Mayo Clinic Health Letter discusses kidney stone treatment options

Sep 17 2009

Here are highlights from the September issue of Mayo Clinic Health Letter. You may cite this publication as often as you wish. Reprinting is allowed for a fee. Mayo Clinic Health Letter attribution is required. Include the following subscription information as your editorial policies permit:

Ways to Quiet Ordinary Snoring

Ordinary, loud snoring doesn't seem to be harmful, according to the September issue of Mayo Clinic Health Letter. But snorers still may want to seek treatment to stop snoring, reduce embarrassment and improve sleep for themselves and their bed partner.

Snoring is caused by relaxed and sagging tissues. As sleep deepens, the tongue relaxes, as do the soft tissues of the throat and the roof of the mouth (soft palate). The tissues can sag into the airway, causing it to narrow. As air is inhaled or exhaled through the narrowed opening, the relaxed tissues of the soft palate vibrate. The result is snoring. Though most snoring is harmless, snorers should consult a doctor to rule out sleep apnea, a serious health concern where breathing stops during sleep.

For ordinary snoring, a doctor will likely discuss conservative treatment options first. Assistive devices or, as a last resort, surgery, can help reduce snoring. Mayo Clinic Health Letter covers these treatment approaches:

Lose weight: Extra bulk narrows airways, contributing to snoring.

Avoid alcohol: Alcohol consumption can cause excessive muscle relaxation. Avoiding alcohol for at least four hours before bedtime may help.

Relieve nasal obstruction: Adhesive nasal strips (Breathe Right, others) or corticosteroid nasal sprays can help reduce nasal obstruction that can contribute to snoring.

Change sleep positions: In back sleepers, the tongue can sag and narrow the airway during sleep. A doctor can suggest techniques to learn to sleep comfortably in other positions.

Stop smoking: Smoking is associated with an increased risk of snoring. People who stop have a lower rate of snoring.

Try assistive devices: The most effective treatment for snoring is a continuous positive airway pressure (CPAP) machine. It delivers pressurized air through a mask, keeping the upper airway open during sleep. Some people have difficulty wearing a mask at night. An oral appliance from a specially trained dentist or orthodontist can help keep the throat open, too, and may be less obtrusive than a CPAP machine.

Consider surgery: Several surgical procedures can help reduce snoring, either by cutting away excess mouth and throat tissue or by stiffening tissues of the soft palate to prevent vibration and sagging. Surgery is considered a last resort because it can cause side effects and complications. Typically, there's only a 50 percent chance that snoring will improve over the long term.

Let's Not Repeat That Pain: Tips to Reduce Risk of Kidney Stones

Passing kidney stones can be an extremely painful process that no one wants to repeat. But patients who have experienced kidney stones have a 50 percent chance of recurrence within 10 years. The September issue of Mayo Clinic Health Letter covers how kidney stones are formed, treatment options and ways to reduce the risk of a repeat.

Kidney stones are made up of crystal-forming minerals in the urine. Normal urine contains substances that inhibit crystal formation. However, if urine is too concentrated or if the crystal-preventing compounds aren't working properly, crystals may gradually accumulate and grow to form one or more kidney stones.

Most kidney stones pass naturally through the ureters (tubes that connect the kidney to the bladder), through the bladder and then out in the urine. Passing a kidney stone may take hours or weeks. Most often, the process takes seven to 14 days. Small stones may not be a big bother. Larger ones can cause extreme pain, typically on the side and the back, just below the rib cage and radiating to the lower abdomen and groin. There are a variety of treatment options, from pain management to surgical removal of the stone.

Once the stone has passed, the focus switches to prevention. Prevention strategies depend somewhat on the composition of kidney stones. About 70 percent are formed primarily of calcium oxalate. Others are formed mainly from calcium phosphate, uric acid or struvite stones. Recommendations for prevention of kidney stones in most people may include:

Drink enough fluid: Drinking at least 12 cups of fluid -- preferably water -- a day is the most basic way to prevent kidney stones. The fluid dilutes the urine and decreases the risk of crystal formation.

Limit meat intake: Consuming more than 6 to 8 ounces of meat daily can increase calcium and uric acid in the urine, increasing the acidity of urine and reducing the chemicals that inhibit crystal formation.

Get adequate calcium: Meeting daily calcium intake recommendations based on age reduces the risk of kidney stone development, probably because calcium binds to oxalate in the gut, reducing oxalate levels in the urine.

Avoid excess vitamin D: Often consumed with calcium to help absorption, vitamin D may raise the risk of developing calcium-based stones. Vitamin D has many health benefits, but for those at risk of kidney stones, limiting vitamin D consumption to age-specific recommended daily limits may be advised.

Consider food choices: Limiting intake of oxalate-containing foods -- such as spinach, beets, chocolate, peanuts, potatoes and many other foods -- is an important preventive strategy for those with calcium oxalate stones who also have conditions that affect the small bowel, such as Crohn's disease. For those who don't have digestive conditions or high urine oxalate levels, the benefits of diet changes are unclear. Because the diet is very difficult to follow, Mayo Clinic experts don't emphasize this strategy.

Vitamin D: Many Benefits; Optimal Dose Uncertain

Vitamin D appears to boost health from head to toe, according to the September issue of Mayo Clinic Health Letter. But, so far, there's no consensus on what level of vitamin D is optimal for good health.

Recent reports on vitamin D suggest that it offers many benefits, especially for older adults. Findings point to improved balance, reduction in the risk of bone fractures, and better thinking skills such as planning, organizing and abstract thinking. Low levels of vitamin D are associated with diabetes, cardiovascular disease, multiple sclerosis and other autoimmune disorders, infections such as tuberculosis, and periodontal disease. Low vitamin D levels also may affect certain cancers, including colon, breast and prostate cancers.

Vitamin D is the only vitamin that the body can manufacture itself. The only requirement is sunshine, specifically ultraviolet B rays. About 10 to 15 minutes of exposure two to three times a week during nonpeak sun hours is considered adequate. But the sunshine approach doesn't work for everyone. With age, the body is less efficient at processing vitamin D. Other barriers are darker skin and living in northern climates. Using sunscreen -- still recommended to prevent skin cancer -- also reduces absorption of ultraviolet B rays.

Food sources are usually an excellent way to obtain vitamins, but choices are limited for vitamin D. Rich sources are fatty fish, fish-liver oils, liver and egg yolks. Milk fortified with vitamin D is another option.

With limited food choices, consumers may opt to rely on vitamin D supplements. The current daily recommended dose of vitamin D for adults 50 and older is 400 to 600 international units (IU). But many researchers believe that a higher amount is warranted because of the many health benefits. The National Osteoporosis Foundation recommends a daily intake of 800 to 1,000 IU per day for adults over age 50. The upper daily limit considered safe for use is 2,000 IU per day, but there's debate about this level. Very large doses of vitamin D taken over time can cause ill effects, including nausea, vomiting, poor appetite, constipation, weakness and weight loss.

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