared decision making in practice. Dr. Summer AllenPrimary Care in Rochester and KassonMosquito Bites 2020Primary Care in Rochester and KassonSkin: It's our largest organ, a protective shield that requires some basic care.<img src="/-/media/ech-media/images/widgets/skin/ech_bodycream_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=950E9EBE5E79493B835FF7340D31E721" alt="ECH_BodyCream_widget" width="100" height="65" DisableNVelocity="true" />The skinny on skin7/13/2020 4:00 AM<img src="/-/media/ech-media/images/widgets/skin/ech_bodycream_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=625E168091BFED3BD9BFE7C225A0850E" alt="ECH_BodyCream_widget" width="300" height="195" DisableNVelocity="true" />Not all of our organs are on the inside. One we wear on the outside and see every day is our skin, our largest organ. In adults, it covers 22 square feet and weighs about eight pounds. Our skin serves as a waterproof, insulating, protective shield and is packed with nerves for keeping us in touch with the outside world.  So, it's a good idea to pay attention to this amazing organ. Here's the skinny on keeping skin healthy throughout our lives:  Wear sunscreen. A sunscreen with a high SPF protects against skin cancer and other sun damage. Anyone from birth to 99+ should apply it whenever we go outside. Wear a hat and cover up in the sun with long sleeves and pants (check out the new ultraviolet-light screening fabrics) for extra protection.  Don't smoke. Smoking ages our skin, making it look older and leading to wrinkles. It also restricts blood flow that supplies nutrients and oxygen essential for skin health.  Eat a healthy, balanced diet — with plenty of water. Many of the best foods for healthy skin also promote good overall health. Eat plenty of fruits and vegetables. Research suggests that antioxidant-rich foods like tomatoes, berries, beans, peas and lentils, and fatty fish like salmon, can help protect our skin. The key is variety — and lots of water to keep skin hydrated.  Keep it clean, but gentle. Use warm rather than hot water when washing, showering or shaving, avoid strong and/or abrasive soaps, pat dry and moisturize all over, especially during the winter.  Check it out. We know our skin and what looks normal for us. Regular skin checks for anything unusual, new, rough, raised, discolored or is taking a long time to heal can catch issues early. A spot getting darker, bigger or more irregular also is a warning sign. Make a note and see your care team. Some health conditions, such as diabetes and cardiovascular disease, can lead skin to break down, making it more susceptible to sores and ulcers. Your care team can help manage wounds by identifying causes and working on nutrition and ways to promote healing.  Older skin, special care. As we age, our skin ages, too. It becomes thinner, more fragile and less quick to heal. We also tend to bruise easier, especially if we're on any type of blood thinner. The bruises to be concerned about are those in more protected areas that typically don't get bumped. To protect against aging skin, keep it moisturized, avoid bumps and falls and eat a healthy, balanced diet, which includes getting enough calories, protein and fats.  <a rel="noopener noreferrer" href="https://communityhealth.mayoclinic.org/providers/paul-takahashi-md" target="_blank">Dr. Paul Takahashi</a> is an internal medicine physician in Primary Care in Rochester and Kasson's Division of Community Internal Medicine (CIM) and practices at the Baldwin Building clinic in Rochester. His interests include geriatric medicine, long-term and nursing home care, and public health. Dr. Paul TakahashiPrimary Care in Rochester and KassonSkin Care 2020Primary Care in Rochester and KassonCall or message your care team to schedule a visit.&nbsp;<img src="/-/media/ech-media/images/widgets/people/ech_pandemiccareoptions.jpg?h=65&iar=0&w=100&sc_lang=en&hash=4B506BE6254431D88375C886DF15FECC" alt="ECH_PandemicCareOptions" width="100" height="65" DisableNVelocity="true" />Video Visits available in Primary Care7/6/2020 10:00 AM<img src="/-/media/ech-media/images/widgets/people/ech_pandemiccareoptions.jpg?h=195&iar=0&w=300&sc_lang=en&hash=E4242E27821A82E356C7C8BAAB26CC80" alt="ECH_PandemicCareOptions" width="300" height="195" DisableNVelocity="true" />Your primary care providers in the Department of Family Medicine and the Divisions of Community Internal Medicine and Community Pediatric and Adolescent Medicine would like to remind you of our availability for video visits.  All primary care providers are trained in video visits and anyone with a Patient Online Services account can easily participate.  Video visits are particularly good for certain types of appointments, such as mental health-related follow-up visits, skin conditions, medication and treatment plan questions, or if you have questions where face-to-face shared decision making needs to occur but an exam is not needed.  Video visits save you time and travel. Many patients have found it convenient to schedule these during a work day when on a break. If you would like to schedule a video visit, please call or message your primary care appointment scheduler with the request and they will be happy to help you.  Below are two helpful videos that show you how to get going with video visit technology. The first demonstrates setting up from the Patient Online Services website and the second from the Mayo Clinic App.  <iframe width="560" height="315" src="https://www.youtube.com/embed/_cYczRSz4V8" frameborder="0" allow="accelerometer; autoplay; encrypted-media; gyroscope; picture-in-picture"></iframe>   <iframe width="560" height="315" src="https://www.youtube.com/embed/0yO5KShM8Cc" frameborder="0" allow="accelerometer; autoplay; encrypted-media; gyroscope; picture-in-picture" allowfullscreen=""></iframe> Your primary care providers are excited to bring you, our patients, more options for finding the type of care you need, when you need it. Primary Care in Rochester and KassonVideo VisitsPrimary Care in Rochester and KassonIf you are experiencing dizziness, it's time to contact your provider.&nbsp;<img src="/-/media/ech-media/images/widgets/people/dizziness_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=58C7F64A2DD7F88C902C5291FCBDCC82" alt="Dizziness_widget" width="100" height="65" DisableNVelocity="true" />Dizziness - a common problem8/24/2020 5:00 AM<img src="/-/media/ech-media/images/widgets/people/dizziness_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=60D6EB39006E4525FC71909B47AA5B6E" alt="Dizziness_widget" width="300" height="195" DisableNVelocity="true" />Dizziness is not a disease, but usually a symptom of a different underlying problem. In most cases, you should see your health care provider if you develop dizziness, a sense of motion or spinning (i.e., vertigo), lightheadedness or wooziness, or unsteadiness.  Problems in various parts of your body could lead to dizziness or feeling out of balance. It is helpful to understand the timing and triggers for the dizziness and know about other accompanying symptoms. Common cases include low blood pressure, dehydration, and medication side effects. An inner ear problem or migraine also can cause dizziness, as can psychiatric conditions like anxiety. Rarely, dizziness can indicate a heart or brain problem such as stroke or tumor.  Sometimes a referral to a specialist is needed to address the cause of the issue. Common inner ear problems, such as BPPV (benign paroxysmal positional vertigo) or vestibular neuritis may be treated with medication and vestibular therapy to improve the symptoms. Referral to an ear, nose, and throat specialist is sometimes needed. If your dizziness is found to be a manifestation of migraine or other nervous system disorder, referral to a neurologist may be helpful.  Dizziness/vertigo usually does not signal a serious condition, but if you have any of the following conditions, you should contact your primary care provider:  <ul> <li>A new, different or severe headache</li> <li>Blurred or double vision</li> <li>Hearing loss</li> <li>Speech problems</li> <li>Weakness in your arm(s) or leg(s)</li> <li>Loss of consciousness</li> <li>Problems walking</li> <li>Numbness or tingling anywhere on the body</li> <li>Chest pain or a fast or slow heart rate</li> </ul> Karen Truitt, DO, is a community neurologist in the Department of Neurology, Mayo Clinic in Rochester. She completed her adult neurology residency and her clinical neurophysiology fellowship at Mayo Clinic. She also performs neurology procedures at Mayo Clinic Health System in Red Wing and Mankato. Karen Truitt, DOPrimary Care in Rochester and KassonDizzinessPrimary Care in Rochester and KassonLearn more about the FODMAP diet and whether it is right for you.&nbsp;<img src="/-/media/ech-media/images/widgets/food/fodmap_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=CC80EED48FD4DA3AFD654B7E24B1D17E" alt="FODMAP_widget" width="100" height="65" DisableNVelocity="true" />What is a FODMAP diet and what symptoms does it treat?8/20/2020 5:00 AM<img src="/-/media/ech-media/images/widgets/food/fodmap_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=6310DE0EEB78F98455529D28AD16788B" alt="FODMAP_widget" width="300" height="195" DisableNVelocity="true" />FODMAPs are poorly absorbed, fermentable, short-chain carbohydrates that are commonly found in our diet. FODMAP stands for Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols. It has been proposed that a diet high in FODMAPs can produce gastrointestinal symptoms including diarrhea, constipation, bloating, gas and abdominal discomfort or pain. The symptoms are common in patients diagnosed with irritable bowel syndrome (IBS).  What are examples of food high in FODMAPs? Foods high in fructose include apples, pears, watermelon, asparagus, sugar snap peas, fruit juices, dried fruit, high fructose corn syrup, and honey. Foods high in lactose include custard, ice cream, milk, cheese, and yogurt. Polyols are found in apricots, nectarines, peaches, plums, cauliflower, and sorbitol. Brussels sprouts, garlic, onion, rye, and wheat are examples of fructans. Finally, chickpeas, legumes, lentils, pistachio nuts, and cashews are examples of galactans.  How do I follow a low FODMAP diet? It is best to meet with a dietitian and discuss how to start a low FODMAP diet.  <ul> <li>Step 1 (the elimination phase) of the diet involves changing from high FODMAP foods to low FODMAP foods for a period of 2-6 weeks. </li> <li>Step 2 (the reintroduction phase) of the diet focuses on the reintroduction of FODMAPs into your diet. One FODMAP should be reintroduced every 3 days. This process of reintroducing foods can take 8-12 weeks. </li> <li>Step 3 (the maintenance phase) is the personalization phase of the diet. In this phase, you work on finding the balance between FODMAP rich foods and low FODMAP foods. </li> </ul> Does this diet help everyone with IBS? Unfortunately, a FODMAP diet will not help everyone diagnosed with IBS. It may help to decrease some of the symptoms of IBS such as bloating, gas, abdominal discomfort and possible diarrhea.  Where can I learn more about a low FODMAP diet? There are several resources available for patient education on FODMAP: <ul> <li><a rel="noopener noreferrer" href="https://www.aboutibs.org/low-fodmap-diet.html" target="_blank">The Low FODMAP Diet Approach: Dietary Triggers for IBS Symptoms</a> (International Foundation for Gastrointestinal Disorders [IFFGD])</li> <li><a rel="noopener noreferrer" href="http://www.myginutrition.com/" target="_blank">My Nutrition Health</a> (University of Michigan)</li> <li><a rel="noopener noreferrer" href="https://www.monashfodmap.com/ibs-central/i-have-ibs/starting-the-low-fodmap-diet/" target="_blank">Starting the FODMAP diet</a> (Monash University)</li> </ul> What if a low FODMAP diet does not help me?  If you fail to improve on the FODMAP diet, it is important that you reintroduce foods and liberalize your diet. A low FODMAP diet is not meant to be a long-term diet for anyone. The long-term goal of this diet is to find balance between symptomatic improvements without having negative effects on your nutrition.  <a rel="noopener noreferrer" href="https://www.mayoclinic.org/biographies/hansel-stephanie-l-m-d-m-s/bio-20055204" target="_blank">Dr. Stephanie Hansel</a> is a gastroenterologist at Mayo Clinic in Rochester. She completed her MS at North Dakota State University, her MD at the University of North Dakota School of Medicine and Health Sciences, her Internal Medicine residency at University of Nebraska Medical Center, and her gastroenterology fellowship at Mayo Clinic in Arizona. Her interests include general gastroenterology, endoscopy, and medical education. Stephanie Hansel, MD, MSPrimary Care in Rochester and KassonFODMAP dietPrimary Care in Rochester and KassonDon't let food labels stress you out! Use these tips to make smart choices.&nbsp;<img src="/-/media/ech-media/images/widgets/food/ech_eating_well_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=E1B9D64EF54BFD64FC484D2928964346" alt="ECH_eating_well_widget" width="100" height="65" DisableNVelocity="true" />Food labels: How to navigate the grocery aisles8/27/2020 5:00 AM<img src="/-/media/ech-media/images/widgets/food/ech_eating_well_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=C03E91A3632E3CA2DCBD7279F97CAB5F" alt="ECH_eating_well_widget" width="300" height="195" DisableNVelocity="true" />We all get that feeling of confusion when staring blankly at the grocery shelves trying to figure out what item to purchase among the vast options available. Do I want the natural version or lower sodium? Organic or non-GMO? What kind of eggs come from the most humane farms? Labels on food packaging can be unclear and misleading. By understanding what some of their claims mean, you can make more informed choices and have confidence the next time you revisit those shelves. Organic: The organic label addresses the type of farming practice used to grow food or ingredients. Organic food is grown without the use of synthetic pesticides and fertilizers, genetically-engineered crops, and antibiotics or growth hormones in livestock. Although synthetic pesticides and fertilizers are prohibited in organic practices, natural chemicals commonly found in nature are allowed in production. Unless the label explicitly states "100% Organic," the organic label only requires that 95 percent of the ingredients in the product be certified organic. While most assume organic is the healthier option, research is inconclusive if these practices produce more nutritious food. If trying to eat healthy, don’t feel compelled to pay the higher prices for organic foods, as conventional versions can be just as nutritious! Non-GMO: Many people confuse "non-GMO" to mean the same thing as "organic." While all organic food is non-GMO, not all non-GMO foods are organic. Non-GMO is a term used to identify foods that do not have genetically-modified organisms. GMOs are typically used to better harvests by selecting traits in crops that are desirable, such as being resistant to certain pests. While some believe GMO foods are unsafe to consume, research does not support this claim; however, long-term safety of these foods is unknown. Natural: The use of the term "natural" on food products does not have a formal definition yet, but the Food and Drug Administration (FDA) has noted the meaning to include foods that contain no artificial or synthetic ingredients, which include color additives. Although natural foods are free from artificial ingredients, it does not address whether a food contains pesticides or has been subject to irradiation or pasteurization.  Grass-fed beef: When purchasing beef, this grass-fed claim often evokes a feeling of a higher quality and healthier product. However, the term "grass-fed" may not mean that the cattle were fed on grass for their entire lives. All beef are fed grass up until the final months before harvest, at which time they may be switched to a grain-based diet to reach goal weight at a faster pace. Products that state the beef is "grass-finished" mean the cattle grazed on grass prior to harvest, but can still be misleading in the sense that these cattle may still have consumed grain at some point. Only products with a "100 percent grass-fed" label come from cattle that consumed an all-exclusive grass diet. Neither claim addresses or prohibits the use of antibiotics or hormones during production. Cage-free vs. free-range vs. pasture-raised: All these phrases evoke pastoral scenes, but they don’t mean the same thing. <ul style="list-style-type: disc;"> <li>Cage-free pertains to chickens that are not housed in individual cages, but can still be kept in close quarters with one another and are not required to have outdoor access. </li> <li>Cage-free is regulated by the United States Department of Agriculture (USDA), but the use of the claim "free-range" is only regulated for poultry, not eggs. This term generally means the hens have access to outdoor space, but the size of the outdoor space is often not defined and does not have to be a field or pasture. </li> <li>Free-range chickens may be able to exit and enter the outdoor space as they please, but does not ensure they were outdoors at all. </li> <li>Pasture-raised is not a term regulated by the USDA and has come to mean the hens have access to a pasture to scratch and peck. The size of the pasture is not defined unless the claim has been humane-certified, which means the pasture has to be a minimum of 108 square feet. Similar to grass-fed claims, these claims pertain to chickens and does not address hormones, antibiotics, or the diet.</li> </ul> The bottom line with food label claims is that we shouldn’t let them stress us out on our next trip to the grocery store. Many of these claims are intended to help companies sell product and provide little insight into the health and nutrition of the food. Next time you feel paralyzed in the grocery aisles by the many claims screaming out to you, know that it’s all based on preference and no claim is superior to the other. A registered dietitian (RDN) is your go-to for advice and guidance on understanding how a particular food could impact health and how it might best "fit" in meeting your nutrition needs. Some grocery store chains hire RDNs to serve their clients to help them sort out all these claims. Encourage folks to ask at their local grocery store for guidance from the store's RDN - nobody should have to face the aisles alone! Victoria Vasquez is a Mayo Clinic dietetic intern and graduated from Montclair State University with her Bachelor's in Nutrition and Food Science. She hopes to pursue a career as a clinical dietitian. Her areas of interest include critical care and nutrition support. Michaeleen Burroughs, RDN, LD, has worked at Primary Care in Rochester and Kasson in Family Medicine for 20 years. She currently helps patients at Mayo Family Clinics Northwest, Southeast and Kasson, and Baldwin Family Medicine and Community Pediatric and Adolescent Medicine (CPAM). Her areas of interest are diabetes and child and adult weight management. Victoria Vasquez and Michaeleen Burroughs, RDN, LDPrimary Care in Rochester and KassonFood Label ClaimsPrimary Care in Rochester and KassonLead exposure can cause serious health issues in both children and adults.&nbsp;<img src="/-/media/ech-media/images/widgets/randomimages/ech_lead_hazard_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=7ACBD0D55388E46FB000D2127FA1528D" alt="ECH_lead_hazard_widget" width="100" height="65" DisableNVelocity="true" />Lead exposure: Why it's dangerous to you and your family8/31/2020 5:00 AM<img src="/-/media/ech-media/images/widgets/randomimages/ech_lead_hazard_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=B1A62045B96D5754A961E84F60F7D292" alt="ECH_lead_hazard_widget" width="300" height="195" DisableNVelocity="true" />Up until the 1970s, lead was used in paint, as an additive in gasoline, in water pipes and many other products, so it was found in homes, the air, water and soil. Children were often poisoned by eating chips of lead-based paint peeled from windowsills and walls or by chewing on painted toys. In Flint, it was caused by lead leaching from corroded water pipes.  Recognizing the health impact of lead, public health agencies took measures to have it removed from gasoline and paint. However, many older homes still may have lead-based paint inside and out, creating an exposure risk from chips and dust.  The U.S. banned lead-based paint in 1978. Homes built before 1978 likely contain lead-based paint. Lead from the paint can contaminate house dust and the grounds around the home as the paint chips, cracks, and wears. Home renovations may inadvertently increase lead exposure from demolition and sanding. Painted wooden windows might release lead when opening and closing causes the painted surfaces to rub and wear. While lead exposure is less of a concern today, it's still a concern, especially for older infants and toddlers. Why? Because at these ages, they tend to put things in their mouth. Lead poisoning is caused when lead builds up in the body. Even small amounts can cause serious health problems, including: <ul> <li> Non-reversible cognitive issues, such as, lower IQ and poorer school performance, which will affect them throughout their lifetime. </li> <li> Slower growth and physical development </li> <li> Damage to the kidneys and nervous system in both children and adults </li> <li> Seizures and unconsciousness from particularly high levels </li> </ul> The main way you can help protect you and your family is to: <ul> <li> Reduce exposure to lead-based paint chips.</li> <li>Wash hands and toys to reduce hand-to-mouth transfer of contaminated dust or soil from chips that may have fallen onto the ground around your home.  </li> <li> Keep up on repairs around your home.  </li> <li> Undertake lead-abatement measures, if necessary.  </li> <li> Eat a healthy diet. Good nutrition and regular meals can help lower lead absorption.  </li> </ul> Also, see your health care provider regularly, especially if your child is under age two. If you're concerned about lead exposure, please tell your care team, so that your child can be screened. Your home also can be checked for lead, and if risk levels are high, we can refer you to the public health department for lead abatement and other programs.  Dr. Yasaman Fatemi completed her medical schooling and pediatric residency here at Mayo Clinic, served as that residency’s chief resident, and now is a fellow at Children’s Hospital of Philadelphia in Pediatric Infectious Diseases.  <a href="https://communityhealth.mayoclinic.org/providers/robert-jacobson-md/">Dr. Robert M. Jacobson</a> is a pediatrician in Primary Care in Rochester and Kasson's Division of Community Pediatric and Adolescent Medicine (CPAM) and medical director of the Primary Care in Southeast Minnesota Immunization Program. Drs. Yasaman Fatemi and Robert M. JacobsonPrimary Care in Rochester and KassonLead Exposure 2020Primary Care in Rochester and KassonWhen you notice cognitive changes in yourself or your loved one, notify your health care team.&nbsp;<img src="/-/media/ech-media/images/widgets/people/dementia_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=4AA1B67D7186EEA03F5DFE219CF3B6A3" alt="Dementia_widget" width="100" height="65" DisableNVelocity="true" />Mild Cognitive Impairment (MCI): When to worry8/17/2020 5:00 AM<img src="/-/media/ech-media/images/widgets/people/dementia_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=A4CCC1C33EBCA3F17CDAF1D97506B5A7" alt="Dementia_widget" width="300" height="195" DisableNVelocity="true" />Changes in cognition (e.g., thinking) are a natural part of aging; everyone will likely experience some form of change in cognition as they get older. Peak cognitive performance may occur from late teens for processing speed to 40s and 50s for measures of emotional intelligence. Once past these peaks, it is common to notice some cognitive changes, which typically fit into one of three categories:  <ul> <li>Normal aging</li> <li>Mild cognitive impairment (MCI)</li> <li>Dementia</li> </ul> Cognitive changes seen with normal aging may be a nuisance, but they are generally minor, do not disrupt one's daily activities, and cannot be detected on formal cognitive tests. Common examples include forgetting names, telling stories repeatedly, relying more on written lists rather than memory, or forgetting tasks.  On the other end of the spectrum, dementia is a progressive decline in cognition that is more severe and leads to impairment in daily activities such as the ability to drive, manage finances, or cook a meal, and in more advanced cases even dressing, bathing, or toileting.  MCI lies between normal age-related cognitive changes and dementia. MCI is a decline in cognition more significant than that expected with normal aging but not yet severe enough to affect one's daily activities. It is significant enough to be detected on formal cognitive tests. MCI is common and affects 10 to 20 percent of adults age 65 and older. Risk increases with age, and men appear to be at higher risk than women. Anywhere from 5 to 20 percent of people with MCI progress to dementia annually, though not everyone with MCI eventually develops dementia.  When you notice cognitive changes in yourself or a loved one, it is important to notify your health care team. If you are diagnosed with MCI, your provider will help determine the underlying cause.  While MCI commonly represents a precursor to dementia — most commonly Alzheimer's dementia — it may have other causes like depression or medication side effects. There are no drugs to treat MCI directly, but, depending on the cause, treatment of an underlying condition may help (for instance, if depression is causing MCI, treatment with an anti-depressant may help). Aerobic exercise, mental activity, social engagement, and management of cardiovascular risk factors (blood pressure, cholesterol, etc.) all may help reduce risk of further cognitive decline.  With early detection, your health care team can help you manage MCI and optimize your function and quality of life.  <a href="https://communityhealth.mayoclinic.org/providers/brandon-verdoorn-md/">Dr. Brandon Verdoorn</a> is an Assistant Professor of Medicine in the Mayo Clinic College of Medicine and a consultant in the Division of Community Internal Medicine, where he practices mainly in nursing homes and other similar venues. He is the medical director of two nursing homes and holds several education leadership roles. Brandon Verdoorn, MD, CMDPrimary Care in Rochester and KassonMild Cognitive ImpairmentPrimary Care in Rochester and KassonA combination of approaches can lead to successful chronic pain management.&nbsp;<img src="/-/media/ech-media/images/widgets/elderly/ech_chronicpain_01_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=9439198FC621C0263C04CCB141028AD4" alt="ECH_ChronicPain_01_widget" width="100" height="65" DisableNVelocity="true" />5 tips to gain control of your chronic pain9/28/2020 6:00 AM<img src="/-/media/ech-media/images/widgets/elderly/ech_chronicpain_01_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=4EF02154877B7DB12957265C2A5EA21E" alt="ECH_ChronicPain_01_widget" width="300" height="195" DisableNVelocity="true" />Up to 15% of the U.S. population suffers from some form of chronic pain, which can cause distress, limit daily activities and lead to debility. This is seen more often in older adults, where health issues, such as degenerative joint disease and diabetes, may cause additional pain and neuropathy. Living with longstanding pain can be frustrating, affecting our moods, relationships, stress and quality of life.  Successful management of chronic pain is a multifaceted process, much of which is influenced by our ability to realign our lives in a meaningful direction, despite physical limitations. These five lifestyle tips can help you gain control of chronic pain:  Develop healthy sleep habits Sleep deprivation can worsen the pain experience. This often becomes a vicious cycle with uncontrolled pain leading to poor sleep quality and quantity, which in turn leads to more pain. Solving chronic insomnia can involve working closely with your doctor to understand your barriers to falling asleep — and staying asleep.  There are many creative strategies to helping you regain restorative sleep. One excellent resource is the book, No More Sleepless Nights by Peter Hauri, that may help you better understand how to achieve restful sleep.  Stay active and find creative ways to do the things you love It's hard to imagine staying active when you're in so much pain. This is how people become trapped in a cycle of decline. Don't let your pain affect your joy in day-to-day activities. If you like biking, you can continue to do so, but maybe for a shorter time. If you love arts and crafts but can no longer do them, consider teaching them to others. If exercise is painful for your joints, try water exercise instead. Exercising is known to boost pain relief with natural endorphins and also helps strengthen muscles to prevent reinjury and further pain.  Reduce stress and anxiety Stress intensifies the pain experience. Negative perceptions from depression, anxiety, stress and anger can increase sensitivity to pain. Explore techniques to promote stress reduction and relaxation. Remove yourself from conditions that are adding to your stress. Surround yourself with supportive friends and family. Look into support groups with people who can identify with you. Be encouraged that there are always manageable ways to redirect your situation.  Incorporate focused physical therapy Physical therapy can be helpful if there are recurring problem areas such as back, neck and joint pain. Our skeleton is aligned in such a way to support the weight of the entire body. Injuries lead to a disruption of the support provided by bones, tendons, ligaments and nerves. Focused therapies directed by a trained physical therapist can provide great guidance in rehabilitation, strength and resilience training to rebuild those crucial support structures. Exercises from your physical therapist can be incorporated into your daily schedule.  Alternative and integrative medicine options There are many integrative practices that have been shown to reduce pain. These are safe alternatives that don't add potentially harmful medications to your current regimen. Acupuncture, massage therapy, medication, biofeedback mechanisms and numerous mind-body techniques can be done daily to improve your pain experience and regain control of your body.  <a rel="noopener noreferrer" rel="noopener noreferrer" href="http://communityhealth.mayoclinic.org/providers/christina-chen-md" target="_blank">Dr. Ying Ying (Christina) Chen</a> is a geriatrician in Primary Care in Rochester and Kasson's Division of Community Internal Medicine (CIM). Dr. Christina ChenPrimary Care in Rochester and KassonChronic Pain TipsPrimary Care in Rochester and KassonThese tips can help keep your child safe during the upcoming school year.&nbsp;<img src="/-/media/ech-media/images/widgets/kids/kidsmasks_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=1F4DCA4F75789DC0AB1C184C96EA4245" alt="KidsMasks_widget" width="100" height="65" DisableNVelocity="true" />Returning to school safely during the COVID-19 pandemic9/8/2020 5:30 AM<img src="/-/media/ech-media/images/widgets/kids/kidsmasks_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=D3CB455919AC3D235E5379478E892C6B" alt="KidsMasks_widget" width="300" height="195" DisableNVelocity="true" />Opening schools during the COVID pandemic has created new challenges and difficult decisions for families and school systems. Some children will be engaged in distance learning, while others will have a hybrid of in-person and virtual classes. Many parents are wondering how to keep their kids safe this school year and make their transition back to school as smooth as possible.  For children returning to in-person classes, we know that masks are an effective way to help prevent spread of COVID-19. Here are a few helpful tips for educating your child on safety: <ul> <li>Teach your child that their mask goes over both their nose and mouth. </li> <li>Have a few different masks for your child so that you can easily wash or replace masks that become dirty or misplaced. </li> <li>Many children also enjoy picking out fabrics with characters or designs they like, which makes mask wearing a little easier!</li> <li>Talk with your child about what they can expect at school, such as staying six feet apart from others and frequent hand washing. </li> <li>Most importantly, keep your child home from school if they are ill. </li> </ul> If your child will be engaging in virtual or distance learning, you may have questions about how to help them stay focused while not in the physical classroom. Maintaining routines at home can help with focus, as can creating a dedicated space for learning. Staying in touch with friends through apps like FaceTime is an option so that your child can remain socially connected even while staying physically distanced. Peer interaction is crucial for children, especially teens.  Both the <a rel="noopener noreferrer" href="https://www.cdc.gov/coronavirus/2019-ncov/index.html" target="_blank">Centers for Disease Control and Prevention (CDC)</a> and <a rel="noopener noreferrer" href="https://www.health.state.mn.us/diseases/coronavirus/situation.html" target="_blank">Minnesota Department of Health (MDH)</a> websites have reliable and up-to-date information about COVID and returning to school. If you have questions or concerns about safety at school during COVID, please reach out to your family's primary care provider. They will be able to provide the best recommendation based on your child's health history and current well-being.  <a rel="noopener noreferrer" href="https://communityhealth.mayoclinic.org/providers/anna-kellund-md/" target="_blank">Dr. Anna Kellund</a> is a pediatrician in Primary Care in Rochester and Kasson's Division of Community Pediatric and Adolescent Medicine. She is an instructor in Pediatrics and has interests in undergraduate and graduate medical education. Anna Kellund, MDPrimary Care in Rochester and KassonCOVID SchoolPrimary Care in Rochester and KassonCOVID-19 and the flu have many similarities and some key differences. Find out what to know and how to protect yourself from these diseases.&nbsp;<img src="/-/media/ech-media/images/widgets/people/uri_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=08E8B686372E07E4C572C50DE280175C" alt="URI_widget" width="100" height="65" DisableNVelocity="true" />Coronavirus versus flu: Similarities and differences9/10/2020 5:30 AM<img src="/-/media/ech-media/images/widgets/people/uri_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=F347820C49206B1F09BE366B63660154" alt="URI_widget" width="300" height="195" DisableNVelocity="true" />During the COVID-19 pandemic, you may have heard that COVID-19 is similar to influenza (flu). COVID-19 and the flu are both contagious respiratory diseases caused by viruses. They have some common symptoms. But through closer comparison, they can affect people differently. Also, since the flu has been around much longer, doctors know more about how to treat and prevent it, while they continue to learn more about COVID-19. How are COVID-19 and the flu similar? The viruses that cause COVID-19 and the flu spread in similar ways. They can both spread between people who are in close contact (within 6 feet). The viruses spread through respiratory droplets or aerosols released through talking, sneezing or coughing. These droplets can land in the mouth or nose of someone nearby or be inhaled. These viruses can also spread if a person touches a surface with one of the viruses on it and then touches his or her mouth, nose or eyes. COVID-19 and the flu have many signs and symptoms in common, including: <ul style="list-style-type: disc;"> <li>Fever</li> <li>Cough</li> <li>Shortness of breath or difficulty breathing</li> <li>Tiredness</li> <li>Sore throat</li> <li>Runny or stuffy nose</li> <li>Muscle aches</li> <li>Headache</li> <li>Nausea or vomiting, but this is more common in children than in adults</li> </ul> The signs and symptoms of both diseases can range from no symptoms to mild or severe symptoms. Because COVID-19 and the flu have similar symptoms, it can be hard to diagnose which condition you have based on your symptoms alone. Testing may be done to see if you have COVID-19 or the flu. You can also have both diseases at the same time. Both COVID-19 and the flu can lead to serious complications, such as pneumonia, acute respiratory distress syndrome, organ failure, heart attacks, heart or brain inflammation, stroke and death. Many people with the flu or mild symptoms of COVID-19 can recover at home with rest and fluids. But some people become seriously ill from the flu or COVID-19 and need to stay in the hospital. What's the difference between COVID-19 and the flu? COVID-19 and the flu have several differences. COVID-19 and the flu are caused by different viruses. COVID-19 is caused by a new coronavirus called SARS-CoV-2, while influenza is caused by influenza A and B viruses. Symptoms of COVID-19 and the flu appear at different times and have some differences. With COVID-19, you may experience loss of taste or smell. COVID-19 symptoms generally appear two to 14 days after exposure. Flu symptoms usually appear about one to four days after exposure.  COVID-19 appears to be more contagious and to spread more quickly than the flu. Severe illness such as lung injury may be more frequent with COVID-19 than with influenza. The mortality rate also appears to be higher with COVID-19 than the flu. COVID-19 can cause different complications from the flu, such as blood clots and multisystem inflammatory syndrome in children. Another difference is that the flu can be treated with antiviral drugs. No antiviral drugs are currently approved to treat COVID-19. Researchers are evaluating many drugs and treatments for COVID-19. Some drugs may help reduce the severity of COVID-19. You can get an annual flu vaccine to help reduce your risk of the flu. The flu vaccine can also reduce the severity of the flu and the risk of serious complications. Each year's flu vaccine provides protection from the three or four influenza viruses that are expected to be the most common during that year's flu season. The vaccine can be given as an injection or as a nasal spray. The flu vaccine doesn't protect you from getting COVID-19. Research shows that getting the flu vaccine does not make you more likely to get COVID-19 or other respiratory infections. No vaccine is currently available to the public for the virus that causes COVID-19. But researchers are working to develop vaccines to prevent COVID-19 and continue to make progress. How might COVID-19 affect this year's flu season? Flu season in North America typically occurs between October and May. It's possible that the viruses that cause COVID-19 and the flu may spread in your community at the same time during the flu season. If this happens, people could become ill with one or both diseases at the same time. Testing can determine which virus you may have and help guide doctors to the appropriate treatment. People who become seriously ill from either disease may need to stay in the hospital at the same time, which could cause the hospitals to become full. How can you avoid getting COVID-19 and the flu? The good news is you can take the same steps to reduce your risk of infection from the viruses that cause COVID-19, the flu and other respiratory infections by following several standard precautions. In fact, some research has found that following these measures, such as social distancing and wearing a face mask, may have helped shorten the length of the flu season and lessened the number of people affected in the 2019-2020 flu season. Standard precautions to reduce your risk of COVID-19, the flu and other respiratory infections include: <ul style="list-style-type: disc;"> <li>Avoiding large events and mass gatherings.</li> <li>Avoiding close contact (within 6 feet) with anyone outside your household, especially if you have a higher risk of serious illness.</li> <li>Washing your hands often with soap and water for at least 20 seconds, or using an alcohol-based hand sanitizer that contains at least 60% alcohol.</li> <li>Wearing a cloth face mask when you're in public spaces such as the grocery store, where it's difficult to avoid close contact with others.</li> <li>Covering your mouth and nose with your elbow or a tissue when you cough or sneeze.</li> <li>Avoiding touching your eyes, nose and mouth.</li> <li>Cleaning and disinfecting high-touch surfaces, such as doorknobs, light switches, electronics and counters daily.</li> </ul> Taking these prevention measures can help you stay healthy and reduce your risk of becoming ill with COVID-19 or the flu. This article is reprinted with permission from Mayo Clinic News Network (August 7, 2020).Primary Care in Rochester and KassonCOVID vs InfluenzaPrimary Care in Rochester and KassonYou can now schedule these appointments on Patient Online Services or with the Mayo Clinic App.&nbsp;<img src="/-/media/ech-media/images/widgets/people/ech_wellchildcheckup_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=07717E5A6583D5B79E2F85E2A839950E" alt="ECH_WellchildCheckup_widget" width="100" height="65" DisableNVelocity="true" />Just a click away: Scheduling well-child checkups9/3/2020 5:00 AM<img src="/-/media/ech-media/images/widgets/people/ech_wellchildcheckup_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=0339CD6FC55C0408FADCDB839A80DBF4" alt="ECH_WellchildCheckup_widget" width="300" height="195" DisableNVelocity="true" />You can schedule your two- to 12-year-old child's next well-child appointment directly on the Mayo Clinic App or from Patient Online Services. Just follow these steps: <ol> <li style="color: black;">Log in to <a href="https://onlineservices.mayoclinic.org/content/staticpatient/showpage/patientonline" title="https://onlineservices.mayoclinic.org/content/staticpatient/showpage/patientonline">Patient Online Services</a> on the web or on the <a href="https://www.mayoclinic.org/apps/mayo-clinic" title="https://www.mayoclinic.org/apps/mayo-clinic">Mayo Clinic App</a>.</li> <li style="color: black;">Open your child’s portal account.</li> <li style="color: black;">Go to Appointments.</li> <li style="color: black;">Select Well Child Check-Up. </li> <li style="color: black;">Select an available date and time to fit your schedule. </li> <li style="color: black;">Select the Schedule button.</li> </ol> The appointment is now scheduled. You can verify this by checking your child's upcoming appointments in Patient Online Services or on the Patient Appointment Guide. Before you come in for your appointment, complete pre-appointment tasks like answering questionnaires and updating insurance information using Patient Online Services on the web or the Mayo Clinic App. Remember to sign in at the kiosk, where available, or the desk when you arrive for the appointment. Some things to keep in mind for online well child check-up scheduling: <ul style="list-style-type: disc;"> <li style="color: black;">If the option to schedule a well child check-up isn't available, it may be because your child is not due for a well-child appointment just yet. </li> <li style="color: black;">Online scheduling is only available for children between the ages of two and 12 who have already been seen at Mayo Clinic by their pediatrician or family medicine provider. New patients should call Primary Care Connection (<a rel="noopener noreferrer" rel="noopener noreferrer" href="tel:5072842272" target="_blank">507-284-2272</a>) to request a primary care team. </li> <li style="color: black;">Your care team may send you a secure message asking for additional information. Please respond as quickly as possible so your team has all the information needed for the appointment.  </li> </ul>Primary Care in Rochester and KassonOnline WellChild SchedulePrimary Care in Rochester and KassonThese tips can help you deal with stressors from social anxiety.&nbsp;<img src="/-/media/ech-media/images/widgets/people/alonegroup_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=DECB4A9DD130420B5F8FD8A0D74D4F43" alt="AloneGroup_widget" width="100" height="65" DisableNVelocity="true" />Scared to speak up? The cause and cure for social anxiety9/21/2020 6:00 AM<img src="/-/media/ech-media/images/widgets/people/alonegroup_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=45992D09FC79A6FD2BCF40C876D99B0F" alt="AloneGroup_widget" width="300" height="195" DisableNVelocity="true" />Social anxiety disorder is one of the most common anxiety disorders. An estimated 12 percent of the population experiences it at some point in their lifetime. A person who has social anxiety feels significant fear or anxiety in everyday social situations like: <ul> <li>Meeting strangers</li> <li>Interacting with groups of people</li> <li>Engaging in a one-on-one conversation</li> <li>Using a public restroom</li> <li>Doing something in front of other people like speaking, writing or eating</li> </ul> Overall, people with social anxiety feel fearful about being judged critically and negatively evaluated by others. They often think that they will humiliate or embarrass themselves or that others will laugh at, make fun of, be offended by, or not like them.  The fear of being negatively evaluated by others often leads people with social anxiety to avoid social situations or experience significant anxiety in them. Passive avoidance, such as avoiding eye contact or trying to look busy while in social situations, can also be common ways to try to cope with their anxiety. As you may expect, social anxiety makes it harder to engage in social situations and can cause problems at home, school, and work.  Rates of depression and substance use tend to be higher in people with social anxiety relative to those with other anxiety-related disorders. Unfortunately, it often takes a long time for socially-anxious people to seek treatment. The <a rel="noopener noreferrer" href="https://adaa.org/" target="_blank">Anxiety and Depression Association of America</a> found that less than five percent of people seek treatment within a year of first experiencing social anxiety and 36 percent wait 10 years or longer.  What causes social anxiety disorder? There are many factors that contribute to the development of social anxiety disorder. Negative social experiences, like being bullied or doing something embarrassing, can lead to social anxiety. You are also much more likely to develop social anxiety if you have a naturally shy personality style or have an immediate family member with similar struggles.  Social anxiety tends to develop earlier in life. The majority of people who are diagnosed with social anxiety disorder begin to experience symptoms in childhood or adolescence, and many continue to experience significant difficulties from their anxiety well into adulthood. What types of treatments are available for social anxiety disorder? Cognitive behavioral therapy (CBT) has the strongest evidence for treating social anxiety disorder. CBT is a skill-building intervention that helps people learn how to identify and manage thoughts and behaviors that contribute to maintaining social anxiety. Common features of CBT for social anxiety include:  <ul> <li>Challenging thoughts: It's good to keep in mind that the anticipation of bad things happening in social situations tends to be worse than the actual outcomes. Most people are quite forgiving and tend not to notice our mistakes and struggles. Socially-anxious individuals tend to be their own worst critic; they often perform better in social situations than they think. </li> <li>Avoiding the avoidance: While avoidance makes sense when we feel uncomfortable, learning how to approach and tolerate social situations is extremely important. Gradual and repetitive exposures to progressively more challenging social situations often helps individuals feel more comfortable over time. </li> <li>Practicing social skills: Learning how to do small talk, ask for help, and maintain eye contact takes practice. Setting small social goals every day, such as saying hello to three people you are less familiar with, can help build confidence in these situations. </li> </ul> Joining social groups or participating in Toastmasters may help individuals gain comfort in social situations. Self-help books, such as The Shyness and Social Anxiety Workbook, can help introduce CBT skills and practical strategies that can be worked on over time. Some individuals may benefit from working with a CBT therapist to learn and strengthen skills to conquer their fears.  For more information on social anxiety disorder, check out: <ul> <li><a rel="noopener noreferrer" href="https://adaa.org/" target="_blank">Anxiety and Depression Association of America (ADAA)</a></li> <li><a rel="noopener noreferrer" href="https://www.abct.org/" target="_blank">Association for Behavioral and Cognitive Therapy (ABCT)</a></li> <li><a rel="noopener noreferrer" href="https://www.anxietycanada.com/" target="_blank">Anxiety Canada</a></li> </ul> Dr. Olivia Bogucki is a clinical health psychology fellow in Primary Care in Rochester and Kasson.  <a rel="noopener noreferrer" href="https://www.mayoclinic.org/biographies/sawchuk-craig-n-ph-d-l-p/bio-20085911" target="_blank">Dr. Craig Sawchuk</a> is a clinical psychologist in Primary Care in Rochester and Kasson and co-chairs the Division of Integrated and Behavioral Health.Olivia Bogucki, PhD, MA, and Craig Sawchuk, PhD, LPPrimary Care in Rochester and KassonSocial AnxietyPrimary Care in Rochester and KassonPints for Preemies brings lifesaving blood donations to patients in need.&nbsp;<img src="/-/media/ech-media/images/widgets/blooddonation/ellamingus_blooddonation_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=30D8404CDE0AA7D7863AA9C6B0577EBE" alt="EllaMingus_BloodDonation_widget" width="100" height="65" DisableNVelocity="true" />Pints for Preemies Blood Donation Challenge to be held through Nov. 1710/12/2020 6:00 AM<img src="/-/media/ech-media/images/widgets/blooddonation/ellamingus_blooddonation_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=156F04804D7231456B85EC54D2B60964" alt="EllaMingus_BloodDonation_widget" width="300" height="195" DisableNVelocity="true" />Stephanie Mingus, a Mayo Clinic nurse, always new the importance of blood donation, but this became more important when she and her daughter needed the precious gift of blood.  While pregnant with her second child, Ella, she began to have complications that required blood transfusions to save the pregnancy. After more complications due to chronic placental abruption, Stephanie when into early labor. Ella was born at 23 weeks, weighing only 1 pound, 3 ounces. Stephanie recalls the doctors saying Ella was so fragile that they didn't know if she would make it.  That was a scary realization to come to terms with.  During her 142-day stay in the Neonatal Intensive Care Unit, Ella required many blood transfusions, was incubated for over a month and needed oxygen for 9 months. Thankfully, Ella was able to come off oxygen in March.  "Ella had many ups and downs during her first few months of life, but we are happy to say she is a happy and healthy 1 year old," recalls Stephanie.  Ella's family saw firsthand the importance that blood products play in helping premature babies.  Pints for Preemies Blood Donation Challenge In honor of World Prematurity Day, the Mayo Clinic Blood Donor Program will host the Annual Pints for Preemies Blood Donation Challenge. This year's goal is to bring in more lifesaving blood donations and raise awareness of World Prematurity Day on Nov. 17.  The challenge will run through Nov. 17. To participate, schedule your appointment by calling <a href="tel:5072844475">(507) 284-4475</a>. Then simply check in at the front desk at the Mayo Clinic Blood Donor Center on the first floor of the Hilton Building. (Note that the Mayo Clinic Blood Donor Center in the Joseph Building on the Saint Marys Campus remains temporarily closed due to the COVID-19 pandemic and low staffing.) More information For more information about donating blood, call the Mayo Clinic Blood Donor Center at <a href="tel:5072844475">(507) 284-4475</a> or <a href="mailto:donateblood@mayo.edu">email the center</a>. Learn more on the <a rel="noopener noreferrer" href="https://www.mayoclinic.org/patient-visitor-guide/minnesota/blood-donor-program" target="_blank">Mayo Clinic Blood Donor Program webpage</a>. Primary Care in Rochester and KassonBlood Donation MingusPrimary Care in Rochester and KassonThis interactive model is a great tool to help you cope with stress related to COVID-19.&nbsp;<img src="/-/media/ech-media/images/widgets/people/blackwomanstress_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=09D53ECA5562FDF1EF52D1060CFA1FB2" alt="BlackWomanStress_widget" width="100" height="65" DisableNVelocity="true" />Building resiliency during the COVID-19 pandemic10/15/2020 5:30 AM<img src="/-/media/ech-media/images/widgets/people/blackwomanstress_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=AED6CD2BD6B169AC926125883AB35EC4" alt="BlackWomanStress_widget" width="300" height="195" DisableNVelocity="true" />Since the World Health Organization declared COVID-19 to be a global pandemic, stress levels have been increasing. Among other things, this stress is related to uncertainty, information overload, and disruptions in daily routines. Stress is a normal, healthy human response. It is also motivating. That means it helps people be more aware of their surroundings, get ready to take action, and plan and prepare for the future. Some common ways the body and mind show stress include:  <ul> <li> Emotionally, such as anxiety, fear, irritability, and sadness. </li> <li> Physically, such as sleep problems, tension, and fatigue. </li> <li> Thinking, such as worry, rumination, and racing thoughts.</li> <li> Behaviorally, such as avoidance, social withdrawal, and seeking reassurance. </li> </ul> Always keep in mind that what goes up does come down. Stressful times do come and go. When things are feeling more uncertain, try to focus on those things you can control. Mayo Clinic has developed an interactive module of active steps that you can take to cope with the stress caused by COVID-19. This interactive module focuses on building resiliency through healthy habits, social activities and media use, worry and mood management, and relaxation training. In each module, you will have access to videos to help you learn more about the topic. In addition, each module includes a prompt to help you set relevant goals. It is recommended that you work through each section of the interactive module week by week to give yourself enough time to practice the skills and work toward your goals. However, it is self-guided and should be completed at whatever pace works best for you. You can access the <a rel="noopener noreferrer" href="https://mccmscontent.mayo.edu/2020/PatientEducation/content/index.html#/" target="_blank">interactive module here</a>. Final thoughts Time and experience will help move things from being uncertain to being more certain. Know your limits. Keep track of your overall stress level and those things that help relieve it. If you find you are having difficulties coping, reach out to your health care team for resources and to discuss additional treatment options. Olivia Bogucki, Ph.D., is a clinical health psychology fellow in Primary Care at Mayo Clinic in Rochester and Mayo Family Clinic Kasson in Kasson.  <a rel="noopener noreferrer" href="https://www.mayoclinic.org/biographies/sawchuk-craig-n-ph-d-l-p/bio-20085911" target="_blank">Craig Sawchuk, Ph.D</a>., is a clinical psychologist in Primary Care at Mayo Clinic in Rochester and Mayo Family Clinic Kasson. He co-chairs the Division of Integrated Behavioral Health. Olivia Bogucki, Ph.D., and Craig Sawchuk, Ph.D.Primary Care in Rochester and KassonBuilding ResiliencyPrimary Care in Rochester and KassonScientific evidence does not support use of supplements at this time.&nbsp;<img src="/-/media/ech-media/images/widgets/medications/vitamins_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=A621C6E533B50E15E8EFF493846927A9" alt="Vitamins_widget" width="100" height="65" DisableNVelocity="true" />Using vitamins to combat COVID-19: What's the evidence?9/17/2020 5:00 AM<img src="/-/media/ech-media/images/widgets/medications/vitamins_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=A081ADA6F20D5043E76BF703A830606C" alt="Vitamins_widget" width="300" height="195" DisableNVelocity="true" />In recent weeks, there've been numerous claims on social media that vitamin supplements are effective for prevention and treatment of COVID-19. But what is the actual evidence that they can help you if you become sick? And what are the risks of using vitamins as a treatment? Vitamin C What's being reported: A very high dosage of vitamin C given intravenously has been reported, by researchers in Italy and China, to be helpful in patients hospitalized with COVID-related pneumonia. The results of these studies have not been formally published for the medical industry's reference, and without published medical trials, we don't know if the results are truly effective or what side effects may be involved. The high doses of vitamin C reported in these stories cannot be met by taking over-the-counter vitamin pills, and if you were to try, you could give yourself kidney stones, nausea, vomiting, diarrhea, dizziness, and interfere with other medications.  More formal studies of whether vitamin C is helpful in patients with COVID-19 are currently being conducted, and the safest course of action is to check with your primary care provider before adding a vitamin supplement to your diet.  Vitamin D What's being reported: There are studies looking at whether low vitamin D levels are related to outcomes in patients with COVID-19 infections. There are no studies looking at actual treatment of COVID-19 with vitamin D. High-dose vitamin D has potential serious side effects, and, again, you should check with your primary care provider before adding a supplement to your diet. If he or she is concerned about your vitamin D status, a blood test can be used to check for a deficiency. They can also advise you on how much vitamin D you should be getting every day and whether you should consider taking supplements to boost your daily intake.  Zinc What's being reported: One study looked at the addition of zinc to azithromycin and hydroxychloroquine in the treatment of hospitalized patients.  The results of these studies have not been published for the medical community's review, and the doses used in the study were very high and exceeded those considered generally safe. Zinc should only be used under a doctor's supervision to ensure proper dosages.  Other substances Other substances have been suggested — including elderberry, thiamine and melatonin — and remain untested, have potential harms, or have shown no benefit and should not be used.  Bottom line The bottom line is that there is no scientific data supporting the use of vitamins C, D, zinc or other vitamin supplements to prevent or treat COVID. Talk to your primary care provider for advice on vitamins and whether you should consider taking supplements to boost your daily intake.  <a href="https://communityhealth.mayoclinic.org/providers/denise-dupras-md/">Dr. Denise Dupras</a> is a general internist in Primary Care in Rochester and Kasson's Division of Community Internal Medicine (CIM). She completed her M.D.-Ph.D. at Mayo Medical School and her residency in Internal Medicine at Mayo Clinic in Rochester. Her interests include medical education and evidence-based medicine. Denise Dupras, M.D.Primary Care in Rochester and KassonCOVID VitaminsPrimary Care in Rochester and KassonIf you have a picky eater in your household, here are a few tips to make mealtime less stressful.&nbsp;<img src="/-/media/ech-media/images/widgets/kids/pickyeater_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=A5055CAB73B82D2EACFD9470F90D1E49" alt="PickyEater_widget" width="100" height="65" DisableNVelocity="true" />Tips for helping a picky eater10/1/2020 6:00 AM<img src="/-/media/ech-media/images/widgets/kids/pickyeater_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=C55695C7FA108A7A6D90F886F0F30D41" alt="PickyEater_widget" width="300" height="195" DisableNVelocity="true" />Having a picky eater in your household can be frustrating and make mealtimes stressful. Picky eating typically begins in young children and can last a lifetime. The good news is that it's never too early or too later to broaden one's palate and take a bite into a new food experience. Should I force picky eaters to eat veggies? You should not force picky eaters to eat their veggies. Force-feeding tends to interfere with the pleasure of eating. However, there is a difference between forcing, and encouraging, guiding and modeling healthy eating habits. Will picky eaters grow out of it? Up to 20% of children between the ages of 2 and 3 could be described as picky eaters. It is normal for young children to have strong likes and dislikes to foods. While most children grow out of it, some still have specific likes and dislikes. Acknowledge this, but continue to expose your children to plenty of healthy options. Also, be patient and try not to make food likes or dislikes a constant battle or topic of discussion. Tips for incorporating new foods Try these tips to help picky eaters incorporate new foods: <ul style="list-style-type: disc;"> <li>Let your children help prepare the food. Give them hands-on experience touching and smelling the food. </li> <li>Allow your children to fill their plate. Let them decide what and how much they will try. </li> <li>Encourage them to take a bite of new foods, but don't get frustrated if they don't like it. It can take up to eight attempts of trying a food before they start to like it. </li> <li>Try growing a few vegetables and have your child help with the process. This gives them an understanding of where food comes from. </li> <li>Offer the same foods to the whole family, and let your child see you eating and enjoying the meal. </li> </ul> What you say matters Telling your children that they have to eat the new food placed in from of them can make them feel as though they don't have a choice. Instead use phrases that help your children understand the sensory or beneficial qualities of a food. For example, instead of saying, "You have to take a bite," instead try saying: "These are carrots, and they are crunchy. They help your eyes so you can see better." By doing this, your children know a little of what to expect when they bite into the food. Adult picky eaters Expanding food preferences in adulthood can take a little more work, as adults have already distinguished the foods they like and dislike. Breaking out of the picky eating habits can be more stressful for adults, but it can still be done. Just as with children, don't force adult picky eaters to try new foods. Instead, encourage and support them. Here are some tips for adult picky eaters: <ul style="list-style-type: disc;"> <li>Take your time experimenting with new foods. </li> <li>Start out slow. For your first experience, just put the food in your mouth to understand its texture and how it tastes. It is OK to spit it out. For your second or third experience, just take one bite and swallow it. Next time, take a couple bites and keep growing from there. </li> <li>Most importantly, trust your own feelings as you try new foods, and go at your own pace. </li> </ul> Madison Hemer is a former dietetic intern at Mayo Clinic in Rochester, Minnesota. She completed her undergraduate education at Iowa State University. She is interested in gastroenterology and oncology for adults and children. Michaeleen Burroughs has been a dietitian at Mayo Clinic in Rochester for 29 years. She works with patients in Primary Care in Rochester and Kasson. Her areas of interest include diabetes, pediatric and adult weight management, and healthy eating for families.Madison Hemer and Michaeleen BurroughsPrimary Care in Rochester and KassonPicky Eater TipsPrimary Care in Rochester and KassonBlood donors became part of the superhero team for Nathan Herber.&nbsp;<img src="/-/media/ech-media/images/widgets/blooddonation/blooddonationnathan_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=E63C810E79F166047DBF96C18E3A62F8" alt="BloodDonationNathan_widget" width="100" height="65" DisableNVelocity="true" />Nathan Herber and his team of medical superheroes work to defeat cancer11/9/2020 5:00 AM<img src="/-/media/ech-media/images/widgets/blooddonation/blooddonationnathan_widget.jpg?h=205&iar=0&w=315&sc_lang=en&hash=86F61A98F4BE9141B13614710B259FFC" alt="BloodDonationNathan_widget" width="315" height="205" DisableNVelocity="true" />Nathan Herber already has been through more medical interventions than many people have to deal with in a lifetime. Diagnosed with non-Hodgkin lymphoma in 2018, Nathan has received multiple rounds of chemotherapy, endured a host of complications, developed several severe infections, required a ventilator to breath, and eventually had to receive extracorporeal membrane oxygenation (ECMO) to take over the work of his lungs. He was hospitalized in Mayo Clinic's Pediatric ICU for months. Through it all, Nathan and his family persevered, buoyed by Nathan's joyful spirit. "He is my little rainbow, and spreads smiles and cheer. He's a fighter, and he's so resilient," says Nathan's mother, Becky. Throughout his medical ordeal, blood products were a crucial part of Nathan's care. They were needed as his medical team prepared for the extracorporeal membrane oxygenation. And while he remained on the lung bypass, Nathan often required a unit or two of blood each day. "The blood bank at Mayo was wonderful," says Nathan's father, Andy. "The nurses were so proactive." Although it was a long process, with careful treatment, monitoring and care from his Mayo Clinic team, Nathan began to recover. After 86 days in the hospital, he was able to go home. Today, Nathan's cancer is in remission, and now he can join his siblings in their fun. Andy says his son's return to a happy childhood is nothing short of miraculous ― a reality that hit home on a recent family trip. "When I watched Nathan on the beach, and he was able to run with his brothers and jump in the ocean, I was overcome with emotion." Nathan's family planned the Crushing Koopas & Childhood Cancer blood challenge in September. They were able to collect many donations in support of this cause. This challenge now will become an annual event. Blood donors are lifesavers. Consider donating for someone today. You never know when that someone may be you or someone you love. When you give, others live. For more information about donating blood, call the Mayo Clinic Blood Donor Center at 507-284-4475 or <a href="mailto:donateblood@mayo.edu">email the center</a>. Learn more on the <a rel="noopener noreferrer" rel="noopener noreferrer" href="https://www.mayoclinic.org/patient-visitor-guide/minnesota/blood-donor-program" target="_blank">Mayo Clinic Blood Donor Program website</a>.Primary Care in Rochester and KassonBlood Donation HerberPrimary Care in Rochester and KassonWatch for the signs and symptoms and contact your provider with questions.&nbsp;<img src="/-/media/ech-media/images/widgets/kids/juvenilediabetes_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=DC9089A968EE622045C0291371580A54" alt="JuvenileDiabetes_widget" width="100" height="65" DisableNVelocity="true" />Is your child at risk for Type 1 diabetes?12/10/2020 5:00 AM<img src="/-/media/ech-media/images/widgets/kids/juvenilediabetes_widget.jpg?h=205&iar=0&w=315&sc_lang=en&hash=6ED00D4F24805AE9EAC7EED9353165E2" alt="JuvenileDiabetes_widget" width="315" height="205" DisableNVelocity="true" />Type 1 diabetes affects 1.6 million Americans; yet, you may not be familiar with or know what signs and symptoms to watch for. This article will familiarize you with this condition.   Who does Type 1 diabetes affect, and what are the risk factors?   Type 1 diabetes, once known as juvenile or early-onset diabetes, commonly affects children and young adults, but it can be discovered at any age. More common ages of diagnosis are 4–7 and 10–14.   If a parent or sibling has Type 1 diabetes, or if you are born with certain genes, your risk increases. Research suggests that there also may be triggers, such as viral infections or exposure to other environmental factors that aren't yet clearly understood. The number of cases of Type 1 diabetes increases the farther away from the equator people live.   What happens in Type 1 diabetes?   Type 1 diabetes occurs when the body accidentally attacks its own cells. Specifically, in Type 1 diabetes, the body attacks cells in the pancreas. The pancreas makes insulin, which is a substance that helps move sugar from the blood stream into the cells to be used for energy. However, in Type 1 diabetes the pancreatic cells are damaged to the point that the organ is unable to produce enough insulin and eventually cannot produce any insulin. Without insulin to move it from the blood into the body's cells, circulating sugar builds up, leading to signs and symptoms of high blood sugar.   What are the signs and symptoms of Type 1 diabetes?   Symptoms often occur suddenly, and may include being extremely tired, increased thirst and urination, unintentional weight loss, blurred vision, yeast infections, itchy skin, nausea or vomiting, extreme hunger, fruity smelling breath, bed-wetting in a child who was previously potty-trained, and irritability. If you or your child exhibit any of those symptoms, you should contact your health care provider.   How is Type 1 diabetes diagnosed?   Blood work is essential in diagnosing Type 1 diabetes. Some tests that can show high levels of sugar in the body include: <ul style="list-style-type: disc;"> <li>Hemoglobin A1c This test gives an average of your blood sugar from the previous three months. </li> <li>Fasting sugar This test measures sugar levels in the bloodstream after at least 12 hours of fasting. </li> <li>Random sugar, or oral glucose tolerance, test This test measures your body's response to sugar.</li> </ul> Urine studies also may show high levels of sugar or ketones. Ketones indicate that the body is using fat to make energy, which it has to do in Type 1 diabetes. That's because the sugar it usually uses is stuck in the bloodstream and not being brought into the cells.   Other less common tests also may be part of the workup, including C-peptide, antibody and genetic testing.   How is Type 1 diabetes treated?   Since a body affected by Type 1 diabetes destroys the pancreatic cells needed to make insulin, all people with Type 1 diabetes eventually will need insulin. Sometimes people experience a "honeymoon phase," where the pancreas still can produce a small amount of insulin for the body to use, and little or no insulin may be needed to stabilize blood sugar levels. However, this typically only lasts a few months to a year until regular use of insulin is needed.   Insulin, which is the mainstay of treatment, can be delivered into the body in various ways, including pens, syringes, pumps or even the newer artificial pancreas systems. It is important that those living with Type 1 diabetes work closely with their medical team to find what insulin regimen and system is best. Other methods of treatment may include oral medications to help with blood sugar control and other conditions often seen along with diabetes, such as high blood pressure or high levels of cholesterol.   Eating a diet that is low in fat and high in fiber, and includes vegetables and whole grain, is important to regulate blood sugar. Meeting with a dietitian is recommended. Physical activity is important for all people, and those with Type 1 diabetes are encouraged to exercise regularly, as well. Exercise can lower blood sugar, so it is important to ask your health care provider to be cleared to do so and to discuss how to safely take part in exercise.   What are the complications of Type 1 diabetes?   In severe cases, the levels of blood sugar from Type 1 diabetes can lead to episodes of dangerously high or low sugar, diabetic ketoacidosis, coma or even death. If diabetes is not treated and the body continues to have high levels of sugar moving around in the bloodstream, it can damage many organs, including the kidneys, eyes, heart and even the nerves. Nerve damage from diabetes can lead to permanent damage and the need to remove the affected body part, often the feet or toes of those living with diabetes.   What is the prognosis for Type 1 diabetes?   It is important to recognize that with a Type 1 diabetes diagnosis comes a big lifestyle change for those living with it. This can be upsetting, frustrating and difficult. However, through hard work, dedication and working closely with their medical team, those living with Type 1 diabetes often go on to live full, active and healthy lives.   For more information, visit the <a rel="noopener" href="https://www.mayoclinic.org/diseases-conditions/type-1-diabetes/symptoms-causes/syc-20353011" target="_blank">Mayo Clinic Type 1 diabetes webpage</a>.   <a rel="noopener" href="https://communityhealth.mayoclinic.org/providers/stephanie-ahrens-cnp/" target="_blank">Stephanie Ahrens</a> is a family nurse practitioner and education assistant in the Department of Family Medicine. She practices at Mayo Family Clinic Northeast and Mayo Clinic Express Care. Her medical interests include obesity medicine and weight management, women's health, diabetes, and pediatric care.Stephanie Ahrens, A.P.R.N., C.N.P., M.S.N.Primary Care in Rochester and KassonJuvenile DiabetesPrimary Care in Rochester and KassonThese tips can help acne sufferers, no matter your age.&nbsp;<img src="/-/media/ech-media/images/widgets/skin/acne.jpg?h=65&iar=0&w=100&sc_lang=en&hash=F021A36361AE65FBB0C54C4DE67CD582" alt="Acne" width="100" height="65" DisableNVelocity="true" />Acne is not just a teenager's problem12/17/2020 4:00 AM<img src="/-/media/ech-media/images/widgets/skin/acne.jpg?h=205&iar=0&w=315&sc_lang=en&hash=9D5EA09F5F3818D6B1336AD55DA1A8FB" alt="Acne" width="315" height="205" DisableNVelocity="true" />Acne is a pesky problem that often shows up during teenage years and can persist into adulthood. It can be confusing to determine what products to use because so many are available in the drugstore.  What causes acne? Acne is caused by the body's inflammatory reaction to bacteria within the oil gland around a hair follicle.  How can you treat acne at home? General principles for home treatment of acne include: <ul> <li>Be persistent. It can take two to three months to see the effects of treatment. </li> <li>Don't touch your face. Avoid scarring by not picking or popping acne lesions. </li> <li>More is not always better. Washing your face twice daily with a gentle cleanser is enough. You don't need to scrub your face. Using a nickel-size amount of product should cover your whole face. </li> <li>Start slow. Many treatments for acne can cause dryness, redness or irritation. Start by applying products every other day. If you tolerate the products, then consider increasing to daily use. </li> <li>Keep things that touch your face clean. Disinfect phones and wash masks regularly. </li> </ul> Here are some things to remember:  <ul> <li>Don't touch your face, and use a gentle face wash, such as Cetaphil, Vanicream, Purpose or Dove Sensitive Skin twice daily. </li> <li>Make sure you use makeup and products with "noncomedogenic" on the packaging. This means it won't clog pores. </li> <li>Try a product with benzoyl peroxide — a mainstay of acne treatment. Luckily, you'll find plenty of over-the-counter products with this active ingredient in any drugstore, including washes, lotions or spot treatment. Spot treatments are often stronger and have higher percentages of benzoyl peroxide but remember more is not always better. A lotion containing a lower percent — less than 5% — covering the whole face once daily after morning cleansing is a good starting point, or every other day initially to reduce irritation. Another option would be to use a face wash containing benzoyl peroxide once daily in the morning and a gentle cleanser in the evening. Starting with a lower percentage of benzoyl peroxide will reduce the likelihood of dryness, redness and irritation. Remember that products containing benzoyl peroxide can bleach clothes, towels and pillowcases. </li> </ul> When should you see your health care provider for acne? If you have significant acne, it is causing scarring, or it is causing emotional distress, see your health care provider so he or she can evaluate it and help you develop a treatment plan. Remember there are many good treatments for acne, but if you have tried some over-the-counter products and they are not helping, your health care provider can help find alternative products for you.  Can you use over-the-counter treatments when you are pregnant or trying to become pregnant?  Do not use over-the-counter products. If you are pregnant or trying to become pregnant, discuss your acne with your health care provider. Treatments are available, but they require a prescription.  <a href="https://communityhealth.mayoclinic.org/providers/elizabeth-curry-do/">Libby Curry, D.O.</a>, is a Senior Associate Consultant and Instructor in the Department of Family Medicine. Her practice interests include women's health and caring for whole families. Libby Curry, D.O.Primary Care in Rochester and KassonAcnePrimary Care in Rochester and KassonIf you develop diarrhea after taking antibiotics, contact your primary care provider.&nbsp;<img src="/-/media/ech-media/images/widgets/people/stomachpain_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=718646FDB083693D1C8F8B4E08283876" alt="StomachPain_widget" width="100" height="65" DisableNVelocity="true" />What you need to know about Clostridium difficile infection12/21/2020 5:00 AM<img src="/-/media/ech-media/images/widgets/people/stomachpain_widget.jpg?h=205&iar=0&w=315&sc_lang=en&hash=A662AAF96F11F0F54C5E8775FA2CFC87" alt="StomachPain_widget" width="315" height="205" DisableNVelocity="true" />Clostridium difficile (C. diff.) is an infection that most commonly presents as diarrhea. It is typically a complication of antibiotic therapy. It is becoming more common and can cause a life-threatening illness. And increasingly it does not always follow antibiotic therapy.  While C. diff. typically starts five to 10 days after antibiotic therapy, it can occur as soon as one day after therapy. Also, it can begin months after a course of antibiotic therapy.  Mild illness related to C. diff. is usually associated with three or more watery stools and crampy abdominal pain that lasts for two or more days. More severe illness related to C. diff. can result in more than 10 stools per day, severe pain, and symptoms consistent with dehydration that require hospitalization.  The intestines contain up to 2,000 kinds of normal bacteria, many of which keep you healthy. Taking an antibiotic to treat infection can destroy some of the normal helpful bacteria. This can create an imbalance in your intestines where the overgrowth of C. diff. can create diarrhea. This is one reason your health care provider may discourage the use of an antibiotic without a proven bacterial cause of infection.  Mayo Clinic lists these antibiotics as being most-strongly associated with the development of C. diff.: <ul> <li>Fluroquinolones</li> <li>Cephalosporins</li> <li>Penicillins</li> <li>Clindamycin</li> </ul> Other medications, like omeprazole and pantoprazole (which are types of proton pump inhibitors), have been associated with the development of C. diff.  Bottom line:  <ul> <li>Don't take antibiotics if you don't need them. </li> <li>If you take antibiotics and develop diarrhea, which means more than three stools within 24 hours, contact your primary care provider. </li> </ul> <a href="https://communityhealth.mayoclinic.org/providers/denise-dupras-md/">Denise Dupras, M.D., Ph.D.</a>, is a general internist in the Division of Community Internal Medicine. She completed her medical and doctoral degrees at Mayo Clinic Alix School of Medicine, and her residency in internal medicine at Mayo Clinic in Rochester. Her interests include medical education and evidence-based medicine. Denise Dupras, M.D., Ph.D.Primary Care in Rochester and KassonClostridium DifficilePrimary Care in Rochester and KassonStrengthen your immune system while strengthening your body.&nbsp;<img src="/-/media/ech-media/images/widgets/people/familywalk_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=0C1393CD52FABDBE5A9C296D6D76FFEB" alt="FamilyWalk_widget" width="100" height="65" DisableNVelocity="true" />Family movement matters12/28/2020 4:30 AM<img src="/-/media/ech-media/images/widgets/people/familywalk_widget.jpg?h=205&iar=0&w=315&sc_lang=en&hash=D63DEF5482DF281E01A95CB03A08978F" alt="FamilyWalk_widget" width="315" height="205" DisableNVelocity="true" />Choosing a healthy lifestyle is a great way to strengthen the immune system. This includes regular exercise, as it helps promote good circulation, allowing immune system particles to move through the body more freely and work more efficiently. A bonus is that physical activity is well-known for its mood-boosting abilities, too. Incorporate your family members to bond and share smiles throughout the day.  Babies It is well-known that a great deal is learned through mirroring the actions of others. Mirroring the actions of your child is also a wonderful way to create and enhance social bonds in a fun and playful manner. While creating a stronger social connection with your little one, you may be surprised as to how much you learn about your own body in the process.  Actions like rocking, rolling and crawling help develop foundational qualities to more complex interactions. Your body reacts simultaneously while interpreting information from the ground and other objects. Help your baby create the foundational stability while you readdress the proper sequencing your body may have forgotten.  The body was designed to accommodate a wide range of positions. Unfortunately, adults typically do not participate in a variety of movement patterns. Simple movements such as rocking, rolling and crawling are effective ways to enhance or maintain a flexible body.  Toddlers and grade schoolers If your littles are beyond floor play, put a twist on your family walk and go for a bear hunt in your neighborhood. People from all over the world are participating in this physical distancing scavenger hunt. Teddy bears are placed in windows or other perches around the house. Hearts also are being displayed to support and spread happiness. Then children and their families go for walks or bike rides to spot as many as they can.  If you have a swing set in your backyard, you can get your strength on while your children are out playing. Complete some suspended rows by holding on to the swing's chains, plant your heels into the ground and drive your elbows back. While keeping your body in a straight line from head to heel, extend your arms straight in a controlled fashion. Then breathe out while bending the elbows and driving them back again. You've just completed your first suspended row.  <img height="300" alt="BeginEndRowCombo" width="600" src="/-/media/ech-media/images/widgets/activities/beginendrowcombo.jpg?h=300&w=600&sc_lang=en&hash=3A4AF6686E687F9276039F8930876842" style="height: 300px; width: 600px;"> Assisted squats can be great using a swing, too. Hold on to the swing's chains, have your feet hip distance apart, and then bend your hips and knees as though you were going to sit in a chair. Use your arms while holding onto the swing for additional support and balance as you return to stand.  <img height="300" alt="BeginEndSquat" width="600" src="/-/media/ech-media/images/widgets/activities/beginendsquat.jpg?h=300&w=600&sc_lang=en&hash=1C9B9FCAB8B0E0E3CE436B9E6FF3B265" style="height: 300px; width: 600px;"> Tweens to teens If you're seeking to up the ante and competition with your tween and teenagers, get creative and set up an indoor or outdoor obstacle course. Obstacles can include physical abilities, such as crab-walking, three-legged races, hopscotch and hula hooping. Brain games can be a fun way to work on educational materials, too. On a piece of paper, put some long division equations that need to be answered correctly before moving on to the next obstacle. Get creative with adding in some science: such as listing the planets in order, starting from closest to the sun or asking younger children if they think specific items will sink or float. Have your child select the correct spelling from a spelling list. You get the idea.  If you're not naturally competitive, get outdoors and toss or kick a ball around. Many fitness professionals are posting free workout videos online. Find one that you all can complete together, and play some active video games.  Whatever option is the most appealing, it's getting up and moving as a family that is important. Being a role model for healthy behaviors can lead to positive choices and behaviors in your kiddos who look up to you.  Angela Hazelton is a wellness activities and assessment specialist at the Mayo Clinic Healthy Living Program at Mayo Clinic in Rochester. She is skilled in exercise design for a wide variety of populations in the preventive and rehabilitative settings. She has a passion for working with prenatal and postnatal women, people with cardiovascular concerns, and kettlebell enthusiasts. Angela HazeltonPrimary Care in Rochester and KassonMovement MattersPrimary Care in Rochester and KassonMedical challenges required Garrett Aakre, a staff member at Mayo Clinic in Rochester, to receive blood donations.&nbsp;<img src="/-/media/ech-media/images/widgets/blooddonation/blooddonationaakre.jpg?h=65&iar=0&w=100&sc_lang=en&hash=C73FB11001F9BA7E3C9068C4BACCB578" alt="BloodDonationAakre" width="100" height="65" DisableNVelocity="true" />Mayo Clinic Blood Donor program hits home for staff member1/11/2021 4:30 AM<img src="/-/media/ech-media/images/widgets/blooddonation/blooddonationaakre.jpg?h=205&iar=0&w=315&sc_lang=en&hash=B111C2C7E05E347402D75B3DBC833CC7" alt="BloodDonationAakre" width="315" height="205" DisableNVelocity="true" />Garrett Aakre faced a difficult medical challenge in 2009 when he underwent a kidney transplant. Ten years later, and now a donor services technician with the Mayo Clinic Blood Donor program, Garrett was dealt another blow.  After abdominal surgery on May 25, 2019, Garrett and his fiancee, Erin, were informed that he had Burkitt lymphoma. Facing the diagnosis head-on, together they supported one another and considered it "just another hurdle" to jump over before beginning their lives together.  Burkitt lymphoma, which has a cure rate of approximately 90%, often grows quickly, and that was the case for Garrett. He spent a lot of time in the hospital, including the ICU, to get the disease under control. Six rounds of chemotherapy that needed 24-hour infusions for four consecutive days caused Garrett's blood counts to drop substantially. During his treatment, his hemoglobin dropped to such dangerous levels that he needed nine units of red blood cells to help him feel better.  After all the difficulties Garrett went through, he is officially in remission as of Nov. 2019. He and Erin were married on Oct. 19, 2019. "Having Erin with me every step of the way was a comforting feeling," says Garrett. "I was never alone in facing the uncertainties of my illness." They both agree that even though donors may not see the effects of their donations personally, Garrett and Erin can assure all donors that the gift they are giving to patients is priceless.  Garrett mentions that this anonymous quote has meant a lot to him in his life: "Your life is your story. Write well. Edit often." Schedule an appointment to donate today For more information about donating blood, call the Mayo Clinic Blood Donor Center at <a href="tel:5072844475">507-284-4475</a> or <a rel="noopener noreferrer" class="Hyperlink SCXW168045806 BCX0" href="mailto:donateblood@mayo.edu" target="_blank" style="color: inherit; background-color: #ffffff; margin: 0px; padding: 0px;">email the center</a>. Learn more on the <a rel="noopener noreferrer" class="Hyperlink SCXW168045806 BCX0" href="https://www.mayoclinic.org/patient-visitor-guide/minnesota/blood-donor-program" target="_blank" style="color: inherit; background-color: #ffffff; margin: 0px; padding: 0px;">Mayo Clinic Blood Donor Program website</a>.Primary Care in Rochester and KassonBlood Donor AakrePrimary Care in Rochester and KassonA healthy diet and exercise are key to maintaining a healthy weight.&nbsp;<img src="/-/media/ech-media/images/widgets/food/ech_kidcentric_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=4E902867D5737741159F8C1A9F506502" alt="ECH_KidCentric_widget" width="100" height="65" DisableNVelocity="true" />What's the best way to maintain a healthy weight?1/18/2021 5:00 AM<img src="/-/media/ech-media/images/widgets/food/ech_kidcentric_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=7770162C1B75BE46BCBA5A14E750491E" alt="ECH_KidCentric_widget" width="300" height="195" DisableNVelocity="true" />There are many ways to lose weight, but some ways are just not good for you. For example, smoking, cancer and cholera can cause you to lose weight. But all are not good for you, and they will not solve society's weight problem. Likewise, there are many diet plans and diet fads on the internet, such as low-carb and low-fat diets, and intermittent fasting. It can be overwhelming.  It is not unusual to yo-yo from one diet plan to another. So, what should you do to promote health, wellness and longevity?  Most medical professionals agree that the healthiest way to maintain a healthy weight, feel good and prevent chronic disease is to eat a diet that is rich in:  <ul> <li>Vegetables</li> <li>Fruits</li> <li>Whole grains</li> <li>Plant-based proteins (e.g., legumes, lentils and soy-based products)</li> </ul> In addition, this diet should be low in animal products, saturated fats and refined sugars.  Although this is how people were designed to eat, you are surrounded by a toxic food environment that makes it too easy to choose convenience or processed foods that are not nutritious versus nutritious whole foods. No wonder that society is fatigued and rapidly gaining weight.  What is the good news? If you decide to go all in and adopt a whole-foods, plant-based, minimally processed diet, you will likely find yourself losing weight and feeling better, without the need for calorie-counting. If you have food and lifestyle-related diseases, such as high blood pressure, high cholesterol, heart disease, erectile dysfunction, fatty liver disease or diabetes, you will likely be able to work with your provider to reduce, if not get rid of some of your medications, and possibly reverse the disease process.  People tend to underestimate the power of lifestyle change. Lifestyle, including nutrition and exercise, is the most important way to treat disease. Unlike medications, the side effects are good.  In the words of Dean Ornish, M.D., a famous cardiologist and lifestyle medicine guru, "What is meaningful is sustainable." If you can commit to even four weeks of a plant-based, whole-foods diet, you will experience meaningful benefits in how you feel and relate to food.  If you eat this way, will you be hungry? Most Americans do not get enough fiber in their diet. The good thing about fiber is that it fills you up, and helps you eat smaller portions than you normally would if you were eating simple carbohydrates and refined sugars. Fiber is good for your gut and helps keep you regular. More and more studies show the health benefits of a high-fiber diet.  If you are interested in reading more on this, check out "Fiber Fueled" by Will Bulsiewicz, M.D. How do you get started? There are plenty of plant-based recipes on the internet with tips for ingredient substitutions, and practical tips for cooking, shopping and eating out. Simply type in "plant-based recipes" in your favorite search engine, and the options are endless.  How can you help your children make healthy food choices? It is important to be an example by eating and preparing healthy foods. Emphasize the importance of good nutrition rather than weight. Get your children involved in the kitchen with meal preparation when they are young. Eat and exercise together as a family.  What are some resources on nutrition and maintaining a healthy weight?  <ul> <li><a rel="noopener noreferrer" href="https://g.co/kgs/R5jNWz" target="_blank">"How Not to Die,"</a> Michael Greger, M.D.</li> <li><a rel="noopener noreferrer" href="https://www.forksoverknives.com/" target="_blank">Forks Over Knives</a></li> <li><a rel="noopener noreferrer" href="https://g.co/kgs/f5J8v7" target="_blank">"The Spectrum,"</a> Dean Ornish, M.D.</li> <li><a rel="noopener noreferrer" href="https://g.co/kgs/57vQsn" target="_blank">"UnDo It!,"</a> Dean Ornish, M.D., and Anne Ornish</li> <li><a rel="noopener noreferrer" href="https://g.co/kgs/aMYr2N" target="_blank">"Plant-Based on a Budget,"</a> Toni Okamoto</li> <li><a rel="noopener noreferrer" href="https://g.co/kgs/uA6GfB" target="_blank">"The Game Changers,"</a> documentary available on Netflix</li> </ul> So how much exercise should you get?  There is a close connection between movement and better health. Ideally, you should work toward a minimum goal of 150 minutes, or about 2-1/2 hours, of moderate activity per week. However, the more the better. People of all ages benefit from exercise, and it is never to late to start. It is OK to start slowly and progress over time.  In conclusion, healthy change begets healthy change. It is a virtuous cycle. If you start with focusing on what's at the end of the fork and a little movement, you will likely begin to make healthy changes in all aspects of your life.  <a href="/providers/meghan-theofiles-md">Meghan Theofiles, M.D.</a>, is a family medicine physician in Mayo Clinic Primary Care's Department of Family Medicine and practices at Mayo Family Clinic Northeast. She will soon join the core faulty for the Family Medicine Residency program at Mayo Family Clinic Kasson. Her medical interests include resident and medical student education, hospital medicine, obesity, and lifestyle medicine. Meghan Theofiles, M.D.Primary Care in Rochester and KassonMaintain Healthy WeightPrimary Care in Rochester and KassonTalk to your provider to figure out the cause.&nbsp;<img src="/-/media/ech-media/images/widgets/people/elderlycouplebed_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=4B8E2556651BC54655BBB23F25CFB5FB" alt="OldCoupleBed" width="100" height="65" DisableNVelocity="true" />Nighttime coughing keeping you awake?1/28/2021 4:30 AM<img src="/-/media/ech-media/images/widgets/people/elderlycouplebed_widget.jpg?h=205&iar=0&w=315&sc_lang=en&hash=0DEC0604CA728E18DE513D50E67884EA" alt="OldCoupleBed" width="315" height="205" DisableNVelocity="true" />Cough is a common health complaint in the winter. One of the most bothersome forms is a cough that worsens at night. Coughing throughout the night disrupts sleep, and this coughing can last for weeks or months if left untreated. Causes of nighttime cough Coughing that worsens at night can be due to a number of different causes, including: <ul> <li>Postnasal drip This is where lying down allows mucus to pool in the back of the throat and trigger a cough. </li> <li>Gastroesophageal reflux disease, or GERD This is where lying flat allows stomach acid to irritate the throat. </li> <li>Underlying medical conditions Asthma, chronic obstructive pulmonary disease or certain types of cancer can cause a nighttime cough. </li> </ul> Treatment of nighttime cough The right treatment depends on what is causing the cough. For example, a nighttime cough due to postnasal drip may be treated with saltwater gargles, nasal saline irrigation and a course of intranasal steroids. Some people also may benefit from addressing allergic reactions to triggers like dust mites. Trying to tackle dust mite allergies may require tactics like special covers for bedding, air filters and other measures. When gastroesophageal reflux disease causes a nighttime cough, people often benefit from elevating the head of the bed, avoiding certain foods, eating earlier in the evening and using certain medications. However, it's important to figure out what's causing the cough to find the most effective treatment. Ruling out things like infection, asthma, cancer and other conditions is paramount. This means having a conversation with your health care provider to ensure you are taking the right steps to address your nighttime cough. <a href="/providers/michelle-duvall-md">Dr. Michelle Duvall</a> is a Family Medicine physician in Mayo Clinic's Primary Care in Rochester and Kasson, and she practices at Mayo Family Clinic Northwest. Michelle Duvall, M.D.Primary Care in Rochester and KassonNighttime CoughPrimary Care in Rochester and KassonParenting responsibilities don't change, despite a couple's struggles.&nbsp;<img src="/-/media/ech-media/images/widgets/people/divorce_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=61A8BD25A18234E4487C48B161255164" alt="Divorce_widget" width="100" height="65" DisableNVelocity="true" />Parenting during divorce1/25/2021 5:00 AM<img src="/-/media/ech-media/images/widgets/people/divorce_widget.jpg?h=205&iar=0&w=315&sc_lang=en&hash=3A99FCC838E9DB8271CE7DD6539EA1C7" alt="Divorce_widget" width="315" height="205" DisableNVelocity="true" />A divorce is never something you anticipate or want to go through. It becomes even more complicated and difficult if you are a parent.  There is so much to sort through, details to decide and changes to make. Your children may seem like they are coping well with the situation or you may notice significant struggles.  Learn more in this Q&A about parenting through a divorce: When should I tell my kids? It's likely that your children have picked up that something is not right. If they come to you with questions, be as honest and age-appropriate as possible. However, it's best not to share about a separation or divorce until the decision is final.  It's developmentally appropriate for children to be concrete in their thinking, so understanding ambiguity or gray areas in a relationship is often difficult for younger children. How should I tell my kids? Ideally, parents should have this conversation together and plan in advance to make sure they are on the same page. Presenting a united front can be reassuring for kids. It sends the message that, although their family is changing, both parents are still working together to take care of them. Keep the conversation simple and straightforward. Reassure your child that you love him or her, that you will always be his or her parents, and that the divorce is not his or her fault.  Do not comment on anything related to extramarital affairs, finances or any other age-inappropriate details. Also, be careful to avoid the temptation to criticize, insult, or blame the other parent.  It's important to tell your children that this is hard, and it's OK to be sad, angry or upset. How do children of divorced parents feel? In a major life change such as divorce, children experience a variety of emotions. There's no right way to feel or go through it.  Some children experience grief and sadness. Some express anger and resentment. Others are relieved.  You might be surprised at how quickly your child adapts to the new normal. Remember, your child's emotional response may be different toward each parent. What's key is using validation and empathy to let your child know that all feelings are OK. How do we decide custody time? The most important part of deciding on parenting and custody time is taking your child's development into account. Ask yourself how you can make the schedule most conducive to school and extracurricular activities.  Keep in mind that it will be hard to give up your child to the other parent for any amount of time, but that in most situations ― assuming there are no concerns about safety ― it's vital to his or her growth and development to have a relationship with both of you.  The more consistent you make the schedule, the better. That way, your child always knows when he or she will be where. It is helpful to create a calendar that your child can refer to. How do we co-parent from two houses? Communication is essential. Find the communication method that works best for you, perhaps through text messages or email if verbal conversations are hard. Make sure the communication is direct between the two of you, and not sent back and forth through your child. When your child is struggling with something, make sure to share that information with the other parent. Both of you should try to attend all medical appointments and school conferences, so that everyone has the same information. When talking with your child, don't act jealous or upset about the time your child spends with the other parent or ask what he or she does together with the other parent. This isn't a competition. Don't discuss finances or negative attributes of the other parent with your child.  As you co-parent during a divorce, remember to take care of yourself and get support if you need it. The better you deal with your feelings, the better your child will be able to deal with his or hers. How do I start dating again? This is an important conversation to have with your child. Discuss why you would date and what you are looking for in a partner.  Try to introduce significant others only when the relationship is more than casual, so you're not bringing many new people in and out of your child's life.Remember that children typically are fairly concrete, so the gray areas that characterize many adult dating relationships can be hard for children to understand.  Once you've met someone who likely will be a steady presence in you and your child's life, help your child become part of the relationship through family dates and quality time together. However, make sure your child knows that he or she is still important to you and deserves one-on-one time with you.Validate your child's feelings about your dating, recognizing all children will handle this change differently. How will I know if my child isn't coping well with the divorce? If you see changes in schoolwork, friendships, behavior or mood, your child may be struggling to manage the change. If your child shows a consistent increase in irritability, sleeping difficulties, toileting or eating problems, then try talking with him or her about how he or she feels about the divorce. Your care team can be an excellent resource when you have concerns about how your child is coping with a divorce. Hannah Mulholland, L.I.C.S.W., M.S.W., is a clinical social worker serving children and adolescents in Primary Care in Rochester and Kasson's Division of Integrated Behavioral Health.Hannah Mulholland, L.I.C.S.W., M.S.W.Primary Care in Rochester and KassonParenting During DivorcePrimary Care in Rochester and KassonResearch studies are important in fighting diseases.&nbsp;<img src="/-/media/ech-media/images/widgets/medicalimages/research_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=684407A984050A178C704E9C6E6D0985" alt="Research_widget" width="100" height="65" DisableNVelocity="true" />New opportunities to be involved in a research study1/12/2021 7:00 AM<img src="/-/media/ech-media/images/widgets/medicalimages/research_widget.jpg?h=205&iar=0&w=315&sc_lang=en&hash=CEE62F71EED9480E73A2D2C3E2947323" alt="Research_widget" width="315" height="205" DisableNVelocity="true" />Are you looking for opportunities to help your neighbors and your community? One way to make a difference is to volunteer in clinical research. Because of volunteers like you, you will soon be able to receive a COVID-19 vaccination. Despite the pandemic, clinical trials concerning various health conditions are underway. And those trials need volunteers. Take a look at the listings on the <a href="https://communityhealth.mayoclinic.org/find-a-study">Primary Care in Rochester and Kasson website</a>. Click "Find a Study" on the header of this page to see what is available. Six studies are now listed. And all sorts of volunteers are needed. One is calling for healthy teens. Another is calling for folks 70 and older. For some trials, you need a certain health condition to volunteer ― depression or common warts, for example. Some of these studies will complete enrollment in the coming months and will no longer need volunteers. Other studies will soon start up, and they will be added on the Primary Care in Rochester and Kasson website when they are available to you. Do not feel that you will be talked into doing anything that you do not want to do. All the research posted here is conducted by Mayo Clinic researchers. Mayo Clinic takes research seriously. All your questions will be answered. That is part of the informed consent process. And signing the informed consent form is not signing a contract. You can end your participation any time after you have signed. All of this will be made clear during the informed consent process. We hope you will take an opportunity to review the studies and enroll. Every volunteer makes a difference in improving the health care of many. <a href="/providers/robert-jacobson-md">Dr. Robert M. Jacobson</a>, is a primary care pediatrician in Mayo Clinic's Primary Care Division of Community Pediatric and Adolescent Medicine and chair of the Research Operations Team for Primary Care in Southeast Minnesota. He conducts research to improve the uptake of recommended vaccines. Robert M. Jacobson, M.D.Primary Care in Rochester and KassonResearch StudyPrimary Care in Rochester and KassonThese tips can help relieve your symptoms.&nbsp;<img src="/-/media/ech-media/images/widgets/people/uri_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=08E8B686372E07E4C572C50DE280175C" alt="URI_widget" width="100" height="65" DisableNVelocity="true" />Most sinus infections do not need antibiotics1/14/2021 5:00 AM<img src="/-/media/ech-media/images/widgets/people/uri_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=F347820C49206B1F09BE366B63660154" alt="URI_widget" width="300" height="195" DisableNVelocity="true" />Did you know that most sinus infections will go away on their own without antibiotics?  It's true.  Upward of 90% of sinus infections are typically caused by cold viruses or allergies, and only rarely do they develop into bacterial infections. Even if bacterial in origin, sinus infections can still clear on their own.  Does a green nasal discharge mean you have a bacterial infection? In most cases, a green nasal discharge does not mean you have a bacterial infection. In most cases, this is a normal response to a virus.  As the body's immune system is responding to the infection, there are more white blood cells present, which in turn causes the thickened and discolored nasal mucus.  Why shouldn't you take antibiotics? Antibiotics are often overprescribed, and overuse can cause risks of antibiotic resistance (meaning these antibiotics won't work as well in the future). Antibiotics also cause many side effects, some of which can be serious or life-threatening.  What will help my symptoms?  To help with your symptoms, try these steps:  <ol> <li>Perform a nasal saline rinse with a sinus rinse bottle or neti pot. </li> <li>Following the sinus rinse, try a nasal steroid spray, such as Flonase or Nasacort. </li> <li>Use an over-the-counter decongestant. </li> <li>Relieve headache or sinus pain with an over-the-counter pain reliever, such as acetaminophen or ibuprofen. </li> <li>Use steam or a humidifier. </li> <li>Get plenty of rest. </li> <li>Drink plenty of fluids. </li> </ol> If you have severe or persistent symptoms, are immunocompromised, or have underlying health conditions, you should seek medical care to determine the best treatment for your symptoms.  Kelly Holtz, A.P.R.N., C.N.P., D.N.P., is a certified nurse practitioner at Mayo Clinic Express Care in Rochester, Minnesota. Kelly Holtz, A.P.R.N., C.N.P., D.N.P.Primary Care in Rochester and KassonSinus InfectionPrimary Care in Rochester and KassonFifteen minutes plus a stability ball equals a stronger core.&nbsp;<img src="/-/media/ech-media/images/widgets/activities/ech_newworkout_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=C1AA5B5BFC0419B9A15D34EB92C3547A" alt="ECH_NewWorkout_widget" width="100" height="65" DisableNVelocity="true" />New Year, new workout2/28/2019 11:00 AM<img src="/-/media/ech-media/images/widgets/activities/ech_newworkout_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=6088D55BE4B66D88E8E031876FC436AB" alt="ECH_NewWorkout_widget" width="300" height="195" DisableNVelocity="true" />Looking for a new way to work fitness into your schedule? With just 15 minutes, a stability ball, yoga mat (optional) and four sets of basic exercises, you can strengthen the core muscles of your back, abdomen and pelvis. Core exercises:  <ul> <li>Improve your balance and stability.</li> <li>Help strengthen and activate your abdominal muscles to improve posture, reduce lower back pain and protect against muscle injuries. </li> <li>Make it easier to do other activities such as swing a golf club, reach for a glass in the cupboard or bend over to fasten your shoes. </li> <li>Reduce fatigue and increase endurance for athletes. </li> </ul> And they don't require special equipment or even a visit to the gym. You can find stability balls and yoga mats at discount and drug stores and online. If you do work out at a gym or fitness center, most have balls and mats for you to use. You can even use one at your workspace to keep those muscles active even when you aren't "working out".  Ready to start a new workout for the New Year? Let's go! #1: Quadraped <ol> <li><img height="130" alt="Quadriped" width="200" src="/-/media/ech-media/images/widgets/activities/quadriped.jpg?h=130&w=200&hash=26747EC5C83937E8E7B95E6EBB619F53BDA50B25&hash=26747EC5C83937E8E7B95E6EBB619F53BDA50B25&sc_lang=en" style="height: 130px; width: 200px; float: right; padding: 2px;" class="img-responsive" /><img height="130" alt="QuadripedArmOnly" width="200" src="/-/media/ech-media/images/widgets/activities/quadripedarmonly.jpg?h=130&w=200&hash=26D5566F0D21E2C7B526078B4C276D5771E98F1C&hash=26D5566F0D21E2C7B526078B4C276D5771E98F1C&sc_lang=en" style="height: 130px; width: 200px; float: right; padding: 2px;" class="img-responsive" /><img alt="QuadripedLegOnly" src="/-/media/ech-media/images/widgets/activities/quadripedlegonly.jpg?h=130&w=200&hash=BAC268E442E55F96F1DEB52D4552EC9E2324D9D2&hash=BAC268E442E55F96F1DEB52D4552EC9E2324D9D2&sc_lang=en" style="height: 130px; width: 200px; float: right; padding: 2px;" class="img-responsive" />Lie on your stomach on a stability ball with your hands and feet on the floor. </li> <li>Keeping your shoulders directly above your wrists, at the same time extend your right leg up to hip height and your left arm out in front to shoulder height. Hold for five seconds. Tip: Keep your shoulders and torso level with the floor. </li> <li>Return to neutral position.</li> <li>Repeat with left leg. </li> <li>Continue alternating legs 10 to 15 times (repetitions). Tip: If this is too difficult, raise just your arm or leg. </li> </ol> #2: Bridge <ol> <li><img height="130" alt="Bridge" width="200" src="/-/media/ech-media/images/widgets/activities/bridge.jpg?h=130&w=200&hash=26747EC5C83937E8E7B95E6EBB619F53BDA50B25&sc_lang=en" style="height: 130px; width: 200px; float: right; padding: 2px;" class="img-responsive" /><img height="130" alt="BridgeBentLeg" width="200" src="/-/media/ech-media/images/widgets/activities/bridgebentleg.jpg;hash=26747EC5C83937E8E7B95E6EBB619F53BDA50B25?sc_lang=en&hash=A7064B475655A179DD0B978A403162D0" style="height: 130px; width: 200px; float: right; padding: 2px;" class="img-responsive" /><img height="130" alt="BridgeStraightLeg" width="200" src="/-/media/ech-media/images/widgets/activities/bridgestraightleg.jpg;hash=26747EC5C83937E8E7B95E6EBB619F53BDA50B25?sc_lang=en&hash=627E766AD64D5E556AC46DE712052647" style="height: 130px; width: 200px; float: right; padding: 2px;" class="img-responsive" />Begin by lying on your back with your legs straight, heels on the ball and your arms resting on the ground by your sides. </li> <li>Tighten your abdominals and lift your hips off the ground until your body is in a straight line. Hold, then lower yourself back to the ground and repeat. Tip: Make sure to keep your abdominals tight and don't let your hips rotate to either side during the exercise. </li> <li>Continue for 10 to 15 repetitions.  </li> </ol> #3: Seated Balance <ol> <li><img height="130" alt="SeatedBalance" width="200" src="/-/media/ech-media/images/widgets/activities/seatedbalance.jpg?h=130&w=200&hash=26747EC5C83937E8E7B95E6EBB619F53BDA50B25&sc_lang=en" style="height: 130px; width: 200px; float: right; padding: 2px;" class="img-responsive" />Sit on your stability ball with your feet flat on the floor.</li> <li>Extend your left leg straight in front of you 8 to 10 inches off the ground. </li> <li>With your leg extended, bring your arms out to the sides, parallel to the floor. </li> <li>Hold this position for five seconds, sitting tall and tightening your core. </li> <li>Return to neutral position.</li> <li>Repeat with your right leg. </li> <li>Alternate legs for 10 to 15 repetitions. </li> </ol> #4: Praying Mantis <ol> <li><img height="130" alt="PrayingMantis2" width="200" src="/-/media/ech-media/images/widgets/activities/prayingmantis2.jpg?h=130&w=200&hash=26747EC5C83937E8E7B95E6EBB619F53BDA50B25&sc_lang=en" style="height: 130px; width: 200px; float: right; padding: 2px;" class="img-responsive" /><img height="130" alt="PrayingMantis1" width="200" src="/-/media/ech-media/images/widgets/activities/prayingmantis1.jpg?h=130&w=200&hash=26747EC5C83937E8E7B95E6EBB619F53BDA50B25&sc_lang=en" style="height: 130px; width: 200px; float: right; padding: 2px;" class="img-responsive" />Begin by kneeling with your hands clasped together, resting on the ball. (If necessary, kneel on a pad or towel for extra cushion). </li> <li>Tighten your abdominals and slowly roll your arms forward on the ball, then bring yourself back to the starting position and repeat. Tip: Be sure to keep your back straight during the exercise and your knees in the same place as you roll forward. </li> </ol> Sara Mansfield, MS, is a wellness exercise specialist at the Mayo Clinic Healthy Living Program in Rochester. Her interests include functional movement and behavioral modification to help others incorporate accessible, healthy behaviors into their lifestyle. Sara Mansfield, MSPrimary Care in Rochester and KassonCore ExercisesPrimary Care in Rochester and KassonThese tips can potentially reduce the cost of diabetes medications.&nbsp; <img src="/-/media/ech-media/images/widgets/medications/ech_diabetesmeds_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=1EB6466EE03FB65744A81DC4A466D62E" alt="ECH_DiabetesMeds_widget" width="100" height="65" DisableNVelocity="true" />Cost tips: Medications for diabetes2/7/2019 11:00 AM<img src="/-/media/ech-media/images/widgets/medications/ech_diabetesmeds_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=5DBEBEDBFD7049B29CBA82A33E3F14A1" alt="ECH_DiabetesMeds_widget" width="300" height="195" DisableNVelocity="true" />Optimal treatment of type 2 diabetes often changes during the course of a person's life and frequently requires multiple medications. Metformin, a generic, affordable diabetes medication, is most often our first-line medication since it's safe, effective and doesn't cause weight gain.  However, if metformin therapy isn't sufficient, there are many secondary treatment options, depending on each patient's needs. Your care team generally tries to prescribe the least-expensive therapeutic options, but some inexpensive, generic treatment options, while effective, can carry increased risk for adverse effects, such as low blood sugar symptoms and weight gain.  There are newer, brand-name medications on the market for type 2 diabetes that may be a better choice for you. They offer other potential advantages for some patients, such as weight loss, less risk of low blood sugar symptoms and cardiovascular benefit. However, they can be more expensive.  These tips can help you find the best value for diabetes medications.  Manufacturer savings cards Manufacturers for most brand-name medications, including insulin, offer savings cards for qualifying patients. If you have a nongovernment-funded prescription insurance plan, such as Medicare or Medicaid, you probably qualify for these discounts, which cover varying amounts of your copay after your insurance pays its portion.  To get a savings card: <ul> <li>Search the internet for the website of the medication.</li> <li>On the site, look for a section offering a savings option, which will lead you to a series of questions to determine if you qualify for the savings card. It's important to read the fine print. </li> <li>If you qualify, you can download a printable card. Present the card in person at the pharmacy, or if you call in your prescriptions, give the information over the phone. </li> <li>These cards generally are valid for one year. Once a card expires, you can download a new one. </li> </ul> Pharmacy discount formularies Many pharmacies have a discounted formulary for select generic medications. These medications are typically $4 for a 30-day supply or $10 for a 90-day supply. These discounts would be most useful if you don't have prescription insurance. Certain pharmacies also offer discounted insulin options. If you're unable to afford your insulin, discuss it with your care team.  Medication coupon websites (<a rel="noopener noreferrer" href="https://www.goodrx.com/" target="_blank">Goodrx</a><a rel="noopener noreferrer" href="https://www.goodrx.com/" target="_blank">®</a>, <a rel="noopener noreferrer" href="https://rxsaver.retailmenot.com/" target="_blank">RxSaver</a><a rel="noopener noreferrer" href="https://rxsaver.retailmenot.com/" target="_blank">®</a>, <a rel="noopener noreferrer" href="http://www.webrxpc.com/" target="_blank">WebRx</a><a rel="noopener noreferrer" href="http://www.webrxpc.com/" target="_blank">®</a>) Multiple websites offer drug discount coupons, which can be useful in some cases as an alternative to prescription insurance. However, if you plan to use your prescription insurance, the coupons won't work. They're most useful if you don't have prescription insurance. Savings on these websites can be very hit or miss, but are worth a try. Once at a coupon website, you will: <ul> <li>Enter your zip code and search for the exact medication name, strength and quantity you have been prescribed. </li> <li>The site will list various price quotes with coupons for each particular pharmacy. </li> <li>You must match the coupon with the pharmacy you plan to use. </li> <li>Coupons are accepted in most cases, but the pharmacy does reserve the right to decline them. </li> </ul> Resources to help with Medicare Part D enrollment The process for enrolling for and choosing between many available Medicare Part D prescription drug plans can be overwhelming. Depending on your specific medication and health care needs, some plans may be more beneficial than others. These resources are available to help you find the plan that fits you best.  Senior LinkAge Line (1-800-333-2433 or <a rel="noopener noreferrer" href="https://mn.gov/senior-linkage-line/" target="_blank" title="Link opens in a new window">mn.gov/senior-linkage-line</a>) <ul> <li>Free Minnesota-based service offering internet or phone support to help you choose or switch your Medicare plan. </li> </ul> Medicare website (<a rel="noopener noreferrer" href="https://www.medicare.gov/" target="_blank">www.medicare.gov</a>) <ul> <li>Sign up or change plans online</li> <li>Online resources to answer common questions about Medicare</li> <li>Help for <a rel="noopener noreferrer" href="https://www.medicare.gov/find-a-plan/questions/home.aspx" target="_blank">finding a plan</a></li> </ul> Joe Herges, PharmD, RPh, is a pharmacist in Employee and Community Health's (ECH) Mayo Family Clinics Northeast and Kasson. Joseph Herges, PharmD, RPhPrimary Care in Rochester and KassonDiabetes Medication CostsPrimary Care in Rochester and KassonIf you're mentally ready to lose weight, your chances for success are greater.&nbsp;<img src="/-/media/ech-media/images/widgets/people/ech_weightloss_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=6CF59BFECBF4D7AF10F72B21FC34228C" alt="ECH_weightloss_widget" width="100" height="65" DisableNVelocity="true" />Are you ready to lose weight?2/21/2019 5:00 AM<img src="/-/media/ech-media/images/widgets/people/ech_weightloss_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=3BD5581ADDD803A32CF1F766D6D21F20" alt="ECH_weightloss_widget" width="300" height="195" DisableNVelocity="true" />"I want to lose weight." That's a great goal, but are you really ready? Starting before you're ready or when you're greatly distracted by other events in your life — job stress, excessive family commitments, or caring for an elderly parent who is ill, for example — can set you up for failure. Why? Because taking off pounds takes a mental "all-hands-on-deck" approach for success.  Before you launch into a weight-loss plan, it helps to understand the reason you want to slim down, what challenges you may face, what you hope to gain from the change and more. What is your burning inner motivation, the one that will help keep you focused? Once you're ready, it's a super motivator! Here's an exercise and a checklist you can do to help identify if you're ready for weight loss — and for success! Start by grabbing a notepad and asking yourself these questions: <ol> <li>Why do you want to lose weight? </li> <li>Is now a good time? If not now, when?</li> <li>Think about what's important to you — what you value, when and where you spend most of your time, etc. </li> <li>How will losing weight fit into the things you value? Will you be able to enjoy them more? </li> <li>What is one small step you'll start with? </li> </ol> Check off all the reasons that move you to lose: <ul> <li>Look better</li> <li>Feel better</li> <li>Feel comfortable in my clothes</li> <li>Improve my physical stamina</li> <li>Manage high blood pressure</li> <li>Improve my cholesterol</li> <li>Prevent or manage diabetes</li> <li>Reduce joint pain</li> <li>Prevent or reduce lower back pain</li> <li>Improve my sleep</li> <li>Increase my energy</li> <li>Improve my self-image and self-confidence</li> <li>Improve my outlook on life</li> <li>Improve my quality of life</li> <li>Increase my life expectancy</li> <li>Be a role model for my family</li> <li>More motivators?</li> </ul> Do some prep work: <ul> <li>Consider your health. If you have health issues, check with your health care provider before you get started. </li> <li>Get support. Losing weight means changing habits and if you have a friend or family member rooting for you, you're more likely to make those changes stick. If you prefer to be independent, be accountable to yourself — weigh in, keep a food and activity journal to monitor progress. </li> <li>Record your starting point. That can include calculating your body mass index (BMI), your waist size (or other measurements) and your weight. </li> <li>Choose your approach. Pick a well-tested nutrition and exercise plan that will work for you and fit into your lifestyle. </li> <li>Pick a start date. Then jump in!</li> </ul> Also, watch for our upcoming series, "Beyond hunger: Discovering your eating patterns", which will help you explore when, what, how much, why you eat and how it makes you feel. For more tips and resources for taking off pounds or maintaining a healthy weight, visit <a href="https://www.mayoclinic.org/" target="_blank">www.mayoclinic.org</a> and check out "<a href="https://www.mayoclinic.org/search/search-results?q=diet%20and%20exercise%20recommendations" target="_blank">diet and exercise recommendations</a>." Rose Prissel, MS, RDN, LD, is a dietician at Mayo Clinic working in pediatric and adult nutrition, with a focus on preventive care, sports nutrition and weight management. Rose Prissel, MS, RDN, LDPrimary Care in Rochester and KassonReady To Lose WeightPrimary Care in Rochester and KassonOlder adults are susceptible to concussion and can take longer to heal.&nbsp;<img src="/-/media/ech-media/images/widgets/elderly/ech_concussion_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=34F9337EE25BD8CB90B724243320720F" alt="ECH_concussion_widget" width="100" height="65" DisableNVelocity="true" />Concussions: Not just for kids3/11/2019 5:00 AM<img src="/-/media/ech-media/images/widgets/elderly/ech_concussion_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=B787EAC428E91EB9F3B25C7F8C6F9904" alt="ECH_concussion_widget" width="300" height="195" DisableNVelocity="true" />Concussions are in the news, especially among kids and student athletes. To help prevent them, parents strap helmets on their kids as they run outside to play and ponder whether their youngsters should participate in contact sports. But what about protecting adult brains from injury?  There's no age limit on getting concussions, whether it's from a fall on the ice, vehicle accident, tumble from a bike or bumping into a kitchen cabinet door. And as we age, we become more susceptible to issues from head injuries. It may not take much of a jolt to cause an injury that takes longer to heal.  With a concussion, there is a violent shaking or blow to the head causing our brains to move inside our skull. Even a single, mild concussion may have a longer-lasting impact, including memory problems and possible increased risk for dementia. As with children, increased numbers of concussions come with increased risk for complications long term.  Typical symptoms in adults include:  <ul> <li>Headaches</li> <li>Trouble thinking or concentrating, feeling like you're in a fog</li> <li>Dizziness</li> <li>Nausea/vomiting</li> <li>Fatigue</li> <li>Withdrawal from social interaction, feeling depressed</li> </ul> Loved ones also might notice that you're sleeping more or having trouble sleeping; experiencing mood swings, including being more irritable; or having memory issues, which can include taking more time to respond and repeating questions.  Don't just write these symptoms off as part of the aging process or that it's "not that bad". If you're on a blood thinner, you should go to the Emergency Department immediately following a head injury. If you're having a headache that's increasing in severity, persistent vomiting, seizure activity or unusual behavior, then emergency evaluation would be needed, as well. Otherwise, if your symptoms affect day-to-day function or you're concerned, see your care team for an evaluation.  While there's no treatment for the concussion itself, treatment can manage symptoms — such as medications to control headaches and physical or occupational therapy to relieve dizziness or improve balance.  Steps to protect the adult brain from concussion are much like those for kids:  <ul> <li>Always wear a seat belt</li> <li>Use a helmet for activities from riding bike to downhill skiing</li> <li>Reduce fall risks around the home, such as slippery surfaces and trip hazards (electrical cords, clutter, throw rugs, etc.)</li> </ul> Stay active, have fun, but watch your head! Dr. Kyle McKenzie is a physician in Employee and Community Health's (ECH) Division of Community Internal Medicine (CIM). He is a fellowship-trained geriatrician and is medical director at Fairview Care Center, Field Crest Care Center and Pine Haven Care Center. Dr. Kyle McKenziePrimary Care in Rochester and KassonAdult ConcussionsPrimary Care in Rochester and KassonFriendships can reap health benefits throughout our lives.&nbsp;<img src="/-/media/ech-media/images/widgets/people/ech_friendship_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=6A838CE060D8D7D70740CCBAD890093F" alt="ECH_friendship_widget" width="100" height="65" DisableNVelocity="true" />Friendship: A plus for well-being, no matter your age3/4/2019 5:00 AM<img src="/-/media/ech-media/images/widgets/people/ech_friendship_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=4C4578A1C5002351E6638BA2493154E1" alt="ECH_friendship_widget" width="300" height="195" DisableNVelocity="true" />What is friendship? Friendship is a mutual interest in another person's experiences and thoughts. Friendships require two key elements: a common interest and desire to get to know each other. Friendships aren't just for children — they provide us with health and well-being benefits no matter our age. And they vary through our life stages: Young children. Friends are typically found among those nearby, perhaps children of family friends or kids in the neighborhood. Preschool friendships help children develop social and emotional skills, increase a sense of belonging and decrease stress. At this stage, it's important for parents to model good friendship skills and to help encourage friendships important to the child.  Adolescents/young adults. Adolescents typically choose to be close to those who share the same interests. Young adulthood is a time when we start finding our own sense of identity. That's when we seek people who will challenge us to try new things or provide encouragement when we're starting new careers. Friendships also evolve when romantic relationships begin.  Adulthood. This is a time when friendships can take a backseat as we start families or become more wrapped up in careers. It takes effort to meet up with friends given the needs of family members, whether they're our kids or elderly parents. However, friends understand (they're often in the same boat), and when time is spent together, we can pick up as if no time has passed.  Later adulthood. Friendship circles start decreasing due to death, limited mobility or relocation. Depression and loneliness can affect us as we experience this shrinking friend group. That's why it's so essential for us to stay as active as possible, whether it's participating in church groups, visiting neighbors, volunteering, playing cards or engaging in other social activities.  Care and feeding of friendships No matter our stage in life, friendships can protect against loneliness, decrease anxiety and improve our physical health and well-being. But they do require care and feeding. Here are some tips for making and keeping friends.  Taking time to foster friendships can provide health benefits throughout the year — and throughout lives: <ul> <li>Acts of kindness are helpful in maintaining friendships; it's not always about buying them a gift for a holiday or birthday. Make plans to spend quality time together or go to a child's event. </li> <li>Invite a friend to do something you're already planning to do. Even with busy schedules, friends can meet for exercise or a cup of coffee. </li> <li>Stay connected with friends, even if you're separated by distance. Pick up the phone occasionally or send a letter in the mail — don't just text. Do little things to stay connected. </li> <li>Plan to get together as often as possible. When spending time together, ask intentional, open-ended questions to show curiosity in your friend's experiences. </li> </ul> Lisa Burke, LICSW, is a clinical social worker serving adults in Employee and Community Health (ECH) at the Baldwin Building. Lisa Burke, LICSWPrimary Care in Rochester and KassonImportance Of FriendshipsPrimary Care in Rochester and KassonAs kids age, their internal clocks change, too.&nbsp;<img src="/-/media/ech-media/images/widgets/teens/ech_teensleeping_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=EB60C64CD2791A51C59041375E84AB20" alt="ECH_teenSleeping_widget" width="100" height="65" DisableNVelocity="true" />Teen sleeping in? It's baked in3/7/2019 5:00 AM<img src="/-/media/ech-media/images/widgets/teens/ech_teensleeping_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=F2C2CB52B9C819F5A932994842032786" alt="ECH_teenSleeping_widget" width="300" height="195" DisableNVelocity="true" />Have a teen who's tough to roust out of bed in the a.m.? Does that same teen stay up long past their "bedtime"? While it can be aggravating for parents, your teen isn't lazy or focusing on their devices late into the evening. Staying up later and sleeping in longer are baked in to your teen's development. In other words, when they hit the teenage years, their internal clocks reset, too. This change can last into early adulthood.  It's not an easy transition to make. Kids have school activities and homework that run into the evenings, but then have to catch the bus or be at school hours before their bodies say, "Wake up!" Plus, our work and school worlds revolve around an eight-to-five schedule, making it harder for schools and parents to make adjustments to meet this new sleep reality.  So what's going on? Our bodies produce a hormone called melatonin, which is responsible for helping us go to sleep. It helps set our internal circadian clock for sleep and wake periods. In teens, melatonin production starts later in the evening. So kids naturally stay up later and wake up later. Genetic factors can also play a role in this delayed sleep phase.  Research shows that teens need a minimum of nine to 10 hours of sleep a night, but only about one-third of them are meeting that goal. Which builds up a sleep debt that's impossible to "pay back" by sleeping in on weekends. The result of this sleep debt can:  <ul> <li>Increase risk for obesity and cardiovascular issues</li> <li>Influence mental health, including anxiety and mood problems</li> <li>Affect academic performance and behavior</li> </ul> For some children, it may worsen into a disorder, which can persist into late life if not treated. If your teen is having problems functioning during the day or using medications, alcohol or other drugs to help fall asleep or stay awake, schedule an appointment with their primary care provider. Treatment can include taking melatonin at night to go to sleep, using a light box in the morning to stimulate waking up and following a fixed sleep schedule every day of the week.  Several school districts nationwide, at the urging of parents and health care professionals, have adopted new school start times at 8:30 or later for teens that reflect their changing sleep-wake phases. Accumulating research indicates this is working. Later school times allow teens to sleep in during the week, creating less of a difference between their weekday and weekend schedules, reducing sleepiness during the day and even decreasing the number of motor vehicle accidents involving teens. You can help your teen get the sleep they need and adjust to their new inner clock by encouraging them to:  <ul> <li>Prioritize sleep</li> <li>Maintain a regular sleep schedule</li> <li>Turn off electronics before they start their bedtime routine</li> <li>Develop a nice, wind-down routine for the day</li> <li>Be physically active, but not too close to bedtime</li> <li>Avoid exposure to bright light in the late evening</li> <li>Expose themselves to bright light first thing in the morning</li> </ul> Creating good sleep habits will help them now and for the rest of their lives.  <a href="https://www.mayoclinic.org/biographies/mansukhani-meghna-p-m-d/bio-20199994" target="_blank">Dr. Meghna Mansukhani</a> is a consultant at Mayo Clinic's Center for Sleep Medicine and associate professor in the Mayo College of Medicine. She also is the lead for Integrated Community Specialties in Sleep Medicine for Employee and Community Health (ECH) at Mayo Clinic. Dr. Meghna MansukhaniPrimary Care in Rochester and KassonTeen Sleep RoutinePrimary Care in Rochester and KassonThe best diet? It's one you can live with and maintain for life.&nbsp;<img src="/-/media/ech-media/images/widgets/randomimages/ech_longtimeweightloss_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=3282D028D181234E6BDB962AF357D9D8" alt="ECH_longtimeweightloss_widget" width="100" height="65" DisableNVelocity="true" />What's the best diet for long-time weight loss?5/6/2019 5:00 AM<img src="/-/media/ech-media/images/widgets/randomimages/ech_longtimeweightloss_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=7187D0DC716E3C989256344F01C38EB3" alt="ECH_longtimeweightloss_widget" width="300" height="195" DisableNVelocity="true" />It's a fact. Millions of Americans — adults and kids — are now overweight. The excess weight is also called "obesity" and results when there's an imbalance between the energy we take in (food) and the energy we spend (resting, digesting, physical activity — both exercise and non-exercise). Studies reveal that the surge we've seen in obesity is driven by our eating behaviors and food choices — not by decreased activity.  You've seen the different weight-loss diets that focus on macronutrients like carbohydrates, fat and protein. They're all equally effective at helping you lose weight because they all have one thing in common: they restrict energy intake (fewer calories). Zeroing in on carbohydrates, fats or protein isn't necessary for weight loss, and it isn't usually sustainable because we get bored with all the restrictions.  Which brings us to an old adage: the best diet is one we can live with or maintain for life. What does that diet look like? It's one that reduces the number of calories (energy) we take in and is built around:  <ul> <li>Fruits and vegetables, which are naturally low in calories</li> <li>Fiber, which helps make us feel full and satisfied</li> <li>Water and other low-calorie beverages to satisfy thirst</li> <li>Avoiding trans-fats and processed foods (anything in a box)</li> <li>Controlling food portions</li> </ul> Also, make it a habit to eat breakfast every day. In a national weight-control registry, people who lost 30 pounds or more and managed to keep them off for at least a year, report eating breakfast every day as a weight-loss maintenance strategy.  Diet is only one piece of a healthy lifestyle. Exercise does play a key role. Try to be physically active — aim for about two-and-a-half hours or 150 minutes of vigorous activity per week for both physical and mental health. Managing your stress also helps you cope with emotional issues that can lead to unhealthy eating patterns.  Find an approach you can live with, and you'll have found the perfect weight-loss plan for you.  <a href="https://communityhealth.mayoclinic.org/providers/ramona-dejesus-md" target="_blank">Dr. Ramona DeJesus</a> is a general internist in Employee and Community Health's (ECH) Division of Community Internal Medicine (CIM). she completed her MD at the University of Florida and residency in internal medicine at Mayo Clinic in Rochester. She is board certified in both internal and obesity medicine. Her interests include chronic disease management in primary care and population health management of high-risk patients. Dr. Ramona DeJesusPrimary Care in Rochester and KassonBest DietPrimary Care in Rochester and KassonAt six months, she was diagnosed with a rare blood disease.&nbsp;<img src="/-/media/ech-media/images/widgets/blooddonation/ech_blooddonor_shea_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=5C6CD38BA8606E08656C4B58FB92AF52" alt="ECH_BloodDonor_Shea_widget" width="100" height="65" DisableNVelocity="true" />Blood Donation: Giving Shea a healthy future4/15/2019 5:00 AM<img src="/-/media/ech-media/images/widgets/blooddonation/ech_blooddonor_shea_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=717EC1439A2A406CC8807310A553A4A2" alt="ECH_BloodDonor_Shea_widget" width="300" height="195" DisableNVelocity="true" />At six months old, Shea Novotny was a happy, healthy baby. So when her mother, Kerry, dropped Shea off at her grandmother's for the weekend, she had no reason to worry. But by Sunday, her grandmother was concerned that Shea had been sleeping a lot and looked a little yellow. So she called Kerry.  Kerry and her husband, Joe, wasted no time taking Shea to the doctor. Under the light, her skin did look jaundiced. The pediatrician initially thought these signs pointed to leukemia, so Shea was sent to Saint Marys Hospital in Rochester. Later that evening, test results revealed that she had autoimmune hemolytic anemia, a rare disease in which white blood cells attack red blood cells.  For two months, Shea and her family lived at the hospital. She received a total of 63 blood transfusions, often two or three a day, as well as a few rounds of chemotherapy. When her hemoglobin returned to a regular level, Shea was finally able to go home.  Now, once every two months she's checked at the hospital, and doctors are hopeful the disease won't return.  'Shea's Day': a birthday present for others needing blood After a routine check in October 2018, Kerry was delighted to learn all of Shea's levels were within normal range and had been staying consistent. Kerry recalls thinking, "This is the first time in five years that we don't have a pending appointment at Mayo Clinic!" She is as curious and lively as ever, thanks to her successful treatment. Like any typical girl her age, she loves unicorns, mermaids, the color pink, Barbies and ballet — and wants to be a ballerina when she grows up. She's working on sight words and reading skills, loves to play outside and is going to try skating lessons.  "We're beyond thankful for the many things that contributed to Shea's recovery — the Mayo Clinic doctors and residents, nursing staff, people in the lab getting her transfusions ready, and of course, those who took the time to give Shea what she desperately needed — blood donations," says Kerry.  Shea's family is so grateful for all the blood donors who helped save her life that they've started "Shea's Day", an annual blood donor day on her birthday to encourage as many people as possible to donate blood. They also donate regularly to help others who may need this life-saving gift.  To read more stories like this, visit the <a href="https://connect.mayoclinic.org/page/blood-donor-program/tab/newsfeed/" target="_blank">Mayo Clinic Blood Donor Program's Blog Page</a>.  Here are ways you can be involved in blood donation: <ul style="list-style-type: disc;"> <li>Donate blood. For more information about donating blood in Rochester, call (507) 284-4475, send an email to <a href="mailto:mailto:donateblood@mayo.edu">donateblood@mayo.edu</a>, or visit Mayo's <a href="https://www.mayoclinic.org/patient-visitor-guide/minnesota/blood-donor-program" target="_blank">blood donation webpage</a>. Blood donation locations in Rochester are: <ul> <li>Hilton Building, First Floor Monday-Friday, 6 a.m. to 4:30 p.m. (507) 284-4475</li> <li>Saint Mary's Campus - Joseph Building Main Floor, Room M-86  Monday-Thursday, 7:30 a.m. to 3:45 p.m. Friday, 6:30 a.m. to 3:30 p.m.(507) 255-4359</li> </ul> </li> <li>Host a blood drive. To make it convenient for you to give blood, Mayo Clinic Blood Donor Center offers mobile blood drives at locations around Olmsted County. Consider hosting a blood drive at your business, church or other site. Contact the Blood Donor Center to discuss. </li> <li>Lead a blood donor challenge. Challenge your family, friends, colleagues or groups in your community to donate blood. These friendly competitions are a fun way to encourage others to donate — and save lives in the process. For the challenge, team members simply check in at one of the donation locations with their team name, which ensures the donation is counted. When the challenge ends, the group with the highest percentage participation wins bragging rights. Are you ready to start a challenge?</li> </ul>  Kimberly Schmidt, Donor ServicesPrimary Care in Rochester and KassonBlood Donation SheaPrimary Care in Rochester and KassonHealthy eyes start with overall good health.&nbsp;<img src="/-/media/ech-media/images/widgets/medicalimages/ech_eyecare_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=CC093BB6C4E6558D160AB229D9921C92" alt="ECH_EyeCare_widget" width="100" height="65" DisableNVelocity="true" />Open your eyes to good eye care3/18/2019 5:00 AM<img src="/-/media/ech-media/images/widgets/medicalimages/ech_eyecare_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=2AF781AD5DB443CF492A019AE75B25E6" alt="ECH_EyeCare_widget" width="300" height="195" DisableNVelocity="true" />Take good care of your health, and you'll be taking good care of your eyes, too. By optimizing your health you can help prevent eye diseases, including:  <ul> <li>Macular degeneration. Thinning of the macula, which is part of the retina responsible for clear vision in your direct line of sight, causes loss of this central vision. </li> <li>Cataracts. The lens in the eye becomes cloudy, leading to blurry or double-vision, light sensitivity and loss of night vision. </li> <li>Glaucoma. Abnormally high pressure in the eye damages the optic nerve. </li> <li>Diabetic retinopathy. Uncontrolled high blood sugar from diabetes can damage blood vessels in the retina and eventually lead to blindness. </li> </ul> Foster good eye health throughout your life by:  <ul> <li>Not smoking. Smoking — and even second-hand smoke — can increase your risk for major eye disorders, such as macular degeneration, glaucoma and cataracts. </li> <li>Eating a healthy diet. A diet that's rich in fruits, vegetables, nuts, seeds, shellfish, fatty fish like salmon, and whole grains provides the nutrients that promote eye health. And that includes carrots (Vitamin A)!</li> <li>Shielding them from the sun. The sun's UV rays can damage your eyes, leading to cataracts and macular degeneration. Choose sunglasses for the whole family that block 99-100% of UV light. </li> <li>Exercising. It's one more element in all-round good health. </li> </ul> Mark your calendar for routine eye exams and screenings, which not only evaluate your vision, but can also catch any diseases early, leading to better and more successful treatment. We recommend that adults undergo a complete eye exam:  <ul> <li>Every five to 10 years in your 20s and 30s</li> <li>Every two to four years from 40 to 54</li> <li>Every one to three years from 55 to 64</li> <li>Every one to two years after age 65</li> <li>Earlier if you have conditions such as high blood pressure or diabetes, a family history of eye disease, or experience difficulty reading, seeing road signs, reduced night vision, any blurriness in the visual field, etc. </li> </ul> The schedule for vision screening for kids includes:  <ul> <li>Children 5 years and younger. For children under three, your pediatrician will likely look for the most common eye problems — lazy eye, crossed eyes or turned-out eyes. They could undergo a more-comprehensive eye exam between the ages of three and five. </li> <li>School-age kids and adolescents. Have your child's vision checked before they enter first grade. If they don't have symptoms and no family history of vision problems, have their vision rechecked every one to two years. </li> </ul> So who should you see for these screenings and exams? A rule of thumb is to see an optometrist for a routine exam and care and an ophthalmologist for specialty care.  Dr. Suzette Barakat is an internal medicine physician in Employee and Community Health's (ECH) Division of Community Internal Medicine (CIM) and practices at Mayo Family Clinic Southeast in Rochester. Her interests include preventive medicine, healthy lifestyle, chronic disease management, patient-centered care and mindfulness. Dr. Suzette BarakatPrimary Care in Rochester and KassonEye CarePrimary Care in Rochester and KassonThere's a lot of information - and misinformation - about obesity and being overweight on every kind of media. Let's set the record straight on some of these myths.&nbsp;<img src="/-/media/ech-media/images/widgets/randomimages/ech_obesityknowledge_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=66C3FB7F89FD369CC99F59B7F8BC879D" alt="ECH_ObesityKnowledge_widget" width="100" height="65" DisableNVelocity="true" />Myth or fact? Test your obesity knowledge5/20/2019 5:00 AM<img src="/-/media/ech-media/images/widgets/randomimages/ech_obesityknowledge_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=B45E8BA522A38E579EB2E8A634234693" alt="ECH_ObesityKnowledge_widget" width="300" height="195" DisableNVelocity="true" />Myth: Obesity is present only in the United States and industrialized countries.  Fact: Obesity has spread worldwide in epidemic proportions. While more than one-third of adults in the U.S. are obese, it's now commonly seen even in low- and middle-income countries. Plus, there's been a 10-times increase in global childhood and adolescent obesity since 1975. At least 2.8 million people die each year as a result of being overweight or obese.  Myth: It's okay for children to be overweight. It shows they're healthy, and they'll outgrow their "baby fat".  Fact: Overweight children are more likely to be obese as adults. They're also more likely than healthy-weight children to develop diabetes and cardiovascular disease at a younger age.  Myth: If you're obese, you need to get your weight to normal to achieve health benefits.  Fact: Research shows that a weight loss of 5-10% results in improved health outcomes, including lower blood sugar levels, lower blood pressure and reduced cholesterol levels. Focus on slow, progressive weight loss with a goal of taking off 10% of your starting weight after six months.  Myth: Only a few diseases are associated with obesity.  Fact: More than 60 diseases have been linked to obesity; among them are diabetes, heart disease, arthritis, stroke and cancer.  Myth: Not that many people die of obesity.  Fact: Worldwide, obesity is one of the top-five leading causes of death. The other four leading causes are high blood pressure, tobacco use, high blood glucose and physical inactivity.  People who are overweight or obese also miss more work days and spend more on medical bills than people of normal weight. The realities of carrying around excess weight can start to creep up on you and take its toll. The good news is that obesity is largely preventable, and a healthy diet and regular exercise can go a long way to help you reach and maintain a healthy weight.  <a href="https://communityhealth.mayoclinic.org/providers/ramona-dejesus-md" target="_blank">Dr. Ramona DeJesus</a> is a general internist in Employee and Community Health's (ECH) Division of Community Internal Medicine (CIM). She completed her MD at the University of Florida and residency in internal medicine at Mayo Clinic in Rochester. She is board certified in both internal and obesity medicine. Her interests include chronic disease management in primary care and population health management of high-risk patients. Dr. Ramona DeJesusPrimary Care in Rochester and KassonObesity Facts FictionPrimary Care in Rochester and KassonStress can be a friend and an enemy, but coping with it is key to your mental and physical health.&nbsp;<img src="/-/media/ech-media/images/widgets/randomimages/ech_stressfrenemy_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=0C09191987573A83DCB252DFD5C6C795" alt="ECH_StressFrenemy_widget" width="100" height="65" DisableNVelocity="true" />Stress: 8 tips for coping with your frenemy5/30/2019 5:00 AM<img src="/-/media/ech-media/images/widgets/randomimages/ech_stressfrenemy_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=4A9DD3E633A61F943A3C54CC9815A379" alt="ECH_StressFrenemy_widget" width="300" height="195" DisableNVelocity="true" />It's good for both your mental and physical health to manage stress. These eight techniques can help you bring it under control: <ol> <li>Prioritize. Make a "to-do" list of all your assignments and tasks, then order them by importance or deadline. Break down bigger things into smaller and more manageable pieces. Make sure you're setting yourself up for success so that you feel the positive, "I did it!", which can serve as a springboard for starting the next task. </li> <li>Manage your time. Find a planner or search online for a schedule template to lay out your projects and commitments. It can help to see all that's on your plate before jumping in. </li> <li>Exercise. Exercise releases the "feel-good" endorphin brain chemicals that help our mood, giving us a natural "high". Exercise can take the form of workouts or classes or activities such as gardening, cleaning and walking to the bus or school. Mayo Clinic recommends at least 30 minutes of moderate physical activity every day. </li> <li>Follow a sleep schedule. Most teens need eight to 10 hours of uninterrupted sleep; adults typically need seven to nine hours. Create and stick with a sleep schedule to ensure your body is consistently getting the time it needs to recharge, heal and process emotional experiences. On weekends, try not to stray too far from this schedule. Also, have a bedtime routine you regularly follow to cue your brain to prepare for sleep. </li> <li>Eat well. Make sure you eat three balanced meals that cover three of the five food groups, have healthy snacks, and hydrate with water throughout the day. </li> <li>Be mindful. Make mindfulness a part of your lifestyle to bring nonjudgmental awareness into your daily routines. It means being present in the moment with your environment, those around you, and with yourself (thoughts, feelings, intentions, values, etc.). Notice things with curiosity and openness, rather than with expectations, comparisons and criticism. Research shows there is a direct link between mind-wandering and unhappiness; check out this <a href="https://youtu.be/qzR62JJCMBQ?list=PLIBBvYr3NmFzJZUYeey7t6sQk-DgbGqrj" target="_blank">TED Talk</a> for more information. </li> <li>Enjoy and relax. Regularly do things that bring you joy. Schedule them in so it's sure to happen. Practice breathing from your diaphragm and learn to regulate your body on your own. The more we practice what seems to be a basic task like breathing, the more control we have over it. Having practiced it, we'll be able to draw on it to calm down during a stressful time. </li> <li>Seek professional support. Sometimes these coping strategies aren't enough, and it may be helpful to seek professional support from a mental health provider who can teach and coach you on a variety of coping strategies. Helpful therapies for stress include cognitive behavior therapy (CBT) and acceptance and commitment therapy (ACT). </li> </ol> Nicole (Nikki) Rose is a clinical pediatric social worker in Employee and Community Health (ECH) at the Baldwin Building and Mayo Family Clinic Northwest. She has been in ECH's Division of Integrated Behavioral Health (IBH) for the past two years. She previously worked in Pediatric Endocrinology and the Mayo Addictions Program.  Caitlin (Cait) Earle is a clinical pediatric social worker. Before joining ECH, she worked in Mayo Clinic's Pediatric Transitions for four years and now sees IBH patients in the Baldwin Building.Nikki Rose, LICSW, MSW and Cait Earle, LICSW, MSWPrimary Care in Rochester and KassonStress Coping TipsPrimary Care in Rochester and KassonWe're using your answers to improve the care you receive.&nbsp;<img src="/-/media/ech-media/images/widgets/randomimages/ech_questionaire_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=CDD77CA5BA651C256641B0A5649AA13C" alt="ECH_Questionaire_widget" width="100" height="65" DisableNVelocity="true" />Answering your questions about questionnaires5/13/2019 5:00 AM<img src="/-/media/ech-media/images/widgets/randomimages/ech_questionaire_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=63C0E35EB4F2EACF4C3398DD925AFD07" alt="ECH_Questionaire_widget" width="300" height="195" DisableNVelocity="true" />You may have noticed when checking in for your appointment, either online or in person, that you're being asked more questions. While these questions may not seem to be related to why you're coming in, we're using this information to improve the care you receive.  How can I check in for my ECH appointment? <ul> <li>Come to the desk</li> <li>Use the kiosk</li> <li>Go online, using either the My Mayo Clinic app or Patient Online Services</li> </ul> What about the questionnaire we're asked to fill out? <ul> <li>This series of questions helps your care team better understand your health. </li> <li>Questionnaires can be completed on a tablet, after you check in and while you're waiting for your appointment, collected during the rooming process, or completed online before arriving for your appointment. </li> </ul> Why am I being asked to complete one or more questionnaires? <ul> <li>Some are routinely used to screen for common conditions, and in general, see how you're feeling or functioning. </li> <li>Others may be used to assess an underlying condition, such as asthma. </li> </ul> How is this information used? <ul> <li>Your care team will use the answers to your questions to determine whether further intervention is needed. </li> <li>Certain questionnaires are very important  to your provider's assessment and completing the questionnaires beforehand will leave more time in your appointment to address other issues. </li> </ul> That sounds important, anything I can do to help? <ul> <li>Answer the questions as honestly as possible. </li> <li>Remind your care team about any responses to questions you'd like to discuss further. </li> </ul> <a href="https://communityhealth.mayoclinic.org/providers/john-matulis-do">Dr. John Matulis</a> is a consultant in Employee and Community Health's (ECH) Division of Community Internal Medicine (CIM). In addition to general internal medicine, he is board certified in preventive medicine and has an interest in quality improvement. Dr. John MatulisPrimary Care in Rochester and KassonQuestionnaires QuestionsPrimary Care in Rochester and KassonWhen creating your baby's nursery, make sure it's safe, as well as welcoming.&nbsp;<img src="/-/media/ech-media/images/widgets/people/ech_welcomebaby_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=487CC3D3FCF150CE6B06D7619E0E675B" alt="ECH_WelcomeBaby_widget" width="100" height="65" DisableNVelocity="true" />Welcoming baby6/17/2019 5:00 AM<img src="/-/media/ech-media/images/widgets/people/ech_welcomebaby_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=820549902101E976D1F4EB7E7A3D9AF7" alt="ECH_WelcomeBaby_widget" width="300" height="195" DisableNVelocity="true" />One of the first things parents do when they learn they're pregnant is start thinking about the perfect nursery to welcome their baby. Along with picking out colors and furniture, make sure you're creating a safe nursery, too.  Here are some tips for designing a safe environment for your bundle of joy when you bring them home and as they grow.  Cribs and beds Carefully choose a crib and mattress for your baby. Make sure all nursery furniture meets safety requirements. You can trust new furniture if it bears the <a href="https://www.jpma.org/" target="_blank">Juvenile Products Manufacturers Association</a> safety certification seal. Some things to consider:  <ul> <li>Bars should be spaced no more than 2-3/8 inches apart. Do not use a crib with drop rails. </li> <li>The mattress should be very firm and should not sag under your baby's weight. It should fit snugly, with no space between it and the crib walls. </li> <li>Keep crib bumpers or pads, large toys, stuffed animals, pillows, bulky comforters and heavy blankets out of the crib. </li> <li>Place your baby on their back for sleep until they're one year old. </li> </ul> Once your child is about three feet tall, they should start sleeping in a bed. If you're worried about them falling out of bed, you may want to start with the mattress on the floor.  Changing tables A changing table makes it easier to diaper and dress your baby, but a fall from it can be serious.  <ul> <li>Choose a sturdy, stable changing table with a two-inch guardrail around all four sides. </li> <li>For the pad, choose one where the middle is slightly lower than the sides. </li> <li>When using, buckle the safety strap, but always keep a hand on your baby too. Never leave them unattended, even if strapped in. </li> <li>Diapering supplies should be handy so you don't have to leave the baby, but out of the baby's reach — including the powder container. </li> <li>Make sure diaper pails have tight-fitting covers. </li> </ul> Other furniture and fixtures <ul> <li>Use a nightlight in the nursery, bathroom and hallways. </li> <li>Install smoke and carbon monoxide detectors inside the nursery and hallway outside the room. </li> <li>Anchor heavy furniture, such as dressers and bookshelves, to the wall to prevent them from falling on children. </li> <li>Choose a toy chest or basket without a lid. If it does have one, make sure there are air holes in case the child crawls inside. </li> <li>If picking out a crib mobile, look for one with bright colors, varied shapes and maybe even music. View it from below, which will be your baby's point of view. Remove it once they can sit up or reach it. </li> </ul> Windows Windows provide natural light and fresh air, but all windows throughout the house pose hazards, too. To make sure they're secure: <ul> <li>Move furniture away from windows. </li> <li>Don't rely on screens to prevent falls. </li> <li>Install stops that prevent windows from opening more than four inches. Most children five and younger can fit through a six-inch opening. </li> <li>Install window guards that cover the lower part of the window. </li> <li>Open double-hung windows from the top only. </li> </ul> For more tips about creating a safe environment for baby, check out stories on <a href="https://www.healthychildren.org/English/ages-stages/prenatal/decisions-to-make/Pages/Choosing-a-Crib.aspx" target="_blank">healthychildren.org</a>.  <a href="http://communityhealth.mayoclinic.org/providers/matthew-meunier-md" target="_blank">Dr. Matthew Meunier</a> is a family physician with Women's Health fellowship training in Employee and Community Health's (ECH) Department of Family Medicine. He is the Chief of Family Medicine Obstetrics and Newborn Services.   Dr. Matthew MeunierPrimary Care in Rochester and KassonSafe NurseryPrimary Care in Rochester and KassonA saltwater wash can help relieve stuffiness of allergies and colds.&nbsp;<img src="/-/media/ech-media/images/widgets/medicalimages/ech_netipot_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=A3BA0AABDC7207103BB04D4A01D1D144" alt="ECH_NetiPot_widget" width="100" height="65" DisableNVelocity="true" />Washing away allergy irritants6/13/2019 5:00 AM<img src="/-/media/ech-media/images/widgets/medicalimages/ech_netipot_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=30696725A2CC134F023F26539A1FB96F" alt="ECH_NetiPot_widget" width="300" height="195" DisableNVelocity="true" />For allergy, cold and sinus-problem sufferers, a stuffy nose is one of the most annoying and uncomfortable symptoms. But a simple, low-risk, inexpensive technique helps wash away the pollen, dirt, mucus and other irritants that can cause nasal congestion.  It's called a nasal saltwater wash, which rinses and moisturizes tissues, helping keep nasal passages open. Research shows that patients who do it routinely two or three times a week can relieve or even prevent congestion.  Here's how it works:  <ul> <li>Start with a nasal saltwater solution that you buy or make. It's available over the counter premixed or in premeasured packets. To make your own solution, use distilled or sterilized water or boil tap water for three to five minutes. Measure out one cup and set aside to cool until lukewarm. Stir in 1/2 teaspoon non-iodized salt, such as sea salt, and 1/2 teaspoon baking soda until they dissolve in the warm water. </li> <li>Pour the solution into a plastic nasal wash bottle or Neti Pot, which looks like a mini teapot. Lean over the sink, and tilt your head so your chin and nose are at the same level. Pour the solution in the upper nostril, letting it run out the lower one. Turn your head and do the other side. Repeat until all the solution is gone or until your nose feels clearer. </li> <li>Another option is to do the saline wash while you're taking a shower. </li> <li>Be sure to wash the bottle or Neti Pot after use and let it air dry. </li> <li>To see the technique, check out this video. </li> </ul> <iframe width="560" height="315" src="https://www.youtube.com/embed/zAF72ZN7Pmc" frameborder="0"></iframe> When first starting, do the nasal saltwater wash every day for two to four weeks, since if you're really congested, it may take time to clear your nasal passages. Then reduce to a couple times a week as a preventive treatment or just when you feel you need it. At first, the sensation can feel strange, but it's not like jumping in a pool and getting a nose full or water! There are few side effects to a nasal saltwater wash, but plenty of benefits. It's low cost, easy to do, won't cause nasal irritation and may even make your nasal spray work better. Give it a try and breathe easier.  <a rel="noopener noreferrer" href="https://communityhealth.mayoclinic.org/providers/joy-fladagermuth-cnp" target="_blank">Joy Fladager Muth, APRN, CNP</a>, is a primary care pediatric nurse practitioner with Employee and Community Health's (ECH) Division of Community Pediatric and Adolescent Medicine (CPAM). She serves as a member on the ECH chronic disease asthma subgroup and is one of four pediatric providers who are Integrated Community Specialists (ICS). In her ICS role. Joy provides expert asthma care and consulting services for ECH pediatric patients with asthma in collaboration with Mayo's Pediatric Pulmonology and Pediatric Allergy specialty providers. Joy Fladager Muth, APRN, CNPPrimary Care in Rochester and KassonAllergy Irritants Salt Water WashPrimary Care in Rochester and KassonBy not paving the way for your child, you're helping them build important life skills.&nbsp;<img src="/-/media/ech-media/images/widgets/kids/ech_healthychild_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=C28817D01D4B08B491BD85205E6BF5B5" alt="ECH_HealthyChild_widget" width="100" height="65" DisableNVelocity="true" />Raising a healthy, resilient child7/8/2019 2:00 AM<img src="/-/media/ech-media/images/widgets/kids/ech_healthychild_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=4B2399224D102E398E69C9109C9A23B3" alt="ECH_HealthyChild_widget" width="300" height="195" DisableNVelocity="true" />As a parent, it can be difficult to stand back and let your child struggle at something. It can be even harder to let your child fail and not sweep in to save the day like the super hero you are. It's okay to not draw on your "Super Parent" powers that make everything better. By not paving the way for your child (think helicopter parenting), you might actually be helping them build important life skills.  Allowing your child opportunities to experience frustration and failure is crucial to building their resilience. Resilience is when your child learns to work through everyday struggles or difficult circumstances and adapt and persevere in the face of challenges.  Resilience is like a muscle, the more you use it, the stronger it gets. If children aren't given opportunities to exercise resilience in a supportive and loving environment, they're missing out on developing the key skills that will help them succeed at whatever life throws at them.  To foster resilience, start by observing your child when they're faced with everyday challenges. How do they respond? Are they quick to cry, give up or ask for help? Or do they keep at it when things get tough? Some of your child's responses in these situations are related to their disposition and personality.  Even babies can begin building their resiliency. When your infant is trying a new skill and getting frustrated, don't step in and do it for them. Instead, sit with them and encourage them to keep trying.  Everyday life offers many opportunities to practice resiliency skills. As a parent, sometimes you need to slow down and let your toddler, child or teen try things on their own. For example:  <ul> <li>When your six year old is learning to buckle their seat belt, let them work through it, then praise them for their effort. </li> <li>When your preteen is experiencing drama with friends, don't rush in and call the other parent to get to the bottom of the situation. Encourage your child to work through it with their friend and give them the skills and support to do so. </li> </ul> These key steps will help your child develop their resilience:  <ul> <li>Teach your child that decisions have consequences and whenever possible, involve your child in decision-making and let the natural consequences play out. </li> <li>Teach your child that failure is part of life. If your child learns to expect to fail at things sometimes, they'll be more willing to try new things. They'll start seeing failure as an opportunity to learn. </li> <li>Foster your child's character strengths. Everyone has strengths! Identify your child's and find ways to nurture them. </li> </ul> If you're interested in learning more about resilience, read about it in chapter 17, "Raising a Resilient Child", of a new book from Mayo Clinic, Mayo Clinic's Guide to Raising a Healthy Child. You can <a rel="noopener noreferrer" href="https://marketplace.mayoclinic.com/shop/healthy-lifestyle/book/mayo-clinic-guide-to-raising-a-healthy-child_296300" target="_blank">buy it</a> from Mayo, your local independent book store or favorite online retailer.  <a rel="noopener noreferrer" href="http://communityhealth.mayoclinic.org/providers/angela-mattke-md" target="_blank">Dr. Angela Mattke</a> is a general pediatrician in Employee and Community Health's (ECH) Division of Community Pediatric and Adolescent Medicine (CPAM) at Mayo Clinic in Rochester. She is also host of Mayo Clinic's interactive FacebookLive show called, <a rel="noopener noreferrer" href="https://www.facebook.com/search/top/?q=%40askthemayomom" target="_blank">#AskTheMayoMom</a>, where she discusses and answers audience questions about common pediatric health topics. You can follow her on Twitter at <a rel="noopener noreferrer" href="https://twitter.com/DrAngelaMattke" target="_blank">@DrAngelaMattke</a>. For more information about pediatric health topics, follow <a rel="noopener noreferrer" href="https://twitter.com/search?q=mayoclinickids&src=typd" target="_blank">@mayoclinickids</a> on Twitter. Dr. Angela MattkePrimary Care in Rochester and KassonHealthy Resilient ChildPrimary Care in Rochester and KassonElectronic cigarettes are all the rage. But what do you really know about them?&nbsp;<img src="/-/media/ech-media/images/widgets/randomimages/ech_ecigs_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=EBE681B73ACEC68B45648F34DD101E24" alt="ECH_ecigs_widget" width="100" height="65" DisableNVelocity="true" />What's up with e-cigs?8/22/2019 5:00 AM<img src="/-/media/ech-media/images/widgets/randomimages/ech_ecigs_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=F26F691EF3A41C668D95A0278E56D483" alt="ECH_ecigs_widget" width="300" height="195" DisableNVelocity="true" />E-cigarettes are sometimes called "e-cigs", "vapes", "e-hookahs", "vape pens" and "electronic nicotine delivery systems (ENDS)". Some look like regular cigarettes, cigars or pipes. Others resemble USB flash drives, pens and other everyday items.  No matter what they're called, e-cigarettes are growing in popularity. Almost one in 20 Americans currently use them, and more than half of users are under age 35, according to a U.S. study. They're touted as a "safe" alternative to cigarettes and as a way to stop or cut back on smoking. But what do you really know about them?  How do they work? <img height="200" alt="EcigAnatomy" width="267" src="/-/media/ech-media/images/widgets/randomimages/eciganatomy.jpg?h=200&w=267&sc_lang=en&hash=E91155A6A738309E3621A119689293C4" style="height: 200px; width: 267px; float: right; padding: 2px;">Electronic cigarettes consist of a lithium battery attached to a heating element ("atomizer") that vaporizes a "humectant" made up of propylene glycol and vegetable glycerin that contains liquid nicotine. The atomizer can be made of different types of metal that are heated or an ultrasonic device, which is activated to produce the vapor you see when people use an e-cigarette.  Vaporizing produces an aerosol that looks like conventional cigarette smoke, but its makeup is completely different. The aerosol or vapor is inhaled — that's why it's referred to as "vaping".  What are the different kinds? There are more than 500 different e-cigarettes on the market. There also are about 8,000 unique flavors of e-juice available. E-cigs can be grouped into three main categories:  <ul> <li>Cigalikes resemble conventional cigarettes. </li> <li>Mods are larger than cigalikes and have "tanks" that can be filled and refilled with "e-juice" or "e-fluid" (nicotine combined with a humectant and flavoring). </li> <li>Pods have custom-fitted cartridges that come either prefilled or are refillable by the user. </li> </ul> What are the pros and cons? E-cigarettes have been shown to help cigarette smokers quit tobacco.  For teens who never smoked tobacco before, using e-cigarettes may increase the risk for smoking tobacco, which is the riskiest product of them all. Drawbacks associated with e-cigarettes are related to ingredients in the e-juice, as well as formaldehyde, which is produced when the heated coil reaches certain temperatures.  Juul™ is a pod-type system that delivers a highly concentrated form of nicotine called a nicotine salt. The amount of nicotine delivered with a salt is three to five times higher than the average e-juice. For adolescents who have never smoked tobacco, nicotine salts can produce symptoms of nicotine use such as irritability, as well as nicotine withdrawal, including cravings, poor sleep and mood changes when they try to stop.  No therapies exist for treating teens who use e-cigarettes, so the best plan is not to start.  <a href="https://communityhealth.mayoclinic.org/providers/jon-ebbert-md">Jon Ebbert, MD</a>, is a physician in Employee and Community Health's (ECH) Division of Community Internal Medicine (CIM). He also works with Mayo Clinic's <a rel="noopener noreferrer" href="https://www.mayoclinic.org/departments-centers/nicotine-dependence-center/sections/overview/ovc-20457521" target="_blank">Nicotine Dependence Center</a> in Rochester. Dr. Jon EbbertPrimary Care in Rochester and KassonEcigarettesPrimary Care in Rochester and KassonMenopause is a major transition in a woman's life and shouldn't be a mystery.&nbsp;<img src="/-/media/ech-media/images/widgets/people/ech_menopause_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=FCE52C853940F61A69E63BB4DAC013CB" alt="ECH_Menopause_widget" width="100" height="65" DisableNVelocity="true" />Menopause: What changes during the 'change'?7/25/2019 4:30 AM<img src="/-/media/ech-media/images/widgets/people/ech_menopause_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=6EF2CF870477E8E60710CE918A7072F1" alt="ECH_Menopause_widget" width="300" height="195" DisableNVelocity="true" />Menopause is the time in a woman's life when she stops having monthly periods. It's often referred to as the "change of life" and marks the transition between a woman's childbearing and non-childbearing years. Menopause is a natural part of aging and happens because of the gradual loss of estrogen, a hormone primarily produced in the ovaries.  What are the signs and symptoms of menopause? As estrogen production declines, women often develop irregular periods, hot flashes, night sweats, mood swings and fatigue. These symptoms usually develop three to five years before a woman's last period — a time referred to as perimenopause.  Menopause usually occurs between the ages of 45 and 55, with an average age of 51. If a woman is 45 or older and stops menstruating completely for one year, it's assumed she's in menopause. Lab testing isn't needed to confirm menopause. If a woman is under 45 and stops having periods or thinks she may be having menopause symptoms, then she should talk with her doctor to determine if any testing is needed. She may need testing to see if it's menopause or another problem causing her symptoms. A woman should also contact her care team if: <ul> <li>She's having really bothersome menopausal symptoms that are interfering with her activities</li> <li>She's experiencing heavy bleeding during her period or between periods</li> <li>She starts bleeding again after entering menopause</li> </ul> Menopause affects all women regardless of race or socioeconomic background, but it's an experience unique to every woman. Some women have more estrogen-deficiency related symptoms and find menopause extremely bothersome, while others may have few or no symptoms.  What are the health concerns for women in menopause? Reduced levels of estrogen after menopause can lead to health problems. The most common is osteoporosis — thinning of the bones — which increases risk of fractures. Postmenopausal women are at risk for other health problems, including heart disease, stroke and cancer, but the relationship to changes in estrogen levels is not clear.  What are the treatment options for menopausal symptoms? Medical treatments available by prescription include hormone replacement therapy, antidepressants and anti-seizure medications.  <ul> <li>Estrogen replacement. It's safe for most healthy women, and it's the most effective treatment. Typically, hormone replacement therapy is recommended for up to five years. It's not recommended for women with a history of breast cancer, heart disease or stroke. Progesterone treatment will also be needed if a woman still has a uterus. </li> <li>Antidepressants. Some types can help ease hot flashes and other menopausal symptoms — even in women who are not depressed. </li> <li>Anti-seizure medications. These have effectively treated hot flashes in some women. </li> <li>Natural remedies. Some may not be safe, so a woman should talk with her care team before taking them, especially if she has a history of breast cancer. </li> <li>Smoking. Women who smoke should quit, since smoking intensifies hot flashes. </li> </ul> Menopause is a normal part of a woman's life and doesn't always need to be treated, unless symptoms are particularly bothersome. If you have questions about "the change" and how it may affect you, talk with your care team.  <a href="https://communityhealth.mayoclinic.org/providers/denise-dupras-md">Dr. Denise Dupras</a> is a general internist in Employee and Community Health's (ECH) Division of Community Internal Medicine (CIM). She completed her MD-PhD at Mayo Medical School and her residency in Internal Medicine at Mayo Clinic's campus in Rochester. Her interests include medical education and evidence-based medicine. Dr. Denise DuprasPrimary Care in Rochester and KassonMenopausePrimary Care in Rochester and KassonThe label has been updated to make it easier for you to make informed food choices.&nbsp;<img src="/-/media/ech-media/images/widgets/randomimages/ech_nutritionlabel_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=EFCD83826D029EFAA9255A1E197FCDA8" alt="ECH_NutritionLabel_widget" width="100" height="65" DisableNVelocity="true" />Nutrition Facts label: A tool for healthy eating7/29/2019 3:30 AM<img src="/-/media/ech-media/images/widgets/randomimages/ech_nutritionlabel_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=7F95D0A0929F4741C2B34720CF79E5BA" alt="ECH_NutritionLabel_widget" width="300" height="195" DisableNVelocity="true" />On every can, box, bottle, jar or bag of packaged food there's a super tool for helping you make healthy food choices. It's the Nutrition Facts label, and it's just <a rel="noopener noreferrer" rel="noopener noreferrer" href="https://www.fda.gov/food/food-labeling-nutrition/changes-nutrition-facts-label" target="_blank">undergone a makeover</a>. The fresh new design and information reflects the most up-to-date scientific nutrition information, including the link between diet and chronic diseases.  Food manufacturers have some time to transition to the new label, but the new one already is showing up on foods nationwide. So let's do a walk-through of the label to see what's new.  <h3>Servings</h3> Serving size is based on the amount of food that typically is eaten at one time and is not a recommendation of how much to eat. The nutrition information listed on the Nutrition Facts label is usually based on one serving of the food; however, some containers may also have per-package information. When comparing calories and nutrients in different foods, check the serving size in order to make an accurate comparison. Servings per container shows the total number of servings in the entire food package or container.  What's new: Servings per container and serving size are now in larger and/or bolder type. Serving sizes have been updated to reflect what people eat and drink today. There also are new requirements for certain sized packages, such as those that are between one and two servings or are larger than a single serving but could be consumed in one or more sittings.  <h3>Calories</h3> Calories refers to the total number of calories or "energy" supplied from all sources (fat, carbohydrate, protein and alcohol) in one serving of the food. As a general guide, 100 calories per serving of an individual food is considered a moderate amount, and 400 calories or more per serving is considered high in calories. For help in determining what your daily calorie needs are, check out the <a rel="noopener noreferrer" rel="noopener noreferrer" href="https://www.myplate.gov/" target="_blank">My Plate Plan</a> and other resources at <a rel="noopener noreferrer" rel="noopener noreferrer" href="https://www.myplate.gov/" target="_blank">My Plate</a>.  What's new: "Calories" is now larger and bolder so it's easier to find.  <h3>% Daily Values</h3> % Daily Value (%DV) shows how much a nutrient in a serving of the food contributes to a total daily diet. Use the %DV to determine if a serving of the food is high or low in an individual nutrient to compare food products. As always, when making comparisons, check to make sure the serving size is the same.  As a general guide, 5% DV or less of a nutrient per serving is considered low, and 20% DV or more of a nutrient per serving is considered high.  What's new: The Daily Values for nutrients have been updated based on new scientific evidence. They are reference amounts of nutrients to consume or not to exceed each day (for adults and children age four and older) and are used to calculate the % Daily Value. <h3>Nutrients</h3> The list of nutrients required on the label has been updated to reflect how they impact your diet.  <ul> <li>Added sugars is now required. Added sugars includes sugars that are either added during the processing of foods or are packaged as such (think a bag of table sugar). They also include sugars from syrups and honey and concentrated fruit or vegetable juices. Aim for less than 10% of your total daily calories from added sugars.</li> <li>Vitamin D and potassium are required because many Americans don't get the recommended amounts. Vitamins A and C are no longer required, since deficiencies of these vitamins are rare today. Manufacturers may voluntarily include them. </li> </ul> Use the label to choose products that are lower in nutrients you want to get less of and higher in those you want more of.  <ul> <li>Nutrients to get less of: Saturated fat, sodium, added sugars and trans fat. Most Americans exceed the recommended limits for these nutrients, and diets higher in them are associated with an increased risk of developing some health conditions, such as high blood pressure and cardiovascular disease. Compare and choose foods to get less than 100% DV of these nutrients each day. Trans fat has no %DV. Use the number of grams to make comparisons and strive to keep your intake of trans fat as low as possible. </li> <li>Nutrients to get more of: Dietary fiber, vitamin D, calcium, iron and potassium. Many Americans don't get the recommended amount, and diets higher in these nutrients can reduce the risk of developing some health conditions, such as high blood pressure, cardiovascular disease, osteoporosis and anemia. Compare and choose foods to get 100% DV of these nutrients on most days. </li> </ul> <h3>Check out the Ingredient List</h3> Although the ingredient list is not part of the Nutrition Facts label, it's also a helpful tool, showing each ingredient by its common or usual name. Ingredients are listed in descending order by weight, so the ingredient that weighs the most is listed first; the one that weighs the least is listed last.  The Nutrition Facts label provides a wealth of information in one handy location By using that information, it's not hard to make better choices about the foods you eat.  Michaeleen Burroughs has worked at Employee and Community Health (ECH) in Family Medicine for 20 years. She currently helps patients at Mayo Family Clinics Northwest, Southeast and Kasson, and Baldwin Family Medicine and Community Pediatric and Adolescent Medicine (CPAM). Her areas of interest are diabetes and child and adult weight management. Michaeleen Burroughs, RDN, LDPrimary Care in Rochester and KassonNutrition Facts LabelPrimary Care in Rochester and KassonIf orthopedic surgery is in your future, precautions can reduce your chance of infection.&nbsp;<img src="/-/media/ech-media/images/widgets/medicalimages/ech_surgicalantibotic_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=26E9CD0BF4581D106E54FA9766ADF342" alt="ECH_SurgicalAntibotic_widget" width="100" height="65" DisableNVelocity="true" />Avoiding infection before, during, after orthopedic surgery8/19/2019 5:00 AM<img src="/-/media/ech-media/images/widgets/medicalimages/ech_surgicalantibotic_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=6EBF21A087F1CE6FD481582CDCBD9F6B" alt="ECH_SurgicalAntibotic_widget" width="300" height="195" DisableNVelocity="true" />Infection after an orthopedic surgical procedure can be draining physically, mentally, emotionally and financially. If you're scheduled for orthopedic surgery, you can help reduce your own risk of infection. Your orthopedic health care team also makes every effort to prevent infection by following Mayo Clinic's and the Center for Disease Control's (CDC) best practice care guidelines before, during and after surgery.  What to do before surgery Your surgeon may advise you to attend a pre-surgery class where you'll learn about measures to prevent infection, including:  <ul> <li>Staying healthy! Work with your health care team to make sure your health is the best it can be before surgery. this is particularly relevant in cases of:  <ul> <li>Obesity. Extra body weight increases the risk of infection.</li> <li>Diabetes. Infection risk is increased, particularly with poorly controlled diabetes, reflected in high hemoglobin A1C levels. </li> <li>Malnutrition. Individuals at higher infection risk include those with metabolic conditions or after gastric bypass surgery. </li> <li>Recurrent infections. Chronic urinary tract infections are the most common. </li> </ul> </li> <li>If you smoke, try to stop. Smoking inhibits healing and increases the risk of infection. Your health care team may recommend postponing your surgery until you haven't been smoking for several weeks. You shouldn't smoke during your recovery, either. Blood work may be used to confirm that you're off nicotine products. </li> <li>Reduce bacteria in your body. The night before and the morning of surgery, you'll use a special soap to thoroughly wash off bacteria regularly found on your skin. Before shoulder surgery, you may also need to wash with benzoyl peroxidase, which is particularly effective at clearing Cutibacterium acnes, a bacteria present on the chest, back and armpit. You may carry staphylococcus in your nose; an antiseptic solution may be used to decontaminate it just before surgery. </li> <li>Taking a medication break. You may be asked to take a break from certain medications before, during and after surgery. These can include blood thinners, anti-inflammatories and immunosuppressive medications. Talk to your health care team before taking a break from any of your medications. </li> </ul> Antibiotics during surgery Your health care team will administer antibiotics through an intravenous line in the operating room right before surgery begins and again at the end, and two more times afterward. The most common antibiotic is cefazolin; vancomycin is added for those at risk for certain infections. If you're allergic to either of these antibiotics, your team will select alternatives. Many other precautions will be observed during surgery, including adequate sterile technique and limited traffic in the operating room.  Precautions after surgery If you've had joint-replacement surgery, you'll need to follow these precautions: <ul> <li>Delay elective high-risk dental procedures, elective gastrointestinal endoscopy and high-risk urologic procedures for at least six months after the procedure. </li> <li>If you develop active dental problems, they need to be evaluated and treated immediately. </li> <li>You should receive antibiotics one hour before dental work for the first year after surgery. </li> <li>If you're undergoing certain high-risk urologic procedures, you'll be given antibiotics one hour before the procedure for the first year after joint replacement. </li> </ul> Preventing infection is of the utmost importance when considering orthopedic surgery. Improving your general health, avoiding nicotine products, and washing off bacteria from your skin and nose will help. Your surgical team will let you know when antibiotics are needed, as well.  Lori McGowan, PA-C, has worked in the Department of Orthopedic Surgery since 2010. She is supervisor for Employee and Community Health's (ECH) Podiatry and Musculoskeletal work units. Lori currently helps patients in the Musculoskeletal Integrated Community Specialties Practice in the Baldwin Building. Her areas of interest include hip, knee, shoulder, foot and ankle orthopedic conditions. Lori McGowan, PA-CPrimary Care in Rochester and KassonAntibiotics Orthopedic SurgeryPrimary Care in Rochester and KassonSwimmer is a shining example of how blood donation can work miracles.&nbsp;<img src="/-/media/ech-media/images/widgets/blooddonation/ech_blooddonorlydia_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=0C4068122634658A4E3EC20D0AF81859" alt="ECH_BloodDonorLydia_widget" width="100" height="65" DisableNVelocity="true" />Blood donation: Back in the swim after cancer diagnosis8/26/2019 3:00 AM<img src="/-/media/ech-media/images/widgets/blooddonation/ech_blooddonorlydia_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=CB0AA0EBB6DE04F545F0365B6437EDEB" alt="ECH_BloodDonorLydia_widget" width="300" height="195" DisableNVelocity="true" />Blessed with a delightful and contagious personality, Lydia Pankratz doesn't seem like someone who has battled a serious disease since age 11. Currently a senior at Century High School in Rochester, Minn. Lydia is enjoying her life in full remission since her acute lymphoblastic leukemia (ALL) diagnosis in September 2012.  While on a family trip to Sweden, Lydia began to feel extremely exhausted and eventually found she couldn't walk, so her dad carried her. Her parents thought she was suffering from anemia and fed her iron supplements. Once home, her doctor found her hemoglobin was at 4.6 — an extremely low and dangerous level. A bone marrow biopsy revealed cancer cells. She then underwent intense chemotherapy treatments at Mayo Clinic through January 2015.  "While being treated, I experienced a lot of issues due to the chemotherapy, including steroid-onset diabetes, kidney stones, a suppressed immune system and pancreatitis," says Lydia. "I missed a lot of school and really missed hanging out with my friends." Detail-oriented, Lydia always wanted to know the "hows" and "whys" of how everything worked. Lydia says she was so impressed that her health care team addressed her in such an adult manner, although she was only 11.  "They all took their time with me and my parents, answering all of our questions," she says. "They were all so wonderful to me in the hospital for my 12th birthday. The doctors and nurses made it extra special by decorating my room and writing 'Happy Birthday, Lydia' on my windows." Lydia enjoys swimming and has received wonderful support from her coach; this year, she's captain of her swim team.  She responded to the chemo treatments very well, and shortly after beginning the treatment regimen, she was found to be in remission. On January 4, 2020, after five years of remission, she'll be completely healed and cancer-free.  Having received many units of blood product during the course of her treatment, Lydia and her family are extremely grateful for the generosity shown by so many people who donated their blood in order to save Lydia's life. Symptom-free, Lydia currently advocates for our program by encouraging her friends to donate blood whenever Mayo Clinic's blood drive comes to their school. She's a shining example of how blood can work miracles.  Here are ways you can be involved in blood donation: <ul style="list-style-type: disc;"> <li>Donate blood. For more information about donating blood in Rochester, call (507) 284-4475, send an email to <a href="mailto:mailto:donateblood@mayo.edu">donateblood@mayo.edu</a>, or visit Mayo's <a rel="noopener noreferrer" href="https://www.mayoclinic.org/patient-visitor-guide/minnesota/blood-donor-program" target="_blank">blood donation web page</a>. Blood donation locations in Rochester are: <ul style="list-style-type: disc;"> <li>Hilton Building, first floor, Monday-Friday, 6 a.m. to 4:30 p.m., 507-284-4475</li> <li>Saint Marys Campus - Joseph Building, main floor, Room M-86, Monday-Thursday, 7:30 a.m. to 3:45 p.m. Friday, 6:30 a.m. to 3:30 p.m., 507-255-4359</li> </ul> </li> <li>Host a blood drive. To make it convenient for you to give blood, Mayo Clinic Blood Donor Center offers mobile blood drives at locations around Olmsted County. Consider hosting a blood drive at your business, church or other site. Contact the Blood Donor Center to discuss. </li> <li>Lead a blood donor challenge. Challenge your family, friends, colleagues or groups in your community to donate blood. These friendly competitions are a fun way to encourage others to donate — and save lives in the process. For the challenge, team members simply check in at one of the donation locations with their team name, which ensures the donation is counted. When the challenge ends, the group with the highest percentage participation wins bragging rights. Are you ready to start a challenge?</li> </ul>Kimberly Schmidt, Donor ServicesPrimary Care in Rochester and KassonBlood Donation LydiaPrimary Care in Rochester and KassonCurious about CBD oil? Here's what you need to know about this hot new health product.&nbsp;<img src="/-/media/ech-media/images/widgets/medications/ech_cbd_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=20687D8BB8324D01223CCF702334F38E" alt="ECH_CBD_widget" width="100" height="65" DisableNVelocity="true" />CBD basics: What you need to know8/15/2019 2:30 AM<img src="/-/media/ech-media/images/widgets/medications/ech_cbd_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=4331AC93C1DF7DDB836DA3FC006F2E9D" alt="ECH_CBD_widget" width="300" height="195" DisableNVelocity="true" />You've heard plenty about CBD oil, and you may have even tried it. But what are the issues and concerns with this hot new health product? What it is Cannabidiol (CBD) is a non-psychoactive derivative of cannabis, also known as marijuana. In other words, you can't get high from it. The opioid epidemic and chronic pain have driven interest in using CBD oil for treating pain. More studies are exploring its effectiveness in relieving pain, but the data is still limited.  Complicated to study One key factor complicates research into CBD: At the federal level, CBD-containing products are illegal, even if they're legal in some states.  No standard regulation Neither the FDA nor federal regulatory agencies oversee the production or distribution of CBD sold from dispensaries or on the internet. States that have legalized cannabis expect the growers, processors and distributors to self-regulate the production, marketing and selling of these products.  As a result, products may not be pure, the concentration and dosing may not be accurate and the labeling may be misleading:  <ul> <li>Among CBD products sold online, studies report significant differences in CBD concentrations; there is no consensus on recommended doses. </li> <li>Studies have identified contaminants in CBD, such as pesticides, metal particles and synthetic cannabinoids, along with molds, bacteria and aflatoxins, which may have entered the plant while it was growing. </li> </ul> What you need to know — for now What you need to know about CBD is there's a: <ul> <li>Lack of evidence for the popular uses of CBD oil </li> <li>Risk of contaminants, misleading labels and legal issues </li> </ul> Before using CBD oil products, be sure to talk with your health care provider. They'll be able to determine if there are potential interactions between CBD and drugs on your medication list. To learn more about CBD, check out Mayo Clinic's story on the <a rel="noopener noreferrer" rel="noopener noreferrer" href="https://www.mayoclinic.org/healthy-lifestyle/consumer-health/expert-answers/is-cbd-safe-and-effective/faq-20446700" target="_blank">benefits of CBD</a> and the <a rel="noopener noreferrer" rel="noopener noreferrer" href="https://naturalmedicines.therapeuticresearch.com/databases/food,-herbs-supplements/professional.aspx?productid=1439" target="_blank">natural medicines website</a>.  <a href="https://communityhealth.mayoclinic.org/providers/sonya-peters-pac">Sonya Peters, PA-C, MS</a>, is a physician assistant with Employee and Community Health's (ECH) Division of Community Internal Medicine (CIM) at Mayo Family Clinic Northwest. Her areas of special interest are women's health and procedural medicine. Sonya Peters, PA-C, MSPrimary Care in Rochester and KassonCBD OilPrimary Care in Rochester and KassonAnxiety disorders are the most common mental condition in the U.S. What do you know about them?&nbsp;<img src="/-/media/ech-media/images/widgets/elderly/ech_anxiety_01_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=D1299D6F6FCAEC5694969135D87C6AC6" alt="ECH_Anxiety_01_widget" width="100" height="65" DisableNVelocity="true" />FAQs about anxiety disorders10/10/2019 5:00 AM<img src="/-/media/ech-media/images/widgets/elderly/ech_anxiety_01_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=79990A6A9EA4E9F88F880683A0B488A3" alt="ECH_Anxiety_01_widget" width="300" height="195" DisableNVelocity="true" />Anxiety disorders are the most common mental health condition in the United States, affecting nearly 30% of the population at some point in their lifetime. The most common anxiety disorders are specific phobias, which affect 19 million people and social anxiety disorder, affecting 15 million. Obsessive-compulsive disorder is the least common, affecting 2 million people each year, yet it can be one of the most impairing. The answers to these frequently asked questions can help you gain a better understanding of these disorders and their treatment.  Q: Where do anxiety disorders come from? A: Anxiety disorders typically come from a combination of biological, environmental and learned factors. Certain anxiety disorders, such as obsessive-compulsive disorder and social anxiety disorder, tend to run in families. Sometimes, certain health conditions, such as hyperthyroidism and asthma, may mimic symptoms of anxiety or make existing anxiety problems worse. Environmental stress can also lead to the onset of anxiety disorders. Other anxiety disorders may be due to negative learning experiences.  Q: What are the different types of anxiety disorders? A: These are the types of phobias providers see most often: Specific phobias: This type of anxiety involves intense fear of: <ul> <li style="margin-left: 40px;">Certain situations, such as driving or flying</li> <li style="margin-left: 40px;">Animals, such as dogs or spiders</li> <li style="margin-left: 40px;">Environments, such as storms or the dark</li> <li style="margin-left: 40px;">Medical situations, such as injections or the site of blood</li> </ul> Individuals with a specific phobia will often experience significant anxiety, even at the thought of managing the triggers for their fears. Avoiding triggers for their phobia is also very common.  Separation anxiety disorder: This type of anxiety involves intense dread and worry about being away from caregivers and loved ones. Uncertainty about their absence can feel intolerable and multiple attempts at seeking reassurance — think phone calls or texts — may be common. Although this tends to be more likely in children, adults can also experience significant anxiety over separation from others.  Generalized anxiety disorder: This type of anxiety involves difficulties controlling worry. Individuals worry about a wide variety of situations, such as health, finances, relationships, work or school. Their worry tends to jump to the worst-case scenarios, they assume these situations are likely to happen, and they doubt their ability to copy with them if they occur. Muscle tension and sleep disruption are also commonly associated with excessive worry.  Panic disorder: This type of anxiety involves the experience of intense surges of physical anxiety, such as rapid heart rate, difficulties breathing, chest tightness, lightheadedness, dizziness, sweating and tingling in the hands and feet. It's also common to experience significant worry over what these symptoms mean, such as fear of losing control or having a heart attack/stroke. Panic attacks can be triggered by specific situations, but they may also seemingly come out of the blue, even waking people up in the middle of the night. The anxiety tends to be about the fear of fear-related symptoms. Avoiding situations because of fear of having these attacks and seeking emergency medical care can be common.  Social anxiety disorder: This type of anxiety involves fears of being negatively evaluated or criticized by others. Worries over making mistakes and embarrassing oneself tend to be common. Individuals often experience significant anticipatory dread even before getting into social situations. They may replay their performance in a negative way after these situations are over, even if nothing objectively negative happened. Avoiding social situations can be common. Social anxiety is often associated with an increased risk for depression.  Obsessive-compulsive disorder: This type of anxiety involves the experience of recurring, intrusive and unwanted thoughts or images (obsessions) and engaging in behaviors to try to reduce or eliminate anxiety (compulsions). Common obsessions include fears of getting contaminated; doubting whether they did something correctly; worry about losing control and causing harm to others; and intrusions related to sexual, moral or religious themes. Most of the time, compulsions are related to the obsessions, such as washing excessively to eliminate fear of contamination, repeatedly checking door locks when feeling doubtful, and praying when experiencing religious intrusions. However, other compulsions can involve more rule-governed, superstition-like behaviors, such as having to get dressed in a particular way, counting in groups of threes, or having to repeat phrases over and over until they sound "just right".  Post-traumatic stress disorder: With this form of anxiety, individuals experience extreme distress in reaction to an event that involved the threat of death, violence or serious injury. A variety of symptoms can be common, including re-experiencing the event(s) in the form of flashbacks and nightmares; being easily startled and hypervigilant to one's surroundings; having mood changes; and avoiding situations or reminders of the traumatic event(s).  Q: What happens if anxiety disorders aren't treated? A: The annual estimated cost of untreated anxiety disorders is approximately $60 billion due to lost wages, unemployment and health care. In comparison to those without anxiety disorders, individuals who experience them are at greater risk for depression and substance abuse.  Q: How are these disorders treated? A: Anxiety disorders are very treatable mental health conditions. Unfortunately, only about one-third of individuals are receiving evidence-based care for their condition. The most effective treatments include cognitive behavioral therapy (CBT) and medication management. CBT is a skills-based approach in which individuals learn to gain control over their anxiety by facing their fears (exposure therapy) and directly challenging negative beliefs (cognitive reframing). The most common medications used to treat anxiety disorders are selective serotonin reuptake inhibitors (SSRIs).  Q: How do I get help? A: Talk with your health care provider about effective treatments for anxiety disorders. Many primary care teams are skilled in treating these disorders with medication strategies. When looking for psychotherapy, be a good consumer of your care and ask to work with a clinician skilled in CBT. CBT providers will often assign homework between sessions, which is extremely important in your recovery. The <a rel="noopener noreferrer" rel="noopener noreferrer" href="http://www.abct.org/Home/" target="_blank">Association for Behavioral and Cognitive Therapies</a> may be able to help locate CBT providers in your area.  The <a rel="noopener noreferrer" rel="noopener noreferrer" href="https://adaa.org/" target="_blank">Anxiety and Depression Association of America</a> is an excellent resource for up-to-date information on anxiety disorders and their treatment. Several self-help books and smartphone CBT apps are also available. A listing of helpful apps for anxiety disorders can be found at <a rel="noopener noreferrer" rel="noopener noreferrer" href="https://psyberguide.org/" target="_blank">PsyberGuide</a>.  <a rel="noopener noreferrer" rel="noopener noreferrer" href="https://www.mayoclinic.org/biographies/sawchuk-craig-n-ph-d-l-p/bio-20085911" target="_blank">Dr. Craig Sawchuk</a> is a clinical psychologist in Employee and Community Health's (ECH) Division of Integrated Behavioral Health (IBH). He is a professor of psychology and co-chairs the Divisions of Integrated Behavioral Health and Professionalism within the Department of Psychiatry and Psychology at Mayo Clinic in Rochester. Craig Sawchuk, PhD, LPPrimary Care in Rochester and KassonAnxiety Disorders FAQPrimary Care in Rochester and KassonYou can help preemies like Ayden with your gift of blood.&nbsp;<img src="/-/media/ech-media/images/widgets/blooddonation/ech_preemieblood_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=BF3AE3679567382BD79E7BCA2D98F807" alt="ECH_PreemieBlood_widget" width="100" height="65" DisableNVelocity="true" />Blood donation: Pints for Preemies challenge is back!10/3/2019 5:00 AM<img src="/-/media/ech-media/images/widgets/blooddonation/ech_preemieblood_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=D97B320AE5559241BEE5EC4A43A63E60" alt="ECH_PreemieBlood_widget" width="300" height="195" DisableNVelocity="true" />Looking at baby Ayden, you'd never know the uphill battles he's already faced in his short life. Now a little over a year old, he's a happy, smiley baby who enjoys playing with his older brother.  Ayden was born at only 23 weeks gestation, weighing just 1 pound 11 ounces. Immediately after his birth, he was taken to the Neonatal Intensive Care Unit (NICU) at Mayo Clinic Hospital - Rochester, Saint Marys Campus. Born with a small hole in his heart, Ayden was given ibuprofen to help repair it.  "He had all sorts of lines, wires and tubes coming out of him. It was surreal seeing such a tiny person have so much attached to his body," recalls his mother, Nicole. "It was a journey we never saw coming." <img alt="AydenHospitalResized" class="img-responsive" src="/-/media/ech-media/images/widgets/blooddonation/aydenhospitalresized.jpg?h=259&w=195&sc_lang=en&hash=6FDD39C598EE40CA9C0DACD17FC99517" style="height: 259px; width: 195px; float: right; padding: 2px;" />When one of his nasogastric tubes rubbed a tear in his gastric lining, he began to lose blood. In order to replenish what was lost and to help him gain strength, Ayden was given six blood transfusions. After 112 days in the NICU, Ayden was able to go home and start growing to be a happy, healthy baby. The only major side effect is that he now needs glasses due to the effects of an eye disease he had as a premature baby. Otherwise, you'd never know he was a micro preemie.  Ayden's family saw first-hand the importance that blood products play in helping premature babies. In honor of World Prematurity Day, the Mayo Clinic Blood Donor Program will be hosting the Second Annual Pints for Preemies Blood Donation Challenge. Our goal for this year is simple — to bring in more lifesaving blood donations and raise awareness of World Prematurity Day on November 17.  The challenge is running September 1 through November 17. To participate, simply stop in at the front desk at one of our two locations and fill out a challenge sheet.  <ul> <li>Hilton Building, first floor, Monday-Friday, 6 a.m. to 4:30 p.m., 507-284-4475</li> <li>Saint Marys Campus - Joseph Building, main floor, Room M-86, Monday-Friday, 8 a.m. to 3 p.m., 507-255-4359</li> </ul> How to donate For more information about donating blood or how to set up a blood drive in Olmsted County, call 507-284-4475, email <a href="mailto:mailto:donateblood@mayo.edu">donateblood@mayo.edu</a>, or visit the <a rel="noopener noreferrer" rel="noopener noreferrer" href="https://www.mayoclinic.org/patient-visitor-guide/minnesota/blood-donor-program" target="_blank">Mayo Clinic Blood Donor Program</a> web page. Katy Maeder, Donor ServicesPrimary Care in Rochester and KassonBlood Donation AydenPrimary Care in Rochester and KassonPeople with chronic kidney disease should check with their provider about using these over-the-counter products.&nbsp;<img src="/-/media/ech-media/images/widgets/medications/ech_herbal_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=A289EC64100EF1E7A3945A9D6D316942" alt="ECH_herbal_widget" width="100" height="65" DisableNVelocity="true" />Kidney disease and vitamins/supplements may not mix10/21/2019 3:00 AM<img src="/-/media/ech-media/images/widgets/medications/ech_herbal_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=EF9CF0CFE4D3E4F1DB714BE10F632F36" alt="ECH_herbal_widget" width="300" height="195" DisableNVelocity="true" />Chronic kidney disease (CKD) affects an estimated 37 million people in the U.S., about one in seven adults. Most people with CKD don't even know they have it, including 90% of people with moderate CKD and 37% of people with advanced CKD.  For a wide variety of reasons, but most often to support their overall health and wellness, many Americans turn to dietary or herbal/botanical supplements. Garlic, fish oil, turmeric, multivitamins, flaxseed, vitamin D all find their way into Americans' medicine cabinets to fill the gaps in nutrition, boost energy or relieve aches and pains. While dietary and herbal supplements are generally considered safe, they may not be for individuals with CKD.  Some of these supplements contain potassium or phosphorous — minerals that can be harmful to people with impaired kidney function. Other supplement ingredients also can be harmful to people with CKD. These individuals have a harder time filtering medications, wastes, and excess fluids from their body, so it's especially important for them to know about the safety or risks of any supplements they're taking.  Despite potential safety concerns, more than one-third of the 15.7 million Americans with moderate or advanced CKD use dietary or herbal supplements, according to new research conducted by a group of Mayo Clinic colleagues. Many Americans decide to take supplements on their own and not because of a doctor's recommendation.  Supplements, in many ways, are an unknown. They aren't regulated by the FDA the same way as prescription medications, may not be completely labeled, or can interact with each other or other prescription medications. For example:  <ul> <li>16% of study participants took flaxseed oil, the most commonly used high-risk supplement that contains phosphorus, but it's not listed on the nutrition label. </li> <li>One tablespoon of whole flaxseeds has about 62 mg of phosphorus — 7% of the daily recommended value for those without CKD, but the safe limit is likely much lower for people with CKD. </li> <li>Flaxseed and flaxseed oil also may interact with blood-thinning and blood pressure drugs and may decrease absorption of any oral drug. </li> </ul> More study is needed to dig deeper into the use of supplements and risk for those with CKD. In the meantime, if you've been diagnosed with CKD, you should have a periodic review of your medications and various supplements with your health care provider or pharmacist. Also, be sure to check with them before starting to take a dietary or herbal supplement.  You can read more about the study in the <a rel="noopener noreferrer" rel="noopener noreferrer" href="https://www.ajkd.org/article/S0272-6386(19)30771-1/fulltext" target="_blank">American Journal of Kidney Disease</a>. This research was funded by the <a rel="noopener noreferrer" rel="noopener noreferrer" href="https://www.mayo.edu/research/centers-programs/robert-d-patricia-e-kern-center-science-health-care-delivery/about" target="_blank">Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery</a>.  Dr. Rozalina McCoy is an endocrinologist and primary care physician in Employee and Community Health's (ECH) Division of Community Internal Medicine (CIM). she specializes in the management of type 1 and type 2 diabetes, osteoporosis and thyroid disorders. Dr. McCoy also is a health services researcher who is passionate about improving the care of patients with diabetes, reducing their burden of treatment and hypoglycemia, and ensuring access and affordability of evidence-based medical care. Dr. Rozalina McCoyPrimary Care in Rochester and KassonKidney DiseasePrimary Care in Rochester and KassonBreastfeeding a baby born at 34 to 38 weeks gestation requires a little extra care.&nbsp;<img src="/-/media/ech-media/images/widgets/people/ech_breastfeeding_01_widget.jpg?h=65&iar=0&w=100&hash=C1DCE7E0AECB8D8A13566AE8B9F60C01" alt="ECH_Breastfeeding_01_Widget" width="100" height="65" DisableNVelocity="true" />Success tips for feeding your late preterm baby11/25/2019 2:00 AM<img src="/-/media/ech-media/images/widgets/people/ech_breastfeeding_01_widget.jpg?h=195&iar=0&w=300&hash=CC362BA6BCA984EBFCC6D2652C65AB0B" alt="ECH_Breastfeeding_01_Widget" width="300" height="195" DisableNVelocity="true" />Congratulations on the birth of your baby and your decision to breastfeed! Breastfeeding your late preterm baby (born between 34 and 38 weeks of gestation) may have some unique challenges. Because they aren't as physically mature as a full-term baby, preterm infants may cue to eat less often, tire more easily while feeding and have less strength to suckle milk from the breast.  This doesn't mean you can't exclusively breastfeed. Often, as late preterm babies near their original due date or soon after, they're able to nurse effectively and exclusively from the breast.  Here are a few tips to ensure your baby is getting enough to eat, and you're able to maintain your milk supply:  <ul> <li>Your baby should be eating every two to three hours around the clock, even if they aren't showing cues. Wake the baby gently with skin-to-skin time, by lightly undressing, talking to them, or changing their diaper. </li> <li>Your baby may not be ready until a few weeks old to fully feed from the breast at every feeding. If they keep falling asleep at the breast within a few minutes, try nursing every other feeding or giving a bottle of pumped milk for the opposite feeding. Or, pump and give baby the expressed milk after they stop breastfeeding. </li> <li>Your baby's cheek muscles may not be fully developed, so they may not be able to extract milk from the breast efficiently quite yet. A nipple shield may be helpful. Your International Board Certified Lactation Consultant (IBCLC) or nurse can help you learn to use it. The shield can be used until baby is able to take all feedings easily from the breast, and then weaned off of it. </li> <li>To maintain a full milk supply, it's a good idea to pump or hand express milk after breastfeeding three to four times a day to stimulate milk production. This should be continued until the baby is nursing well from the breast, and your milk supply is fully established. Most moms are producing at least 16 ounces a day by one week of age. If you're concerned about your supply, reach out to your breastfeeding professional. </li> <li>Your baby's provider will want to monitor their weight to ensure they're growing well. Your baby should be gaining about four to seven ounces a week. Fortified breast milk supplements may be recommended to ensure adequate growth. </li> </ul> Although breastfeeding your preterm infant may require a little more practice, providing breast milk is a wonderful way to give them the nutrition and germ-fighting antibodies they need to grow and thrive. Reach out to your lactation specialist to help with your unique situation. We're here to help you meet your breastfeeding goals! Maegen Storm, APRN, CNP, is a certified pediatric nurse practitioner in Employee and Community Health's (ECH) Division of Community Pediatric and Adolescent Medicine (CPAM) and has a special interest in breastfeeding for the health of the baby. Maegen and her husband have enjoyed partnering to breastfeed their four boys. Maegen Storm, APRN, CNPPrimary Care in Rochester and KassonBreastfeeding Late Preterm BabyPrimary Care in Rochester and KassonHealthy mom, healthy dad can help ensure a healthy baby.&nbsp;<img src="/-/media/ech-media/images/widgets/people/ech_birth_defects_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=6B61A95FD252E836E05FD9410B216473" alt="ECH_birth_defects_widget" width="100" height="65" DisableNVelocity="true" />Get your new family off to a healthy start11/21/2019 10:30 AM<img src="/-/media/ech-media/images/widgets/people/ech_birth_defects_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=FA656932EA5CC98E0F29E63DC307DCC9" alt="ECH_birth_defects_widget" width="300" height="195" DisableNVelocity="true" />Thinking of getting pregnant? Preparing for a baby is a good reason for mothers- and fathers-to-be to take a look at your current lifestyle. Establishing healthy eating and activity habits before your baby arrives will make it easier to maintain them as a family.  The first step in preparing for a healthy pregnancy is for both of you to have pre-conception exams with your health care provider. Other steps the two of you can take to help reduce the risk of complications and set the course for a healthy pregnancy and healthy family include:  <ul> <li>Stop smoking. </li> <li>Don't drink alcohol. </li> <li>Avoid exposure to harmful substances. </li> <li>For moms-to-be, get an appropriate amount of folic acid to prevent birth defects. Folic acid is found in fortified whole grains, eggs, legumes, nuts, berries and greens, as well as supplements (if recommended). </li> <li>Eat a healthy diet. </li> <li>Reach or maintain a healthy weight. </li> <li>Exercise every day. </li> </ul> Why are these so important to building a healthy future for your child?  <ul> <li>Mothers who are living a healthy lifestyle deliver children with fewer birth defects and chronic health problems. </li> <li>A healthy lifestyle includes eating a variety of nutritious foods so you get needed vitamins and minerals; being at a healthy weight before becoming pregnant; and then when pregnant, gaining an appropriate amount of weight, exercising regularly and avoiding harmful substances. </li> </ul> Healthy eating for a healthy baby Moms-to-be need a variety of foods from all the <a rel="noopener noreferrer" rel="noopener noreferrer" href="https://www.myplate.gov/" target="_blank">"My Plate"</a> food groups to get the nutrition needed for a healthy pregnancy. Before and during pregnancy, a woman should eat a balanced diet including whole grains, fruits, vegetables, lean animal and/or plant protein, low-fat dairy or dairy alternatives and healthy fats. If you prefer to reduce or omit animal proteins, are lactose intolerant or prefer non-dairy alternatives, the My Plate protein group includes options for you.  Your doctor or registered dietitian nutritionist (RDN) may recommend a prenatal multivitamin or complete multivitamin that contains folic acid and iron. This help you get enough of these and other nutrients before and during pregnancy — and beyond, if you're nursing your baby.  Remember that during pregnancy, you're eating for both your and your baby's health.  <ul> <li>Research shows the risks of problems during pregnancy and delivery is lowest when a woman begins her pregnancy at a healthy weight and weight gain is kept within a healthy range during pregnancy. </li> <li>Focus on nutrient-dense foods that don't up your calorie intake. It's not until the second trimester that you'll need those extra calories. </li> <li>The amount of food you need before and during pregnancy depends on a number of things, including body mass index (BMI) before pregnancy, the rate at which you gain weight, age and appetite. If needed, an RDN can help you develop a food plan that meets your nutrition and calorie needs — and fits your lifestyle and food preferences. </li> <li>Because pregnant women are at a higher risk of food poisoning, be sure to practice food safety. </li> </ul> Tips for creating a healthy lifestyle for you and your family to be <ul> <li>Keep a food and activity journal. </li> <li>Eat only at the kitchen table/counter.</li> <li>Schedule your workouts, just as you do meetings and date nights. </li> <li>Create a menu for the week. </li> <li>Set achievable goals for the day, week and month. </li> <li>Make sure your beverages are low in calories and nutritious. Water should be your first choice, but milk and milk alternatives are good, too. Just watch the added sugar in hot and cold drinks. </li> <li>Check for non-hunger or "emotional eating."</li> <li>Eat at least three cups of low-cal vegetables daily and 1-1/2 cups of whole fruit. </li> <li>Swap out ultra-processed foods (check ingredients on the food label) with whole grain, whole fruit or vegetables. </li> <li>Take the stairs more often, park your car further away from your destination and just walk more throughout the day. </li> <li>Understand what your calorie requirements are for the day for weight management. </li> </ul> Now you're a family ... Maintain those habits you established! Once the baby has arrived, it's essential that newborns receive the best possible nutrition right from birth. Studies have shown that breastfeeding provides many advantages to both baby and mother, including health benefits and financial savings.  In addition to eating right from birth, developing physical activity habits at an early age also is key. Active young children are better prepared for life than those who spend childhood sitting in front of a television or video game screen. Having fun and being active together as a family builds the base for a healthy life and lasting memories.  Rose Prissel is a dietitian at Mayo Clinic working in pediatric and adult nutrition, with a focus on preventive care, sports nutrition and weight management.  <a rel="noopener noreferrer" rel="noopener noreferrer" href="https://communityhealth.mayoclinic.org/providers/matthew-meunier-md" target="_blank">Dr. Matthew Meunier</a> is a family physician with Women's Health fellowship training in Employee and Community Health's (ECH) Department of Family Medicine. He is the Chief of Family Medicine Obstetrics and Newborn Services. Rose Prissel, RDN, and Dr. Matthew MeunierPrimary Care in Rochester and KassonHealthy Start BabyPrimary Care in Rochester and KassonOptions for receiving health care at home are customized for each patient's needs.&nbsp;<img src="/-/media/ech-media/images/widgets/people/ech_homehealthcare_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=F73163C0902609BB59B744F793E4E9A4" alt="ECH_HomeHealthCare_widget" width="100" height="65" DisableNVelocity="true" />Making the choice: What home health care fits you best?11/11/2019 1:30 AM<img src="/-/media/ech-media/images/widgets/people/ech_homehealthcare_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=9065EFAC4ECE9B850711891D23E764F4" alt="ECH_HomeHealthCare_widget" width="300" height="195" DisableNVelocity="true" />At some point, all of us will have to make health care decisions for ourselves or loved ones. One option is receiving care at home, which can increase the quality of live for the patient and their family since the patient is cared for in the comfort of their own home. One size doesn't fit all, so home health care agencies tailor care to meet the individual consumer's needs. Services can be provided on a short-term, long-term or intermittent basis and range from complex skilled nursing to brief custodial care. These services can cost less than care provided at a facility.  Arranging for home care Finding an experienced and compassionate caregiver can be challenging, but doesn't have to be. Consumers can arrange home care services through an agency or by hiring an individual directly. Home care providers must be registered or licensed by the Minnesota Department of Health. Some agencies are also Medicare-certified, which requires both a state license and federal certification for certain standards of operation. Home health care agencies work to ensure the consumer is matched with a caregiver that has the skills, qualities and expertise to meet their needs.  It's important to be an informed consumer when deciding on home health care. Agencies provide information about their services directly over the phone. Generally, it's best to compare the availability of service, insurance coverage, policies and credentials of the agency before deciding to hire them. A face-to-face meeting with the patient's health care provider must take place 90 days before or 30 days after the start of service. This visit needs to be related to the reason for seeking in-home services.  Once you've chosen an agency, the patient will have an appointment with a registered nurse care coordinator who will oversee their care. The nurse care coordinator will collaborate with the care provider and patient to detail a plan identifying the type and frequency of service and its projected outcome. The agency will then begin making regular scheduled visits, providing the agreed-upon care to meet the patient's needs.  People are often eager to resume their activities and lifestyle after being in the hospital. Their provider may refer them to a home health care agency for occupational, physical and/or speech therapy.  <ul> <li>An occupational or physical therapist can assess the patient's ability to function safely and independently at home. They check out the home environment, identify fall risks and make recommendations, if needed, for adaptive equipment, such as ramps and grab bars. They also provide in-home training to maximize the patient's ability to perform daily tasks.</li> <li>An occupational therapist helps the patient regain independence in taking care of themselves, such as dressing, bathing and preparing meals. </li> <li>A physical therapist helps the patient restore strength, balance, mobility and stamina. </li> <li>A speech therapist helps improve the patient's ability to communicate and swallow. </li> </ul> Home health care agencies also can provide skilled nursing care, which often reduces the length of a hospital stay and prevents recurrent hospitalizations. In-home skilled nursing helps the patient recover from an illness and increase their independence as they learn to take care of their own health needs. Some typical needs for skilled nursing would include IV therapy, wound care, medication management and palliative care.  Home health care agencies use home health aides to provide hands-on assistance with activities of daily living to patients who aren't able to safely perform them independently due to physical or cognitive limitations. They commonly perform tasks that don't require the expertise of skilled nursing, including managing personal cares, bathing, grooming, hygiene, walking, transfers, light housekeeping and meal preparation. The services provided by home health aides are only covered through Medicare insurance when there is also a "skilled" need.  Medicare, Medicaid, VA benefits, county-waivered funds, and some private health insurance policies may cover the fees for the services. Home health care services are most commonly covered by Medicare, as long as it's medically necessary and prescribed by a provider, there's a "skilled" need, and the individual is homebound.  <ul> <li>Skilled need. This refers to occupational, physical or speech therapy, or a skilled nursing service for IV therapy, wound care, medication management and palliative care. </li> <li>Homebound. Medicare considers an individual homebound if leaving the home involves considerable and taxing effort and absences from home are infrequent and brief. Even if the individual is considered homebound, they can still go to medical appointments, religious services, and for short periods of time, special non-medical events without affecting their homebound status. </li> </ul> For more information and assistance, call the Senior LinkAge Line at <a href="tel:18003332433">1-800-333-2433</a>. This is a free service to help you find answers to a wide variety of questions. Trained information specialists will work with you to understand your needs and goals and can connect you to services. You can also find more resources on the National Council on Aging's <a rel="noopener noreferrer" href="https://www.benefitscheckup.org/" target="_blank">BenefitsCheckUp</a> website.  Chad Ellis, LICSW, is a licensed, independent clinical social worker and a member of the Integrated Behavioral Health team (IBH) within Employee and Community Health (ECH). He has previous experience with inpatient psychiatry and in the community, working primarily with adults, children and families. Chad Ellis, LICSWPrimary Care in Rochester and KassonHome Health CarePrimary Care in Rochester and KassonWhile there's no cure for memory impairment, talk with your provider about managing it.&nbsp;<img src="/-/media/ech-media/images/widgets/elderly/ech_caregiver_stress_01_widget.jpg?h=65&iar=0&w=100&hash=5EA68E0BDAB984B76E1564A96472EF8C" alt="ECH_Caregiver_Stress_01_widget" width="100" height="65" DisableNVelocity="true" />Signs of memory impairment? Speak up11/14/2019 5:00 AM<img src="/-/media/ech-media/images/widgets/elderly/ech_caregiver_stress_01_widget.jpg?h=195&iar=0&w=300&hash=8B5430B510532665498CB9AC2463DEFE" alt="ECH_Caregiver_Stress_01_widget" width="300" height="195" DisableNVelocity="true" />Everyone forgets where they've put their keys, the name of an acquaintance they run into at the grocery store, where they've parked or who stars in the movie about the washed up pro golfer. But when these memory lapses start interfering with daily functioning, it's time to pay attention to, not ignore them.  Some signs of more serious memory impairment seen by you, family members or your loved ones include:  <ul> <li>Taking more effort to learn something new</li> <li>Forgetting not just details, but complete events</li> <li>Having trouble finding the right words or mixing up words</li> <li>Struggling with organization</li> <li>Having difficulty following a recipe or directions that were previously easy</li> <li>Asking the same question again and again</li> <li>Looking at a complex background and not seeing an object or individual</li> <li>Getting lost in a familiar place</li> </ul> If you start noticing symptoms of memory impairment, write them down to make it easier to see a trend. Then set up an appointment with your primary care provider. And take a family member or friend with you. It's important that someone be with you to fill in additional details, as well as hear what the provider has to say.  While we currently don't have a cure for dementia, it can be managed to ensure you or your loved ones know all the facts about the condition and live the best possible quality of life. Initial assessment and testing can be done right in your provider's office. Many conditions can also mimic dementia. Sometimes the symptoms aren't caused by memory impairment but by other things, such as a medication side effect, thyroid deficiency or vitamin deficiency.  If the initial diagnosis suggests dementia, it may be followed by more in-depth tests and possibly a CT scan or MRI. There are many types of dementia and giving a name to it can help your provider individualize the treatment. Now is the time to start proactive care and forming a partnership with your provider. Memory impairment brings new challenges, but also new solutions.  Your provider will talk with you about the role of medications and ways to stay active and foster your mental capabilities. They also will look at the best way to manage any other health conditions. For instance, they may simplify diabetes monitoring or the schedule for taking medications.  Is there a way to prevent or avoid dementia? While we can't control our genes, there are powerful risk factors we can control by paying attention to our lifestyle. Researchers are finding these factors affect whether or not we develop dementia: <ul> <li>Uncontrolled high blood pressure</li> <li>Uncontrolled high blood sugar (diabetes) </li> <li>Untreated depression</li> <li>Social isolation</li> <li>Physical inactivity</li> <li>Smoking</li> <li>Low education level</li> <li>Mid-life, untreated hearing loss</li> </ul> That last one needs a bit of explanation. Hearing loss causes some degree of sensory deprivation, which may lead to cognitive impairment. When you have untreated hearing loss, it takes more effort to hear, which stresses your brain and uses up brain reserves. That leaves less reserve for remembering things.  Memory impairment doesn't define the individual, it's a chronic condition. And we manage those by capitalizing on what the individual is still doing really well and filling in where there are deficits. It's nothing to be embarrassed about and your health care provider is there to help keep you as safe and independent as possible.  <a rel="noopener noreferrer" href="https://communityhealth.mayoclinic.org/providers/ericka-tung-md" target="_blank">Dr. Ericka Tung</a> is an internist and geriatrician in Employee and Community Health's (ECH) Division of Community Internal Medicine (CIM). she practices across the community in clinic, skilled-nursing facilities and home-care based settings. She also directs the Mayo Clinic Geriatric Medicine Fellowship training program. Dr. Ericka TungPrimary Care in Rochester and KassonMemory ImpairmentPrimary Care in Rochester and KassonFor three years, lactating mothers have helped vulnerable, fragile, ill or premature babies.&nbsp;<img src="/-/media/ech-media/images/widgets/randomimages/ech_breastmilkbank_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=F7C6BEBF4C6317F4AC804B3ABEBD8B64" alt="ECH_BreastMilkBank_widget" width="100" height="65" DisableNVelocity="true" />Breast Milk Depot celebrates 3rd anniversary12/19/2019 4:30 AM<img src="/-/media/ech-media/images/widgets/randomimages/ech_breastmilkbank_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=77559FF903D3FD60CED3DB6A65CC8D2B" alt="ECH_BreastMilkBank_widget" width="300" height="195" DisableNVelocity="true" />Happy third anniversary to the Breast Milk Depot located at Mayo Family Clinic Southeast, which serves as a collection point for the <a rel="noopener noreferrer" href="https://uichildrens.org/mothers-milk-bank-iowa" target="_blank">Mother's Milk Bank of Iowa</a>! Thanks to all the generous lactating mothers who have contributed 15 transports of donated breast milk. Each transport is the size of a chest freezer full of milk. That milk has helped numerous vulnerable, fragile, ill or premature babies get a better start in life.  If you're a lactating mother who has extra milk or experienced the loss of a child and are interested in donating, here's how:  <ul> <li>Set up a verbal interview by contacting the donor coordinator Heidi Baudhuin by email (<a href="mailto:baudhuin@healthcare.uiowa.edu">baudhuin@healthcare.uiowa.edu</a>) or by phone (<a href="tel:18778915347">1-877-891-5347</a>). </li> <li>Fill out a written questionnaire; there also will be a form for your health care provider to complete. </li> <li>Arrange for a blood test. You'll receive a screening kit in the mail. You'll need to take it to <a href="/locations/southeast-clinic">Mayo Family Clinic Southeast</a> to have your blood drawn. <ul> <li>Blood tests are done 8 a.m. to noon, Monday through Friday. Your blood will be screened for HIV, hepatitis B and C, HTLV and syphilis. </li> </ul> </li> </ul> If you qualify to donate, congratulations! When you're ready to make a donation, call <a href="tel:5072938590">1-507-293-8590</a> and ask for the charge nurse at the Southeast Clinic before dropping off your milk to make sure someone will be available to accept it. Drop-off hours are 8:30 a.m. to 4 p.m., Monday through Friday.  Thank you for your part in giving babies the best start in life possible. Primary Care in Rochester and KassonBreast Milk Depot AnniversaryPrimary Care in Rochester and KassonThese two forces have a single goal of healing the patient.&nbsp;<img src="/-/media/ech-media/images/widgets/elderly/ech_spiritualitymedicine_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=7D6872D9784DB1994CCBC765C26EB75E" alt="ECH_SpiritualityMedicine_widget" width="100" height="65" DisableNVelocity="true" />Spirituality + Medicine: Caring for the whole person12/12/2019 2:00 AM<img src="/-/media/ech-media/images/widgets/elderly/ech_spiritualitymedicine_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=F61E63BB04B0EEE5A50246F1528E86E9" alt="ECH_SpiritualityMedicine_widget" width="300" height="195" DisableNVelocity="true" />Many institutions of higher learning have centers dedicated to spirituality and health. That's because, in the life course of individuals, these two forces are often closely related.  Spirituality has been described as "the quality of being concerned with the human spirit or soul as opposed to material or physical things." On the other hand, medical care falls in the realm of science, defined as "the intellectual and practical activity encompassing the systematic study of the structure and behavior of the physical and natural world through observation and experiment." While these two concepts appear to be on the opposite ends of a spectrum, they often reside side-by-side within the person, and can influence each other deeply.  In many religious traditions, spirituality informs almost all aspects of people's lives. Faith and religious beliefs have a strong role in life and death, illness and healing. For instance, illness may be perceived as being present because it was allowed by God. The health care provider (or science), is being simply the "vessel" He uses for healing. In this way, spirituality and health care are two forces with the single goal of healing the patient.  Some religious stipulations that patients observe, such as periods of fasting, may require that providers adjust medications, or postpone tests and appointments for a few weeks. Providers can be partners and advocates for their patients during this time, which helps strengthen the patient-provider relationship.  It's important that your provider is aware of the role spirituality plays in your life, so please talk this over with them. This awareness can help guide your medical care and support your healing.  Recognizing this link between spirituality, health and healing, allows providers to treat the whole person, with their multiple dimensions — physical, cognitive, psychological, emotional, social and spiritual.  <a href="https://communityhealth.mayoclinic.org/providers/jane-njeru-mbchb/">Dr. Jane Njeru</a> is a general internist in Employee and Community Health's (ECH) Division of Community Internal Medicine (CIM). She completed her medical school training at the University of Nairobi, Kenya, and her residency in Internal Medicine at Mayo Clinic in Rochester. Her interests include developing interventions to reduce health disparities, with special focus on patients with limited English proficiency, immigrants and refugees. Jane Njeru, MB, ChBPrimary Care in Rochester and KassonSpirituality MedicinePrimary Care in Rochester and KassonMarilyn and Sara now channel their passion into encouraging others to donate.&nbsp;<img src="/-/media/ech-media/images/widgets/blooddonation/ech_blooddonationmarilynsara_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=0B4D97C938392738FC1F4DBD078A7F3F" alt="ECH_BloodDonationMarilynSara_widget" width="100" height="65" DisableNVelocity="true" />Blood donation: Long-time donors inspired by being recipients1/6/2020 5:00 AM<img src="/-/media/ech-media/images/widgets/blooddonation/ech_blooddonationmarilynsara_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=932924B277F3264771F70497735BC308" alt="ECH_BloodDonationMarilynSara_widget" width="300" height="195" DisableNVelocity="true" />When she was diagnosed with Still's disease, Marilyn, who had been a faithful blood donor for many years, experienced what it feels like to have a blood transfusion. "I'll always remember feeling better immediately following the transfusion," Marilyn says. Afterward, she wasn't able to donate for quite a while, but that didn't stop this Mayo Clinic employee from finding other ways to help our patients.  As a Wellness Champion, Marilyn decided to spearhead a blood donor challenge in her department. Blood donor challenges at Mayo Clinic in Rochester typically are friendly competitions between departments to see which team can contribute the most blood for our patients or a single department aiming to reach its team goal.  Marilyn's team, Lenaye's Lifesavers, successfully achieved its goal. "This is our way of helping our patients. We don't do the surgeries, and we don't have direct contact with them," she says. "It's fun to get new people to donate blood and give back after all that Mayo has given to us." During last year's competition, the meaning of a blood donation became even more personal for her team. Marilyn's colleague, Sara, needed an emergency C-section during delivery in order to save her baby's life. Where a typical C-section might only take an hour to perform, she was on the table for nearly three. After Gwen was born, she struggled at first, but then stabilized. Sara, however, had extremely low hemoglobin, so was offered a transfusion, which she accepted.  Also a blood donor prior to giving birth, Sara says, "Never in all my donations, and while participating in this challenge, did I ever think that I'd receive a blood transfusion. It was very emotional. While apprehensive about receiving blood, I was surprisingly very comfortable." Marilyn adds, "I remember, too, the thoughts I was having while receiving the transfusion. What if it doesn't adhere to me? But I really didn't have a choice. Once I had received it, I felt to much better.  Having come full circle in the experience of blood donation, Sara and Marilyn continue to use their passion to inspire their staff to participate in the challenges.  How to donate For more information about donating blood or how to set up a blood drive in Olmsted County, call <a href="tel:5072844475">507-284-4475</a>, email <a href="mailto:donateblood@mayo.edu">donateblood@mayo.edu</a>, or visit the <a href="https://www.mayoclinic.org/blood-donor-program/minnesota">Mayo Clinic Blood Donor Program</a> web page. Primary Care in Rochester and KassonBlood Donors Being RecipientsPrimary Care in Rochester and KassonThis series aims to take some of the confusion out of making healthy food choices for your kids.&nbsp;<img src="/-/media/ech-media/images/widgets/food/ech_calcium_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=4E8AD62F91B39851B45170C775660831" alt="ECH_calcium_widget" width="100" height="65" DisableNVelocity="true" />Healthy eating for kids: Myth #16/25/2018 9:00 AM<img src="/-/media/ech-media/images/widgets/food/ech_calcium_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=A4B901A9BE456E469489480DEBE51546" alt="ECH_calcium_widget" width="300" height="195" DisableNVelocity="true" />With so many competing messages about the “best” way to eat, navigating the grocery aisles can be confusing. We all have the same goal: to provide our families with healthy meals and snacks. So it’s important to be equipped with the evidence supporting a well-balanced diet when you head to the supermarket. Starting healthy habits in childhood leads to healthy habits in adulthood. When it comes to healthy eating, the focus is “the more whole foods, the better”. This includes fruits, vegetables, whole grains and legumes like dried peas, beans and soybeans. In this series, we’re addressing several nutrition myths to help make healthy food choices less confusing. Myth #1: Kids need cow’s milk We commonly hear that kids have to drink cow’s milk in order to get the calcium they need to grow strong bones. The fact is that most of us get more calcium than we need. A 2013 study in JAMA Pediatrics showed that children in countries with lower dairy milk intake had lower rates of bone fractures than those in countries with high dairy milk intake, including the U.S. In addition, the rates of lactose intolerance are exceptionally high, especially in certain populations. For example, some estimates indicate that 90% of Asian-Americans and 70% of African-Americans are lactose intolerant. Yet, we continue to put milk at the center of meals served both at school and home.  What options do we have for dietary calcium, without the sugar, calories and other adverse effects of drinking dairy milk? It turns out that several plant-based foods are great sources of calcium, including bok choy, collards, kale, chia seeds, almond butter, beans, broccoli and tahini. There also are several plant-based milk alternatives that are excellent sources of calcium such as soy, hemp, almond and coconut milks. And remember, calcium is not the only key to strong bones. Daily exercise is essential for building strong bones for life! For more detailed information on nutrition recommendations, check out <a rel="noopener noreferrer" href="https://www.hsph.harvard.edu/nutritionsource/" target="_blank">The Nutrition Source</a> website from the Harvard School of Public Health and <a rel="noopener noreferrer" href="https://nutritionfacts.org/" target="_blank">NutritionFacts.org</a>. If you or your child’s health care provider is concerned about your child’s weight, consider KidShape offered by <a rel="noopener noreferrer" href="http://exercisabilitiespt.org/" target="_blank">ExercisAbilities, Inc.</a>, in Rochester. It’s a program delivered by a registered dietitian and youth exercise specialist for children ages six to 12 and includes six interactive sessions that focus on nutrition, family cooking, cognitive behavior modification, self-esteem, parenting support and more. For more information, visit ExercisAbilities’ website and select “KidShape” under the Nutrition Wellness tab. If you’re covered by Medical Assistance and Minnesotacare, you’re eligible for Medical Nutrition Therapy (MNT), which provides certain services by a registered dietician or nutrition professional. In our next article, we’ll look at the myth about how much sugar is too much. Dr. Natalie Gentile is a provider in Employee and Community Health’s (ECH) department of Family Medicine. Her key areas of interest are nutrition, obesity and preventive and lifestyle medicine. She is also a certified Power Vinyasa yoga instructor and group fitness instructor. <a rel="noopener noreferrer" href="https://communityhealth.mayoclinic.org/providers/kristine-penza-cnp" target="_blank">Kristine Penza</a>, APRN, CNP, is a Family Medicine nurse practitioner at Mayo Clinic Express Care. Her interests include nutrition and functional medicine. Kayla Allen, RN, is a pediatric RN care coordinator with ECH.Dr. Natalie Gentile, Kristine Penza, APRN, CNP, and Kayla Allen, RNPrimary Care in Rochester and KassonHealthy Eating Kids Myth 1Primary Care in Rochester and KassonA rainbow of fruits and veggies on your plate is healthy and delicious!<img src="/-/media/ech-media/images/widgets/food/ech_coloryourway_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=610C4DC0CE8E53D638A17730BFBD89D1" alt="ECH_coloryourway_widget" width="100" height="65" DisableNVelocity="true" />Color your way to 5 a day7/23/2018 5:00 AM<img src="/-/media/ech-media/images/widgets/food/ech_coloryourway_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=4FED5398DCB4DFEB71D87A572231F2F2" alt="ECH_coloryourway_widget" width="300" height="195" DisableNVelocity="true" />With fresh, in-season fruits and vegetables flooding into supermarkets and local farmers markets, it's a perfect time to practice and have fun "painting" your plate with color.  There are thousands of health-promoting phytochemicals found in plants. Researchers are just beginning to understand how they work to improve our health. But they do know it's important to eat a wide variety of colorful fruits and veggies to reap those health benefits.  Putting a rainbow of colors on your plate or in your lunch bag can make it easier to eat the five to nine services of fruits and vegetables recommended for every day. Painting your plate starts at the supermarket or farmers market. When shopping, look for an array of colors, choosing ones you and your family love and maybe experimenting with something new.  Here are some ideas for fruits and veggies to help you build your healthy-eating paint box: <ul> <li>Red: Strawberries, raspberries, cherries, watermelon, apples, radishes, tomatoes, red kidney beans, red peppers (spicy or sweet), red-skinned potatoes</li> <li>Orange: Oranges, apricots, peaches, cantaloupe, mangoes, sweet potatoes, acorn squash, pumpkin, summer squash, carrots</li> <li>Yellow: Lemons, pineapple, golden apples, bananas, starfruit, yellow tomatoes, sweet corn, yellow peppers, summer squash, golden beets</li> <li>Green: Kiwi fruit, green grapes, avocados, Granny Smith apples, honeydew melon, spinach, green beans, broccoli, Brussels sprouts, snap peas</li> <li>Blue/purple. Blueberries, blackberries, boysenberries, black seedless grapes, plums, raisins, purple cabbage, eggplant, purple potatoes, radicchio</li> <li>White. Grapefruit, pears, baking potatoes, onions, mushrooms, jicama, cauliflower, navy or cannelloni beans, parsnips</li> </ul> Fresh fruits and veggies that are in season can be easier on your food budget. And remember that frozen produce is just as nutrient-packed as fresh and often can be more affordable.  Start your plate painting with these easy, colorful and summery recipes.  Grilled Fruit Chunks Cut peaches, pears, apples, pineapple or a combination of these fruits into chunks. Toss with a little canola oil, sprinkle with cinnamon and thread onto skewers. Wrap in foil and grill over low heat for 3 to 5 minutes.  Pasta Primavera Cook whole-grain pasta. Steam cut-up broccoli, cauliflower, carrots and green peas. Stir in chunks of fresh tomatoes and torn-up fresh basil. spoon the veggies over the pasta. Drizzle with a little light or no-calorie Italian dressing and sprinkle with Parmesan cheese.  Rose Prissel, MS, RDN, LD, is a dietitian at Mayo Clinic working in pediatric and adult nutrition, with a focus on preventive care, sports nutrition and weight management. Rose Prissel, MS, RDN, LDPrimary Care in Rochester and KassonColor Your WayPrimary Care in Rochester and KassonThis series aims to take some of the confusion out of making healthy food choices for your kids.&nbsp;<img src="/-/media/ech-media/images/widgets/food/ech_sugar_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=A52039F6BA1941901101FF4291253D17" alt="ECH_sugar_widget" width="100" height="65" DisableNVelocity="true" />Healthy eating for kids: Myth #2 - sugar in moderation7/16/2018 10:00 AM<img src="/-/media/ech-media/images/widgets/food/ech_sugar_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=4BE483C24455E2A947A1A6AE6B400867" alt="ECH_sugar_widget" width="300" height="195" DisableNVelocity="true" />With so many competing messages about the "best" way to eat, navigating the grocery aisles can be confusing. We all have the same goal: to provide our families with healthy meals and snacks. So it's important to be equipped with the evidence supporting a well-balanced diet when you head to the supermarket. Starting healthy habits in childhood leads to healthy habits in adulthood. When it comes to healthy eating, the focus is "the more whole foods, the better". This includes fruits, vegetables, whole grains and legumes like dried peas, beans and soybeans. In this series, we're addressing several nutrition myths to help make healthy food choices less confusing.  Myth #2: Sugar is OK in moderation For decades, the low-fat craze has led food manufacturers to make their products more enticing with another ingredient: sugar. Sugar in some form — think high fructose corn syrup, honey, maple syrup — is now in almost every processed food.   The latest research is showing that sugar is highly addictive and a promoter of chronic diseases, such as obesity, diabetes, cancer and heart disease, to name a few. That’s why it’s so important to cut back on them. The American Heart Association and World Health Organization recommend kids ages two to 18 should have less than 25 grams (six teaspoons) of added sugar per day. For adult women, that amount is 25 grams and for adult men, 36 grams. One 12-ounce soda contains almost twice as much! Unfortunately, diet beverages may not be the solution, either. Be cautious with artificial sweeteners. In April 2018, researchers from the Medical College of Wisconsin linked artificial sweeteners to obesity and diabetes in rodents. The journal, Nature, reported that artificial sweeteners can promote insulin resistance, leading to diabetes, and may have a negative impact on the gut microbiome, which is the three pounds of helpful bacteria that lives in our gut.  Much like cigarettes, sugar is addictive, and it’s difficult to stop consuming it cold turkey. Fortunately, as you and your kids decrease your sugar intake, it will take less sugar for foods to taste sweet. Also, those intense cravings will diminish the longer you avoid sugar. But start eating it again, and they’ll come right back! If you can’t stop cold turkey, here’s one simple place to start: try diluting your child’s juice with sparkling water. Start small, just add an ounce or two to their glass, then slowly add more as everyone gets used to it. Satisfy sugar cravings with sweet fruits, such as watermelon and cherries. And be on the lookout for the sneaky places that sugar hides, such as in bread, yogurt, salad dressings and other condiments, like ketchup. Nutrition labels on packaged foods say how many grams of sugar are in a serving. And deli counters at your supermarket can provide nutrition information, including sugar, for sliced meats, salads, etc., if you ask. Treat your sugar search as a scavenger hunt! For more detailed information on nutrition recommendations, check out <a rel="noopener noreferrer" href="https://www.hsph.harvard.edu/nutritionsource/" target="_blank">The Nutrition Source</a> website from the Harvard School of Public Health and <a rel="noopener noreferrer" href="https://nutritionfacts.org/" target="_blank">NutritionFacts.org</a>. If you or your child’s health care provider is concerned about your child’s weight, consider KidShape offered by <a rel="noopener noreferrer" href="http://exercisabilitiespt.org/" target="_blank">ExercisAbilities, Inc.</a>, in Rochester. It’s a program delivered by a registered dietitian and youth exercise specialist for children ages six to 12 and includes six interactive sessions that focus on nutrition, family cooking, cognitive behavior modification, self-esteem, parenting support and more. For more information, visit ExercisAbilities’ website and select “KidShape” under the Nutrition Wellness tab. If you’re covered by Medical Assistance or Minnesotacare, you’re eligible for Medical Nutrition Therapy (MNT), which provides certain services by a registered dietician or nutrition professional. Watch for Myth #3, which will address soy, next month! Dr. Natalie Gentile is a provider in Employee and Community Health’s (ECH) Department of Family Medicine. Her key areas of interest are nutrition, obesity and preventive and lifestyle medicine. She is also a certified Power Vinyasa yoga instructor and group fitness instructor. <a rel="noopener noreferrer" href="https://communityhealth.mayoclinic.org/providers/kristine-penza-cnp" target="_blank">Kristine Penza, APRN, CNP</a>, is a Family Medicine nurse practitioner at Mayo Clinic Express Care. Her interests include nutrition and functional medicine.Dr. Natalie Gentile and Kristine Penza, APRN, CNPPrimary Care in Rochester and KassonHealthy Eating Kids Myth 2Primary Care in Rochester and KassonAre you hearing, "There's nothing to do!"? Get the kids outside for a tech-assisted treasure hunt.&nbsp;<img src="/-/media/ech-media/images/widgets/kids/ech_geocaching_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=5153C5E6E4B9249AAD94A64620EF1714" alt="ECH_geocaching_widget" width="100" height="65" DisableNVelocity="true" />Kids bored? Try a treasure hunt!8/2/2018 5:00 AM<img src="/-/media/ech-media/images/widgets/kids/ech_geocaching_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=E9418DE3B7D86D2F5EA7F7EFD50C1E6B" alt="ECH_geocaching_widget" width="300" height="195" DisableNVelocity="true" />As summer wanes, are you hearing, "There's nothing to do!"? Banish boredom with a modern-day treasure hunt. It's called geocaching (jee-oh-cash-ing). Instead of hunting for a buried chest, you're looking for a cache of goodies hidden in above-ground sites. "X" still marks the spot, but instead of a map, you use a GPS system. The one in your smartphone works great, just search for free GPS/exergaming apps. At some locations, such as state parks, you can borrow geocaching kits.  So what's geocaching all about? It's one of the fastest-growing outdoor activities. Caches are hidden all over the world by geocachers who put together a hodgepodge of trinkets, a logbook and a pen or pencil, and, sometimes, a disposable camera. These items are then stuffed into a weatherproof box and hidden under a rock, behind a tree, under a bench or by an outdoor landmark or statue.  There are no dues to play or clubs to join. Simply log onto <a href="http://www.geocaching.com/" target="_blank">geocaching.com</a> to access the more than 3 million cache coordinates. Geocache sites range from easy to challenging, and their level of difficulty is indicated alongside the cache's coordinates for easy access.  Geocaching is fun, but it's also educational (don't tell the kids that). As they sleuth for and identify clues, they're polishing problem-and puzzle-solving skills and learning navigation and orienteering.  It's also a great way to explore a Minnesota State park. Check out where you can borrow <a href="https://www.dnr.state.mn.us/state_parks/loaner.html" target="_blank">free GPS kits</a> and attend interpretive programs.  Before you give it a try, you can <a href="https://www.geocaching.com/guide/" target="_blank">brush up on your geocaching skills</a>, <a href="https://www.rei.com/learn/expert-advice/gps-geocaching.html" target="_blank">read tips from an expert</a> and a Minnesota Conservation Volunteer’s <a href="https://www.dnr.state.mn.us/mcvmagazine/issues/2015/may-jun/geocaching-in-minnesota.html" target="_blank">first-hand experience of geocaching</a> with kids in our state parks.The Mayo Clinic Employee Well-being TeamPrimary Care in Rochester and KassonBored KidsPrimary Care in Rochester and KassonSoy-based products benefit kids and grown-ups.<img src="/-/media/ech-media/images/widgets/food/ech_soy_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=DAC6A419376F8932A0AF3665FD782F27" alt="ECH_soy_widget" width="100" height="65" DisableNVelocity="true" />Healthy eating for kids: Myth #39/6/2018 10:00 AM<img src="/-/media/ech-media/images/widgets/food/ech_soy_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=FDD9AE93F59EF891520C92EF64202A48" alt="ECH_soy_widget" width="300" height="195" DisableNVelocity="true" />With so many competing messages about the “best” way to eat, navigating the grocery aisles can be confusing. We all have the same goal: to provide our families with healthy meals and snacks. So it’s important to be equipped with the evidence supporting a well-balanced diet when you head to the supermarket. Starting healthy habits in childhood leads to healthy habits in adulthood. When it comes to healthy eating, the focus is “the more whole foods, the better”. This includes fruits, vegetables, whole grains and legumes like dried peas, beans and soybeans. In this series, we’re addressing several nutrition myths to help make healthy food choices less confusing. Myth #3: Soy is bad for you One type of food we hear a lot about in the news and on social media is soy. So what is it, and why should we work it into our family’s diet? Soy is a legume, like chickpeas and kidney beans. It’s found in products such as tofu, soymilk and tempeh; edamame is the fresh soybean pod. Soy is low in fat, contains no cholesterol and is high in folate, potassium, iron and magnesium. And it’s a great source of plant protein and fiber, both of which promote cardiovascular health, gut health and weight control. However, these benefits apply only to whole soy products, not partially hydrogenated soybean oil or other refined soybean oils used in processed foods. Reading food labels can help you steer clear of these oils. Soybeans contain isoflavones, which are a type of phytoestrogen. Many people see the word “estrogen” in phytoestrogen and think that eating soy products causes development of feminine characteristics or even leads to breast cancer. That’s not the case. Soy phytoestrogens have a special property that acts like estrogen in some parts of the body (like helping reduce menopausal symptoms and protect bones) and anti-estrogen in others (like protecting breast and uterine tissues). As dietary guidelines point more and more toward the beneficial effects of plant-based diets on our health, soy is a great plant protein option to mix into your weekly meal plan, and because it’s available in so many forms, it’s versatile for a wide variety of recipes. For an easy, tasty meal starter or snack, steam edamame and dip in soy sauce or hummus. When choosing soy products, look for organic or non-GMO, as well as products made from whole beans, not supplements. Legumes, including soybeans, add variety, texture and flavor to dishes from snacks to desserts. Here are some ideas for incorporating them into your meals: <ul> <li>Adzuki beans (field peas or red beans): Soups, sweet bean paste, Japanese and Chinese dishes</li> <li>Anasazi beans: Soups and Southwestern dishes; can be used in recipes that call for pinto beans</li> <li>Black-eyed peas (cowpeas): Salads, casseroles, fritters and Southern dishes</li> <li>Edamame: Snacks, salads, casseroles and rice dishes</li> <li>Fava beans (broad beans): Stews and side dishes</li> <li>Garbanzo beans (chickpeas): Casseroles, hummus, minestrone soup, Spanish and Indian dishes</li> <li>Lentils: Soups, stews, salads, side dishes and Indian dishes</li> <li>Soy nuts: Snack or garnish for salads</li> </ul> Dr. Natalie Gentile is a provider in Employee and Community Health’s (ECH) department of Family Medicine. She is also a certified Lifestyle Medicine physician with key areas of interest in whole foods, plant-based nutrition and pediatric obesity. <a rel="noopener noreferrer" href="https://communityhealth.mayoclinic.org/providers/kristine-penza-cnp" target="_blank">Kristine Penza, APRN, CNP</a>, is a Family Medicine nurse practitioner at Mayo Clinic Express Care. Her interests include whole foods nutrition and functional medicine.Dr. Natalie Gentile and Kristine Penza, APRN, CNPPrimary Care in Rochester and KassonHealthy Eating Kids Myth 3Primary Care in Rochester and KassonTalk about the pros and cons with your provider.&nbsp;<img src="/-/media/ech-media/images/widgets/people/ech_hormonereplacement_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=002A86DAC0C9744554ABE2C16CC0173C" alt="ECH_hormonereplacement_widget" width="100" height="65" DisableNVelocity="true" />Is hormone replacement therapy right for you? 10/11/2018 3:30 AM<img src="/-/media/ech-media/images/widgets/people/ech_hormonereplacement_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=FD1EC6E79B0EB259D0BEB37E661E67D5" alt="ECH_hormonereplacement_widget" width="300" height="195" DisableNVelocity="true" />When women begin experiencing the uncomfortable — and sometimes embarrassing — symptoms of menopause, such as flushing, hot flashes, heavy sweating, or vaginal dryness or pain during intercourse, one of the first questions they ask is, “Would hormone therapy be right for me?” The answer is, “It might be,” and depends not only your current symptoms, but also on your personal and family medical history. That’s why it’s important to have a good discussion with your provider to go over the pros and cons of hormone therapy (HT) to your individual circumstance. Why take hormones? Women might be prescribed hormones to alleviate or improve uncomfortable symptoms, such as hot flashes, flushing, sweating and sleep disturbances, as well as vaginal dryness and pain during intercourse. Women often experience these when they reach the age of perimenopause (around the time of menopause) or early in menopause (stopped having periods). Hormone therapy — estrogen, progesterone or both — may be an option because your uncomfortable symptoms develop from low levels of these hormones. HT may be considered during perimenopause or menopause. It also may be prescribed if you have had a hysterectomy at a young age or experience ovarian insufficiency (your ovaries quit working) at a young age (under 45). Talking with your provider, making informed decisions When you talk over HT with your provider, here’s what they’ll go over with you: <ul style="list-style-type: disc;"> <li>Personal and family health history </li> <li>Personal cancer risks or history, as well as family history of cancer, specifically breast or ovarian cancer </li> <li>Personal and family history of cardiovascular (CV) disease, clotting disorders, and liver disease</li> <li>Risk factors for CV disease, such as smoking, high blood pressure, diabetes, cholesterol problems and weight</li> </ul> They also may want you to be current on preventive screening for breast, cervical and colon cancer and screenings for factors that increase CV risk. Your provider likely will recommend addressing any concerns, including stopping smoking and treating high blood pressure, diabetes or cholesterol problems to lower your overall CV risk. After gathering the information about your health, health history and risks, your provider will give recommendations about whether HT is appropriate for you — or information about other non-hormone options for treating bothersome symptoms. Part of your discussion will include the risks of HT, which include potentially stimulating an undetected hormone-sensitive cancer, and increasing your risk for blood clots or CV events, such as stroke or heart attack. And finally, your provider will go over the side effects of HT, including nausea, headaches, breast tenderness, vaginal spotting, bleeding or bloating. Treating your symptoms There’s a timeframe when HT is safer — usually at the onset of menopause (average age is 51) and for the next 10 years after your periods have stopped. Your provider will prescribe the lowest dose possible for the shortest amount of time needed to treat or reduce your symptoms. Your treatment is customized for you, since symptoms vary for each woman. HT usually is delivered through a pill or a patch; your provider will help you choose the best option for treating your symptoms. You’ve probably heard or read about over-the-counter (OTC) herbal supplements that can relieve symptoms. Some of these are black cohosh, ginseng and ginkgo. These herbal remedies may or may not be helpful. If you’re interested in trying a supplement, check with your provider first, since the supplement may interact with medications you’re currently taking, and for some, may actually increase health risks. If you’d like more information before talking with your provider, check out this <a href="https://www.mayoclinic.org/diseases-conditions/menopause/in-depth/hormone-therapy/art-20046372">Mayo Clinic article</a> on HT. While your primary care provider is an excellent resource, you also may consider consulting with someone who specializes in menopause and menopausal symptoms. Once you and your provider have decided HT is a good fit, be sure to follow up at a future appointment to review if HT is still right for you. <a href="https://communityhealth.mayoclinic.org/providers/marcia-obrien-md" target="_blank">Dr. Marcia O'Brien</a> is a Family Medicine physician at Employee and Community Health's (ECH) Mayo Family Clinic Northeast. She practices the full spectrum of family medicine, including hospital medicine, newborn nursery and obstetric care. One of her areas of specialty is women's health. Dr. Marcia O'BrienPrimary Care in Rochester and KassonHormone Replacement TherapyPrimary Care in Rochester and KassonBlood donations save lives. And Robyn is living proof.&nbsp;<img src="/-/media/ech-media/images/widgets/blooddonation/ech_blooddonation_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=0DD5C6FFDCBDB16B76517B1344628BFD" alt="ECH_BloodDonation_widget" width="100" height="65" DisableNVelocity="true" />Blood donation: Robyn's story underscores need11/5/2018 5:00 AM<img src="/-/media/ech-media/images/widgets/blooddonation/ech_blooddonation_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=68DF516B203DE108519578CD5EE8942B" alt="ECH_BloodDonation_widget" width="300" height="195" DisableNVelocity="true" />It was 1995, late February. Robyn was driving to work when she was rear-ended by another driver. She was okay, but when an officer arrived on the scene, and Robyn got out of her vehicle, a second car struck her, throwing Robyn into the vehicle parked behind hers. “When the second driver tried to back up, my left leg got caught on his license plate, and I was dragged 10 feet,” says Robyn. She ended up with two broken legs and a hairline fracture of her pelvis. She was also six months pregnant, which meant she couldn’t take pain medication until the hospital could monitor her baby’s condition. Over the next three days, Robyn had three surgeries at Mayo Clinic. Two months later, Robyn gave birth —while in traction — to a healthy baby boy. Over the next 20 years, Robyn underwent multiple surgeries and received approximately 15 units of blood. She’s still undergoing skin grafts because of the damage and is recovering from a left knee replacement, also a result of the accident. Though more surgeries lay ahead, Robyn feels grateful. “Without the generous blood donors, there would not have been blood available for me or my son,” she says. “I am very, very lucky.” Robyn donated her own blood for the first time in June — after donor guidelines changed to allow people who have received blood transfusions to donate. To read more stories like this, visit the <a href="https://connect.mayoclinic.org/page/blood-donor-program/tab/newsfeed/" target="_blank">Mayo Clinic Blood Donor Program’s blog</a> Here are ways you can be involved in blood donation: <ul> <li>Donate blood. For more information about donating blood in Rochester, call (507) 284-4475, send an email to <a href="mailto:donateblood@mayo.edu">donateblood@mayo.edu</a>, or visit Mayo’s <a href="http://www.mayoclinic.org/donateblood" target="_blank">blood donation webpage</a>. Blood donation locations in Rochester are: <ul> <li>Hilton Building, First Floor Monday-Friday, 6 a.m. to 4:30 p.m. (507) 284-4475</li> <li>Saint Mary’s Campus - Joseph Building Main Floor, Room M-86 Monday-Thursday, 7:30 a.m. to 3:45 p.m. Friday, 6:30 a.m. to 3:30 p.m. (507) 255–4359</li> </ul> </li> <li>Host a blood drive. To make it convenient for you to give blood, Mayo Clinic Blood Donor Center offers mobile blood drives at locations around Olmsted County. Consider hosting a blood drive at your business, church or other site. Contact the Blood Donor Center to discuss.</li> <li>Lead a blood donor challenge. Challenge your family, friends, colleagues or groups in your community to donate blood. These friendly competitions are a fun way to encourage others to donate — and save lives in the process. For the challenge, team members simply check in at one of the donation locations with their team name, which ensures the donation is counted. When the challenge ends, the group with the highest percentage participation wins bragging rights. Are you ready to start a challenge?</li> </ul>Katy Maeder, Donor ServicesPrimary Care in Rochester and KassonBlood Donation 110518Primary Care in Rochester and KassonEating out holds pitfalls that can pack on pounds.&nbsp;<img src="/-/media/ech-media/images/widgets/food/ech_eatingout_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=2318A40FAB3D11331351CA445A605360" alt="ECH_EatingOut_widget" width="100" height="65" DisableNVelocity="true" />Eating out, eating smart11/12/2018 5:00 AM<img src="/-/media/ech-media/images/widgets/food/ech_eatingout_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=1153255BC2BE466A59D0A3A1519800C9" alt="ECH_EatingOut_widget" width="300" height="195" DisableNVelocity="true" />Did you know? <ul> <li>One third or more of the calories Americans consume come from foods eaten in or bought from restaurants. </li> <li>The Applebee's Grilled Chicken Oriental Salad tallies 1,310 calories, while a Salted Caramel Mocha from Starbucks tops out at 570 calories and a Lemon Poppy Seed Muffin at Perkins will set you back 700. The average adult should consume about 2,000 calories a day, including snacks and beverages. </li> <li>The obesity epidemic is showing no signs of abating in people over age five. </li> </ul> Eating out holds pitfalls that can pack on the pounds — but not if you're smart about it. Here are some tips that let you enjoy eating out (or ordering in) with friends and family: <ul> <li>Do a little research before you leave home. Most family-friendly restaurants now have extensive menu information on their websites, including calories, nutrition and even calculators that let you plan your calorie counts ahead. There also are easy-to-use independent online sites and apps.</li> <li>Watch the portions. Some menus have "senior" or "lighter side" offerings that tend to be smaller. Consider splitting an entrée. Or ask for a to-go box as soon as your meal arrives; split everything in half and set aside to take home. </li> <li>Watch your kids' portions. Just because kids can eat adult food, doesn't mean they should eat adult portions. Share meals, take some home or ask for kid-sized portions. </li> <li>Control your order. Ask for dressing and mayo on the side, dry toast (then you control the amount of spread put on it), order egg-white omelets, choose grilled over fried or breaded. </li> <li>Beware of before-meal extras like baskets of chips or popcorn, breadsticks and endless refills of beverages. Noshing on these meal starters can add 300-500 calories on top of those for your entrée. </li> <li>Build your own meal around a carryout entrée. Try ordering a smaller pizza (remember those portions) and rustle up your own sides at home such as baby carrots and fruit cups or grapes and assorted olives. </li> <li>Share desserts. Everyone gets a taste without putting a bite in their calories for the day. </li> </ul> Save eating our or picking up carryout for special occasions or as a treat. When you cook at home, it's easier to make healthy choices — and it's easier on your budget.  Michaeleen Burroughs, RDN, LD, has worked at Employee and Community Health (ECH) in Family Medicine for 20 years. She currently helps patients at Mayo Family Clinics Northwest, Southeast and Kasson, and Baldwin Family Medicine and Community Pediatric and Adolescent Medicine (CPAM). Her areas of interest are diabetes and child and adult weight management. Michaeleen Burroughs, RDN, LDPrimary Care in Rochester and KassonEating Out Eating SmartPrimary Care in Rochester and KassonFor 33-year-old Joanna, blood transfusions are crucial for her care&nbsp;— and her future.&nbsp;<img src="/-/media/ech-media/images/widgets/blooddonation/ech_blood_donor_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=D65708AB3136E8EF43B7C3BA94A356B0" alt="ECH_blood_donor_widget" width="100" height="65" DisableNVelocity="true" />Blood Donation: Living a normal life depends on donors1/21/2019 3:00 AM<img src="/-/media/ech-media/images/widgets/blooddonation/ech_blood_donor_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=D0B1C9FA9D067DFF9144A595BA788AAD" alt="ECH_blood_donor_widget" width="300" height="195" DisableNVelocity="true" />When Joanna was just 15 years old, doctors discovered her brain was herniated at the base of her skull, which caused a large cyst in her spinal cord. By age 18, she had been diagnosed with another four conditions and had already undergone 12 brain and spine surgeries. This was the start of Joanna's long medical journey — one that is still ongoing today at the age of 33.  But despite her 63 surgeries, over 100 blood transfusions, and more than 10 rare medical conditions — Joanna remains optimistic and grateful for life.  While each of Joanna's conditions has a different set of symptoms, they all affect each other, causing each one to behave differently than it would on its own. Her physicians describe it as the perfect storm — you can never treat just one condition, and you have to factor in how the other conditions will react before deciding on treatment.  One of Joanna's conditions is a buildup of excess cerebrospinal fluid in her brain. For years, she has had a shunt, which is a medical device implanted in her brain to relieve pressure by diverting the excess fluid into her heart. Shunts generally last anywhere from several years to a lifetime, but Joanna's shunt required replacement every three to six months, and each brain surgery to replace it got increasingly difficult and dangerous. In the spring of 2012, Joanna's care team in Atlanta contacted Mayo Clinic for help determining why her shunt was failing much more than normal.  Finding an answer Joanna's first trip to Mayo in April 2012 included testing and consultations with nine different departments. She finally received an answer after a visit to the Hematology Department. After many tests, she was diagnosed with an autoimmune blood-clotting disorder that was causing tiny blood clots to form around the tip of her shunt, which stopped it from being able to drain properly and led to failure.  No one had ever seen this condition cause this complication before, but her team at Mayo decided to begin treatment in hopes it would help. There is no cure for Joanna's condition, but it can be treated with blood thinners that make it hard for the body to develop blood clots. She has been giving herself anticoagulant injections every day since her diagnosis.  Facing emergency brain surgery every few months, Joanna found it difficult to live day-to-day and plan for the future. However, the diagnosis she received at Mayo Clinic saved and changed her life. Her shunt has continued working since she began treatments; this is the longest she's every gone without needing brain surgery to replace it.  Accident deals her a setback Joanna had a couple stable and wonderful years following that diagnosis, despite the chronic conditions that she continued to manage. That changed suddenly in 2015 when she was hit by a large delivery truck. This accident resulted in injuries that required emergency brain surgery and a shoulder injury that left her with almost no use of her right arm.  Joanna returned to Mayo earlier this year and underwent a major surgery for her shoulder with the Orthopedic Department, which included a triple-tendon transfer and a scapuloplexy. She spent the four months following the operation immobilized in an upper-body brace, but she is happy to report that she now has more use of her right arm than she has had since the accident.  While Joanna recovers from her surgeries and lives with many chronic symptoms, she remains positive and optimistic about life. She is thankful for her wonderful support system and the dedicated support of her health care team.  "I am especially grateful for the innovative and advanced diagnosis that I have received, along with Mayo Clinic's expertise in treating rare and complicated conditions. I don't believe I would still be here without the help of Mayo Clinic," she says.  Joanna receives frequent blood transfusions, so she is able to spend more time and special occasions with her family. Because of this, her family members make a point to donate at the Mayo Clinic Blood Donor Center whenever they are in Rochester for her checkups or surgeries. They know firsthand that blood donation has helped save Joanna's life more than once.  To read more stories like this, visit the <a href="https://connect.mayoclinic.org/page/blood-donor-program/tab/newsfeed/" target="_blank">Mayo Clinic Blood Donor Program's Blog Page</a>.  Here are ways you can be involved in blood donation: <ul> <li>Donate blood. For more information about donating blood in Rochester, call (507) 284-4475, send an email to <a href="mailto:donateblood@mayo.edu">donateblood@mayo.edu</a>, or visit Mayo's <a href="https://www.mayoclinic.org/patient-visitor-guide/minnesota/blood-donor-program" target="_blank">blood donation webpage</a>. Blood donation locations in Rochester are:  <ul> <li>Hilton Building, First Floor Monday-Friday, 6 a.m. to 4:30 p.m. (507) 284-4475</li> <li>Saint Mary's Campus - Joseph Building Main Floor, Room M-86  Monday-Thursday, 7:30 a.m. to 3:45 p.m. Friday, 6:30 a.m. to 3:30 p.m.(507) 255-4359</li> </ul> </li> <li>Host a blood drive. To make it convenient for you to give blood, Mayo Clinic Blood Donor Center offers mobile blood drives at locations around Olmsted County. Consider hosting a blood drive at your business, church or other site. Contact the Blood Donor Center to discuss. </li> <li>Lead a blood donor challenge. Challenge your family, friends, colleagues or groups in your community to donate blood. These friendly competitions are a fun way to encourage others to donate — and save lives in the process. For the challenge, team members simply check in at one of the donation locations with their team name, which ensures the donation is counted. When the challenge ends, the group with the highest percentage participation wins bragging rights. Are you ready to start a challenge?</li> </ul>Katy Maeder, Donor ServicesPrimary Care in Rochester and KassonBlood Donation 012119Primary Care in Rochester and KassonTips for building a breakfast routine that works for you.&nbsp;<img src="/-/media/ech-media/images/widgets/food/ech_breakfast_to_go_widget.jpg?h=65&iar=0&w=100&sc_lang=en&hash=BF898887273831B7DB3B9A7FBA8C89BF" alt="ECH_Breakfast_to_go_widget" width="100" height="65" DisableNVelocity="true" />Fuel your day with breakfast1/28/2019 3:30 AM<img src="/-/media/ech-media/images/widgets/food/ech_breakfast_to_go_widget.jpg?h=195&iar=0&w=300&sc_lang=en&hash=352F312C44E8640A6DC6A3CE4FCFE326" alt="ECH_Breakfast_to_go_widget" width="300" height="195" DisableNVelocity="true" />"Breakfast is the most important meal of the day." How often have you heard that comment? There are good reasons why: <ul> <li>Our bodies use up nutrient supplies while we're sleeping, and by the time we wake up, they need to be replenished. </li> <li>Breakfast is the first opportunity to refuel. </li> <li>Research shows that those who eat breakfast have healthier weights, less risk of heart disease, smaller waistlines and better performance at work and school. </li> </ul> As the New Year gets underway, consider making a resolution to establish a regular breakfast routine. Here are some tips to get you started:  <ul> <li>Eat within a couple of hours of getting up. You don't have to chow down the minute your feet hit the floor. </li> <li>Include two to three food groups. Choose from the milk group (milk, cheese, ice cream and other milk-based foods), meat group (meat, fish, poultry, eggs, dried legumes and nuts), fruits and vegetables group, breads and cereal group. </li> <li>Any food is breakfast food. Not a fan of traditional breakfast food? Consider a peanut butter sandwich, hard-boiled egg paired with a piece of fruit, slice of cold pizza or leftover rice and beans as part of your wake-up meal. </li> <li>Be flexible. Some days you may need to tote breakfast to eat at your desk or on the bus, another day you can relax and enjoy a bigger breakfast. </li> </ul> Breakfast doesn't need to be fancy, but it does need to be doable. Being portable is another plus. Try these combos for starters: <ul> <li>Two food groups: Yogurt + granola. Add fruits or berries to boost it to three food groups. </li> <li>Two food groups: Leftover roasted veggies + whole-grain rice. </li> <li>Three food groups: Peanut butter toast + glass of milk. </li> <li>Three food groups: Homemade trail mix of dry cereal, nuts and dried fruit. </li> </ul> As you begin your 2019 breakfast routine, remember: Do what works for you, and do it every day. Good luck and good health! Michaeleen Burroughs, RDN, LD, has worked at Employee and Community Health (ECH) in Family Medicine for 20 years. She currently helps patients at Mayo Family Clinics Northwest, Southeast and Kasson, and Baldwin Family Medicine and Community Pediatric and Adolescent Medicine (CPAM). Her areas of interest are diabetes and child and adult weight management. Michaeleen Burroughs, RDN, LDPrimary Care in Rochester and KassonBreakfast TipsPrimary Care in Rochester and KassonThese four tips can ease back-to-work breastfeeding for you and your baby.&nbsp;<img src="/-/media/ech-media/images/widgets/people/ech_breastfeeding_01_widget.jpg?h=65&iar=0&w=100&hash=C1DCE7E0AECB8D8A13566AE8B9F60C01" alt="ECH_Breastfeeding_01_Widget" width="100" height="65" DisableNVelocity="true" />4 success tips for returning to work while breastfeeding9/18/2017 5:00 AM<img src="/-/media/ech-media/images/widgets/people/ech_breastfeeding_01_widget.jpg?h=195&iar=0&w=300&hash=CC362BA6BCA984EBFCC6D2652C65AB0B" alt="ECH_Breastfeeding_01_Widget" width="300" height="195" DisableNVelocity="true" />In the U.S., 68% of women who breastfeed work outside the home. The American Academy of Pediatrics (AAP) recommends only breastfeeding until your baby is six months old, followed by breastfeeding, complemented by solid foods, until your child is one. Studies show that not only does breastfeeding provide health benefits to both mother and baby, but working parents of breastfed infants also have an absenteeism rate three times lower than those whose infants are formula fed.  Pumping at work may seem like a challenge, but these four tips can ease the transition form home to work while providing the best nutrition possible for your little one.  #1: Set yourself up for success Work with your supervisor to accommodate your needs. A flexible schedule or splitting up your break time(s) can give you the pumping frequency you need. Where you pump should be private and have electricity Some items that can make pumping more manageable are:  <ul> <li>Extra set of pump parts</li> <li>Hands-free pumping bra</li> <li>Microwavable steam bag to sterilize pump parts. </li> </ul> Bring a cooler with refreezable ice packs to store your milk until you get home. Milk can be stored: at room temperature up to eight hours, in an ice-packed cooler up to 24 hours, and in the refrigerator up to eight days.  #2: Practice introducing a bottle Typically, it is wise to introduce a bottle to your baby when they are about three to six weeks old so they will be comfortable using it while you are at work. Breastfeeding usually is established by this time; babies older than six weeks may refuse to take a bottle. At first, be sure to use a slow-flow nipple. If your baby isn't taking to bottle feeding, try:  <ul> <li>Different feeding positions</li> <li>Having someone other than mom feeding with the bottle</li> <li>Different milk temperatures</li> <li>Other styles of nipples</li> </ul> #3: Using your pump About two weeks before returning to work, start pumping an additional time to store up some milk. At first, you will not pump much milk, but you are setting your body up to make more later. When you do pump some extra, freeze it for use on the day you return to work. Once back at work:  <ul> <li>Try to relax and consider bringing sensory cues, such as a photo, a onesie your baby has worn or an audio of them crying. </li> <li>You should pump as often as your baby typically nurses. </li> <li>If your baby is a frequent nurser, you may need to space out your pumping times, but setting aside about 15-20 minutes should be sufficient. </li> <li>You should pump until no more milk comes out, and then for another minute or two if you are trying to boost your supply. You may also use the let-down button on your pump to trigger more rapid suction, which stimulates a second milk let-down. </li> <li>To completely remove milk, hands-on pumping using breast compression, massage and then finishing with self-expression can increase your pumped volume. </li> </ul> #4: Skin-to-skin time Once you are home from work -- especially if you are experiencing a dip in volume pumped -- allow your baby to nurse on demand while cuddling them skin-to-skin. Some babies take less volume by bottle during the day and prefer to nurse more often in the evenings.  If you need support or guidance on pumping while at work, talk with your local lactation specialist -- they are here to help you succeed! Also, consider enrolling in a free class from the Mayo Clinic Perinatal Education department. To register, call 507-266-7473.  Maegen Storm, APRN, CNP, is a certified pediatric nurse practitioner in Employee and Community Health's (ECH) Division of Community Pediatric and Adolescent Medicine (CPAM) and has a special interest in breastfeeding for the health of the baby. Maegen and her husband have enjoyed partnering to breastfeed their four boys. Maegen Storm, APRN, CNPPrimary Care in Rochester and KassonBreastfeeding Return To WorkPrimary Care in Rochester and Kasson4 success tips for returning to work while breastfeedingbreastfeeding, pumping, working, These four tips can ease back-to-work breastfeeding for you and your baby