Here are highlights from the April issue of Mayo Clinic Health Letter:
How the placebo effect enhances healing
Researchers are working to better understand the placebo effect, how it works and how it can be harnessed to improve therapies. The April issue of Mayo Clinic Health Letter covers what's known about this phenomenon and how it may work to improve health.
The placebo effect is most evident in medical research. It's a person's belief that an inactive treatment is working just as well as the presumed active therapy being studied. Well-intentioned medical advances, when compared to the placebo treatment, sometimes derive most of their benefit from positive expectations rather than the therapy itself.
The placebo effect isn't limited to research and doesn't have to involve false therapy. It's likely to occur to some degree just about any time a patient seeks healing in a setting that creates the expectation of improvement. And it's not separate from — or in conflict with — true active therapies that have proved to work. In many cases, effective drugs, injections and surgeries can attribute a major portion of the effects to healing that occurs over time, as well as the placebo effect.
The placebo effect can vary from having zero to a 100 percent effect, even in the same condition. Variation can be caused by preset beliefs or expectations, the words or tone used by the doctor and the body's biological mechanisms, such as those that impact pain, the immune system and chemicals produced by the body in response to stress.
Optimal therapy isn't about avoiding the placebo effect, it's about using it to add to healing. Researchers don't fully understand how people in need of healing can harness the placebo effect to help themselves. Several factors appear to be important, including:
Believing health will improve: Patients who maintain optimism improve their situation by matching their belief with actions. They follow through on therapy recommendations, focus on healthy eating, stay physically active, maintain social connections and take time for relaxation and stress reduction.
Healthy relationships: Having trust and confidence in a physician supports healing, as do healthy relationships with friends and family members.
Alternative therapies: Adding alternative therapies - acupuncture, massage, spinal manipulation, meditation or hypnosis — may play a role in the placebo effect.
As doctors learn more about the placebo effect, more deliberate attempts at harnessing its power in open ways are expected to emerge.
Dizziness often can be managed with help from a physician
Recurrent dizzy spells shouldn't be dismissed, according to the April issue of Mayo Clinic Health Letter. Any recurrent, sudden, severe attacks or prolonged episodes of dizziness, faintness, light-headedness or vertigo can signal underlying disorders and warrant a visit to the doctor.
Aging increases the risk of certain conditions that cause dizziness and a sense of imbalance. Symptoms can have more than one cause. Often, the underlying conditions aren't life-threatening and can be managed with help from a physician.
Maintaining balance requires that the brain, eyes, sensory nerves and inner ear are all working as a finely tuned system to gather and process information about how the body moves relative to the surroundings. Balance also depends on the heart beating consistently and effectively, as well as the blood vessels maintaining constant pressure and circulating an adequate volume of blood throughout the body.
Other possible contributions to being out of balance include muscle weakening, nerve damage in the arms and legs, anxiety disorders, migraines, central nervous system disorders such as multiple sclerosis, and certain medications. Especially in older adults, antidepressants, anti-seizure drugs and medications to control high blood pressure can cause dizziness.
Identifying what's contributing to dizziness is often a process of elimination. The physician will suggest a series of tests to determine if the symptoms stem from inner ear problems and other health concerns that can be treated or managed differently.
Although uncommon, dizziness can signal a serious health condition. A person should seek emergency care when dizziness occurs with:
• A new, different or severe headache
• Blurred or double vision
• Hearing loss
• Impaired speech
• Leg or arm weakness
• Loss of consciousness
• Falling or difficulty walking
• Numbness or tingling
• Chest pain or rapid or slow heartbeat
Any of these signs or symptoms could signal a serious problem such as a stroke, brain tumor or heart disease.
A pouch in the throat can cause swallowing difficulties
Swallowing that becomes progressively more difficult could be a sign of Zenker's diverticulum, a pouch that develops in the back of the throat.
The April issue of Mayo Clinic Health Letter covers this problem, which is fairly rare in the general population but occurs most often in men older than 70.
Doctors believe that Zenker's diverticulum starts to develop when the swallowing reflex becomes uncoordinated due to the inability of certain muscles to fully open at the appropriate times. This can occur because of various age-related changes. Difficulty swallowing increases pressure on the esophagus, causing it to gradually balloon out at a weak point and form a pouch.
Over months or years, the pouch grows, trapping food particles, mucus and even pills. As it fills, symptoms can include continued swallowing difficulties, throat irritation, bad breath or a gurgling noise at the back of the throat. When the pouch becomes large enough, its contents may spill into the throat after a person eats, causing coughing or spitting up food. Pouch contents can be inhaled into the lungs. In extreme cases, swallowing and eating become very difficult, causing weight loss and malnutrition.
Surgery is recommended when symptoms become troublesome. Most often, surgery can be done endoscopically, with instruments inserted through the throat.
To correct the problem, the surgeon opens the pouch to the inside of the throat and turns the diverticulum into part of the esophagus. Surgery can improve symptoms for about 90 percent of patients. For those whose condition does not improve, a second procedure can be done to further open up the diverticulum.
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