Dear Doctor: I’m worried about my best friend. She seems overwhelmed taking care of her elderly parents as well as her own family, but she won’t admit it. How do I know if she’s in trouble?

Dear Reader: There’s a name for the rapidly increasing number of Americans who find themselves in your friend’s position of caring for older parents while raising a family -- the sandwich generation. They account for a significant chunk of the estimated 43 million adults in the United States who act as unpaid caregivers to aging parents or relatives. And when the scope and stress of the duties they’ve taken on become too great, many put the needs of loved ones ahead of their own well-being. Among cooking, cleaning, shopping, errands, homework help, extracurricular activities for their own families and managing similar tasks, plus medical appointments for an aging or ailing relative, personal welfare often falls by the wayside. This includes no longer spending time with friends and engaging in personal interests, and neglecting their careers, medical care, and mental and spiritual health.

There’s no question that being a caregiver can be rewarding. When you pitch in to help an aging parent, relative or friend, you enhance that person’s quality of life. Often, this unpaid care allows older adults to remain in their own homes. Much of the help involves emotional support, and many caregivers report a deepening of their relationships with the people they’re helping.

But the role of caregiver is often complicated. It can be difficult for both parties to navigate the change of roles when a child becomes a parent’s guardian. An aging parent’s escalating lack of control over his or her own life can be frightening, and the parent can grow demanding and even unreasonable. This becomes even more of a challenge when someone has cognitive problems, as with dementia and Alzheimer’s disease.

You're correct that the demands of caregiving can be overwhelming. They often lead to fatigue, apathy, anger, depression and, eventually, burnout. Signs of this include withdrawal from family, friends and activities, as well as feelings of loss, worthlessness or hopelessness. There may be changes to sleep and mood; changes to weight; abuse of alcohol or drugs, which includes prescription medications; and a lack of interest in self-care.

To prevent burnout, it’s important for caregivers to make time each day for themselves. Even a half-hour for a solo walk, a dive into a magazine or a novel or to chat with a friend can help to ease stress. It’s also important to be willing to ask for help, and to be specific. Make a list of tasks for friends and relatives who want to lend a hand, such as shopping for groceries, handling a doctor’s visit, taking a pet to the vet or doing some housecleaning.

A support group for caregivers is a great place to share experiences, vent, meet new friends and learn about support services. Speaking of which, you’ll find very good suggestions at the AARP website (AARP.org) and the U.S. Department of Health & Human Services website (HHS.gov). Just put the words “caregiver resources” into the search box.

(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.)

Hello, dear readers, and welcome back to our monthly letters column. We’re happy to report that you’ve kept our mailboxes full, so we’ll dive right in.

-- Pet-related topics always get a lot of mail, and a recent column about a study into the health benefits of living with a dog was no different. A reader from Tulsa, Oklahoma, wrote to say that limited mobility need not be a barrier to canine companionship. “People who are physically unable to walk a dog outdoors can experience the joy provided by a pet and the other benefits of pet ownership, particularly with a small breed,” she wrote. “They can be trained to use potty pads indoors. We recently adopted a 3-year-old rescue Chihuahua who quickly learned to use the potty pads. As I write this, my current ‘favorite child’ is right here beside me. Life is just better with a pet in your lap.”

-- A reader from Coeur d’Alene, Idaho, who volunteers at a local hospital with her therapy dog, wrote to say she sees the happiness that a dog imparts with every visit. “It’s refreshing to read about how dogs make a difference in the healing process. I witness that emotion every time we visit,” she wrote. “And, as you pointed out, the nurses, doctors and support staff all love interacting with the dogs as well."

-- In response to a column about carpal tunnel syndrome, a reader from Fresno, California, found that a small tweak to his work habits made a big difference to the severe carpal tunnel pain he experienced while using a mouse during computer work. “I went to several doctors, but ultimately decided to just move the mouse to the left side of the keyboard,” he wrote. “It was awkward for about a week, but eventually I adapted, and after two months, the pain was gone.” Since then, he switches hands on the first day of each month and reports, “my carpal tunnel pain has never returned.”

-- A column about the flu that mentioned that symptoms can be similar to those of a bad cold left a reader in Spokane, Washington, confused. “All my life -- 62 years -- the flu has been referred to as an illness with symptoms such as fever, stomach upset or vomiting, lack of appetite, diarrhea and achiness, and it seems to take longer to get well from than a cold,” he wrote. “Have I been confused about what flu really is?” To clarify, the flu is an infection of the influenza virus. It typically shares respiratory symptoms with the common cold, and can cause the additional symptoms that you mention. The diagnostic difference between the flu and a cold is the virus that causes each infection. And, as you mention, the flu lasts longer than a cold and tends to be more severe.

That’s it for this month. Thank you again for all of your questions, tips, comments and kind words. We love hearing from you. And just a reminder to new readers -- we can’t make a diagnosis, recommend medications or offer a second opinion.

(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: Would you please explain the terms we keep hearing in news reports about that new virus, like “epidemic” and “outbreak” and “pandemic”? It seems like they’re being used interchangeably, and it makes it hard to understand what’s really going on.

Dear Reader: You are referring to what initially was known as Wuhan coronavirus, a new respiratory illness identified in China at the end of December 2019. The name referred to the city where the illness first appeared and the specific virus that causes it. In mid-February, the World Health Organization officially gave the virus a name -- COVID-19. That breaks down to “CO” for corona, “VI” for virus, “D” for disease, and 19, which indicates the year this new illness appeared.

Your question is important because each of the terms you mention -- outbreak, epidemic and pandemic -- refers to a different type of event. They arise from a branch of medicine known as epidemiology, which is the study of how, where and why disease and illness spread, and how to predict and prevent them. And we agree that misusing these terms can lead to confusion and misunderstanding.

An outbreak is a disease or condition that occurs in greater-than-expected numbers. The departure from the norm can include the time of year during which the increase in illness appears, the specific group of people it affects, the geographical area it covers or the type of illness itself. For example, polio has become so rare in the U.S. that just a handful of cases in one area would be considered an outbreak. At the other end of the spectrum is the influenza virus. We have become so accustomed to the annual surge in influenza infections that, rather than calling it an outbreak, it is often referred to simply as “flu season.”

An outbreak that increases rapidly in both the number of new cases and in geographic scope is referred to as an epidemic. That’s what happened with COVID-19, which began as a localized outbreak in Wuhan and then spread throughout much of China. In this case, the epidemic was caused by a new strain of coronavirus that health officials believe “jumped” from animals to humans.

When an epidemic spreads across the globe, it’s known as a pandemic. The numbers of people who become ill, as well as the fatality rate, is much higher in a pandemic. Unfortunately, some news reports are misusing the word when talking about COVID-19. While it’s true that the virus has spread to other nations, the numbers of cases outside of China remain quite low at this time and don’t meet the definition of a pandemic.

A lot of people in the United States are worried about the new coronavirus, but the risk here is low. We agree with health officials who say that the greater health risk continues to come from our own ongoing influenza season. Respiratory viruses enter our bodies via the mucous membranes in the mouth, nose and eyes. So wash your hands often, don’t touch your face, and seek treatment and stay home if you’re sick. And remember, it’s still not too late for a flu shot.

(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.)