Mayo Clinic Health Matters

Drug shortages continue to be a major health care issue in the U.S., with more than 200 ongoing and active shortages per year since 2018. "Drug shortages are not new to health care," explains Dr. Mary Gilmer, director of pharmaceutical supply and procurement for Mayo locations across the Midwest. "But, really, over the last two years with the COVID-19 pandemic, the shortages have really exposed the vulnerability of our global drug supply chain. And these drug shortages remain high, despite decades of continued and increased awareness, effort and significant resource investment in these drug shortage programs at the highest level." At Mayo Clinic, the Pharmacy and Theruapuetics Committee has strategies and an organized approach to managing each drug shortage that's encountered."We engage our staff right down to the front-line team members when we're experiencing a shortage," says Dr. Gilmer. "When we place an order for a medication, and we do not receive sufficient quantities of what we're needing to take care of our patients, that's when we start escalating it, and really coordinating around how we understand and identify shortages so that we can best proactively manage them. So that's getting everybody on board for awareness, and any changes in our electronic health system that we need — or engaging our formulary colleagues to understand what alternatives or substitutes we can use." In addition to work done internally, Mayo Clinic also has taken a leadership role in combating drug shortages across the U.S., including joining the End Drug Shortages Alliance. The coalition is a collaboration of health system, supply chain and industry partners seeking to prevent drug shortages by solving pharmaceutical supply challenges and increasing transparency.Mayo was also a founding member of Civica Rx, a nonprofit generic drug company whose goal is to reduce shortages of essential medications that hospitals use. Civica Rx recently announced plans to manufacture and distribute affordable insulin. "We often talk about mitigating the impact of a drug shortage, but our goal is really to get further upstream and actually end them and stop them from happening,"says Dr. Eric Tichy, chair of the Division of Pharmacy Supply Solutions at Mayo Clinic. "So we do a lot of advocacy with the government and different regulatory agencies. And anytime someone says they want to help end or manage drug shortages, we're always interested in what that opportunity is."On the Mayo Clinic Q&A podcast, Drs. Gilmer and Tichy discuss Mayo Clinic's work to combat drug shortages. Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

The menstrual cycles for adolescents vary significantly, including the age at which the first period begins. Frequency, length of period, and amount of bleeding also vary widely."The factors that define when you're going to get your first period really is when did mom get her first period, so genetic factors, but there are a lot of lifestyle factors, too" says Dr. Asma Chattha, chair of Pediatric Gynecology at Mayo Clinic. "Definitely weight gain and rate of weight gain plays into it as well. New research is suggesting socio-economic factors and adverse childhood experiences also affect when you get your first period. So that's probably why there's such a variation and when you'll first get your period."Menorrhagia is the medical term for menstrual periods with abnormally heavy or prolonged bleeding. Although heavy menstrual bleeding is a common concern, most women don't experience blood loss severe enough to be defined as menorrhagia.While what's considered normal covers a wide range, heavy bleeding during menstrual cycles can be a concern. In these cases, teens and their parents should reach out to their health care team for an evaluation."From a hematology standpoint, we always worry that there's some kind of predilection to bleeding," explains Dr. Asmaa Ferdjallah, a Mayo Clinic pediatric hematologist. "And there's a few inherited bleeding disorders that are not that uncommon in the population, honestly. And sometimes their only presentation is heavy periods. At times, many of these girls and young women go their whole life, and they just don't know that they have these deficiencies, or bleeding propensities, and those are fairly easy to screen for."Another common issue is menstrual cramps. Menstrual cramps, or dysmenorrhea, are throbbing or cramping pains in the lower abdomen. Many girls and women have menstrual cramps just before and during their menstrual periods.For some, the discomfort is merely annoying. For others, they can be severe enough to interfere with everyday activities for a few days every month. Menstrual cramps that aren't caused by another condition tend to lessen with age and often improve after giving birth.There are hormonal and non-hormonal treatment options and products to help girls and young women cope with heavy periods."I know it's hard to talk about these things, but talk to your health care team with any question you have about heavy periods," says Dr. Ferdjallah. "Ask all your questions. None of them are dumb, and we will do our best to help you. More often than not, we can find you a solution to make your periods better." On the Mayo Clinic Q&A podcast, Ask the Mayo Mom host Dr. Angela Mattke, a Mayo Clinic pediatrician, is joined by Mayo Clinic Children’s Center experts Drs. Chattha and Ferdjallah to discuss misconceptions about, and treatment options for, heavy menstrual cycles.More resources:Dads, daughters and talking about menstruation — advice from an expert. Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

When cancer spreads from its original location to other parts of the body, it has metastasized. Central nervous system metastases occur when cancer cells spread from their original site to the brain and spinal cord. Any cancer can spread to the central nervous system, but the types most likely to cause such metastases are lung, breast, colon and kidney cancers, and melanoma.Treatment for brain and spinal cord metastases can help ease symptoms, slow tumor growth and extend life. To determine which treatment might work best for a person's tumor type, some health care professionals now use liquid biopsies. When a metastatic tumor is in a place in the body that cannot be reached through surgery for a tissue biopsy, liquid biopsies are especially helpful.A liquid biopsy involves collecting fluid and analyzing it for tumor biomarkers that can help health care professionals determine the tumor's molecular structure and individualize treatment for the best outcome. "So we have excellent drugs for different cancer types that are really based off of your specific cancer," explains Dr. Wendy Sherman, a Mayo Clinic neurologist. "So, not just your lung cancer, but does your lung cancer have a specific mutation? And there are drugs that match up to the mutation that have been very effective."Dr. Sherman explains that halfof the time when a cancer travels to a different part of the body, particularly to the brain, the cancer may change and lose its mutation. "So, if you treat someone based off of the information that you had a couple years ago from where the cancer started, that may not reflect the current state of your cancer and what it looks like," says Dr. Sherman. And, so, our treatment really depends on that. And with a lot of these new-generation treatments that are going after these mutations, it has been very beneficial to look for those in the spinal fluid. And it absolutely has improved how people deal with this from a symptom standpoint because we're often able to give them often drugs that are better tolerated because they're more targeted."Research is underway to further expand the use of liquid biopsies."We want to learn more about the use of liquid biopsy, particularly as it pertains to spinal fluid for not just brain metastases but also for cancers that start in the brain," explains Dr. Sherman. "And then also, can we use other fluids in the body? Those samples — urine and blood — are being collected and tested so that hopefully we can make progress toward that use."On this Mayo Clinic Q&A podcast, Dr. Sherman discusses the use of liquid biopsy in caring for people with breast, lung and gastric cancer that has spread to the brain and spinal cord. Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

The BA.5 omicron variant is now the dominant strain in the U.S., and it is leading to a new wave of COVID-19 infections. BA.5 was responsible for nearly 54% of COVID-19 cases in the U.S., and BA.4, a similar variant, accounted for another 17%, according to the latest data from the Centers for Disease Control and Prevention. Experts are concerned because this particular variant appears to be good at evading the immune system. "This BA.5 variant is hypercontagious, and right behind it, new variants are coming," says Dr. Gregory Poland, an infectious diseases expert and head of Mayo Clinic's Vaccine Research Group. "We will continue to generate these variants until people are masked and immunized." Dr. Poland explains that the transmissibility of BA.5 represents the evolution of the virus to become more contagious and able to evade immune protection from previous infection or vaccination. "Whether you've been vaccinated, whether you've been previously infected, whether you've been previously infected and vaccinated, you have very little protection against BA.5 in terms of getting infected or having mild to moderate infection," says Dr. Poland. "Thankfully, you still do have good protection against dying, being hospitalized or ending up on a ventilator if you are up to date on your vaccinations." Due to the consequences of reinfection, including the possibility of long COVID-19, Dr. Poland urges people to continue to take precautions to protect themselves."The reality is, it's important to be up to date on the COVID-19 vaccinations that are recommended for your age group, health condition, etc.," says Dr. Poland. "Sometime this fall, we may well have a variant-focused vaccine, so get it when it becomes available. And wear a proper mask properly when you are indoors around people who are not your family or in a crowded outdoor venue."On the Mayo Clinic Q&A podcast, Dr. Poland shares the latest COVID-19 news and answers listener questions. Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

An estimated 2.8 million people worldwide are affected by multiple sclerosis (MS), a potentially disabling disease of the brain and spinal cord. In this disease, the immune system attacks the protective covering around the nerve fibers."Multiple sclerosis — the term means multiple scars — is a disease that leads to damage of the central nervous system, which is the brain, the spinal cord and the optic nerve," explains Dr. Eoin Flanagan, a Mayo Clinic neurologist. Signs and symptoms of MS vary widely. Some people with severe MS may lose the ability to walk independently or at all, while others may experience long periods of remission without any new symptoms. Most people with MS have a relapsing-remitting disease course. They experience periods of new symptoms or relapses that develop over days or weeks and usually improve partially or completely. These relapses are followed by quiet periods of disease remission that can last months or even years.While there is no cure, treatments can help modify the course of the disease and manage symptoms."In the last five to 10 years, we really have strong medications that can keep MS very quiet," says Dr. Flanagan. "We're hopeful that will prevent a lot of the long-term damage that patients used to get in the past where after many years of having an MS diagnosis they may struggle with walking or have additional disability that would develop from those scars. And I think with these new medications we're going to be able to stop MS in its tracks. So it's a really hopeful time for all of our patients with MS."In addition to medications to manage MS, Dr. Flanagan notes that patients with MS can be monitored in new ways. New technologies include a digital floor mat to monitor a patient's waking, an optical scan that can measure microscopic nerve damage, and a blood test to measure inflammation levels and response to treatments."We really are trying to embrace technology here at the Mayo Clinic," says Dr. Flanagan. "We're using these new technologies to both learn more about MS and see how we can better help our patients because, at the end of the day, the needs of the patient come first."On the Mayo Clinic Q&A podcast, Dr. Flanagan discusses advances in the management of MS. Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

The amount of physical activity children need depends on their age. According to the Centers for Disease Control and Prevention, children ages 3 through 5 years need to be active throughout the day while children and adolescents ages 6 through 17 need to be active for 60 minutes every day.Many common school-age activities — such as playing on playground equipment and jumping rope — help kids get the recommended amout of exercise. Organized sports are a great way to stay fit, too, but team sports aren't the only options. Nature hikes, walking, biking or even dancing to their favorite music can get kids moving. Including physical activity in a child's daily routine sets the foundation for a lifetime of fitness and good health. And beyond the physical benefits, there are cognitive benefits as well."The literature really speaks to the benefit on cognition from cardiovascular exercise," says Dr. Tanya Brown, a Mayo Clinic neuropsychologist. "So we can see a positive benefit on how a child's emotionally feeling as well as cognitively functioning. The brain is developing throughout childhood, so it is really primed to be improved." Children who get regular exercise have lower levels of depression and stress and higher levels of positive self-image, according to the American Psychological Association. Exercise also is linked to better thinking skills, which leads to improved behavior, attention and academic performance.Even a short burst of exercise can help."To get the cognitive benefits of exercise, it's important to get the heart rate up," says Brandi Brian, a physical therapist at Mayo Clinic and certified neurologic clinical specialist. "Getting the heart rate up for as little as four minutes will have short-term benefits that can kind of help in the moment. Then longer term, improving physical fitness through aerobic activity will have longer-term implications on cognition."On the Mayo Clinic Q&A podcast, Dr. Brown and Brian join pediatrician and host Dr. Angela Mattke for a discussion focused on the cognitive benefits of exercise for children. Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

COVID-19 vaccine recommendations in the U.S. have been expanded to include children ages 6 months to 5 years. The new vaccine recommendations mean children in the under-5 age group can receive a three-dose primary series of the Pfizer vaccine or a two-dose primary series of the Moderna vaccine."This age group is one that can't wear a mask or anything else reliably," explains Dr. Nipunie Rajapakse, a Mayo Clinic pediatric infectious diseases specialist. "And so this is one of the really important layers of protection for them. Vaccinations will help protect the child, the family and the community." Dr. Paige Partain, a Mayo Clinic pediatrician, says while parents may wonder if getting their young children vaccinated against COVID-19 is necessary, it is important to recognize the benefits. "When I look at our primary goal, which is keeping kids out of the hospital, keeping them from dying from COVID, we know that vaccines do that very well," explains Dr. Partain. "And we don't have a good way to predict whether your child might be in that small percentage that gets really sick from COVID, so we want to make sure that we give them the best protection. Even for folks that have already had COVID, because the natural immunity that we get from these infections doesn't last as long as we would like. So when we can combine that immunity with the immunity from a vaccine, what we're really doing is giving kids the best protection and the best chance to do well if they do get COVID." Dr. Partian says the benefits of vaccinating kids younger than 5 goes beyond preventing severe disease and hospitalizations."Having our kids vaccinated decreases the chances that they might pass COVID along to someone else, maybe more vulnerable adults that they spend time around or other children under 6 months who aren't old enough to get their vaccine yet."On the Mayo Clinic Q&A podcast, Dr. Rajapakse and Dr. Partain from the Mayo Clinic Children’s Center join pediatrician and host Dr. Angela Mattke for a discussion on COVID-19 vaccinations for children ages 6 months to 5 years. Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Sarcoma is the general term for a broad group of cancers that begin in the bones and soft tissues of the body, including muscle, fat, blood vessels, nerves, tendons and the lining of your joints. There are more than 70 types of sarcoma. Bone cancer is a rare disease, accounting for just 0.2% of all cancers. An estimated 3,910 new cases of sarcoma of the bones and joints will be diagnosed in 2022, according to the National Cancer Institute. Some types of bone cancer occur primarily in children, while others affect mostly adults. "When we think of sarcomas of the bone, the common types are chondrosarcoma, Ewing sarcoma, and osteosarcoma," says Dr. Safia Ahmed, a radiation oncologist at Mayo Clinic. "While sarcoma can happen in any bone in the body, the most common sites include the pelvis, the spine, and the skull base for most of these tumors."Treatment for sarcoma varies depending on sarcoma type, location and other factors. Treatments can include surgery, chemotherapy and radiation therapy. Proton beam therapy is a type of radiation therapy that is more precise than traditional X-ray treatment, which delivers radiation to everything in its path. Proton beam therapy uses positively charged particles in an atom — protons — that release their energy within the tumor. Because proton beams can be much more finely controlled, specialists can use proton beam therapy to safely deliver higher doses of radiation to tumors. This is particularly important for bone cancers."When we treat these tumors in the bone with radiation, they need much higher doses of radiation than, say a sarcoma that arises purely in the muscle, what we call a soft tissue sarcoma," explains Dr. Ahmed. "And these high doses of radiation often exceed what the normal tissues around the area can tolerate. So proton therapy allows us to give this high dose of radiation while protecting the normal tissues."July is Sarcoma Awareness Month. On this Mayo Clinic Q&A podcast, Dr. Ahmed discusses sarcoma diagnoses and treatment options, including proton beam therapy. Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Diabetes is a chronic condition that impairs the body's ability to regulate blood sugar due to inadequate insulin production. Producing insulin is a function of the pancreas — a long, flat gland that sits behind the stomach in the upper abdomen. People with diabetes can experience significant complications from the disease, including heart disease, chronic kidney disease, nerve damage and vision loss. While advances have been made in diabetes treatments, many people with diabetes struggle with the disease."Diabetes is an abnormality in consuming or metabolizing blood glucose," says Dr. Tambi Jarmi, a Mayo Clinic nephrologist. "So diabetic patients have a hard time adjusting their blood sugar to the level that their cells needed. It could be a result of a deficiency in the production of the insulin that comes from the pancreas or it could be a result of resistance to that insulin."To restore normal insulin production and improve blood sugar control, a pancreas transplant may be an option.Most pancreas transplants are performed to treat Type 1 diabetes. A pancreas transplant can potentially cure this condition. But such a transplant is typically reserved for those with serious complications of diabetes because side effects can be significant.In some cases, a pancreas transplant also can treat Type 2 diabetes. A pancreas transplant is often performed in conjunction with a kidney transplant in people whose kidneys have been damaged by diabetes."The idea of a pancreas transplant is to actually cure the diabetes," says Dr. Jarmi. "While treatment with a mechanical pump does a great job, it is not a cure. An organic pump, meaning a pancreas transplant, does cure diabetes." Pancreas transplants are sourced from a deceased donor, and the organ to be transplanted must match the blood type of the recipient. With the replaced function of the pancreas and natural ability to produce insulin, Dr. Jarmi says patients no longer are diabetic.On the Mayo Clinic Q&A podcast, Dr. Jarmi discusses pancreas transplant as a cure for diabetes. Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Regenerative medicine is an emerging field that looks to repair, replace or restore diseased cells, tissues or organs. One specialty that's a natural fit for regenerative medicine is dermatology. That's because the skin is the largest organ that regenerates in the body. "Regenerative medicine is the idea that we can reestablish form and function," says Dr. Saranya Wyles, a Mayo Clinic dermatologist. "So when we are born, we have that baby skin. And as we age, that sort of shifts and changes over time. So how do we utilize regenerative technologies to get that skin to go back to regenerating or restoring that form and function?" Mayo Clinic's Center for Regenerative Medicine is leading efforts to integrate new regenerative biotherapeutics into clinical care. Dr. Wyles explains the regenerative medicine "toolkit" includes stem cells and platelet-rich plasma, and the latest tool: exosomes."I think it's these new technologies within regenerative medicine that we are going to look to directly be playing against that root cause of aging," explains Dr. Wyles.Products to repair aging skin are in demand, but Dr. Wyles cautions people to make sure there is science-based evidence and not just hype. The focus of Dr. Wyles' lab is to provide a validated scientific approach to conditions such as wrinkles, age spots and thinning skin. Her studies examine the role of cellular senescence as a biomarker of skin aging."I think that this is a very exciting time, and we're seeing a convergence of longevity and aging science and regenerative medicine," says Dr. Wyles. "I would just advise you to really ask about the research that's being done and really know the science — and then decide on a product that would be best fitting for you." On the Mayo Clinic Q&A podcast, Dr. Wyles discusses regenerating damaged skin. Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy