Dear Doctor: I am a 72-year-old man and have been diagnosed with aortic regurgitation. My cardiologist said since I’m not experiencing any of the usual symptoms connected with this, he thinks I should just continue to monitor it until I do. What can I expect if and when I do start experiencing symptoms?

Dear Reader: Aortic regurgitation is a condition in which the aortic valve in the heart isn’t closing properly. The aortic valve separates the left ventricle, which is the lower pumping chamber of the heart, from the aorta. When functioning properly, it’s a one-way valve that closes completely between heartbeats. As with the other three cardiac valves, the main job of the aortic valve is to maintain the one-way flow of blood through the heart.

When someone has aortic regurgitation, the valve isn’t closing tightly. This allows a portion of the oxygen-rich blood, which the left ventricle had just pushed into the aorta during a heartbeat, to flow back into the chamber as the ventricle relaxes. The leakage interferes with optimal blood flow through the heart and throughout the body.

As a result of inadequate blood flow, which delivers oxygen to the tissues of the body, people with aortic regurgitation can become easily fatigued and out of breath. In order to compensate for the glitch in the system, the heart will begin to work harder. Over time, this can cause the left ventricle to become enlarged. It can also cause a condition known as hypertrophy, which is when the walls of the ventricles thicken due to the extra work they’re being asked to do. These structural changes make the left ventricle less efficient and add to the burden on the heart.

Aortic regurgitation is often symptom-free when it is mild. It is typically detected when a physician listens to the heart and hears the tell-tale sounds of a leaky valve. As the condition begins to worsen, symptoms can include the fatigue and shortness of breath that we mentioned, as well as chest pain, irregular heartbeat, swelling in the feet and ankles and difficulty breathing when lying down. These are what your physician will be looking for. In more severe cases, diastolic blood pressure -- that’s the bottom number -- becomes low and is often accompanied by a forceful heartbeat, known as a “bounding” pulse. Some people may experience severe light-headedness that can lead to fainting.

The decision to monitor your condition without a surgical intervention at this time is known as watchful waiting. In making that choice, a cardiologist weighs a number of factors. These include the severity of the individual’s condition, the appearance of their heart as obtained through scans, and the person’s general health. When someone does need surgery to repair or replace an aortic valve, it can often be done via a catheter that is threaded through a vein. Although this is a minimally invasive procedure, it’s still surgery and, therefore, carries some risks.

If you begin experience any of the more advanced symptoms that we have discussed, it’s important to seek out 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.)

Dear Doctor: My daughter got a rash across her cheeks that we thought was an allergy. A year later, she was diagnosed with lupus. She’s only 17, and the doctors keep putting her on different meds, which worries her dad and me. I’ve been reading that ginger can be helpful. What do you think?

Dear Reader: Lupus is what is known as a chronic autoimmune disease. That means it’s a long-term condition in which the immune system, which isn’t behaving properly, has begun to attack the body’s own tissues. There are several forms of the disease, but the most common is systemic lupus, which can affect the joints, skin and certain internal organs, including the heart and kidneys.

Although anyone can develop the disease, about 90% of people with a form of lupus are female. It usually appears between the ages of 15 and 44, which are a woman’s reproductive years. Genetics plays a part, and people who have a family member with lupus, or another kind of autoimmune disease, are at higher risk of developing it. It’s also more common in people of African American, Native American, Asian, Latino and Hispanic descent.

The rash that you noticed on your daughter’s face is one of the classic signs of a flare, or episode, of systemic lupus. Known as a butterfly rash, it looks somewhat like a localized sunburn that affects the upper cheeks and spreads across the bridge of the nose. Additional symptoms can include fatigue; swelling, pain or stiffness in the joints; chest pain; dry eyes; and other types of rashes.

Treatment consists of managing symptoms, which, as you have discovered, can require a number of medications. They address issues such as blood clots, inflammation, immune system response, fluid retention, infections and high blood pressure. Each case of lupus is different, with different levels of severity and varying symptoms. As a result, a shifting range of medications can be required. This can be daunting, and even alarming, and we encourage you to discuss your concerns with your daughter’s rheumatologist.

As to your question about ginger, there’s an interesting new study led by researchers from the University of Michigan. When they looked into the effects of 6-gingerol, the main bioactive compound in ginger, they found evidence it inhibited a specific mechanism associated with abnormal clot formation. Mice that were given 6-gingerol had lower levels of sticky, weblike proteins known as neutrophil extracellular traps, or NETs. These play an important role in immune function. In autoimmune diseases, however, NETs become overactive. After giving the mice 6-gingerol, the researchers noted that the formation of blood clots was markedly reduced.

While this research is exciting, and even encouraging, it’s only an early step in a long process. More research is needed in animal models, and then, if that continues to be promising, with humans. In the meantime, your daughter should continue to make regular visits to her rheumatologist and use the medications prescribed. Her doctors will monitor her disease and recommend the treatment protocols that her specific type of lupus requires.

(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: What can you tell me about the new monthly HIV treatment that was recently approved? My uncle has been living with HIV for almost 25 years. He’s a senior citizen now, and growing forgetful about all of the meds he’s on.

Dear Reader: You’re referring to a monthly injectable HIV treatment that was just given the green light by the U.S. Food and Drug Administration. It’s an extended-release drug -- the first of its kind to win FDA approval -- and it will be a game-changer for a lot of people living with HIV. The treatment, which comes in a two-shot combination, isn’t for everyone, and it comes with some caveats.

Human immunodeficiency virus, or HIV, is a virus that attacks the immune system. Left untreated, it can cause the disease we know as AIDS, or acquired immunodeficiency syndrome. It’s most often spread through unprotected sex or sharing syringes with an infected individual. It can also be acquired in a medical setting via infected blood products. However, since the implementation of HIV testing of blood products and donated organs, this type of transmission is rare. While mother-to-child transmission during pregnancy, labor or breastfeeding is also possible, effective interventions have lowered that transmission rate to less than 5%.

At this time, about 1.2 million people in the U.S. are living with HIV. About 14% of them -- that’s 1 in 7 -- aren’t aware of their HIV-positive status.

Until the advent of antiretroviral therapies in the early 1990s, the average life expectancy of someone with AIDS was one year. Thanks to antiretrovirals, HIV/AIDS became a manageable chronic condition. At first, to prevent the virus from replicating and to limit drug resistance, treatment consisted of multiple medications taken throughout the day. This eventually changed to fewer pills, but for certain patients, including some older adults, this was still a challenge.

The newly approved drug, known as Cabenuva, is a complete regimen that gets injected once a month. It allows patients, like your uncle, to improve their compliance. They go from having to remember to take their medication 365 times per year to receiving the treatment monthly. Cabenuva combines an existing drug with a new drug, packaged together and given as two separate shots. An every-other-month regimen, which is already available in Europe, is being tested in the U.S. The FDA also approved the new drug in tablet form, to be taken for a month prior to starting the injectable therapy. The goal is to prep the body for a smooth transition to the injectable drug.

As with all drugs, the new injectable therapy has potential side effects. These include fatigue, headache, joint and muscle pain, swelling at the injection site, rash, dizziness and trouble sleeping. Cabenuva is meant for people who are already on a successful HIV/AIDS regimen, with no previous treatment failure, and who have no history of resistance to the antiretroviral drugs in the injectable. The therapy, which is eligible for insurance coverage, cannot be administered at home and requires monthly clinic visits.

(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.)