Dear Doctor: I'm a 77-year-old woman, and I'm a hoarder. Well, maybe I'm a hoarder. Or maybe I'm just lazy or even a procrastinator. Regardless, how can I get myself in gear?

Dear Reader: Hoarding behavior has only recently been recognized as a disorder. According to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, six criteria must be present for someone to be diagnosed with hoarding disorder:

1) The person must have difficulty parting with an item, regardless of its value;

2) The person feels a need to save the item, and has distress upon discarding it;

3) Such items lead to clutter of the living areas;

4) The hoarding causes decreased socializing, affects work or can lead to dangerous situations in the home;

5) The disorder is not caused by a brain disorder;

6) The disorder is not caused by depression, obsessive-compulsive disorder or schizophrenia.

Under this classification, hoarding disorder affects about 1.5 percent of people. Older people are more prone to hoarding disorder, as are those who are unemployed or single. People with hoarding disorder are also more likely to have depression, anxiety, panic and post-traumatic stress disorder. Hoarders are more likely to be perfectionists than non-hoarders, but are also likely to be procrastinators, avoidant and indecisive. Lastly, studies of identical twins have found a substantial genetic factor for hoarding behavior.

Obviously, I don't know the degree of your hoarding behavior or even if you fit the criteria of hoarding disorder. Hoarders may have a strong sentimental attachment to the objects they possess or may feel that the object has some value -- either for its aesthetics or for its potential use. Many people with hoarding disorder are not aware that their behavior is a problem, so it's good that you have the insight to see that it may be an issue.

As for what you can do, the first course is to target a specific spot in your house -- an area with little clutter is fine. Get a plastic bag. Put everything in that specific spot in the plastic bag. From the items in that bag, make three piles: a keep pile, a discard pile and a recycle/donation pile.

The discard pile should go straight to the trash. The recycle/donation pile should be taken to a local charity or recycling center. The items you want to keep should be itemized by what you intend to do with them.

If you're saving items for your children, you might want to have them with you during this time, so they can tell you if they actually want the items. If not, then the items should be discarded or recycled.

Because you may experience distress when discarding, try focusing on one portion of your house at a time, and set multiple days for going through your entire house.

Many people with hoarding disorder benefit significantly from cognitive behavioral therapy, in which a therapist helps reduce clutter and prevent future hoarding. Don't be afraid to get help for hoarding: Quelling this behavior will have a positive impact on your life.

Even if you don't have hoarding disorder, the above plan can help you, as you phrased it, get "in gear."

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctor: I was having trouble with muscle spasms in my legs that made it hard to walk and have now been diagnosed with hereditary spastic paraplegia. The doctors in my area don't seem to know anything about it. What can you tell me about this disease? Where do I go for help?

Dear Reader: We're very sorry to hear about this difficult diagnosis. One of the reasons you're struggling to find medical help is that hereditary spastic paraplegia is a rare condition that affects between 10,000 and 20,000 individuals in the United States. That puts it into the category of "orphan diseases," which are conditions that affect 200,000 or fewer individuals nationwide.

Hereditary spastic paraplegia, or HSP, is an umbrella term for a group of neurological disorders that affect an individual's leg and hip muscles. Individual forms result from a mutation to a specific gene. Some forms of HSP are inherited, and some are believed to arise from a new mutation in the affected individual.

The word "spastic" refers to the muscle stiffness and spasms that are a hallmark of this disease. "Paraplegia," which comes from the Greek, is a fancy way of saying that a person's legs don't function properly. Taken together, this means that HSP is a genetic neurological disorder that affects an individual's ability to walk. It is also progressive, which means that it grows more pronounced over time.

Most broadly, HSP is divided into two classifications. Pure or uncomplicated HSP affects only the lower body. In complex or complicated HSP, an array of additional symptoms, such as ear or eye disorders, skin conditions, seizures and intellectual disabilities may also be present. At this time, more than 30 different types of HSP have been identified.

The main symptom of all types of HSP is slow and progressive weakness in the legs due to muscle stiffness, spasms and sometimes cramps. This can be also accompanied by fatigue, insomnia and pain. In most cases, the disease progresses at a steady rate. HSP appears in individuals of all ages, and -- this makes accurate diagnosis a challenge -- can present differently even within members of the same family.

At this time, there is no cure for HSP. Instead, medical care consists of therapies targeted to each individual's specific symptoms. That includes physical therapy to maintain muscle tone, range of motion and flexibility, medications to address spasticity, and sometimes orthotic devices to deal with foot and ankle problems. Occupational therapy and antidepressants are often useful for maintaining quality of life. Genetic testing is available, and genetic counseling is important.

As you noted, finding treatment is a challenge. If you live near an urban environment, chances are good that a neurologist in your area is familiar with HSP. If you're in a more rural area, you will have to expand your search to the larger medical centers.

The Spastic Paraplegia Foundation is a very good resource. Visit its website (sp-foundation.org) and you'll find information about the disease, a medical provider directory and, perhaps just as important, a community to help inform and support you.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctor: I've heard that a product called paractin, a plant extract, promotes a healthy inflammatory response. Is this true? How does it work?

Dear Reader: Paractin is an extract from the herb Andrographis paniculata that has been used as a remedy for hundreds of years in China, India, Thailand and other Southeast Asian countries for multiple infectious and inflammatory diseases and to relieve various symptoms. A. paniculata's main active ingredient is andrographolide, which inhibits the activity of chemicals linked to inflammation, and which may decrease fever and diarrhea by boosting the immune system.

As for its effectiveness, a 2015 review assessed six randomized controlled trials that studied the use of A. paniculata for cough. Combined, the studies compared 333 patients who took the herb to 348 who took a placebo. The studies all showed benefit in decreasing the severity of the cough, but there was significant variation as to the degree of benefit.

A 2004 review of seven double-blind studies, with a total of 896 patients, looked at the use of A. paniculata for upper respiratory infections. Participants started the herbal preparation 36 to 72 hours after the onset of symptoms. Five of the studies used a dose of 60 milligrams, one study used a 48-milligram dose, and one study compared doses of 180 milligrams and 360 milligrams. A confounding factor is that three studies used A. paniculata in combination with another herb, Eleutherococcus senticosus.

Nonetheless, all the studies showed improvement of symptoms with A. paniculata, with users reporting decreased fever, runny nose, cough and sore throat. Side effects included nausea, vomiting, dizziness and drowsiness, which were reported at higher frequency in the 180- and 360-milligram dosages. The authors concluded that the herb was a promising treatment for the symptoms of an upper respiratory infection.

The anti-inflammatory effect of A. paniculata has also been studied against ulcerative colitis. In a 2013 study published in the American Journal of Gastroenterology, researchers randomized 224 patients with mild to moderate ulcerative colitis to 1,200 or 1,800 milligrams of A. paniculata or a placebo for eight weeks. A colonoscopy was performed prior to the trial and then after eight weeks, and symptoms such as stool frequency and blood in the stool were monitored at two, four, six and eight weeks.

After eight weeks, 45 percent of those who took 1,200 milligrams showed measurable response to the herb's efficacy, while 40 percent of those who took a placebo showed response as well. So the results weren't so great at this dose. But at 1,800 milligrams, 60 percent of patients showed some measurable response to the herb.

Further, on the follow-up colonoscopy, 33 percent of the placebo group showed mucosal healing, while 50 percent who took 1,800 milligrams of A. paniculata showed healing. While this is a good response, it is significantly inferior to the medication Mesalamine, which has mucosal healing rates of 68 to 80 percent.

Also, a rash occurred in 8 percent of patients who took this high dose of A. paniculata.

In short, much remains unknown about Andrographis paniculata. Those interested in the herb could consider it for an upper respiratory infection or for a cough, but I would hope they would do so with caution. We need more studies of the herb before I would recommend it further.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.)