Dear Doctor: I never gained the infamous "freshman 15" while I was in college. But now I've graduated and am behind a desk for nine hours a day for my new job. I'm not only putting on the pounds, I feel generally lousy. Is this just adjusting to working life, or is sitting so much bad for you?

Dear Reader: Making the switch from the freeform life of a college student to the strictures and structure of a full-time job can indeed be a challenge. It's quite possible that some of what you're feeling is a result of this shift in lifestyle. However, your question zeros in on an important element of the modern workplace, and one that numerous studies have identified as a genuine health hazard. That is, the fact that so many of us spend the majority of our days sitting. To quote more than a few of the headlines we've seen on the topic -- sitting may be the new smoking.

Our bodies are built for movement. Every one of our systems -- lungs, circulatory, lymphatic, skeletal and muscular -- benefits from regular activity. Even improved mood and memory have been linked to physical fitness. Yet the default of our modern world has become inactivity, whether it's in cars, at desks, on couches or seated in front of screens. As more and more of us began to spend our lives sitting down, researchers examined the consequences. The results have been anything but reassuring. Numerous studies have now linked those long hours of sitting to an increased risk of a number of health threats, including diabetes, some cancers and heart disease.

An intriguing new study from the University of Illinois-Chicago suggests a new way forward for desk-based workers. Researchers evaluated the merits of three different types of work stations. One was the desk-and-chair combo we're all too familiar with. One was the standing desk, which has become a common sight in many workplaces. And one was a seated desk that had been outfitted with a mobile foot rest. The device, which goes by the brand name HOVR, is basically a leg swing that allows the seated person to stay in motion.

According to the study, individuals who used the mobile foot rest burned 17 percent more calories than did those who sat still. Interestingly, the foot rest group also used 7 percent more calories than people at standing desks. Admittedly, it's a modest step forward (sorry), but the point we took from the study is that even small interventions can be beneficial.

Whether the option of a foot swing is in your future, you can make some changes to how you spend your work day. Stand up and stretch every 10 or 15 minutes. Take short walks around the office. As much as possible, add motions that flex and stretch your legs, arms and trunk muscles. And it wouldn't hurt to ask whether your workplace offers any alternatives to the seated desk.

(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: My ex-wife was seeing a primary care doctor who also treated her heart issues, which were not of a serious nature. She sought a second opinion from a specialist, which prompted her own doctor to unceremoniously drop her as a patient, without even informing her. She found out the next time she called for an appointment. Is this ethical -- or even legal?

Dear Reader: One of the most satisfying elements of a physician's job is helping a patient. That sense of satisfaction, along with the respect for the profession and praise from our patients, can infuse a physician's sense of self-worth, potentially inflating the ego of even the most humble physician. Conversely, when a patient is unhappy with a doctor or when a doctor's diagnosis proves to be incorrect, a physician can question his or her ability and value. And, of course, doctors -- like everyone else -- have biases, personality quirks, stressful days and distractions caused by many nonwork factors. In short, doctors are people too.

I don't know whether your ex-wife and her primary care doctor had a good, long relationship or a short one marked by poor communication. But a strong primary care relationship is essential to overall high-quality medical care. A primary care doctor is the physician you see for physicals, and the first doctor you see for colds, injuries and many other maladies. Because of this, such physicians often have a deeper understanding of the whole patient than would a short-term specialist, and they take that position seriously. When a patient seeks a new primary care doctor, or seeks the advice of a specialist without the other doctor's knowledge, the doctor might feel that his or her care was considered inadequate.

When that happens, some doctors may feel that it's an attack upon their self-worth and will act in a defensive way. Others are more deferential, realizing that they can't help or please everybody. These doctors don't feel threatened by opinions from other physicians.

Obviously, I don't know what transpired in the mind of your ex-wife's primary care doctor -- and I'm not defending his or her actions. A conversation that sought to identify any potential concerns on her part would have been a better way of handling the perceived slight. That said, a doctor has every right to fire a patient for not following recommendations, rude behavior or missing multiple appointments.

As for the legality of the doctor's actions, laws in many states penalize doctors who abandon patients needing specific medical care. That means if a patient is in a medical crisis, it is incumbent upon the doctor to either take care of the patient or find an immediate alternate provider. In writing a discharge letter from a practice, a doctor usually gives a 30-day window, giving the patient time to find a new doctor and obtain medication refills. Clearly, the doctor should have provided a warning letter or a letter of discharge.

The relationship between doctor and patient is fraught with the difficulties of human interaction. A poor relationship with a primary care doctor can lead to bad outcomes, regardless of who is primarily at fault. Dissolving the relationship under these circumstances may be for the best.

(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.)

Hello again, dear readers! How is 2018 treating you so far? Thank you, as ever, for your emails and letters. Your kind comments warm our hearts; your criticisms make us want to do better; and your questions, comments and opinions widen our worldview. And on that note, onward!

-- After our column about teething remedies was published, we received quite a few questions regarding the purported benefits of amber teething necklaces. These necklaces have become popular teething aids in some parts of the country. Amber, which is fossilized tree resin, has long had a role in folk medicine. When it comes to teething, the idea is that the succinic acid contained in Baltic amber will be absorbed via the skin and confer therapeutic effects.

While it's true that Baltic amber does contain small amounts of succinic acid, we were unable to find any research that shows it acts as an analgesic, that body heat will cause it to be released or that it can be absorbed through the skin. Even if the above were possible, the dose of succinic acid available in an amber necklace would be miniscule. Add in the choking hazard presented by the size of the amber beads and a recent study that found these necklaces to be associated with bacterial colonization, and our position is that the very real risks outweigh the unproven benefits.

-- A recent column about portion control showed us how creative you readers are. The range and variety of visual guidelines you use for portion control has been fascinating to see. We particularly liked this whole-plate approach to making sure a meal doesn't stray into overeating:

"Make it simple," writes Noreen, who uses a small salad plate as her template. She fills two-thirds of the plate with vegetables, then fills the remaining space with meat or a meat substitute, and a serving of fruit. Noreen reverses the typical American approach and eats her largest meals at breakfast and lunch and goes light on dinner.

-- And, finally, thank you to a reader for adding to our discussion of urinary incontinence.

"You have mentioned stress incontinence in your column a couple of times recently, but I don't recall that there was any mention of obesity as a contributing factor," our reader points out. "If weight loss can be part of treatment for UI, it would be helpful to know for people who have both of those conditions."

You're right -- a number of studies have shown a clear link between obesity and urinary incontinence. Individuals who are overweight experience an increase in intra-abdominal pressure. This has the effect of increasing pressure on the pelvic floor, including the bladder and the bowel, and plays a role in developing urinary incontinence, or UI.

The good news is that several studies have shown that weight loss can significantly reduce the number of stress incontinence episodes experienced by participants. In fact, weight loss, along with exercise, is recommended as a first-line treatment for urinary incontinence among individuals who are significantly overweight.

(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.)