Dear Doctors: My daughter is overdue for her second shot of the HPV vaccine, but I’m hesitant due to the pandemic because I want her immunity to be strong right now. Are you recommending people get this vaccine during COVID?

Dear Reader: The short answer is yes, we strongly encourage everyone to receive all of their routine vaccinations at this time, including the series for the human papilloma virus, also known as HPV. Although vaccines work by interacting with the immune system, each one is specific to a certain infectious agent. The HPV vaccine creates antibodies to the human papilloma virus. That means it will not interfere with the immune system’s ability to respond to the coronavirus that causes COVID-19.

The human papilloma virus refers to a large group of related viruses. Most cause warts on various parts of the body. The viruses are divided into low-risk types, which are rarely dangerous, and high-risk types, which can develop into cancers. These include cervical cancer, cervical precancer, certain throat cancers, anal cancer and cancers of the penis, vulva and vagina.

Taken together, HPV infection causes up to 40,000 cases of cancer each year. This includes 11,000 cases of cervical cancer, which cause 4,000 deaths each year. Cervical precancer, which means abnormal cells are present on the cervix, affects almost 200,000 women each year. Treatment to prevent more advanced cases of cervical precancer from progressing to cancer include cryosurgery or laser therapy to freeze or burn away the cells. These treatments can limit the patient's future ability to have children.

The good news is that the HPV vaccine, which was introduced in 2006, is extremely effective at offering protection from the virus. Widespread vaccination could prevent more than 90% of cancers that are now caused by HPV. Younger patients between the ages of 9 and 14 will be protected by two doses of the vaccine, with the second dose given six to 12 months after the first. Three doses are recommended for individuals between the ages of 15 and 24, with the second dose given two months after the first and the third within six months of the first. It can be a little confusing, but your health care provider will advise you on the optimal schedule for each child according to their age.

We heard from another reader, who asked us to discuss HPV and colon cancer. Although the role of HPV in anal cancer is well-established, a potential link to colon cancer has been a source of controversy. That may be changing. A study published by the National Institutes of Health found HPV infection is common in patients with colorectal cancer. The study reported that HPV infection was often found in colorectal cancer tissues, as well as tissues adjacent to the cancers. Analyses of data in Europe, Asia and South America also found a higher incidence of colon cancer among individuals infected with HPV. With a recent increase of colon cancer among younger adults, research into a potential link is increasing and may soon lead to a more definitive answer.

(Send your questions to askthedoctors@mednet.ucla.edu. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctors: Our grandmother, who is 91, fell and broke her left hip. She wound up needing a partial hip replacement. I’ve read that hip fractures are dangerous for older adults. Can you explain why? Is she still at risk, even though the surgery went well?

Dear Reader: A hip fracture is a serious and yet common outcome when an older adult has a fall. It occurs due to the progressive decrease in bone mass that often affects women and men as they age. Another risk for hip fracture is osteoporosis, a skeletal disease marked by a loss of bone density, which leaves bones porous, thin and brittle.

Because of the hormonal changes that occur during menopause, women are at increased risk of developing osteoporosis. (Although it’s more common in women, men can develop osteoporosis, as well.) These skeletal changes are reflected in hospital records, which show that more than 300,000 adults over the age of 65 are admitted each year due to a hip fracture, nearly all the result of falling, usually sideways.

Unfortunately, it’s true that a hip fracture in older adults can contribute to poor outcomes, including an increased risk of death. A number of factors play a role. These include the age of the patient, their sex, and the health problems the person was living with before the fracture, such as cardiovascular, pulmonary or neurological issues; diabetes; declining cognition or frailty.

Most hip fractures in older adults require surgery to restore mobility and to manage pain. This puts patients at risk for a range of post-surgical complications, including infection, blood clots in the lungs or legs, bedsores, urinary tract infection and pneumonia. Recovery for adults who are older or frail can take months. This often leads to further loss of muscle mass, which then increases the risk of a subsequent fall. Due to the length of recovery, a hip fracture also often leads to a decrease in independence.

Following surgery, many patients are surprised to learn that physical therapy starts almost immediately. It’s an important part of the recovery process. Not only does physical therapy help patients regain mobility, but it also helps prevent the more serious complications associated with being immobilized, such as infection, developing a blood clot or pneumonia. Proper nutrition, with adequate protein, also plays a role in recovery. So does occupational therapy. It keeps the patient mentally and emotionally engaged, and can lessen the risk of depression.

One factor that can go overlooked, particularly among older adults, is pain management. It’s crucial to an optimal recovery. Make sure your grandmother’s pain levels are being clearly communicated, and that her health care providers are responding appropriately. It’s useful for her to think of pain in terms of a scale of 1-to-10, and important for her to communicate to her doctors and nurses what she is experiencing.

Unfortunately, many older adults won’t return to their same level of activity and independence following a hip fracture. Your family should be prepared to make arrangements to get your grandmother the future help she will need.

(Send your questions to askthedoctors@mednet.ucla.edu. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctors: I had this scary episode happen where all of a sudden, it felt like the world wasn’t real. My heart was racing and I thought I was going to pass out. The friend I was with said it was probably a panic attack. Is there any kind of treatment? I really don’t want that to happen again.

Dear Reader: Not a day goes by in our practices without there being a discussion about anxiety or panic with at least one of our patients. In fact, the data collected by internet search engines shows that searches for the keywords “anxiety” and “panic,” which began to rise in March, have surged in recent weeks. Considering the length of time we have all been dealing with the many uncertainties of life during the pandemic, as well as the social isolation that it has caused, it’s not surprising that the rigors of this strange new normal are taking a psychological toll.

From what you described, it does sound like you had a panic attack. These often occur as an acute manifestation of anxiety. In addition to major life stresses such as a grave illness, job loss or the death of a loved one, people with a family history of anxiety disorders may be at increased risk of experiencing a panic attack.

The symptoms, which appear suddenly, include the rapid heartbeat and shortness of breath that you described. Additional symptoms include sweating, heart palpitations, chest pain, weakness, chills, nausea, stomach pain, numbness in the fingers or hands and trembling. For many people, a panic attack is accompanied by an extreme emotional or psychological response, which can include the feelings of unreality and disconnection that you experienced. People also report feelings of looming peril and of hopelessness. Most share your distress at the thought of having to navigate another panic attack in the future.

The first thing to know is that no matter how intense the experience, it’s temporary. If you should find yourself having another episode, try closing your eyes, bring your awareness inward and focus on taking deep, steady breaths. Breathe in deeply through your nose, to the bottom of your lungs, hold your breath for a beat or two, and then breathe out just as slowly. Some people find it helpful to count from one to five on each inhale and exhale. Be careful not to hyperventilate, which can make you feel worse.

Although a panic attack is frightening, it’s not dangerous. However, due to an overlap in symptoms with other health problems, such as a heart attack, getting a professional opinion is important. In addition to breathing techniques, many people find cognitive behavioral therapy, yoga and mindfulness to be helpful. Lifestyle changes, such as getting regular aerobic exercise, spending time in nature and steering clear of caffeine, nicotine, alcohol and recreational drugs, can make a difference.

If you continue to struggle with panic attacks, your doctor may prescribe anti-anxiety medications. Some of these can be addictive, though, and some have potential for abuse, so we discourage taking that path unless all other approaches have failed to bring relief.

(Send your questions to askthedoctors@mednet.ucla.edu. Owing to the volume of mail, personal replies cannot be provided.)