Dear Doctors: I have been having anxiety, and now my blood pressure is getting high, too. Are they related? I understand that medications might become necessary, but I would prefer to try nonmedical treatments first. Can you recommend supplements that can help to reduce these issues?

Dear Reader: You've asked about two topics that will be of interest to a large number of people. Health data show that close to half of all adults in the United States have high blood pressure. According to the latest guidelines, this is defined as systolic blood pressure (that's the top number) readings of 130 mmHg or more, or diastolic blood pressure (that's the bottom number) greater than 80 mmHg.

When it comes to anxiety, that is a condition that is estimated to affect close to one-fifth of us, making it the most common mental health issue in the U.S. And while anxiety doesn't always lead to high blood pressure, it can be a contributory factor for some people. Surges of anxiety can cause blood pressure spikes, but these are typically temporary. Over time, however, chronic anxiety can begin to have an adverse effect on someone's baseline blood pressure.

We understand your desire to manage each of these conditions without the use of medication. At the same time, we are glad you understand that in order to safeguard your long-term health and well-being, medication may become necessary.

To that end, we think it's important that you bring up your concerns about anxiety and blood pressure with your medical care provider. If your blood pressure isn't dangerously or chronically high, they can offer guidance as you make lifestyle changes to improve it and accurately assess and track the results. These include regular exercise, improving diet and avoiding stress. They will also advise if delaying medication might become a health risk.

Regarding supplements, there are several that can be potentially helpful. For anxiety, these include magnesium, ashwagandha, lemon balm, chamomile, l-theanine and valerian root. Supplements such as garlic, green tea, magnesium and l-arginine can be useful in improving blood pressure. But don't go it alone. Always check with your doctor when adding supplements to your daily regimen. Some can interact or interfere with medications, or they can have adverse side effects. Getting guidance with dosages is important, as well.

When talking about these issues with our own patients, we emphasize that supplements, however natural, should never be the sole approach. This holds true for both anxiety and blood pressure. With anxiety, it's important to identify any specific triggers that lead to that feeling. This awareness can then help you understand the root cause. With this knowledge, you can make the appropriate changes in your life that can begin to bring relief. Additional natural approaches can include meditation, mindfulness, deep breathing, yoga, weightlifting, running or other aerobic exercise. Each of these have been shown to help.

Sleep is also extremely important. Studies have linked poor sleep to both anxiety and elevated blood pressure. And please don't discount therapy or, if needed, appropriate medication.

(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: 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.)