Dear Doctor: Is there anything I can do to keep my doctor from interrupting me? He's a really nice man, and I know he's busy, but I never get to share all of my concerns or have my questions answered before the visit is over.

Dear Reader: You've brought up an issue that's getting a lot more attention than it once did, and one that doctors in all specialties are actively working to address. We do have some specific strategies, but first, allow us to nerd out a bit.

A study on this subject with a statistic that often gets cited -- that on average, a patient speaks for about 17 seconds before the physician cuts in -- was conducted all the way back in 1984. Subsequent studies, which used larger sample sizes, highlighted the same challenge. These days, the amount of time a patient gets to speak uninterrupted has edged up about 50 percent. But considering that's now in the neighborhood of 25 seconds, it doesn't seem like much of an improvement.

So what can you do?

Begin your appointment with a mission statement. Politely tell your doctor that, before he or she responds, you would like the chance to lay out all your questions and concerns. This may sound like you're asking permission for an interminable monologue. However, in studies where patients were allowed to speak without interruption, it took them between 90 seconds and two minutes to present their information.

So you've said your piece. Now, it's your turn to help things move smoothly.

Begin by listing the things you want the doctor to address. Perhaps you have a specific medical issue, and you also want general advice about another topic or two. Make that clear. This will let your doctor mentally prepare for how best to spend the remaining time in your appointment.

If you do have a specific medical issue, be prepared with a concise and fact-filled narrative. Tell him or her when the symptoms began, how and when they changed or escalated, and what they feel like. A burning sensation, a stabbing pain, an ache that occurs when you move a certain way -- all is useful diagnostic information.

When you're finished speaking and are ready to listen, let your doctor know. And when he or she begins to answer, pay attention. Take notes. If something that is said needs follow-up questions, make a note of it. As the visit ends, use your notes to quickly summarize the information and instructions. This way, you both know you're on the same page.

Sometimes you do wind up with follow-up questions once the appointment ends. Here at UCLA we have an electronic communications portal that our patients can use to reach us. Perhaps your medical provider has something similar. Ask for a few minutes with a nurse or physician's assistant. And don't be afraid to make another appointment if you feel that's what you need.

Life in a doctor's office moves quickly these days. We understand that speaking up can be uncomfortable for you (and perhaps even for your doctor). But when you do, we believe both of you will come away with a greater sense of satisfaction.

(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 diagnosed with myasthenia gravis in 2014 after years of trying to find an answer to my symptoms. The disease is so difficult to diagnose that I'm afraid others have been searching as well, but without answers. Could you shed some light on this disease?

Dear Reader: To understand myasthenia gravis, you have to first understand how the nerves of your body make your muscles contract. Nerves that control muscle contraction attach to the muscle in an area called the neuromuscular junction. There, a nerve releases the neurotransmitter acetylcholine, which then binds to a receptor in the muscle. The binding to the receptor causes a cascade of changes that leads to the contraction of a muscle.

In the majority of people with myasthenia gravis, antibodies attack the acetylcholine receptor at the neuromuscular junction. The attack damages, and can even destroy, these receptors to such an extent that nerve impulses can't cause muscular contraction. Some people have other antibodies that impair the actual formation of the receptor. The thymus gland, a lymphatic gland behind the breastbone, is often the source of the antibodies that lead to myasthenia.

The telltale sign of myasthenia gravis is muscle weakness and muscle fatigue with recurrent muscle use. Patients can have no signs of muscle weakness in the morning, but with repetitive contraction of muscles during the day, the muscles get fatigued and weak. About 50 percent of the time, the muscles of the eye are affected, leading to drooping of the upper eyelid and sometimes double vision. Myasthenia gravis can also cause weakness of the jaw, leading to difficulty chewing or closing the mouth, and weakness of the facial muscles, interfering with facial expressions.

Elsewhere in the body, the disease can affect the muscles of the neck, making it difficult for people to hold up their head, and the upper arms and legs (arms are more often affected than legs). Sometimes, the disease also affects movements of the wrists, fingers and ankles. When severe, myasthenia gravis can impact the respiratory muscles, causing difficulty breathing, and even the muscles involved with swallowing.

Sudden severe weakness from the disease, called myasthenic crisis, can be precipitated by infections, antibiotics and some heart medications. In these situations, breathing difficulties lead to hospitalization and sometimes ventilator use.

Myasthenia is a rare disease, which may be why some doctors don't recognize the symptoms. Each year, myasthenia is diagnosed in eight to 10 out of 1 million people; within the United States, about one out of every 5,000 people are affected. The disease can be diagnosed by blood tests that detect antibodies to the acetylcholine receptor or antibodies to the enzyme that helps form the receptor, called MuSK. Another way to diagnose myasthenia is through repetitive nerve stimulation tests that evaluate whether muscle strength declines.

Muscle weakness can be treated with a medication that increases the amount of acetylcholine at the receptor or through drugs that dampen the immune system in order to limit the receptor-attacking antibodies. In younger patients with enlarged thymus glands, removal of the gland can cure myasthenia. One comforting fact is that in the majority of patients dealing with myasthenia, the symptoms go away with time.

(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 had lower back pain for years, but I can't afford to go to a physical therapist. My husband, who started taking a yoga class at the community center here a few months ago, swears that his back pain is going away. Just how effective is yoga for lower back pain?

Dear Reader: When it comes to back pain, you and your husband have plenty of company. It's estimated that 80 percent of all adults will experience it over the course of their lifetimes. And little wonder.

The spine is a feat of engineering. Bones, joints, muscles, ligaments, nerves and other specialized tissues interconnect to form a strong and flexible column. They bear the weight of the upper body while providing an axis from which we can stretch, bend, reach and pivot. But when any one part of the spine moves out of alignment, whether due to injury, illness or overuse, the result is pain and, occasionally, immobility.

Your question addresses pain in the lower back, which is also known as the lumbar spine. And for that, we have some promising news. The results of a recent study by researchers at the Boston Medical Center suggest that practicing certain yoga poses is a viable alternative to physical therapy for dealing with chronic lumbar pain.

The study recruited 320 adults who were living with chronic lower back pain that they rated from moderate to severe. The participants were divided into three separate treatment groups.

One group took part in 15 one-hour physical therapy sessions over the course of three months, and was assigned additional exercises to do at home. A second group took weekly 90-minute yoga classes over the course of the three months, and was also assigned additional home exercises. The third group of participants did not take part in any kind of treatment. Instead, they received a self-help book about back pain, occasional newsletters with information about lumbar health and access to telephone check-in sessions.

After the first three months of the study, the yoga group and the physical therapy group each continued with their forms of therapy for an additional nine months. When the study concluded a year after it had begun, the group that underwent physical therapy and the group that took yoga classes self-reported similar improvement in both pain levels and improved mobility.

Both of these groups reported feeling better than the group that was given only back pain literature. In addition, the individuals in the physical therapy group and the yoga group were more likely to have stopped using medication to manage their pain.

But before you rush out and sign up for any old yoga class, it's important to note that the exercises done by the participants in this study were geared specifically to address issues of the lumbar spine. That means that the areas of the spine targeted by the yoga postures, as well as the pace of the exercises and their intensity, were carefully calibrated.

If you decide to give yoga a try, find an experienced teacher and be sure to let her or him know your specific limitations.

(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.)