Dear Doctor: I was recently diagnosed with giant cell arteritis, but I don't know what it is or how to treat it. My pain is above my right eye, and it gets worse when I'm eating.

Dear Reader: Giant cell (temporal) arteritis is an inflammatory condition of the body's large and medium arteries. Headaches such as yours are one of the most common symptoms. Some patients also experience jaw pain when eating, but more severe symptoms are also possible. We'll explore that later.

First, let's focus on the basics of giant cell arteritis (GCA), a condition whose cause is largely unknown. GCA is more likely to develop after the age of 50 and occurs more frequently in people of Northern European ancestry; it is exceedingly rare in people of African, Asian or Latin descent. Atherosclerosis and a history of smoking increase the risk in women, but not in men. GCA is also associated with an inflammatory muscle condition, polymyalgia rheumatica; in fact, GCA occurs in about 15 percent of patients with polymyalgia rheumatica. If GCA is caused by infection, no link has yet been found.

What is known about GCA is that the immune system attacks and inflames the blood vessel walls, especially those within the head. Aside from causing headaches and jaw pain when eating, this inflammation can lead to fever, decreased appetite and weight loss. When GCA affects the medium-sized arteries going to the eye, it can lead to a temporary loss of vision in one or both eyes, but the most feared common symptom of GCA is permanent vision loss. Partial or complete vision loss in one or both eyes occurs in 15 to 20 percent of people with GCA. Sometimes these symptoms occur suddenly. A daily baby aspirin appears to lower the risk.

GCA can also attack the large vessels of the body, including the aorta and the arteries that go to the limbs. Involvement of the aorta can lead to aneurysms within the artery and a risk or rupture of the large blood vessel. In GCA, the aorta in the chest is more likely to be involved than the aorta in the abdomen. That means people with the condition -- including you -- should be screened for aneurysms of the aorta. When the arteries to the limbs are affected, people can experience sensations of cold in their feet and hands.

Diagnosis begins with a recognition of symptoms consistent with GCA, and then the discovery of an elevated blood sedimentation rate and/or an elevated C-reactive protein level. A temporal artery biopsy is necessary for complete confirmation.

Due to the worries regarding blindness, GCA should be treated quickly with high doses of anti-inflammatory steroids, usually the oral medication prednisone. However, if vision loss is apparent, high-dose intravenous methylprednisolone is needed before the prednisone. In both cases, the prednisone must be gradually lowered over a nine- to 12-month period due to the possible side effects of chronic steroid use, including diabetes, osteoporosis, weight gain and an increased risk of infection. Because of the possibility of side effects, some people have used the arthritis drugs tocilizumab or methotrexate in addition to a shorter course of prednisone.

In summary, immediate treatment with high-dose steroids is the first and most important step, as is an evaluation of your aorta for potential aneurysms. A diagnosis of giant cell arteritis means you have to be proactive about your own health. Asking questions is the first step.

(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 people can die from a broken heart. Is that really possible?

Dear Reader: We think you're referring to a condition known as "broken-heart syndrome," which has been in the news recently thanks to the unique backstory of an otherwise technical and wonky article published in The New England Journal of Medicine. The scientific name for broken-heart syndrome is "Takotsubo cardiomyopathy," also referred to as stress cardiomyopathy. Most people who experience broken-heart syndrome will recover. In some rare cases, though, it can lead to death.

The article that got so much attention examined the case of a 61-year-old woman in Texas who, upon waking up one morning, had such bad chest pain that she went to her local emergency room. Because her symptoms seemed to indicate a heart attack, she was promptly airlifted to a cardiac care hospital in Houston. However, a series of medical tests there took an unusual turn.

Although the woman's blood chemistry findings and altered heart rhythms were consistent with a heart attack due to coronary artery disease, doctors were startled by the scans of the woman's heart. Unlike in a heart attack, in which the heart muscle is starved of oxygen due to blockages in the major arteries, this woman's arteries were clear. What further tests did suggest was a classic case of Takotsubo cardiomyopathy.

The patient's left ventricle, the main pumping chamber of the heart that sends blood throughout the body, had stopped working properly. Instead of working at 100 percent capacity, the blood flow from the left ventricle was significantly compromised. The precise reasons for this phenomenon aren't yet known. Researchers suspect that a combination of stress hormones released during a particularly difficult physical or emotional incident stun the heart and alter its function.

The truth is the condition isn't all that rare. Up to 2 percent of the 735,000 Americans who have a heart attack each year go on to get a diagnosis of stress cardiomyopathy. The vast majority are women over the age of 50. The thinking is that after menopause, vanishing protection offered by estrogen leaves women more susceptible to this type of heart condition.

While taking the Texas woman's medical history, the hospital team learned what had pushed her into an emergency situation. Already worried about her son's upcoming back surgery and a son-in-law's recent job loss, the woman was left inconsolable after the death of one of her closest companions, her Yorkshire terrier. She and her husband considered the little dog to be a family member. When the Yorkie passed away, it broke her heart.

Once the diagnosis was made, the path to appropriate treatment became clear. Doctors put the woman on a medication called an ACE inhibitor, which widens the blood vessels. They also prescribed a beta-blocker to address her high blood pressure. A month later, tests showed significant improvement. And the very good news is that, a year later, the woman's symptoms have not returned.

(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: Like millions of other women, I've always slathered myself with moisturizers and creams without paying any attention to the ingredients. But recently I read that the parabens found in these products have also been found in breast tissue. Should we rethink our use of these creams?

Dear Reader: That's a smart question to ask. Before we explore the data, let's take a look at what parabens are and what they do. These are chemicals used as preservatives in commercial moisturizers, shampoos, shaving gels, sunscreens and makeup. They were first used nearly 100 years ago to preserve drug products and are still used to preserve drugs applied to the skin, injected into veins and taken by mouth. Lastly, parabens are used as a preservative in multiple food products.

Parabens are good preservatives because they have antibacterial properties as well as activity against yeast and molds. They also don't allow water to enter or break down the product they are preserving. Parabens are relatively inexpensive to make and are considered generally safe for food consumption by the Food and Drug Administration and European Union.

The widespread use of parabens, however, leads to their deposit in unintended places. Parabens are found at various concentrations in indoor dust and air. The potential health effects are more concerning in children than in adults, because their ingestion rate of parabens from dust is five to 10 times higher. In addition, parabens can end up in wastewater, ultimately sending them into the water supply, agricultural soil and fish, which leads to higher paraben exposure through consumption of fish and food products. One good aspect of parabens is that they are quickly eliminated from the body, so it is less likely they will build up over time.

As for the health effects, the primary concern is about parabens' effect on sex hormones. Parabens can bind to estrogen receptors in the body, meaning they have an estrogenlike effect that could potentially raise breast cancer risk and impact fertility. They also can bind to testosterone receptors, potentially affecting male fertility as well. In rats, very high doses of parabens decrease levels of estrogen and testosterone and cause menstrual irregularities in females and alterations in sperm counts in male.

A study of 501 couples actively attempting pregnancy in Michigan and Texas supports concern over parabens. Researchers measured urinary levels of parabens in both men and women and found that women with the highest amounts of parabens in their urine had a 34 percent reduction in pregnancy compared to women with the lowest amounts in the urine.

Parabens have been found in both breast tumors and in the breast tissue adjacent to tumors. This doesn't mean that parabens cause breast cancer, but it also doesn't mean we should simply call them innocuous.

Also, in humans, higher levels of parabens in the urine have been associated with lower levels of thyroid hormones, although this potential link is clouded by the fact that women use more parabens than men and also have more thyroid problems. Lastly, parabens applied to the skin, in combination with UVB light, can increase the risk of skin damage and possibly skin cancer.

In short, parabens at current human exposure may not cause harm. But with greater use and with greater accumulation of parabens in our food and water supply, we should all ask questions about their future health effects.

(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.)