Here are highlights from the February 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: Visit HealthLetter.MayoClinic.

Aging Skin -- Are Those Spots Normal?

Over time, skin suffers from wear and tear, and wrinkles, spots and growths begin to appear.

The February issue of Mayo Clinic Health Letter covers some of these normal changes and possible treatment options.

Harmless growths include:

Age or liver spots -- These flat, brown areas, also called solar lentigos, typically occur on the hands, back and face. Using a topical retinoid -- often in conjunction with bleaching cream and a mild topical steroid -- may gradually fade an age spot.

Skin tags -- These flesh-colored growths protrude from the skin, often on a stalk. They're often found on the neck or in the armpits. A doctor can remove them with surgical scissors, an electrical device or liquid nitrogen.

Cherry angiomas -- These small, smooth, cherry red spots are commonly found on the torso. They range from pinhead size to ¼ inch across. They can be removed with a laser, liquid nitrogen or an electrical device.

Seborrheic keratoses -- These brown, black or pale growths look waxy, as if they were dripped on the skin by a candle. They usually appear on the face, chest, shoulders and back, often in multiples. Their size ranges from ¼ inch to 1 inch across. They can be removed with a simple surgical procedure or with liquid nitrogen.

The cost of removing any of these harmless spots -- considered cosmetic procedures -- may not be covered by insurance.

Not all skin spots are harmless. Skin cancer can look similar to a harmless spot or growth. Any spots that bleed and don't heal should be examined by a physician. Other concerning symptoms are itchiness, pain or a changing outline, color or appearance.

The Liver: Multitasker, Regenerator and Vital for Health

The liver, the largest internal organ, is the body's ultimate multitasker. While the liver is not glamorous or sentimental -- there are no love songs about a broken liver -- it simultaneously plays a key role in the body's metabolic, digestive and regulatory systems.

A Special Report in the February issue of Mayo Clinic Health Letter offers comprehensive coverage of the liver, its function, types of liver diseases and treatments.

Some highlights from the report include:

A multitasker: Among its many functions, the liver helps regulate blood sugar levels, converts consumed fats into usable fuel for cells and transforms fats and sugars into protein building blocks. It converts cholesterol from the diet into bile acids, which help in digestion. It metabolizes hormones. And specialized cells in the liver trap bacteria and toxins that arrive in the bloodstream, break them down, render them inactive and secrete them into bile for elimination.

A regenerator: The liver -- unlike other organs -- can fully regenerate itself. This unique ability has led to a growing role for living-donor liver transplantation, where the donor provides a substantial portion of his/her liver to a recipient. After a successful transplant, the liver grows back to its full size in both the donor and the recipient within about two months.

Liver disease: There are many causes and types of liver disease. Symptoms often go unnoticed until the disease is advanced because the symptoms frequently mimic other, more benign ailments. Signs and symptoms may include fatigue, a general feeling of weakness or feeling unwell, loss of appetite, mild weight loss, nausea, fever, abdominal pain, dark-colored urine, or bowel movements that may be light colored, bloody or black. Specific tests sometimes are the only way to confirm liver disease. Untreated, liver disease can progress to liver failure.

Healthy-liver tips: Infectious liver diseases, such as hepatitis A, B and C are spread through contaminated body fluids or blood. Avoiding risky behaviors -- unprotected sex and use of contaminated needles -- reduces the risk of liver disease. Vaccines are available to prevent hepatitis A and B.

Another healthy-liver tip is to minimize exposure to toxins, including garden and household chemicals and cigarette smoke. Maintaining a healthy weight is important, too. A diet high in calories and saturated fats can overwhelm the liver's ability to process fats, in turn causing inflammation, an early stage of liver disease. Minimizing alcohol consumption benefits the liver. Excessive alcohol intake can flood the liver and prevent it from working efficiently.

New Pain Management Approaches Reduce Pain, Speed Recovery for Knee or Hip Replacement

Patients undergoing knee or hip replacements recover more quickly when treated with targeted pain-blocking medications that may eliminate the need for general anesthesia during surgery and intravenous narcotics drugs after surgery.

The February issue of Mayo Clinic Health Letter explains the newer pain management options and their benefits.

A decade ago, patients undergoing hip or knee replacements were almost exclusively given general anesthesia during surgery and intravenous narcotic pain medications afterward. This approach works for most people and still is commonly practiced. But both general anesthesia and intravenous narcotic drugs can cause nausea, vomiting, grogginess, decreased bowel function and other side effects.

In the early 2000s, Mayo Clinic anesthesiologists began developing new anesthesia protocols for joint replacement surgery that used known anesthetic and pain relief techniques in new combinations. Their goal was to eliminate the need for general anesthesia and intravenous narcotics and the resulting side effects.

The new procedures may vary but typically involve:

A choice: Even with the new protocols, patients may choose regional anesthesia, where the lower half of the body is numbed, or general anesthesia.

Oral pain medications early on: A combination of oral narcotic pain medications are given prior to surgery. Oral narcotics have fewer side effects than narcotics given intravenously. This technique is helpful for recovery whether general or regional anesthesia is used.

Sedation: Sedative drugs given before surgery help patients using regional anesthesia nap during the procedure, but not lose consciousness.

Nerve blocks: Through a catheter, a continuous infusion of numbing medicine is pumped near the surgery site for 48 hours. Nerve blocks are performed in conjunction with general or regional anesthesia.

Oral pain medications after surgery: For more than 95 percent of patients, pain that occurs after the nerve blocks are removed can be managed with oral pain medications such as acetaminophen (Tylenol, others), tramadol (Ultram, others) or oxycodone. Intravenous narcotic medications are used as a last resort.

Patients who receive regional anesthesia report significantly less pain after surgery than those receiving general anesthesia and intravenous narcotics. These patients are out of bed sooner, begin physical therapy sooner and leave the hospital one to two days before patients who were given general anesthesia and intravenous narcotics. With the newer protocols, patients may still experience typical side effects including nausea and vomiting, but to a lesser degree than with the older anesthesia methods.

Another benefit is that regional anesthesia protocols make surgery an option for older adults with more complicated conditions. A decade ago, older adults often were not considered candidates for surgery because they would have fared poorly with older anesthesia techniques.

Doctors report few downsides to these newer pain management approaches. Nerve injury is a rare potential complication. For most people, the regional anesthesia protocols are a change for the better, resulting in less pain, fewer complications and a quicker recovery.

Mayo Clinic Health Letter

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