Dear Doctor: My wife and I appreciate your articles about ticks, and we wonder if you could talk about Rocky Mountain spotted fever? A friend of ours here in Arkansas got really sick from it, and since our family is big on outdoor activities, we want to know what to look for.

Dear Reader: We’re glad the information about tick-borne infections and illnesses has been useful. We get quite a few questions on the topic, which reflects the growing awareness of ticks and the health dangers associated with them.

Rocky Mountain spotted fever, or RMSF, is a potentially deadly disease acquired when an individual is bitten by a tick infected with the bacterium Rickettsia rickettsii. Depending on the region, the disease is spread by the Rocky Mountain wood tick, the American dog tick or the brown dog tick. Although it has been found across wide areas of the United States, Rocky Mountain spotted fever is most often reported in Oklahoma, North Carolina, Missouri, Tennessee and in your home state of Arkansas. It can also be found in parts of the American Southwest and in Mexico.

As with many tick-borne diseases, initial signs of RMSF can be general enough that they are easily attributed to other causes, including a cold or the flu. Symptoms commonly include fever, headache, abdominal pain, nausea, vomiting and lethargy. The rash that usually accompanies RMSF often develops between two and four days after the initial infection, which adds to the challenge of a swift and accurate diagnosis. The rash can take a variety of forms, from bold red splotches to tiny pinpoint dots.

Although a laboratory test is needed to confirm RMSF, the Centers for Disease Control and Prevention urge health care providers to commence immediate treatment when clinical signs and symptoms, as well as a thorough health and travel history, point to the disease. Immediate treatment is crucial in cases of Rocky Mountain spotted fever, and waiting for confirmation from a lab test can put the patient at risk.

The recommended treatment for RMSF is the antibiotic doxycycline. Early treatment can prevent serious illness and death. When left untreated, the bacterium that causes Rocky Mountain spotted fever can cause extensive damage to blood vessels throughout the body, which leads to tissue and organ damage. Death can occur in as little as eight days after the onset of symptoms. At this time, there is no vaccine for RMSF, which makes prevention the only way to avoid infection.

Summer is high season for ticks. These tiny arachnids can be as small as a poppy seed early on in their life cycle, and since a tick bite is usually painless, ongoing vigilance is key. At the risk of repeating ourselves, this includes avoiding densely wooded and brushy areas, covering exposed skin with light-colored clothes, wearing closed-toed shoes, tucking pants into socks, using appropriate pesticides and doing visual body scans, including of pets. And check into local resources. Many communities throughout the U.S. have vector control agencies, which are devoted to the identification and control of dangerous local pests, including ticks.

(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: Our granddad is 86 and wound up in the ER with extreme abdominal pain, which turned out to be gallstones. The doctors say he should have his gallbladder removed. Why? Isn’t that a big operation just to take care of gallstones?

Dear Reader: The gallbladder is a small, pear-shaped pouch that sits on the right side of the abdomen, just beneath the liver. It’s part of the biliary tract, which is a system of organs, ducts and vessels. The structures of the biliary tract -- sometimes referred to as the biliary tree -- secrete, store and guide a bitter greenish-yellow liquid called bile, which aids in the breakdown of dietary fat. Bile is secreted by the liver and is stored in the gallbladder. It’s a complex liquid with dissolved substances that aid in the digestion of fat and play a role in the elimination of certain waste products. When bile isn’t being used for digestion, it is stored in the gallbladder.

In some people, small hardened deposits known as gallstones may form. This often happens because of too much cholesterol, or when the gallbladder is unable to empty properly. People who are overweight or obese are at an increased risk of gallstones, as are those who live with diabetes. This is due to the higher level of triglycerides, a type of lipid, in the blood. Rapid weight loss has been known to trigger the formation of gallstones. So can fasting, which is one of the things that can prevent a gallbladder from adequately emptying. A tendency to form gallstones can also run in families.

Gallstones can irritate the lining of the gallbladder and lead to inflammation or infection. Because the gallbladder stretches and squeezes as it fills and empties, gallstones can also shift and move into the bile ducts. Although small stones can pass unimpeded, larger stones can become lodged and cause a blockage. This prevents the gallbladder from emptying into the small intestine.

Sudden and severe pain in the upper right section of the abdomen may be a symptom of a gallbladder attack. The pain can last just a few moments, or it can go on for hours. Pain in the upper back and the area of the right shoulder can also occur during a gallbladder attack. Urine may turn a dark yellow color, and the attack may be accompanied by nausea, vomiting and profuse sweating.

The most common treatment for a gallbladder attack is surgery. That’s because -- even when symptoms recede -- the stones are still there. This raises the risk of another blockage, infection and even rupture. The good news is that most gallbladder surgeries are now done laparoscopically, meaning that instead of an abdominal incision and an “open” surgery that can result in a weeklong hospital stay, the procedure is done with instruments and a camera that are introduced into the abdomen via small incisions. Patients typically leave the hospital in 24 to 48 hours, and are fully recovered in about two weeks.

(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: I’m 95 and was recently diagnosed with dementia. The doctor recommended a pill, but it’s not a cure. I don’t want to go through that illness for years, as it would be too hard on my daughter. Do you have any other suggestions? I do word search puzzles all the time.

Dear Reader: We were moved by your loving and thoughtful letter, which focused so much more on the welfare of your daughter than on what the diagnosis of dementia means for your own future. Living to 95 is quite an accomplishment, and we are sorry that you and your family must now face this new challenge.

"Dementia" is a general term used to refer to an array of progressive neurodegenerative diseases, of which Alzheimer’s is the most common. It’s true that patients now have access to several dementia medications, which work by bolstering chemical messengers in the brain that play a role in learning, memory, mood and judgment. However, the effects of these medications are often uneven, and, unfortunately, they are always short-lived. In addition, they can result in side effects such as nausea, fatigue, muscle aches, insomnia and headache.

A number of herbal and alternative therapies have been promoted as aids for dementia, but the data regarding their effectiveness is weak. If you do decide to explore alternative therapies, please be sure to let your medical care team know so you stay safe. It’s possible for certain herbs and supplements to interfere or interact with prescription medications.

In our individual practices, we focus on helping patients and their families with supportive care. This includes maintaining a consistent environment for the patient, whether at home or in a skilled nursing facility. Exercising the mind with reading, games and all kinds of puzzles, including the word search puzzles you’re already completing, has been shown to be helpful in delaying the onset of symptoms.

Avoiding social isolation is also crucial. It’s common for the elderly to withdraw from family and social life as they age, and this can become even more pronounced after a dementia diagnosis. We would urge you and your daughter to begin researching the community-based services that are available in your area. This will allow you to develop a support network appropriate for both your current needs and future ones. You will be able to connect with others who are facing a similar diagnosis, and your daughter will find a supportive community. The Alzheimer’s Association offers help with home and personal safety, recreational opportunities and quality of life factors. Educating yourself about dementia and its progress can help both you and your daughter prepare for the future.

It’s also important to make any financial or legal decisions, including documents like power of attorney, before things progress too far. A good starting place for more information on all aspects of dementia is the Alzheimer’s Association. You can find the website at alz.org.

(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.)