Dear Doctor: Can you please explain scoliosis? My 11-year-old daughter was recently diagnosed with it, and though it's mild, we're very worried. Why did she get it? Will she need surgery?

Dear Reader: Scoliosis is a condition in which the spine gradually takes on a lateral curve in the shape of either an S or a C. It can occur at any age, but scoliosis is most common in young people between the ages of 10 to 14. It's estimated that between 2 and 4 percent of youths will develop scoliosis during the growth spurt that accompanies the onset of adolescence. And while the condition is equally common in boys and girls, girls are 10 times more likely than boys to develop more severe spinal curvature.

Most cases of scoliosis are mild and require only ongoing monitoring of the existing curvature, making sure it doesn't escalate. In more severe cases, treatment with a brace or surgery is often required. For anyone who saw footage of her royal wedding last fall, the U.K.'s Princess Eugenie wore a low-backed dress designed specifically to show the scar from her own scoliosis surgery at age 12.

When someone has or is developing scoliosis, it becomes visible in their posture. Signs of the condition include uneven shoulders, visible differences in arm length, a shoulder blade that becomes more prominent than its partner, a tilted waistline, or uneven hips. In serious cases, the curving spine may cause the torso to rotate or twist. Since this affects posture, the condition can result in the rib cage pressing against the lungs and heart, which can interfere with breathing and cardiac activity. For adults who had scoliosis as children, chronic back pain can become a problem later in life.

The condition develops gradually and without pain, so it can be difficult to identify. Diagnosis typically begins with a neurological exam to assess strength and reflexes, and to check for numbness that occurs due to pinched nerves. This is followed by imaging tests to visualize the spinal structure.

The type of treatment depends on multiple factors, including the age and sex of the patient, and the location and pattern of the curve. For children with a mild curve and who are still growing, like your daughter, "watchful waiting" may be the most appropriate approach. In some cases, to prevent the condition from worsening, they may be fitted with a custom-made brace. In severe cases, when the spinal curvature is progressing rapidly or is causing pain or dysfunction, surgery may be required.

As for what causes scoliosis, the answer remains unclear. It has been associated with neuromuscular conditions like muscular dystrophy and cerebral palsy, can be a birth defect, and may occur as a result of spinal injury or infection. But the majority of cases are considered idiopathic, which means the root cause is unknown.

Emerging research suggests a link between some cases of scoliosis and a rare gene variant that may interfere with the absorption and use of manganese, a mineral required for growing bones and cartilage. Initial research, which was done on zebrafish, has been intriguing enough that further studies are already in the works.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctor: My wife and I love raw oysters. Whenever they're on the menu, we always order a dozen or even two. But I recently read that someone died from some kind of bacterial infection after eating them. Just how risky are they?

Dear Reader: We are aware of at least two instances in 2018 when someone died after eating raw oysters. The cause was infection with a bacterium known as Vibrio vulnificus, which lives in the same marine environments that support oysters. One of the deaths occurred in Florida in July, a time of year that warmer waters can encourage bacterial growth. In fact, there's an old saying that oysters should only be eaten during months that contain the letter "r," which excludes the late spring and summer months.

However, that bit of folklore is far from infallible. In warmer waters, the bacterium can be present throughout the year. And since oysters consume nutrients by filtering the water they live in, if Vibrio vulnificus is present, chances are the oysters will contain it. A state legislator from North Dakota, who ate raw oysters during a visit last year to New Orleans in the "r" month of October, ingested the bacterium and died.

Infection with Vibrio vulnificus is the leading cause of death in the United States associated with eating seafood. Symptoms typically begin between 24 and 48 hours after eating something contaminated with the bacterium. These symptoms include nausea, vomiting, fever, chills, diarrhea, skin lesions and shock. If anyone who has eaten raw shellfish experiences any of these symptoms, he or she should seek immediate medical care. Be sure to tell the physician or health care professional what was eaten and when.

The bacterium can attack on two fronts. Most common among individuals who ingest it in raw shellfish is a systemic blood infection known as primary septicemia. This infection can be life-threatening and must be treated in a hospital as quickly as possible.

Also, Vibrio vulnificus is a so-called "flesh eating" bacterium that can cause necrotizing fasciitis if it enters an open wound. This is a fast-moving infection that causes widespread tissue death. Treatment includes antibiotics and supportive care. For those who develop necrotizing fasciitis, aggressive wound therapy may include amputation. People with weakened immune systems are at greater risk from Vibrio vulnificus infection.

If you want to protect yourself, don't eat raw oysters or raw or undercooked seafood from coastal waters or estuaries. Lemon juice and hot sauce have no effect on Vibrio vulnificus.

For those cooking seafood at home, always throw away any oysters, clams or mussels with shells that have opened prior to cooking or shucking. In addition:

-- Boil in the shell for at least three minutes in order to kill the bacterium.

-- When steaming, cook for at least four minutes. Any oysters that do not open during cooking should go into the trash.

-- When frying or broiling, set the timer for at least three minutes. Broiled oysters need to be no more than three inches away from the heat source.

-- Baked oysters need at least 10 minutes in a 450-degree oven.

Always keep cooked and raw seafood separate to avoid cross-contamination. And, as with all cooking, wash your hands often.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctor: Last year, my best friend, who was home in bed with a bad case of the flu, died of a heart attack. He was fit, strong and relatively young -- only 42 years old -- and his death was a shock. But now research suggests having the flu actually increases the risk of a heart attack. Can we protect ourselves?

Dear Reader: We're very sorry for your loss and understand why it would be shocking. When we think of the complications that arise from the flu, it's usually something like an ear or sinus infection. When things get more serious, flu can lead to pneumonia.

However, inflammation caused by the influenza virus can affect the body in even more severe and unexpected ways. This includes developing encephalitis or myocarditis, which are inflammation of the brain and the heart respectively, or sepsis, a full-body inflammatory response that can lead to multiple-organ failure and death. Individuals with the flu can also sometimes experience a worsening of chronic medical conditions, such as asthma or heart disease.

Now, as you mention, researchers have uncovered what they believe is a surprisingly strong connection between influenza infection and heart attack. In a study published last year in the New England Journal of Medicine, scientists at the Institute for Clinical Evaluative Sciences in Toronto reported that in the seven days following a lab-confirmed diagnosis of influenza, heart attacks were six more times as likely as they were either a year prior to or following the diagnosis. The researchers arrived at this conclusion using details from hospital admissions in Ontario between 2008 and 2015. They analyzed data from individuals with confirmed cases of influenza, as well as 364 heart attacks.

According to the data, the hospital saw 3.3 heart attack admissions per week in the year before and after a flu diagnosis. But during the week of a flu diagnosis, the heart attack rate rose to 20 admissions per week. Of the 332 people in the study who had a heart attack during the seven-day window following a flu diagnosis, 69 percent had not received a flu shot that year. The data also suggested that individuals older than 65 were at a slightly higher risk than younger people of suffering a post-flu heart attack. Other acute respiratory infections can also increase heart attack risk, although not as sharply as influenza, according to the study.

Previous studies have tied influenza infection to a three-fold increase in the risk of stroke. This range of extreme complications is believed to arise in response to the sudden and systemic inflammation that accompanies an acute respiratory infection.

The best way to protect yourself against the flu is by getting your annual flu shot. Research has shown that hospitalizations and deaths are markedly lower among people who get a flu vaccine when compared with those who do not. People who get the flu despite being vaccinated tend to have milder and shorter illnesses. Anyone who experiences heart attack symptoms during or shortly after an acute respiratory illness, including chest pain, arrhythmia, shortness of breath, exhaustion or edema, should seek immediate medical care.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)