Dear Doctor: I've been having trouble with my handwriting, not being able to control the letters. I have also had an occasional tremor in my little finger, and have an ongoing problem with a "frozen shoulder." Do you think a neurological evaluation would be appropriate?

Dear Reader: While this collection of symptoms can certainly be benign, the fact that they are occurring together gives us pause. We're happy to help you by discussing them here. However, we also urge you to make an appointment with your family doctor. He or she will have an understanding of your medical history and can make an informed decision regarding a neurological evaluation.

Let's start with the frozen shoulder. This condition, which is also called "adhesive capsulitis," usually develops gradually. The symptoms -- stiffness and pain in the shoulder joint, which results in a limited range of motion -- tend first to grow more severe, and then slowly begin to improve. The condition usually resolves by itself over the course of months or a few years. Some people categorize the arc of the condition in three distinct phases -- freezing, frozen and thawing.

Frozen shoulder can occur after surgery, or as the result of an injury like a broken bone or damaged rotator cuff. It can arise in people with diabetes, those who have suffered a stroke, people with a thyroid condition, with cardiovascular disease, and in individuals with Parkinson's disease. It's more common among women than men, and in people over the age of 40.

Treatment can include the use of over-the-counter NSAIDs for pain, as well as any mobility and range-of-motion exercises that the patient can tolerate. In severe cases, oral steroids or a steroid injection can bring relief.

When it comes to handwriting, things get a bit trickier. The onset of problems with handwriting can, as you referenced in your question, signal a neurological problem. You mention not being able to "control the letters," and we're not sure whether that's due to shakiness in your hands, or that the letters are not the size and shape you are trying to form.

Shaky handwriting can be caused by something as harmless as too much caffeine, the side effect of a medication or even lack of practice. With so many of us trading in our pens for keyboards of all sizes, handwriting suffers.

A common cause of shakiness, particularly in the hands, is something known as an "essential tremor." While not dangerous, it can become worse over time and interfere with simple tasks. Tremors are also associated with diseases like Parkinson's. However, in Parkinson's, the tremors are most prominent when the hand or limb is at rest. In an essential tremor, the shakiness worsens with movement.

Changes in handwriting have also been associated with certain types of dementia, as well as Alzheimer's disease. In Parkinson's disease, handwriting becomes progressively smaller, a condition known as micrographia.

We can tell from your letter that this cluster of symptoms worries you. Please, as we said at the start of our reply, do see your doctor. Whatever the cause turns out to be, you'll have the advantage of an early diagnosis.

(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: How effective is the CA 125 blood test at detecting ovarian cancer? Because ovarian cancer is diagnosed so late, wouldn't it make sense to screen women with this test at the same time they get their Pap smears?

Dear Reader: As you point out, ovarian cancer is often diagnosed when the disease has spread far beyond the ovaries. Only 15 percent of the time is it detected while confined to one of the ovaries; 17 percent of the time, it has spread to local lymph nodes; and 61 percent of the time it has spread distantly. Each year, nearly 14,000 women in the United States die from the disease.

Many people logically think that screening for CA 125 could help reduce those numbers. After all, CA 125 is a glycoprotein that is elevated in 85 percent of ovarian cancers, and blood levels of it are used as a marker for the efficacy of ovarian cancer treatment.

But let's look at the data. In a 1996 study in the United Kingdom, 22,000 women over the age of 45 underwent annual CA 125 tests for three years. Those with a CA 125 level greater than 30 also had an ultrasound of the ovaries. Of the 767 women who had a measurement greater than 30, 49 were ultimately diagnosed with ovarian cancer. The authors determined that the test was able to detect ovarian cancer in only 3.1 percent of cases.

Although an elevated CA 125 was linked to an increased risk of ovarian cancer, the majority of women with elevated numbers did not have ovarian cancer. This high false positive rate has been seen in multiple other studies of CA 125. The fact is, this glycoprotein is elevated in 1 percent of healthy women and can fluctuate during the menstrual cycle. Women with fibroids in the uterus, endometriosis, cirrhosis of the liver and other cancers also may have elevated numbers.

To further evaluate the efficacy of CA 125, in 2011, U.S. researchers conducted a trial involving 78,216 women ages 55 to 74; half received yearly CA 125 tests for six years plus pelvic ultrasounds, and half received usual care. While there was a slight increase in the diagnosis of ovarian cancer in the screening group, there was also a minimal increase in the death rate in that group possibly due to the investigation of false positive tests.

That's not to say some women won't benefit. A 2013 study in the U.K. found that women with a genetic predisposition for ovarian cancer, such as those with BRCA1 or BRCA2 mutations or Lynch syndrome, benefitted from CA 125 screening with the addition of ultrasound. Those who were not vigilant with the screening were more often diagnosed with later-stage ovarian cancer.

The take-home message from these studies: Unless you're at high risk of ovarian cancer or have a family history of the disease, there doesn't appear to be any benefit in a CA 125 test. I wish that were not the case.

Note to readers: A recent column on myasthenia gravis should have said not that symptoms would improve, but that symptoms can stabilize over the course of time and subside in many people. My thanks to those readers who clarified this important point.

(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: It seems like you can't go a day without probiotics turning out to be the cure for some ailment or another. Now we're being told they help depression. How can that be?

Dear Reader: We agree with you that probiotics are in the news quite a bit these days, and sometimes with more than a bit of hyperbole. Much of the news comes from legitimate scientific research now being done into the fascinating world of the gut biome. Having read many of the resulting papers, we can assure you that the researchers themselves are far more temperate and restrained in their findings than some headline writers, who seem to love the idea of a medical miracle.

Probiotics are live micro-organisms that are ingested for their health benefits. Found in yogurt, kefir and other fermented foods, as well as in dietary supplements, they live in our digestive tracts, particularly in the gut. There, they are believed to enhance immune function and inhibit the growth of pathogens.

The spate of recent news reports drawing a link between probiotics and depression relief are likely coming from the results of a study published last spring in the journal Gastroenterology. Researchers in Canada followed 44 adults with irritable bowel syndrome, or IBS, a bowel disorder. IBS causes abdominal pain and diarrhea or constipation, and there is evidence that probiotics can ease some of those symptoms. The subjects in this study also suffered from mild or moderate anxiety and depression, which can be common among people with IBS.

Half of the people in the study were given a certain strain of probiotic, and the other half received a placebo. At the six-week mark of the study, 64 percent of the patients taking the probiotic saw a decrease in test scores that rate depression. The placebo group's depression scores dropped half that amount, or 32 percent. Interestingly, the rate of anxiety in both groups remained the same. A final evaluation at the end of the 10-week study yielded the same results.

If you're wondering whether the depression lessened because the probiotic group felt better physically, you're not alone. But researchers also performed brain scans on the test subjects. The results of those scans led them to conclude that the probiotic reduced depression by changing brain activation patterns, specifically in the limbic system, which is the collection of structures in the brain associated with emotion and memory.

This research follows on the heels of a handful of other studies in recent years that suggest probiotics can alleviate the symptoms of depression. The thinking is this occurs because probiotics reduce gut inflammation, while simultaneously raising serotonin levels. There's even a great name for this emerging area of study -- the gut-brain axis. Communication goes both ways -- from gut to brain and from brain to gut -- via the nervous system, glands and hormones, and the immune system.

Thus far, studies into probiotics and depression have been small and brief, involving limited strains of probiotics. As researchers create larger, well-controlled and long-term studies that investigate multiple probiotic strains, the results should be fascinating.

(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.)