Dear Doctor: I am a 66-year-old female currently recovering from Rocky Mountain spotted fever. I was prescribed Vibramycin and Atarax. I stopped taking the Atarax after a few days because of the confusion that I was experiencing. I am wondering, though, if there are any lasting effects of this rare disease?

Dear Reader: The most important aspect of Rocky Mountain spotted fever (RMSF) is the need for early diagnosis and treatment. The bacterium that causes RMSF, Rickettsia rickettsii, is transferred to humans through a tick bite. The disease was first identified in the Rocky Mountains and can occur anywhere in North or Central America, but it's most commonly found in the southeastern United States. Each year, an estimated 2,000 to 4,000 cases are diagnosed in the U.S.

Ticks transmit the bacteria to humans during feeding, with symptoms occurring two to 12 days later. Early signs include nausea, fever, muscle aches, headache and abdominal pain, which in children can be very severe. The spotted rash associated with RMSF, which is the most characteristic sign of the disease, occurs because the bacteria directly injure the skin's blood vessels.

You were fortunate to have your disease caught early. Before the use of antibiotics, RMSF was a deadly disease -- with a death rate between 20 percent and 80 percent. Today, however, the death rate is extremely low; in 2007, it was 0.3 percent. Higher death rates and greater complications are more likely in people younger than 4 or older than 60. African-Americans, men and people who abuse alcohol also face a greater risk of death and chronic complications.

Those complications are related to the severity of the disease. The bacteria can lead to inflammation within the brain, causing confusion, memory problems, seizures, difficulty controlling body movements, balance problems and falls. The bacteria can also affect vision and hearing, potentially leading to the inability to see or hear. Because the disease can affect the nerves that go to the limbs and bladder, patients can lose sensation and strength in the legs and/or arms, as well as bladder control. When the disease is severe, skin ulcerations can develop, potentially requiring skin grafts. Lastly and rarely, the organism can lead to abnormal heart rhythms and fluid in the lungs.

So, yes, there are lasting effects to the disease, but the likelihood of those depends upon the severity of the disease at the outset. That's one of the reasons why it's important to treat the disease early. Your early use of Vibramycin (doxycycline) helped prevent many of these severe effects. (As for Atarax, that's for itching -- and shouldn't affect the course of the illness one way or the other.)

Because you appear to have none of the neurologic, skin, heart or lung problems seen with severe RMSF, you're unlikely to ever develop them. Thus, you should have no lasting effects of the disease -- and no need to worry.

Still, your case highlights the importance of seeking immediate medical attention upon the development of this rare -- but still dangerous -- disease.

(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: One of our teens, who is obsessed with science and medicine, says she read a story that there's something in toothpaste that causes colon cancer. Now she's refusing to brush her teeth. Is there any truth to what she's read? If so, should we all stop using toothpaste?

Dear Reader: Your teen is referring to triclosan, a highly effective antimicrobial and antifungal agent. This won't make her happy, but it's found in more than 2,000 consumer products, including cleansers, personal care and household goods, and some pet supplies. That means it's found in everything from toothpaste, clothing and makeup to kitchenware, furniture and toys.

In 2016, the FDA stopped manufacturers from offering for sale any over-the-counter antiseptic wash products like liquid, foam and gel hand soaps, bar soaps and body washes that contain triclosan. The ruling came as a result of studies that found the compound can alter hormone regulation in animals, could have a hand in the development of antibiotic-resistant germs and might be harmful to the immune system. So far, the FDA hasn't stepped in to prevent the use of triclosan in toothpaste, where it is claimed to help protect against gingivitis. And for products like clothes, cookware, furniture and toys, which don't make health claims, the regulation of triclosan is up to the Environmental Protection Agency.

The reason your teen is talking about triclosan right now is the publicity generated by the results of a recent study, which linked even short-term oral exposure to triclosan with adverse effects on the colon and its colonies of beneficial bacteria. Before we get to the details, it's important to note that these studies were done on mice, and that further research regarding the effects of triclosan on humans is needed. However, because the mouse genome is similar to our own, with many shared genes, research in mice offers insights into certain risk factors that can extend to the human population.

Regarding this new study, mice who were fed a diet laced with triclosan over the course of three weeks wound up with inflammation of their colons. They also had a gut microbiome that was measurably depleted, particularly of Bifidobacterium, a strain that has been shown to fight inflammation. Another group of mice who had triclosan introduced into their diets and were then induced to develop inflammatory bowel disease had symptoms that were more severe, and colon damage that was more extensive, than the non-triclosan mice. Although some triclosan mice developed colon cancer with tumors that were larger and more aggressive than those of the non-triclosan mice, the researchers reported that the differences between the two groups were too small to be statistically reliable.

Because colon cancer is associated with inflammation, interest in these new triclosan studies is quite keen. We fully expect to see more research into the subject. In the meantime, no, we definitely don't think you should stop brushing your teeth. But there are toothpastes without triclosan, and identifying them for the family seems like a great project for the young scientist in your household.

(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: For years now, I've been trying to eat more fruits and vegetables, less meat and a whole lot of olive oil and mixed nuts. Now I'm seeing that one of the studies supporting this has been retracted. Can I go back to hamburgers and fries?

Dear Reader: The Mediterranean diet has been the focus of all sorts of attention in the decades (yes, decades) since it was first introduced. Based on the eating habits of people living in southern Italy, Spain and Greece in the 1940s and '50s, it's just as you outlined -- a fruit- and vegetable-forward diet with lean proteins, whole grains, and plenty of nuts, legumes and olive oil. First publicized in the mid-1970s, the diet really entered the public consciousness in the 1990s. That's when a spate of studies looking into the eating plan got a lot of ink, and diet books devoted to the concept began to hit best-seller lists.

In 2013, a large study in Spain randomly assigned 7,447 individuals to either the Mediterranean diet or to a low-fat diet. All were overweight, and all had risk factors for heart disease, such as smoking and diabetes. Although the study participants assigned to the Mediterranean diet faithfully followed the plan, those assigned to the low-fat diet tended to return to their normal eating habits. As a result, the study turned out to be as much a referendum on the modern diet as it was about the Mediterranean plan. After five years, researchers concluded that the Mediterranean diet lowered heart disease by 30 percent.

But did it? According to a recent analysis of the study by a scientist in England, it's impossible to know. That's because of two extremely important words in the description of the 2013 study -- randomly assigned. For the results of these types of studies to be free from bias, participants must be randomly assigned to the treatment option they will follow. Without absolute randomization, you can't be confident the resulting data is the effect of the treatment. And as you've probably already guessed, the English scientist discovered that the 2013 study did not, in fact, use absolute randomization. In some cases, entire villages were assigned to the Mediterranean diet. Although those participants all followed the same food rules, they also shared other important environmental factors that could affect their health outcomes. This was sufficient to derail the claim of randomization for the 2013 study, and to merit both a retraction and a rewrite by the New England Journal of Medicine in June.

The original takeaway of the 2013 study was that several thousand people had fewer heart attacks and strokes because they followed the Mediterranean diet. The new conclusion is several thousand people had fewer heart attacks and strokes and they followed the Mediterranean diet. In this study, the diet can no longer be cited as the specific reason for the health benefits.

Finally, regarding your question about burgers and fries, the answer is moderation. As an occasional treat? Probably fine if you're in good health. But as a dietary staple? Please don't.

(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.)