Dear Doctor: I've heard that people can die from a broken heart. Is that really possible?

Dear Reader: We think you're referring to a condition known as "broken-heart syndrome," which has been in the news recently thanks to the unique backstory of an otherwise technical and wonky article published in The New England Journal of Medicine. The scientific name for broken-heart syndrome is "Takotsubo cardiomyopathy," also referred to as stress cardiomyopathy. Most people who experience broken-heart syndrome will recover. In some rare cases, though, it can lead to death.

The article that got so much attention examined the case of a 61-year-old woman in Texas who, upon waking up one morning, had such bad chest pain that she went to her local emergency room. Because her symptoms seemed to indicate a heart attack, she was promptly airlifted to a cardiac care hospital in Houston. However, a series of medical tests there took an unusual turn.

Although the woman's blood chemistry findings and altered heart rhythms were consistent with a heart attack due to coronary artery disease, doctors were startled by the scans of the woman's heart. Unlike in a heart attack, in which the heart muscle is starved of oxygen due to blockages in the major arteries, this woman's arteries were clear. What further tests did suggest was a classic case of Takotsubo cardiomyopathy.

The patient's left ventricle, the main pumping chamber of the heart that sends blood throughout the body, had stopped working properly. Instead of working at 100 percent capacity, the blood flow from the left ventricle was significantly compromised. The precise reasons for this phenomenon aren't yet known. Researchers suspect that a combination of stress hormones released during a particularly difficult physical or emotional incident stun the heart and alter its function.

The truth is the condition isn't all that rare. Up to 2 percent of the 735,000 Americans who have a heart attack each year go on to get a diagnosis of stress cardiomyopathy. The vast majority are women over the age of 50. The thinking is that after menopause, vanishing protection offered by estrogen leaves women more susceptible to this type of heart condition.

While taking the Texas woman's medical history, the hospital team learned what had pushed her into an emergency situation. Already worried about her son's upcoming back surgery and a son-in-law's recent job loss, the woman was left inconsolable after the death of one of her closest companions, her Yorkshire terrier. She and her husband considered the little dog to be a family member. When the Yorkie passed away, it broke her heart.

Once the diagnosis was made, the path to appropriate treatment became clear. Doctors put the woman on a medication called an ACE inhibitor, which widens the blood vessels. They also prescribed a beta-blocker to address her high blood pressure. A month later, tests showed significant improvement. And the very good news is that, a year later, the woman's symptoms have not returned.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctor: Like millions of other women, I've always slathered myself with moisturizers and creams without paying any attention to the ingredients. But recently I read that the parabens found in these products have also been found in breast tissue. Should we rethink our use of these creams?

Dear Reader: That's a smart question to ask. Before we explore the data, let's take a look at what parabens are and what they do. These are chemicals used as preservatives in commercial moisturizers, shampoos, shaving gels, sunscreens and makeup. They were first used nearly 100 years ago to preserve drug products and are still used to preserve drugs applied to the skin, injected into veins and taken by mouth. Lastly, parabens are used as a preservative in multiple food products.

Parabens are good preservatives because they have antibacterial properties as well as activity against yeast and molds. They also don't allow water to enter or break down the product they are preserving. Parabens are relatively inexpensive to make and are considered generally safe for food consumption by the Food and Drug Administration and European Union.

The widespread use of parabens, however, leads to their deposit in unintended places. Parabens are found at various concentrations in indoor dust and air. The potential health effects are more concerning in children than in adults, because their ingestion rate of parabens from dust is five to 10 times higher. In addition, parabens can end up in wastewater, ultimately sending them into the water supply, agricultural soil and fish, which leads to higher paraben exposure through consumption of fish and food products. One good aspect of parabens is that they are quickly eliminated from the body, so it is less likely they will build up over time.

As for the health effects, the primary concern is about parabens' effect on sex hormones. Parabens can bind to estrogen receptors in the body, meaning they have an estrogenlike effect that could potentially raise breast cancer risk and impact fertility. They also can bind to testosterone receptors, potentially affecting male fertility as well. In rats, very high doses of parabens decrease levels of estrogen and testosterone and cause menstrual irregularities in females and alterations in sperm counts in male.

A study of 501 couples actively attempting pregnancy in Michigan and Texas supports concern over parabens. Researchers measured urinary levels of parabens in both men and women and found that women with the highest amounts of parabens in their urine had a 34 percent reduction in pregnancy compared to women with the lowest amounts in the urine.

Parabens have been found in both breast tumors and in the breast tissue adjacent to tumors. This doesn't mean that parabens cause breast cancer, but it also doesn't mean we should simply call them innocuous.

Also, in humans, higher levels of parabens in the urine have been associated with lower levels of thyroid hormones, although this potential link is clouded by the fact that women use more parabens than men and also have more thyroid problems. Lastly, parabens applied to the skin, in combination with UVB light, can increase the risk of skin damage and possibly skin cancer.

In short, parabens at current human exposure may not cause harm. But with greater use and with greater accumulation of parabens in our food and water supply, we should all ask questions about their future health effects.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctor: I just read about a study that says exercise cancels out alcohol's higher risk of death from cancer. Is it possible that I can walk off the cancer risk of the cocktail I have each night after dinner? (For the record, my husband is sure that you're going to say no.)

Dear Reader: While we commend your creative thinking, your husband has guessed right. In our opinion, you can't depend on added exercise to cancel out the increased risk of cancer that can be caused by alcohol consumption. It's not that we think the study itself is wrong. It's the way the results have been interpreted in some news stories -- as cause and effect -- that is, at best, misleading.

Let's start from the beginning.

Researchers in England looked at a decade of medical data collected from 36,370 women and men, all 40 or older. They sorted the study subjects by how much alcohol they consumed and by how much they exercised.

Not surprisingly, they found a statistical link between "hazardous drinking" and an increased risk of death from all causes, including cancer. In this study, hazardous drinking was defined as 8 to 20 servings of alcohol per week for women, and 21 to 49 servings of alcohol for men.

Then the researchers included exercise as a variable in their calculations. They found that among people who spent at least 150 minutes per week doing moderate aerobic activity, like a brisk walk, the mortality rate due to cancer dropped. This proved to be true even among the heavier drinkers, as long as they exercised.

On its face this seems to suggest, as many news reports went on to state, that exercise can cancel out the elevated risk of cancer due to drinking. But -- and this is crucial -- this is what's known as an observational study. That means the study is based solely on data collected from the same subjects over a period of time.

While studies like these are useful for pointing out the existence of certain patterns based on the information at hand, they can't be used to prove cause and effect. The level of exercise among the drinkers is just one among countless variables that can play a role in whether someone goes on to get cancer. These variables include genetics, family history, diet, environmental causes, and levels of stress and anxiety, to name just a few. Even how forthcoming and reliable the study's subjects were in self-reporting their drinking and exercise habits would have an impact on the outcome.

That said, what this study does do is add to the significant body of existing evidence that exercise plays a role in good health. Exercising may not automatically equal risk-free drinking, but people who exercise regularly do get some pretty great benefits. It can help maintain weight, aid in weight loss, bolster cardiovascular health and play a role in maintaining healthful blood lipid levels. It can also help with sleep and boost mood.

Get your husband on board and maybe instead of a nightly cocktail, the two of you can head outside after dinner for a companionable (and brisk) walk.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.)