Dear Doctor: I am a 62-year-old woman diagnosed last year with a myelodysplastic syndrome. I have blood work done every three months, but my white count keeps dropping. Most days, I feel fine, but I retired from teaching because of fatigue. What foods and drinks should I avoid? Should I eat only organic produce?

Dear Reader: To bring other readers up to speed, let's explain the basics of myelodysplastic syndrome, a bone marrow disorder. For starters, bone marrow contains a type of stem cell that produces the body's red blood cells, white blood cells and platelets. When these stem cells acquire multiple mutations, which can happen with various cancers, their ability to produce the other cells is compromised.

In myelodysplastic syndrome (MDS), a slowly developing form of cancer that can devolve into acute leukemia, abnormal stem cells reproduce within the bone marrow, where they die prematurely -- decreasing their ability to produce red and white blood cells and platelets. As you're aware, MDS often causes fatigue (caused by anemia) and a drop in white blood cells, putting people at greater risk of infection.

To answer your question about dietary changes, we might want to consider what exposures have been linked to MDS. A study in Greece compared the dietary habits and work exposures of 126 people with MDS with those of 102 people without the disease. The authors found that general pesticide exposure was linked to a 2.5 times greater risk of MDS. The association was even greater for people specifically exposed to insecticides and even greater for those exposed to the herbicide paraquat.

As for diet, those who ate meat more than five days per week had three times the odds of developing the disease compared to those who ate it less frequently, while those who ate more than two eggs a week had twice the odds compared to those who ate fewer eggs. Second, eating fruits more than five days per week decreased the likelihood of illness by nearly half. Lastly, drinking more than 15 alcoholic drinks nearly doubled the odds of developing MDS.

Of course, this was a small and retrospective study, meaning it relied on participants to recall their chemical exposure and dietary habits. A stronger prospective study in 2009 followed 471,799 men and women ages 50 to 71, and after about six years, found no association between meat, fruit or vegetable intake and MDS. The researchers did, however, find an association between obesity and smoking and MDS. Although that study didn't assess pesticide exposure, a 2014 analysis of 11 studies did. It found that exposure generally doubled the odds of MDS, although the connection was lower in the United States than Europe and Asia.

While I would like to provide dietary guidance, there simply are no studies specifically about diet for MDS patients. That said, you might want to consider organic food in order to avoid pesticides that could increase the risk of future stem cell mutations. If you smoke, obviously, you should stop, and if you have more than two drinks per day, you should decrease your intake. Increasing your fruit intake may also be helpful, as might weight loss and exercise.

Overall, take the best possible care of yourself. Your questions suggest you're already doing so.

(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 older brother was experiencing abdominal pain and nausea, and when he went to his doctor, he was told he had a "hot" appendix. But instead of surgery, he was treated with antibiotics. Is this safe? Shouldn't his appendix have been removed?

Dear Reader: You're correct that surgery has long been the go-to method of dealing with appendicitis. The first successful appendectomy was actually performed in London in 1735, to remove the perforated appendix of a young boy who had swallowed a pin. (And this was pre-anesthesia, so you can imagine what a grueling procedure that must have been.)

Since that time, surgical techniques have advanced to the point where, by the late 1990s, traditional open surgery had given way to the less invasive laparoscopic approach. Now, medicine is revisiting the idea of treating the existing infection in the appendix -- that's where the antibiotics come in -- rather than pre-emptively removing the organ.

The appendix is a thin, tubular pouch, about 2 to 4 inches long in adults, which descends from the colon on the lower right side of the abdomen. Since it has no obvious purpose, it has been the subject of scientific speculation pretty much from the moment it was first identified. However, according to the most recent findings, the appendix is more complex and more important than was previously thought. Research shows that it's the site of vital cellular activity during fetal development. In adults, it appears to have a role in immune function.

An inflamed or infected appendix is a medical emergency. That's because, if left untreated, the buildup of infectious materials inside of it can cause it to become perforated or even burst. If that happens, the contents of the appendix will spill into the abdominal cavity, which can lead to serious complications, like peritonitis. In cases of a burst or perforated appendix, surgery is always the primary treatment. Not only does the appendix need to be removed, the abdominal cavity must be cleansed to prevent infection.

When the appendix is merely inflamed, though, and when CT scans confirm that the organ is not in danger of bursting, treating the existing infection with antibiotics becomes an option. Patients say they opt for this treatment because they want to avoid the risks of surgery and the resulting time spent recovering from the procedure. They are also drawn to the lower cost of the antibiotics option. And while studies support the use of antibiotics in treating uncomplicated acute appendicitis, the approach has its drawbacks.

A study published in the Journal of the American Medical Association in 2015 compared the outcomes patients who underwent appendectomies with those who underwent treatment with antibiotics. In the group that had the surgery, all but one of the 273 surgical patients had successful outcomes. Among the non-surgical group, 70 of the 256 patients -- that's 27 percent -- had a recurrence and required surgery within the next 12 months. Still, for the other 186 patients, antibiotic therapy spared them the risks and costs of surgery.

Of course, every person's circumstance is unique. We're assuming your brother had a conversation with his doctor about the best treatment for him, and we would encourage others to do so as well.

(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 doctor wants me to take amiodarone for my heart. But the potential side effects scare the heck out of me: possible death, permanent blindness, liver problems, thyroid problems. Should I do catheter ablation instead? My doctor says my fears are unwarranted.

Dear Reader: I can understand your concerns regarding amiodarone; the potential side effects do sound alarming. But keep in mind that the drug has been used for many years to help control the heart from going into abnormal rhythms and, unlike other medications used to maintain normal heart rhythm, amiodarone is less likely to cause abnormal heart rhythms, meaning that it is less likely to lead to sudden cardiac death. Because of this, amiodarone is the most commonly prescribed anti-arrhythmic medication.

That doesn't mean one should discount the possible side effects. First, amiodarone can be toxic to the lungs, causing an inflammatory reaction that leads to cough, shortness of breath, weight loss and chest pain. Lung toxicity occurs 5 to 15 percent of the time at doses higher than 400 milligrams per day, but only 1.9 percent of the time at doses of 150 to 330 milligrams per day. Because amiodarone is stored in fat cells, it may take months for the symptoms to begin to reverse, so afflicted patients will need to take prolonged courses of oral steroids to decrease inflammation.

Amiodarone can also affect the thyroid, causing low or high thyroid levels in the blood. Low thyroid levels are most likely, occurring in up to 20 percent of patients on high doses of the medication, but in only 3 to 4 percent of patients taking lower doses. High thyroid levels can result up to 3 percent of the time. Because of these effects, you should have your thyroid levels checked before starting amiodarone and every six months after starting the medication.

As you mentioned, the drug can also cause nerve dysfunction in the eye, leading to blindness, though this is rare. Amiodarone can also affect other nerves of the body, leading to tremors, loss of sensation and loss of bodily control. This happens much less frequently at lower doses, but still occurs about 4 percent of the time. Further, the drug can elevate blood tests for liver enzymes, with some people developing significant liver inflammation. As with the thyroid, you should monitor your liver function every six months while taking amiodarone.

A host of minor side effects include nausea, skin reactions and urinary difficulties.

You mentioned considering catheter ablation, which is sometimes performed for abnormal heart rhythms. In this procedure, an energy source is used to destroy the portion of the heart causing the abnormal rhythm. However, with some heart rhythm problems, such as atrial fibrillation, catheter ablation may initially convert the rhythm, but after one year the atrial fibrillation returns in up to 60 percent of patients. Using amiodarone before and after the catheter ablation can significantly increase the rate of success for the ablation. So, if you have atrial fibrillation, you may benefit from both amiodarone and catheter ablation.

I'm not certain what type of heart condition you have or why your doctor recommends amiodarone specifically. But it is indeed a good medication for preventing abnormal heart rhythms. Just be sure you're monitored closely for lung toxicity, thyroid abnormalities and liver inflammation.

(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.)