Dear Doctor: My husband is in kidney failure, has chronic obstructive pulmonary disease, congestive heart failure and Type 2 diabetes. We have been married 48 years. He sleeps most of the day, is so short of breath that a walk to the bathroom is difficult and never leaves the house except to go to the doctor. He is angry and depressed, often taking his temper out on me. What can I do to help him (and us) besides watch his diet?

Dear Reader: My heart goes out to you and your husband. As you're now painfully aware, and as I've learned as a physician, illness affects not just the person stricken, but their loved ones as well. In your long marriage, you and your husband have undoubtedly had your share of ups and downs, persevering and working together. Now you have new challenges, possibly unimaginable when you were younger, focused on your husband's illnesses.

Let's start with the depression. Some people have the mistaken notion that depression is part of the aging process. In fact, healthy independent elderly adults have a lower rate of depression than the general adult population. But each physical malady increases the risk.

With his many troubles, treating your husband's irritability and depression won't be easy. He may not acknowledge that he is suffering from depression, or he may suggest that, because of his physical ailments, he has every right to be depressed and every right not to go out of the house.

So, if the only time he goes out of the house is to see the doctor, go with him to the doctor. Talk to the doctor about your husband's increasing isolation, his feelings of depression, his irritability -- and his nighttime sleep, which can be affected by his conditions. Notice whether he's having trouble breathing while asleep, snores or awakens frequently to urinate. There may be aspects of his medication that the doctor may want to change to help him sleep more at night and less during the day.

Also, ask your doctor about whether his medications may be causing drowsiness or having depressant effects. These include, but are not limited to, opiates, benzodiazepines (Ativan, Klonopin, Valium, Xanax) and gabapentin, which is often used in diabetic patients for painful neuropathy. Further, pain itself can lead to feelings of depression. So take note of your husband's level of pain and share it with the physician if your husband does not.

Regardless of the root of his depression, psychotherapy could help your husband feel more in control of his situation and help him communicate his needs to you. Similarly, although your husband is likely taking a host of medications and would be hesitant to start another medication, anti-depressants can help decrease his irritability and make him more alert.

With therapy and possibly medication, your husband may be more apt to go outside and do some form of exercise, which will additionally help his mood.

Your love and support for your husband may seem to go unnoticed, but be assured it's a stabilizing foundation for him. That said, improving his mood is ultimately up to him. Your doctor can partner with you both, but your husband has to commit to getting better. Whether he does or doesn't, only time will tell. But, regardless, please take care of yourself. That, too, will benefit you both.

(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: Is kefir really the miracle food that it's cracked up to be? I'll confess that fermented milk does not sound very appealing to me. What is it, exactly? And how much should I consume a day?

Dear Reader: If you've paid attention to food trends over the years, you've seen fads and enthusiasms come and go. This year's super-food becomes next year's shrug of the shoulder. Kale, kombucha, green tea, quinoa, acai berries, oatmeal, salmon and even orange juice have each had their heyday in the headlines.

Now it appears that kefir, a fermented drink traditionally made from the milk of cows, goats or sheep, is having its moment. If you've never tried it, kefir is sometimes mildly effervescent, has a silky texture that is slightly thicker than milk, and has the sharp tang of plain yogurt. It's a good source of protein, calcium and B vitamins, and delivers a generous dose of a range of gut-friendly bacteria. In a time of intense interest in probiotics, it's this last quality that has helped propel kefir into the super-food category.

Kefir comes to us from the Caucasus Mountains, and has long been part of the food traditions of Eastern Europe, Russia and Southwest Asia. It's made by inoculating milk with a substance known as kefir grains. These kefir grains are made up of lactic acid bacteria and beneficial yeasts that are held in a matrix of fats, sugars and proteins. They form irregular clusters that can look a bit like cauliflower florets.

The kefir grains break down the sugars in milk to form lactic acid, which imparts a sour flavor. It also renders kefir nearly lactose-free, which means that many people who can't tolerate milk, yogurt or other dairy products will be able to consume kefir without physical consequences. For individuals who don't use milk, non-dairy versions of kefir -- made with coconut milk, coconut water, rice milk and even fruit juices -- are available. However, these don't have the same amount of protein as milk-based kefir and have a somewhat different probiotic profile.

A number of health benefits are being attributed to the combination of probiotics, prebiotics and beneficial yeasts that kefir contains. In addition to supporting a healthy gut, studies have found that kefir, which contains upward of 30 different strains of bacteria and yeasts, has anti-inflammatory and anti-microbial properties. Other studies have suggested that kefir can boost immune response, and may even have anti-carcinogenic effects. It's important to note, however, that these are small studies with numerous caveats attached. Much more research is needed before making the leap from observation to medicinal claims.

If you do decide to work kefir into your diet, be sure to read the nutrition labels. The flavor of plain kefir ranges from tart to mouth-puckering. As a result, many brands add sugar, fruit and other flavorings to make it more palatable. Consider the fat, calories and carbohydrates you'll be adding to your daily total and adjust accordingly. And as with any food, don't go overboard. Add kefir to your diet gradually and see how you feel.

(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'm too old (almost 30) for the HPV vaccination that can reduce my risk of cervical cancer. But I read that an IUD could do the same thing. Should I think about getting one, even though I prefer other forms of contraception?

Dear Reader: What a good question -- and a relevant one. Cervical cancer is the third most-common cancer among women worldwide. The majority of cases and deaths occur in countries with poor access to regular Pap smears; in the United States, where Pap smears are more readily available, the rates of cervical cancer and cervical cancer deaths are dramatically lower. Vaccination against the human papilloma virus (HPV) -- the causative virus that leads to inflammation and eventually cancer of the cervix -- has the potential to reduce those rates even further, but the vaccine is given only to young people with no prior exposure to the virus.

The possibility of IUDs as a risk reducer is an intriguing notion that's been raised before. Intrauterine devices (IUDs) -- used in the United States since the late 1950s -- prevent sperm from joining with the egg by either damaging the sperm or creating a hostile environment for it. A 2011 study analyzed cervical cancer rates among women from 11 countries who had used an IUD and among women who hadn't. Women who had a history of IUD use had half the risk of developing cervical cancer as women with no IUD use, regardless of whether the use was for 10 years or only one year. There was no difference in HPV infection rates between the two groups, so obviously some other factor was involved.

The recent study you mention was a review of 16 studies exploring the link between cervical cancer and IUDs. The studies were from the 1980s and 1990s, and three of them were performed in the United States. Overall, cervical cancer rates were 30 percent lower among women using the device compared to nonusers. Keep in mind that the finding was a correlation and so does not prove that IUDs actually lower the rate of cervical cancer. But the authors surmised that the reason IUDs could potentially reduce the risk of cervical cancer is because insertion of an IUD causes an inflammatory reaction that increases the immune response in the cervix. This could lead to the clearance of the human papilloma virus.

The results of another study, one that followed 676 sexually active women in San Francisco from 2000 to 2014, conflict with this theory. The average age of the women at the beginning of the study was about 18. The women were routinely tested for HPV, and 85 of them used an IUD at some point during the study. No benefit was seen in either the acquisition or the clearance of HPV in women using an IUD. The authors of this study wondered if IUDs decreased the incidence of cervical cancer by somehow clearing precancerous lesions in the cervix.

In conclusion, I'm not certain that getting an IUD for the purpose of decreasing cervical cancer risk is necessary. It seems even less necessary if you have had multiple negative HPV tests and Pap smears. Nonetheless, for women making an initial birth control choice who are weighing the risks and benefits of an IUD, these studies may be an influencing factor.

(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.)