Dear Doctor: A month ago, our 69-year-old mother became nauseated and had pain in her jaw. Then she got so weak that my brother made her go to the ER. It turned out she’d had a heart attack. She never had chest pain, so she had no idea anything bad was going on. Is that common?

Dear Reader: The scenario you’ve described could happen to at least half of the world’s population -- women. The symptoms of a heart attack in women can be very different from those in men, often with little or no overlap. A woman has a 50% higher chance of her heart attack being misdiagnosed than a man, according to the Centers for Disease Control and Prevention. Many women having a heart attack won’t get appropriate or timely treatment.

Heart attack is the term used to describe what happens when delivery of oxygen and nutrients to the heart is interrupted. This occurs when something stops or slows the flow of blood through a crucial network of vessels that surround the heart, known as coronary arteries. The blockage, which can be caused by a blood clot, plaque or a narrowing of the vessels, prevents blood that is rich in oxygen and nutrients from reaching the heart tissues. Without this blood flow, the heart muscles begin to die.

Recent research into heart disease in women has found that female patients’ major arteries are often clear of plaque, but that the smaller coronary blood vessels are adversely affected. This also results in a decrease or stoppage of blood flow -- and therefore oxygen and nutrients -- to the heart. Women with this type of coronary blockage will have seemingly normal angiograms, which adds to the diagnostic challenges.

With quick treatment after a heart attack, permanent damage can be limited. However, fewer women than men survive a first heart attack, due in part to their symptoms not being recognized. Unlike men, who often have the so-called “Hollywood heart attack,” with pain or numbness in the left arm followed by sudden and sometimes crushing chest pain, heart attack symptoms in women are subtler. They include the nausea, jaw pain and exhaustion that your mother experienced; pressure in the chest that doesn’t read as pain; indigestion or heartburn; pain in the throat, neck or back; vomiting; or shortness of breath. Women experiencing these symptoms should seek emergency medical care and state clearly that a heart attack is suspected.

Factors that increase heart attack risk for women -- and for men -- include smoking, high blood pressure, poor diet, being overweight, physical inactivity, diabetes and family history. To reduce risk, lifestyle changes are key. Eat more plant-based foods, limit animal fats, exercise, drink in moderation, maintain a healthy weight and don’t smoke. If possible, add some stress-reduction activities, such as meditation, yoga or hiking.

(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.)

Hello again, dear readers, and welcome to the monthly letters column. Although it’s almost autumn, the heat waves keep on coming. Please take precautions. Stay hydrated, avoid peak heat hours and use your fans or air conditioning. If needed, seek out air-conditioned public places, such as shopping malls, libraries or local cooling centers. And now, your letters:

-- A reader whose mother has reached the age of 100 without eating vegetables wonders if this means she can skip that food group as well. “My mother, who speeds down the hall with her walker at an assisted living facility, has shunned vegetables her entire life,” she wrote. “She enjoys candy, cookies and bacon. I have inherited her distain for vegetables, but I force myself to eat them. Might I also forgo vegetables?”

While reaching 100 shows that her mother is doing something right, we just cannot ignore the abundance of literature supporting the health benefits of vegetables. Our advice -- we’re sorry! -- is to please keep eating them.

-- Many of you wrote regarding a column about gallstones. A reader from Hazelton, Pennsylvania, asked about a drug regimen to shrink gallstones.

“After numerous surgeries, my MRI shows I have gallstones,” he wrote. “I’m afraid to have another surgery and have asked to be put on ursodiol to shrink the gallstones, but my doctor ignores my request. Would ursodiol affect gallstones?”

Gallstones are crystalline masses that form within the gallbladder and interfere with function. Ursodiol, a bile acid taken as an oral medication, will reduce certain gallstones. It’s a conservative approach, and instead, most patients opt for cholecystectomy, a laparoscopic procedure to remove the gallbladder. Since you want try ursodiol first, make that very clear to your physician. Ask direct questions: Will ursodiol help my specific case? If the answer is no, ask why. If the answer is yes, request a prescription. If you don’t get clear answers, consider taking your test results to a different physician.

-- A reader with Grover’s disease, a challenging skin condition marked by raised red bumps on the body that are very itchy, offered a suggestion:

“I discovered that applying a thin coating of mentholated petroleum over the bump does two things for me,” he wrote. “First and fabulous, the itching pain ceases immediately. Second, over two to four days, the bumps dry up and don't spread, as they do if one scratches them.” This advice comes from an engineer who reports he has tried numerous approaches.

Thank you again for taking the time to send us your questions, comments and kind thoughts. We love hearing from you and will see you here for another letters column next month.

(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 had a yeast infection, and even though I did everything the doctor told me to, it has come back twice. What causes a yeast infection? How do I keep from getting another one?

Dear Reader: About three-quarters of all women are regrettably familiar with the unique torment of a vaginal yeast infection. Also known as vaginal candidiasis, it’s a condition that occurs due to an overgrowth of a species of Candida fungus, most often Candida albicans. The result is irritation, discharge, odor and a nonstop, maddening itch.

An overgrowth of Candida can occur when something disrupts the pH balance within the vagina. This prevents certain bacteria naturally present in the vagina, including Lactobacillus, from successfully keeping the fungal growth in check.

Despite the discomfort, a yeast infection isn’t considered to be serious. Over-the-counter topical treatments like Monistat, which are used from one to three days, are usually quite effective. (Please note that many of these topicals are oil-based, which can weaken a latex condom and a diaphragm.) In more serious or persistent cases, oral fluconazole, a prescription medication, may be required.

When over-the-counter treatments don’t cure the infection, or when symptoms recur within eight weeks, it’s important to seek a medical opinion. Several other conditions, including a vaginal infection known as bacterial vaginosis, and trichomoniasis, a common sexually transmitted disease, may have similar symptoms to a yeast infection, but require different treatments.

Causes of a yeast infection include the use of oral antibiotics, which affect the balance of bacterial colonies throughout the body. Spermicides can adversely affect the vaginal environment, as can the prolonged use of tampons. Glycerin, which is present in many lubricants, can be a contributing factor in yeast infections. The mouths of up to half of adults contain Candida albicans, which has led researchers at the University of Michigan, Ann Arbor to link oral sex to an increased risk of developing a yeast infection. The hormonal changes that occur during pregnancy or menopause, a weakened immune system and high blood sugar can also be contributing factors.

To prevent yeast infections, remember that fungi thrive on warmth and moisture. Wear breathable underwear, and avoid prolonged time in a damp bathing suit, sweaty gym clothes or tight pants. If you use panty liners, change them frequently. Dry off thoroughly after bathing; don’t use douches or sprays, which adversely alter the chemical environment of the vagina; and steer clear of scented tampons, pads or other feminine products.

Unfortunately, about half of women will go on to have a second yeast infection, and an unlucky 5% are faced with recurrent vaginal candidiasis, which is four or more yeast infections per year. To reiterate: Whenever a yeast infection persists despite treatment, or when one recurs within a few weeks, contact your health care provider.

(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.)