MAYO CLINIC HEALTH LETTER
To o l s f o r H e a l t h i e r L i v e s
VOLUME 26 NUMBER 8 AUGUST 2008
Inside this issue
HEALTH TIPS . . . . . . . . . . . . . 3
Reducing foot odor.
NEWS AND OUR VIEWS . . . . . 4
Sleep duration linked to weight
gain. Inflammatory bowel disease
and infection concerns.
CHRONIC OBSTRUCTIVE
PULMONARY DISEASE . . . . . . 4
Steps for better breathing.
TRIGLYCERIDES
AND HEART DISEASE . . . . . . 6
Healthy diet, exercise are musts.
PREVENTING KYPHOSIS . . . . 7
Reducing your risk of getting a
hunched back.
SECOND OPINION . . . . . . . . 8
Coming in September
CATARACT REMOVAL
Continued advances in surgery.
VASCULITIS
Blood vessel inflammation takes
many forms.
DUAL-ENERGY X-RAYS
Two is better than one.
THYROID NODULES
What’s that lump in your throat?
www.HealthLetter.MayoClinic.com
Stress
incontinence
Surgical treatments
for women
You’ve tried the conservative ap-
proaches to manage your urinary
incontinence — everything from
faithfully doing pelvic floor muscle
exercises to scheduling regular toilet
trips. But despite your best efforts,
you still experience urinary leakage
every time you cough, sneeze, laugh
or lift something heavy. In fact, your
stress incontinence has gotten so bad
that you alter your activities out of
fear of leakage.
Surgical options for
urinary incontinence
Visit us on the Internet at the address listed to the left, where you’ll find more
health information, great offers and more!
If conservative measures fail to
address the problem of stress incon-
tinence, it may be time to consider
surgical treatment options. Compared
with other therapies, surgery comes
with possible complications. But it
may be a treatment worth consider-
ing when stress incontinence begins
to interfere with your quality of life.
On the plus side, most surgeries
for stress incontinence are minimal-
ly invasive and have good results.
Proper surgical treatment can signif-
icantly improve the problem and can
provide a long-term solution.
The pressures of time
The most common cause of stress
incontinence in women is weakened
pelvic floor support of the following:
Sling procedure
Bladder neck suspension
 ■ The bladder
■ The narrow tube through which
urine is eliminated (the urethra)
■ The thickened muscle where
the bladder connects to the urethra
(the bladder neck)
In women, the risk of stress in-
continence increases with age. It’s
more common in women who are
obese and in women who have
given birth vaginally multiple times.
Although stress incontinence
can be distressing, surgical treat-
ment is rarely needed on an urgent
basis. Once you have an accurate
diagnosis of the problem, it’s impor-
tant to carefully consider your sur-
gical treatment options.
Added support
The goal in treating stress incon-
tinence is to strengthen the urethra’s
support system. Several procedures
do just this. Most of them fall into
two main categories — sling pro-
cedures and bladder neck suspen-
sion procedures.
■ Sling procedures — These
procedures are much more com-
Possible concerns after surgery
As with surgery of any sort,
surgical procedures for urinary
incontinence aren’t risk-free.
Potential complications —
although uncommon —
include bleeding, wound
infection and organ injury. A
urinary tract infection (UTI)
may develop in the early post-
surgery time frame, especially if
temporary catheterization is
needed. Antibiotics are general-
ly effective in treating a UTI.
Beyond these immediate
problems, you need to be
aware that surgery for urinary
incontinence may result in
urinary and genital problems
that previously didn’t exist.
These may include:
2 www.HealthLetter.MayoClinic.com
monly used, especially in the last
decade. Some sling procedures are
considered minimally invasive. De-
pending on the facility and surgeon,
some can be performed on an out-
patient basis with local anesthesia.
Basically, strips of tissue or syn-
thetic mesh are used to construct
a pelvic sling or hammock under
the bladder neck and the urethra.
The sling is inserted through a small
vaginal incision and then directed
under the middle part of the urethra.
The ends of the sling are then
brought through each of two small
incisions — either just above the
pubic bone or in the groin area.
Choices for sling materials in-
clude using your own tissue, a syn-
thetic mesh or tissue from animal
sources. Using your own tissue
avoids some complications related
to foreign materials, but it also in-
volves making an additional abdom-
inal incision to acquire that tissue.
As a result, recovery time is longer
and a catheter may be needed for
two to three weeks. No abdominal
incision is needed when synthetic
■ Difficulty passing urine
and incomplete emptying of
the bladder, although usually
temporary. In rare cases, an
additional sling-loosening
procedure may be required.
■ Development of overac-
tive bladder, which in some
cases can lead to an urgent
need to urinate (urge inconti-
nence). If severe, this can
actually lead to loss of urine
before you’re able to reach the
bathroom.
■ Difficult or painful inter-
course.
Before surgery, ask your
surgeon about the risks and
benefits associated with the
different types of surgery.
August 2008
mesh is used, and healing is usu-
ally much faster, taking just a week
or two. However, there can be prob-
lems associated with mesh healing
and the vaginal incision, but these
complications are uncommon.
Regardless of which material is
chosen, with the sling’s support, the
urethra has a backstop of sorts to
help close the urethra so that urine
doesn’t leak out even if you sneeze
or cough. If local anesthesia is used,
your surgeon may ask you to cough
in order to help determine the right
sling tension. Some sling techniques
may allow for adjusting sling ten-
sion after surgery. Ask your surgeon
about the various sling procedures
available and which might be best
suited for you.
■ Bladder neck suspension pro-
cedures — These types of proce-
dures also provide support to the
urethra and bladder neck, but use
MAYO CLINIC HEALTH LETTER
Managing Editor Medical Editor
Aleta Capelle Robert Sheeler, M.D.
Associate Editors Associate Medical Editor
Carol Gunderson Amindra Arora, M.D.
Joey Keillor
Editorial Research
Medical Illustration Deirdre Herman
Michael King
Proofreading
Customer Service Miranda Attlesey
Manager Donna Hanson
Ann Allen
Administrative Assistant
Deborah Adler
EDITORIAL BOARD
Shreyasee Amin, M.D., Rheumatology; Amindra
Arora, M.D., Gastroenterology and Hepatology; Brent
Bauer, M.D., Internal Medicine; Tracy Berg, R.Ph.,
Pharmacy; Julie Bjoraker, M.D., Internal Medicine;
Bart Clarke, M.D., Endocrinology and Metabolism;
William Cliby, M.D., Gynecologic Surgery; Diane
Dahm, M.D., Orthopedics; Mark Davis, M.D.,
Dermatology; Timothy Hobday, M.D., Oncology; Lois
Krahn, M.D., Psychiatry; Michael Mahr, M.D.,
Ophthalmology; Lance Mynderse, M.D., Urology;
Suzanne Norby, M.D., Nephrology; Robert Sheeler,
M.D., Family Medicine; Phillip Sheridan, D.D.S.,
Periodontics; Peter Southorn, M.D., Anesthesiology;
Ronald Swee, M.D., Radiology; Farris Timimi, M.D.,
Cardiology; Aleta Capelle, Health Information. Ex-
officio: Carol Gunderson, Joey Keillor.
Mayo Clinic Health Letter (ISSN 0741-6245) is published
monthly by Mayo Foundation for Medical Education
and Research, a subsidiary of Mayo Foundation, 200
First St. SW, Rochester, MN 55905. Subscription price
is $27 a year, which includes a cumulative index
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an abdominal approach to achieve
this goal. They’re highly effective
and have been used for decades
compared with synthetic slings,
which achieved widespread use
only during the past decade.
Under general anesthesia, a 3-
to 5-inch incision is made in the
lower abdomen through which your
surgeon places stitches in tissue near
the bladder neck. From there, the
stitches are secured either to a liga-
ment near the pubic bone (Burch
procedure) or in the cartilage of the
pubic bone itself (Marshall-Marchet-
ti-Krantz, or MMK, procedure).
The idea is to shore up the ure-
thra and bladder neck so that they
don’t sag. Typically, recovery from
from this type of surgery takes up to
Do your Kegels
Pelvic floor exercises — also
referred to as Kegel exercises
— involve squeezing and
relaxing muscles in your pelvic
and genital area. Maintaining
strength, endurance and proper
action of these muscles is
important for bladder and
bowel control.
To locate your pelvic floor
muscles, imagine that you’re
trying to stop your urine flow.
Without tightening your but-
tocks or belly, squeeze and lift
the vaginal and rectal areas.
When you squeeze, you should
experience a sensation of
pulling or closing in your
genital area. This sensation is
produced by your pelvic floor
muscles. The following are a
couple of ways to give your
pelvic floor muscles a workout:
■ Holding — Slowly tight-
en, lift and draw the pelvic
floor muscles and hold for a
count of three. Relax, and then
repeat. At first, you may not be
able to maintain the hold for
six weeks. During recovery, a cath-
eter is usually needed for about one
or two weeks, until you have re-
sumed normal voiding.
Temporary bulk
If a quicker and less invasive
treatment is desired, you may want
to consider the possible use of an
injectable bulking agent to tempo-
rarily help control urine leakage.
A bulking material — such as col-
lagen — is injected into tissue sur-
rounding the urethra next to the ure-
thral sphincter, located at the base
of the bladder.
Unfortunately, these lose their
effectiveness with time. Repeat in-
jections are typically needed every
six months or so. ❒
very long. If that’s the case, try
holding for one to two seconds.
Gradually increase over a
period of several weeks to as
long as 10 seconds. If you feel
the contraction letting go, just
re-tighten the muscles. Rest for
10 seconds between each
contraction. You’ll note that
over time your contractions
become stronger.
■ Quick flicks — Do a
series of rapid contractions and
releases by quickly tightening
the muscles, lifting them up
and then letting them go.
Pelvic floor muscle exercis-
es can be done almost any-
where. Practice while you’re
driving, watching TV or sitting
at your desk. You might start by
doing 10 of them before getting
out of bed, another 10 after
lunch, 10 more after dinner
and a final set of 10 before
going to sleep. When done
correctly for six to 12 weeks,
an improvement in bladder
control should be noticeable.
August 2008
Health tips
Reducing foot odor
Everyone’s feet sweat. And
nearly everyone wears shoes,
which create a warm, mois-
ture-trapping environment,
ideal for bacterial and fungal
growth. Naturally, foot odor is
the frequent result. Keep it in
check by:
■ Bathing daily — This
helps reduce the number of
bacteria and fungi on your
feet. Dry your feet thoroughly,
especially between toes, be-
fore putting on clean socks.
■ Powdering your feet —
A light dusting with an anti-
fungal foot powder before put-
ting on your shoes can help.
■ Choosing the right shoes
and socks — Shoes made of
natural materials breathe, al-
lowing moisture to escape.
Wool or cotton socks absorb
moisture, which can help keep
feet dry. Athletic socks made
of high-tech fabrics may be
even better, as they wick mois-
ture away from the skin.
■ Rotating shoes — Try
not to wear the same pair of
shoes two days in a row. This
gives them time to dry out.
Removing shoe inserts helps
them dry even faster.
■ Airing your feet — If
those around you don’t mind,
kick off your shoes now and
again to let your feet air out.
■ Changing shoes, socks
— Consider changing shoes
and socks a couple of times a
day to keep things dry.
If your feet sweat exces-
sively, talk to your doctor about
therapies that can help. ❒
www.HealthLetter.MayoClinic.com 3
 Chronic
News and our views obstructive
Sleep duration linked to weight gain
A recent study confirms research linking how long a person sleeps pulmonary
at night with risk of weight gain. The study, published in the April 1,
2008, issue of the journal Sleep, found weight gain happens with both
too much and too little sleep.
disease
In the study, those who averaged five to six hours of sleep at night Steps for better breathing
gained 4.4 pounds more than did average-length sleepers who got
the typically recommended seven to eight hours at night. Among those If you needed another reason to stop
who slept from nine to 10 hours, the weight gain was 3.5 pounds smoking, this is it. Your doctor diag-
above that of average-length sleepers. nosed the persistent coughing and
The study design doesn’t provide any clear answers on why weight shortness of breath you’ve been
gain differs with sleep duration. However, researchers speculate experiencing as chronic obstructive
that one plausible explanation for the differences may be a disruption pulmonary disease (COPD).
in the production of hormones that control appetite. Of specific inter- This progressive disease occurs
est are the hormones leptin, which diminishes appetite, and ghrel- when lung damage — typically
in, which stimulates appetite. ❒ caused by smoking — leads to ob-
struction of your lung’s airways,
Inflammatory bowel disease and infection concerns which may shorten your life.
A recent Mayo Clinic study has found that people who have inflam- Fortunately, when COPD is
matory bowel disease (IBD) who are on multiple immunosuppressive detected at a mild to moderate stage
medications or who are over the age of 50 are at higher risk of devel- — as the majority of cases are —
oping infection. Yet, a combination of medications are often need- stopping smoking and adopting a
ed to manage this disease and control its life-altering consequences. healthier lifestyle likely means your
Ulcerative colitis and Crohn’s disease are the most common forms symptoms will remain mild and may
of IBD. Typically, IBD causes severe bouts of diarrhea and abdomi- improve. For more severe COPD,
nal pain due to inflammation of the lining of the digestive tract. Often drugs and therapies can be added
it’s treated with a combination of immunosuppressive medications, to greatly improve your ability to
which help diminish intestinal inflammation and relieve symptoms breathe, and your quality of life.
but may also compromise the body’s normal immune function.
The Mayo Clinic study, published in the April 2008 issue of the Clear-cut cause
journal Gastroenterology, considered the records of 300 people with Among older adults, COPD is a
IBD. Of these, 100 had experienced opportunistic infections — that leading cause of death in the United
is, infections that come about when the immune system is weakened States. Still, most people with mild
and that ordinarily wouldn’t develop or would be very mild if the to moderate COPD who stop smok-
immune system were functioning normally. Shingles and thrush topped ing don’t die of the disease. COPD
the list of these kinds of infections. is most commonly a combination
Those who were 50 or older were three times more likely to expe- of two disorders:
■ Chronic bronchitis — This is
rience infections than were younger people with IBD. Opportunistic
infections were three times more likely in people taking one immuno- a chronic inflammation and thick-
suppressive drug, compared with those taking none. And among those ening of the tubes of your lungs
taking two or three, the risk of infections was 14 times greater. (bronchial tubes). The disorder is
Mayo Clinic researchers say the findings make it all the more characterized by an ongoing cough
important for people who have IBD and are taking immunosuppres- with persistent phlegm production.
■ Emphysema — This involves
sive medications to seek medical attention at any sign of infection,
such as a cough or fever. They also warn against changing your med- inflammation damage to the tiny,
ications without talking to your doctor, who can determine the right elastic air sacs (alveoli) at the ends
treatment for your situation. ❒ of bronchial tubes. Shortness of
breath when you exert yourself often
is the first symptom of emphysema.

4 www.HealthLetter.MayoClinic.com August 2008

 Normal
bronchus
Normal
alveoli
These problems develop gradu-
ally over the years and produce few
signs and symptoms in early stages.
If you’re a smoker, a breathing test
called spirometry and a chest X-ray
can determine if you’re on your way
to developing COPD, even before
symptoms develop. And, don’t dis-
miss a chronic cough or a change
in your breathing as a case of smok-
er’s cough or as being out of shape.
They may be early signs of COPD.
Easing your breathing
Slowing COPD progression re-
quires eliminating exposure to the
cause. For most, this means stop-
ping smoking. If you have mild to
moderate COPD, one study found
that 11 years after stopping smok-
ing, risk of developing severe COPD
dropped from 18 to 3 percent.
Strategies that can help mild to
moderate COPD include:
■ Avoiding respiratory infections
— This involves getting the pneu-
monia vaccine and annual flu vac-
cinations, and taking basic sanitary
precautions such as washing your
hands frequently.
Bronchitis
Emphysema
■ Getting daily exercise — This
increases the efficiency of your mus-
cles and circulatory system.
■ Using short-acting broncho-
dilators — These help relax muscles
around your airways that can go into
spasm, helping to relieve coughing
and making breathing easier.
■ Avoiding irritants — In addi-
tion to stopping smoking, you’ll
need to avoid lung irritants such as
secondhand smoke, air pollution,
wood smoke, strong odors or dust.
■ Maintaining a well-balanced
diet —Maintaining a healthy weight
is best. Being too thin may make you
frail, while being overweight in-
creases shortness of breath.
Additional therapies for moder-
ate to more severe COPD include:
■ Long-acting bronchodilators
— Long-acting beta-agonist bron-
chodilators, including salmeterol
(Serevent) and formoterol (Foradil),
can improve life span, lung function
and quality of life, and can reduce
risk of life-threatening infections
(exacerbations) and hospitalization.
Another class of bronchodilators
called long-acting anti-muscarinics,
August 2008
Exacerbations
Even with ongoing treat-
ment, your COPD symptoms
may suddenly get worse.
This is called an acute exac-
erbation, and without prompt
treatment, it may lead to
lung failure. You may experi-
ence an increase in mucus
and a change in its color. An
increase in breathing diffi-
culty or coughing that
doesn’t go away with normal
drugs also may occur.
Treatment often involves
using a bronchodilator, corti-
costeroid drugs and oxygen
therapy, as well as starting
antibiotic therapy. You may
need to be hospitalized.
including tiotropium (Spiriva), have
a similar effect on symptoms, but
haven’t been proved to improve lon-
gevity. Recently, concern was raised
about stroke risk among those tak-
ing tiotropium. The Food and Drug
Administration announced a cau-
tion for the drug, but it’s not known
whether the benefits of tiotropium
outweigh this small risk. A major
study due this fall should answer
questions about tiotropium.
■ Corticosteroids — For more
severe and uncontrolled COPD, a
corticosteroid inhaler may be added.
■ Supplemental oxygen — If
normal breathing doesn’t get enough
oxygen into your blood, you may
need to use a device that delivers
oxygen to your lungs.
Because these therapies are a lot
to manage, many people benefit
from a comprehensive pulmonary
rehabilitation program.
If you have advanced emphyse-
ma, a procedure in which diseased
portions of lung are surgically re-
moved to allow remaining lung tis-
sue to work more effectively may be
considered. ❒
www.HealthLetter.MayoClinic.com 5
Triglycerides
and heart
disease
Healthy diet,
exercise are musts
The results of your blood tests are
in. Your low-density lipoprotein
(LDL), or “bad,” cholesterol levels
look better, but now your doctor
says it’s time to address your high
triglyceride levels.
Triglycerides are a form of fat
that circulates in your blood. In a
standard test measuring blood fats
(lipids), they often play second fid-
dle to LDL cholesterol. But elevat-
ed triglycerides likely increase your
risk of cardiovascular disease, par-
ticularly heart disease. In fact, some
studies suggest that the increase in
heart disease risk from elevated tri-
glycerides may rival that of high LDL
cholesterol. In addition, very high
triglyceride levels put you at risk
of pancreatitis, a painful, life-threat-
ening inflammation of the pancreas.
For most people, elevated tri-
glycerides are caused by three relat-
ed factors — consuming too many
calories, inadequate exercise, and
being overweight or obese. That’s
why, for most, weight loss from
changes in diet and improved exer-
cise habits are the first steps toward
lowering triglyceride levels. If that’s
not enough, medications can help.
What are triglycerides?
Any time you consume calories,
your digestive system makes triglyc-
erides, which are an important source
of energy for your body. Once your
immediate energy needs have been
met, extra triglycerides can be stored
in your body’s fat cells for later use.
Elevated triglyceride levels most
commonly mean you’re consuming
more calories than you burn — par-
6 www.HealthLetter.MayoClinic.com
What’s desirable?
The National Cholesterol
Education Program considers
triglyceride levels below 150
milligrams per deciliter
(mg/dL) to be normal.
However, Mayo Clinic
cardiologists’ recommenda-
tions — shown in the chart
below — tend to take a more
aggressive approach, recom-
mending that for optimal
heart health, people work to
keep triglyceride levels
below 100 mg/dL.
Risk level Triglycerides*
Optimal Below 100
Borderline 100 to 149
High 150 and up
*milligrams per deciliter
ticularly calories from fat, and quick-
ly digested carbohydrates such as
sugars and refined grains. Additional
factors associated with increased
triglyceride levels include:
■ Having certain conditions,
such as elevated blood sugar levels,
type 2 diabetes, hypothyroidism,
kidney or liver disease or certain
genetic disorders
■ Taking certain medications,
such as thiazide diuretics, beta
blockers or hormone therapies
■ Alcohol, which for some peo-
ple can dramatically raise triglyc-
erides independent of other factors.
Lowering levels
If you’re found to have elevated
triglyceride levels, your doctor will
likely look for triglyceride-raising
side effects of any drugs you’re tak-
ing — and test for and treat diseases,
such as type 2 diabetes, that may be
underlying or contributing factors.
Still, most people benefit from
lifestyle modifications including:
■ Moderating your diet —
You’ll likely need to consume fewer
August 2008
calories, but do so in a way that
maintains a healthy, balanced diet.
Focus on consuming a plant-
based diet that emphasizes fruits,
vegetables, beans, legumes, and
whole-grain, minimally processed
breads, pasta, rice and cereals.
Choose items containing healthier
fats, such as olive or canola oil, over
those containing saturated fat and
trans fat. Fish is particularly attrac-
tive as a lean protein source because
the omega-3 fatty acids contained
in many varieties can help reduce
triglyceride levels.
Work to minimize or moderate
sources of fat, sugar and simple car-
bohydrates in your diet. Choose
low-fat items such as skim milk and
small portions of lean meats over
whole milk and processed meats.
Sugary drinks — such as soda pop,
sports drinks and fruit juices — are
major sources of calories, as are sug-
ary or fatty desserts and pastries and
other snacks and foods containing
processed grains. Calorie-laden al-
coholic beverages should be con-
sumed in moderation, if at all. Some
should avoid alcohol altogether if it
appears to be significantly raising
triglyceride levels.
■ Exercising — Moving your
body in a moderately strenuous way
for about 30 minutes a day can sig-
nificantly lower triglyceride levels,
particularly in men.
Drugs that can help
If healthy lifestyle changes don’t
sufficiently lower your triglyceride
levels, adding supplemental niacin
or high-dose fish oil to the treatment
mix is often effective. Drugs in the
statin class — often prescribed to
lower LDL cholesterol — can have
a modest positive impact on triglyc-
eride levels. Drugs known as fibrates
— including fenofibrate (TriCor, oth-
ers) or gemfibrozil (Lopid, others)
— can help lower triglyceride lev-
els, but haven’t been shown to
improve longevity. ❒
Preventing
kyphosis
Reducing your risk Normal
spine Kyphosis
of getting a hunched back
If the human body came equipped
with operating instructions, among
them would be directions to stand
up tall and sit up straight.
Poor posture has a way of catch- Sit forward on a chair, tuck in your chin and
ing up with you. If you add to this relax your shoulders. With elbows bent and arms
the changes that sometimes accom- drawn back, pull your shoulder blades together
as you straighten your upper back. Inhale deeply
pany getting older — in particular
while gently pulling your arms back. While
the changes in your vertebrae that exhaling return to the starting position.
result from thinning bones (osteo-
porosis) — the result may be a for-
ward rounding of the back, known
as kyphosis (ki-FO-sis).

A fracture in time
Your spine is a series of bones
(vertebrae) and springy cartilage
disks between the vertebrae. These
are held in place by tough, fibrous
ligaments and supported by back
muscles. At the top of your spine are
seven neck (cervical) vertebrae fol-
lowed by 12 middle-back (thoracic)
vertebrae and five lower back (lum-
bar) vertebrae. Below that are the
five fused vertebrae of the sacrum
and at the tail end are the three tiny
fused vertebrae that make up the
tailbone (coccyx).
The most common fractures due
to osteoporosis occur in the verte-
brae and hipbones. A compression
fracture occurs when bone is lost
and weakened to the point of col-
lapse within the bone’s structure.
Sometimes, these compression
fractures in the spine are painful,
producing stiffness or tenderness in
the area of the compressed verte-
brae. However, it’s not uncommon
for these fractures to go undetected
until a spinal X-ray is done or they’re
seen when a chest X-ray is done for
a different reason.
In older adults, kyphosis asso-
ciated with osteoporosis is typical-
ly found in the vertebrae of the tho-
racic spine, which is the portion of
the spine that supports your shoul-
ders, arms, chest and trunk. Multiple
compression fractures can produce
a loss of height and a curvature of
the spine, possibly creating the ap-
pearance of a hump on your back.
From the standpoint of posture,
kyphosis creates the appearance of
a forward bend in the back. Wed-
ging from the compression fractures
causes the front of the vertebra to
be shorter than the back, which cre-
ates the curve.
Strengthening the back
Stooped posture due to com-
pression fractures adds to pressure
along the spine, creating the poten-
From a hands-and-knees position,
raise one leg at the hip, keeping your
knee bent and without changing the
position of your trunk. Maintain
this position for five seconds.
Repeat with the other leg.
tial for more compression fractures
to occur. On the flip side, straight
posture reduces excess pressure on
the front portion of the vertebra that
otherwise can lead to wedging and
contribute to kyphosis curvature.
What can you do to help de-
crease your risk of vertebral frac-
tures? In conjunction with an over-
all treatment plan for osteoporosis,
ask your doctor about specific exer-
cises to help strengthen your back
muscles and improve posture.
As a general rule, avoid exer-
cises that round the back, as this
posture combined with activity can
increase pressure on the vertebrae,
especially if you have osteoporosis.
Instead, you can strengthen your
back muscles and minimize bone
stress by doing exercises that gently
straighten the trunk and back. ❒

August 2008 www.HealthLetter.MayoClinic.com 7

Second opinion
Questions and our answers
Q: In terms of nutrition, does it
matter whether I buy canned tuna
that’s packed in oil rather than
packed in water?
A: Yes. In terms of nutrition, it’s
probably better to buy the water-
packed canned fish.
Although some people prefer the
flavor of tuna or other types of fish
that have been canned in oil, oil-
packed fish is significantly higher in
calories and fat — even after you
drain away the oil. That’s because
some of the oil is retained in the fish.
In addition, when fish is canned
in oil, some of the healthy oils con-
tained in the fish — particularly the
omega-3 fatty acids that are bene-
ficial to heart health — leach out of
the fish and into the packing oil.
Draining away the packing oil means
you’re draining with it a portion of
the fish’s omega-3 fatty acids.
In contrast, healthy oils in fish
that has been packed in water won’t
leach out because water and oil
don’t mix.
In the chart below, note the dif-
ferences in 3 ounces of drained,
white tuna depending on whether
it was canned in water or oil:
Water
C al
ories
Fat 109
Om 2.5g
ega-3s
0.8g
Copyright
© 2008 Mayo Foundation for Medical
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8 www.HealthLetter.MayoClinic.com
Q: What is mucus? And why is so
much produced in your nose when
you have a cold?
A: Mucus is a liquid, slippery secre-
tion that cleans and moisturizes
nasal membranes and helps you
fight infection. In addition to water
and various salts, mucus also con-
tains a lubricant (mucin) and white
blood cells.
Normally, mucous membranes
and glands in your nose and sinus-
es are continually producing mucus.
Most of the mucus is used to humid-
ify the air you inhale or it’s swal-
lowed. It also acts as a safety net for
the lungs by catching smoke, for-
eign particles and air pollutants in
the nasal passages. Mucus makes
swallowing easier and protects the
stomach lining from stomach acids.
On a typical day, normal mucus
production can range from 1 to 2
quarts. While that may sound like a
lot, most people aren’t aware of it.
If your body is fighting off a cold
or flu virus or dealing with allergies,
the daily mucus production is
stepped up considerably.
Essentially, the lining of the nose
becomes inflamed. Blood flow is
increased, which leads to conges-
tion, and the mucus glands are stim-
ulated, which leads to increased
mucus production. All of this occurs
to help clear the virus or allergens
from your nasal passages. ❒
Oil
158
Clarification
6.9g
0.4g
Second Opinion in the April issue
of Mayo Clinic Health Letter incor-
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rectly stated that plastic containers
marked with a 1 are made with or-
thophthalates. Orthophthalates have
raised health concerns over the pos-
sibility of harmful chemicals leach-
ing out of products in which they’re
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