Thursday, September 20, 2018
Health

Mayo Clinic Q&A: gangrene causes and prevention; irregular bleeding

PEOPLE WITH DIABETES, PERIPHERAL ARTERY DISEASE AT INCREASED RISK OF GANGRENE

I have heard that a stubbed toe can lead to gangrene in some individuals. Is that true? What are the signs of gangrene, and how can it be avoided?

Gangrene, which refers to tissue death caused by a severe shortage of blood supply or serious bacterial infection, occurs in lower extremities. It is more common in the toes than other parts of the body. Gangrene tends to happen more often among people with peripheral artery disease, a common circulatory problem in which narrowed arteries reduce blood flow to the limbs. People with diabetes and peripheral artery disease are especially vulnerable to complications such as gangrene, because, in addition to poor blood circulation, they often have decreased sensation in their feet due to nerve damage. If an injured toe goes unnoticed and blood supply is inadequate to help heal the wound, tissue death may occur.

Gangrenous tissue typically becomes discolored, ranging from pale purple to black. The skin may become dry, hard and shriveled, with a clear line separating the dead tissue from healthy tissue. If an infection is present, the area may look swollen or form blisters filled with fluid on the skin. There’s often a foul-smelling odor.

These signs and symptoms require immediate care, as they quickly can lead to loss of limbs and death — at times quickly — due to sepsis. Treatment may involve taking antibiotics for infection, re-establishing blood flow to the area and removing the dead tissue.

See your health care provider if you have leg pain or numbness, sores that won’t heal on your feet or legs, or changes in the color of the skin around your legs or feet. Peripheral artery disease, which often accompanies diabetes and coronary artery disease, is strongly associated with smoking.

If you have diabetes, maintain careful control of your blood glucose level and take good care of your feet. Always wear protective footwear that properly accommodates your feet. Do a daily check for redness, calluses and wounds. If you find any of these problems, treat your feet promptly and adjust your activity. If you’re a smoker, stop. Regular exercise and a healthy diet can keep peripheral artery disease, diabetes and heart disease in check, thus minimizing your risk.

Karen L. Andrews, M.D., Director, Vascular Ulcer/Wound Healing Clinic, Mayo Clinic, Rochester, Minn. (Adapted from Mayo Clinic Health Letter)

BLEEDING SHOULD BE CHECKED OUT BY DOCTOR

I am 52 and had recently gone 10 months without a period. I assumed I was postmenopausal. But, over the past few months, I’ve had light spotting. Does this mean I’m not past menopause? Do I need to see my doctor?

It’s possible you haven’t reached menopause yet. Clinically, menopause is defined as going without a period for one year. At 10 months, you don’t quite meet that threshold. But it’s also possible that you are postmenopausal, and the bleeding is a result of something else. It would be a good idea to make an appointment to see your health care provider and check your condition.

Menopause is the natural process that marks the end of a woman’s reproductive years when menstrual cycles stop. It typically happens in the 40s or 50s, with the average age of menopause in the United States at 51.

Skipping periods as you approach menopause, a stage sometimes called perimenopause, is common and expected. During that time, menstrual periods often skip a month and return, or skip several months and start monthly cycles again for a few months. Periods also tend to happen on shorter cycles, so they may be closer together than is typical for you.

Ten months between periods is longer than usual in the perimenopause stage. But it is possible, and the spotting you’ve noticed may not signal anything other than the fact that your body isn’t to menopause at this point. However, if you have gone through menopause, then the bleeding could be cause for concern.

Bleeding after menopause is not normal, and it must be evaluated. Postmenopausal bleeding can have various causes.

One of the most serious underlying conditions that could lead to this type of bleeding is cancer. For example, cancer that begins in the uterus, called endometrial cancer, often triggers abnormal vaginal bleeding. For many women with this form of cancer, bleeding is their only symptom. That’s why it is so important to have postmenopausal bleeding evaluated as soon as possible.

If your health care provider suspects endometrial cancer, she or he may recommend removing a sample of tissue from your uterine lining with a procedure called endometrial biopsy. The tissue that’s removed then is examined in a laboratory for signs of cancer. An endometrial biopsy may be performed in your health care provider’s office, and it usually doesn’t require anesthesia.

Less common kinds of cancer that also could cause abnormal bleeding are cancer of the cervix or vagina, as well as uterine sarcoma. Other underlying medical concerns that may lead to vaginal bleeding after menopause include conditions that thin the tissue that lines the uterus or the vagina, called endometrial atrophy and vaginal atrophy. In some cases, uterine fibroids or polyps may trigger bleeding, too.

The bleeding also could be the result of a condition known as endometrial hyperplasia, in which there is a precancerous overgrowth of cells that make up the uterine lining. An infection, injury or other pelvic trauma, as well as certain medications, also have been known to cause postmenopausal bleeding.

Despite this list of disconcerting possibilities, please know, too, that the bleeding you are experiencing may be harmless. At this time, you should see your health care provider to find out what’s going on.

Jamie Bakkum-Gamez, M.D., OB-GYN, Mayo Clinic, Rochester, Minn.

Mayo Clinic Q & A is an educational resource and doesn’t replace regular medical care. Email a question to [email protected] For more information, visit mayoclinic.org. © 2017 Mayo Foundation for Medical Education and Research. Distributed by Tribune Content Agency, LLC. All rights reserved.

Comments
All Children’s unveils a $95 million research center. Next step: ‘Cure some diseases.’

All Children’s unveils a $95 million research center. Next step: ‘Cure some diseases.’

ST. PETERSBURG — "Vicky Hopkins" is 37 weeks pregnant and splayed on a bed at Johns Hopkin’s All Children’s Hospital. Four obstetricians surround her as she groans."My back is killing me," she complains, but she keeps pushing. Soon the round shape of...
Updated: 7 hours ago
I was hospitalized for my eating disorder. Here's what Netflix shows get right and wrong about it.

I was hospitalized for my eating disorder. Here's what Netflix shows get right and wrong about it.

It took me a year and a half to watch Netflix’s To the Bone. The movie, which debuted in January 2017, portrays Ellen, a 20-year-old woman battling anorexia nervosa, and her experience being in and out of various treatment programs. When it w...
Updated: 12 hours ago
Watchdog slams safeguards for foster kids on psych drugs

Watchdog slams safeguards for foster kids on psych drugs

WASHINGTON — Thousands of foster children may be getting powerful psychiatric drugs prescribed to them without basic safeguards, says a federal watchdog agency that found a failure to care for youngsters whose lives have already been disrupted...
Published: 09/17/18
Doctors dismissed her, but she turned out to be right after years of needless suffering

Doctors dismissed her, but she turned out to be right after years of needless suffering

The prominent New York City gynecologist didn’t bother to conceal his disdain."Stop practicing Google medicine," Lina Kharnak remembers the doctor chiding her when she asked about a possible cause of her worsening leg and back pain. The disease about...
Published: 09/16/18
Updated: 09/17/18
Tampa General Hospital’s East Pavilion advised not to use running water after water main break

Tampa General Hospital’s East Pavilion advised not to use running water after water main break

Since Saturday morning, patients and staff in Tampa General Hospital’s East Pavilion and Rehabilitation Center have been advised against using running water.As of Sunday afternoon, it was not known when the recommended ban would be lifted.According t...
Published: 09/16/18
Anger management: Learn healthy ways to handle it, and unlearn bad behavior

Anger management: Learn healthy ways to handle it, and unlearn bad behavior

What makes you mad? Dropping your new phone in the toilet — after deciding not to take the extra coverage that would have replaced it? Being cut off in traffic? Having a parking place "stolen" from you? Doing dishes after shopping for and cooki...
Published: 09/14/18
Red Tide outbreak can be particularly bad for people with asthma or allergies

Red Tide outbreak can be particularly bad for people with asthma or allergies

The toxic algae bloom known as Red Tide has left a trail of dead fish in its wake up the western coast of Florida. The bloom that had been wreaking havoc on our southern neighbors has now made its way to the Tampa Bay area. High concentrations of the...
Published: 09/14/18
In Florida and everywhere, a big shift is underway. It’s changing the way we go to the doctor.

In Florida and everywhere, a big shift is underway. It’s changing the way we go to the doctor.

The health care business in Florida and across the nation is the midst of monumental change as insurers, hospital chains and even retailers begin to venture outside their traditional roles. Hospitals are getting into the insurance end of the busines...
Published: 09/17/18
Calling teen vaping ‘epidemic,’ officials weigh flavor ban

Calling teen vaping ‘epidemic,’ officials weigh flavor ban

WASHINGTON — U.S. health officials are sounding the alarm about teenage use of e-cigarettes, calling the problem an "epidemic" and ordering manufacturers to reverse the trend or risk having their flavored vaping products pulled from the market. The w...
Published: 09/12/18
Doctors explore lifting barriers to living organ donation

Doctors explore lifting barriers to living organ donation

WASHINGTON — Surgeons turned down Terra Goudge for the liver transplant that was her only shot at surviving a rare cancer. Her tumor was too advanced, they said — even though Goudge had a friend ready to donate, no matter those odds. "I have a living...
Published: 09/10/18