Dear Doctors: Our grandfather is 84 and has prostate cancer. He has been declining and has asked to stop treatment. He and his doctors decided that he will begin hospice care. What happens in hospice care? How do you choose a provider? We hope this can be done at home.

Dear Reader: When someone lives with a serious illness, they are faced with an ongoing series of decisions regarding their medical care. For some people, this eventually includes the choice to discontinue treatment. It may be that the available interventions are no longer effective, or that they interfere with the individual's desired quality of life. When this occurs and doctors have determined that the person is nearing the end of their life, hospice care becomes an option.

The words “hospice care” may bring to mind a nursing home or other type of facility. And while some medical facilities are devoted to hospice care, the term actually refers to a specific type of end-of-life medical care.

When someone enters hospice care, it means that the treatments, medications and procedures that had been employed to stop or slow disease progress are no longer used. Instead, the focus shifts to addressing the person's physical, mental, emotional and spiritual needs as they navigate the final stages of illness.

Medications and treatments may still be part of hospice care. So may specialized equipment and supplies. However, they do not treat the disease itself. Instead, they are used to manage pain, discomfort and other symptoms or side effects that may be present due to the disease or condition. The goal is to bolster the patient's physical and emotional well-being as they near the end of life. If appropriate, spiritual support is offered, as well. While hospice care acknowledges death as an endpoint, it doesn't postpone it. And it never takes any steps to hasten it.

As we mentioned, some hospice care is carried out in a specialized facility. However, it can also take place at home. In those cases, it is offered by a specialized hospice care provider. Programs may be run by independent nonprofit organizations, or they can be affiliated with hospitals, nursing homes, religious institutions or home health care agencies. There are also some for-profit providers.

The practice of hospice care involves a team approach. It typically includes nurses, doctors, home care aides, a spiritual adviser, social workers and case managers. Offering help and support to family members is an important component of hospice care. This can include something known as respite care. This is when family members, who are the primary caregivers in home hospice care, are given time away to recharge and regroup.

Most communities have at least one hospice care provider. Your medical care provider and the person overseeing a patient's discharge from the hospital can offer information on available options. The departments of health or social services of each state also maintain a list of licensed agencies. National organizations, including the National Hospice and Palliative Care Organization or the National Association for Home Care and Hospice Care, are also excellent resources.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctors: I had severe pain in my neck and couldn't turn my head. I saw an orthopedist, and she diagnosed me with bone spurs on my vertebrae. Apparently, my choices are doing physical therapy, seeing a pain specialist or having surgery. Can you please talk about these options?

Dear Reader: Bone spurs, which are also known as osteophytes, are rounded, bumpy or knobby overgrowths that can develop on the surface of a bone. They form as the body's response to injury or skeletal instability and as a result of various forms of arthritis.

Osteophytes typically form at or near the juncture of a bone and a joint and in areas where a ligament or tendon attaches to a bone. When bone spurs occur in the vertebra of the neck, which is the cervical spine, they are known as cervical osteophytes.

In and of themselves, these bony growths are not painful. However, depending on their size, number and location, they can crowd or touch a nerve or the spinal cord. This can lead to symptoms such as numbness, tingling, muscle weakness, headache and dull, sharp or radiating pain.

Treatment for cervical osteophytes usually begins with a conservative and nonsurgical approach. This includes the use of medications and ice packs, along with rest, to reduce inflammation and manage pain. When over-the-counter drugs don't bring relief, prescription pain relievers, as well as stronger anti-inflammatories, may be recommended. Another option is the use of corticosteroid injections, which can also be effective for inflammation.

Problems with posture and alignment and deficits in structural support often play a role in the development of bone spurs in the neck. For those reasons, physical therapy to strengthen muscles that support the neck can be helpful. A physical therapist will also be able to evaluate your posture as you sit, stand and move. They can identify any bad habits that have developed and pinpoint potential movement triggers that make the symptoms worse. For some people, several sessions of physical therapy can bring relief. For others, it can become an ongoing part of managing the condition. Your doctor may also recommend integrative treatments, such as acupuncture or chiropractic adjustment, which can increase mobility and manage pain.

When the symptoms are severe enough and have failed to improve with more conservative treatment, surgery may become an option. There are several approaches, including some that are minimally invasive. Each involves the removal of excess tissues that are impinging on nearby nerves or the spinal cord. In some cases, it is possible that a compressed or damaged disc may need to be removed. The specifics of each person's condition, which include where on the cervical spine the bone spurs are located, will determine the optimal approach.

While this type of surgery can offer significant relief, there are also risks involved. These include nerve damage, blood clots, infection and injury to the surrounding tissues. It is always important to get a second opinion when opting for surgery, and to take great care in selecting a surgeon who is experienced in the intended procedure.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctors: I am baffled that what used to be a thorough and comprehensive physical exam is now just a few questions, taking some vital signs and a few blood tests. No checking your eyes, throat, glands or reflexes. No breast exam. Why has this changed? What constitutes a complete physical these days?

Dear Reader: The annual physical exam has long been considered a cornerstone of preventive health care. But as surprising as it may seem, there are no official guidelines as to what it should entail. At the same time, some doctors and medical practices have recently begun to move away from offering their patients a yearly checkup. This change has been prompted by several studies that, in parsing large troves of health care data, have questioned the efficacy of this yearly ritual. However, for both of us, the annual physical exam continues to be an important part of our practices.

Absent the existence of official guidelines for the annual physical, we can only discuss the specifics of our own approaches. We see it as an overall assessment of someone's general health and as a chance to reconnect with the patient. It's an opportunity for both the patient and doctor to take stock of the previous year and to assess any changes. It's also an opportunity to set new goals and plan for the future.

In our practices, the annual exam begins with a review of the person's medical history, along with any updates that are needed. This includes illnesses or injuries, vaccinations, medications prescribed by other doctors and mental health updates. Family medical history, including new instances of diseases such as certain cancers, coronary artery disease or Alzheimer’s disease get updated as well. Patients often deal with smaller, less pressing medical issues on their own. Adding information about these to their medical history can prove to be important for future visits.

When we conduct a physical exam, we review each patient's blood pressure, heart rate, weight and body mass index. If there have been significant changes, we address them. We explore possible causes and discuss changes to diet, medication or behavior that may be needed. When it comes to diagnostic tests, we order a complete blood count; tests that analyze liver, kidney and thyroid function; as well as diabetes and cholesterol screenings. We also check vitamin D levels. We review those results, discuss them with the patient and offer mitigations if needed.

When screening tests such as mammograms, Pap smears and bone density tests are called for, we recommend them to our patients. We also discuss the risks and benefits of the PSA test, which screens for prostate cancer. In keeping with newly updated guidelines, we recommend colon cancer screening with a colonoscopy for patients 45 and older.

The information collected in an annual physical exam can help patients get a better understanding of their physical well-being. It also provides a useful baseline against which future changes or anomalies can be evaluated. In our view, this yearly screening empowers patients, strengthens their relationship with their health care providers and paves the way to better health.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)