Dear Doctors: Our grandfather was diagnosed with congestive heart failure a few years ago. His strength and endurance have declined a lot, and now he’s on oxygen. What are some of the signs that his congestive heart failure is advanced?

Dear Reader: When someone has congestive heart failure, it means that the heart muscle, along with the structures of the heart, are no longer able to pump enough blood and oxygen throughout the body to meet its needs. An estimated 6.2 million adults in the United States are living with congestive heart failure, according to the Centers for Disease Control and Prevention. The condition cannot be cured, but it can be managed with medication, exercise and lifestyle changes. At some point, however, a patient will enter the end stages of heart failure. For family members, and for the patients themselves, it’s important to be able to identify the symptoms.

Shortness of breath, which is often present even in the early stages of congestive heart failure, becomes progressively more pronounced as congestive heart failure advances. A patient often finds they are short of breath not only during activity, but also while at rest. When this occurs, the use of supplemental oxygen, as in your grandfather’s case, can help to relieve symptoms. Addressing shortness of breath also helps to allay the fear and anxiety that quite understandably arise when someone is struggling to breathe.

When the ability of the heart to pump blood throughout the body declines, it results in swelling due to a buildup of fluid in the tissues, which is known as edema. This swelling is often first observed in the feet, ankles and lower legs. As congestive heart failure advances, fluid often builds up in the abdomen and within the lungs. Fluid buildup in the tiny sacs of the lungs, known as alveoli, reduces the surface area needed for oxygen exchange. This contributes to shortness of breath, as well.

As the flow of blood to the body slows down, fatigue becomes increasingly common. At the same time, the brain responds by directing the heart to beat faster. This can result in the sensation of a racing or throbbing heart, and may also contribute to feeling weak and dizzy. The patient may begin to have trouble with balance and become weak enough that they have trouble walking, or even getting out of a chair or bed. As blood flow throughout the body slows down, it triggers a number of chemical changes. These can lead to cognition changes, mental lapses, confusion, memory loss and feeling disoriented.

As with many people who are feeling unwell, people living with advanced congestive heart failure often lose their appetites. The digestive system is receiving less blood, which can lead to feelings of fullness or nausea. Along with this range of physical symptoms, many patients will also experience anxiety and become depressed.

For patients whose health care providers believe that they have less than six months to live, the supportive medical and emotional services offered through hospice care may be a good option. A range of supportive hospice services are covered through Medicare.

(Send your questions to askthedoctors@mednet.ucla.edu. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctors: My husband slipped while out on his boat and cracked two ribs. He had a broken rib as a teenager (varsity football) and remembers having his chest wrapped, but that’s not happening this time. Why not? He’s in a lot of pain and it seems like wrapping could help.

Dear Reader: Although your husband is facing pain and discomfort as a result of the fall he took, those two cracked ribs are proof that the structures of his chest did their intended jobs and helped him escape a graver injury. We’re specifically talking about the rib cage, which is an ingenious bit of architecture. It’s light, airy and flexible, supports the upper body and allows for a wide range of motion. This includes the ability to take in and expel deep breaths. At the same time, the rib cage is highly effective at protecting important and vulnerable organs and anatomical structures, including the heart and the lungs.

Rib injuries typically fall into three categories: bruised, cracked and broken. They can also include damage to the muscles and cartilage, which are the soft tissues holding the whole structure together. Injuries to the ribs typically occur due to some type of blunt force to the chest, such as a car accident, a fall, being struck by an object or from a physical assault. It’s less common, but possible, to injure your ribs while coughing. Ribs are most likely to break at their weakest point, which is the outer curve. Severe injuries can lead to a punctured lung, ruptured aorta or lacerations to the spleen, liver or kidneys -- each of which can be life-threatening.

As your husband has let you know, rib injuries can be extremely painful. In fact, pain at the injury site is the most common symptom. Additional symptoms include pain when flexing the rib cage, either by breathing or moving; muscle spasms; difficulty breathing; audible crunching sounds that arise from the injury site; and a visible change to the appearance of the chest. A rib injury diagnosis often begins with the patient detailing the incident that led to the symptoms. This is followed by a physical examination, and sometimes by a chest X-ray. Unlike the bones of the legs and arms, the anatomical structure of the ribs means it’s not possible to immobilize them with a cast as they heal.

At one time, it was common to wrap the chest in an attempt to immobilize the damaged bones. However, this limits the person’s ability to breathe deeply and freely, which can increase the risk of developing pneumonia. Instead, treatment is now focused on pain relief, reducing inflammation and rest. This includes the use of ice packs and pain meds (both prescription and over-the-counter), and the avoidance of activities that may stress the injured area.

Depending on the extent of the injury, it can take from six weeks to several months for rib damage to heal. For many patients, once the initial pain is under control, limiting activities to prevent re-injury often proves to be the toughest part of the treatment.

(Send your questions to askthedoctors@mednet.ucla.edu. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctors: We heard a story on the news that bee venom can cure breast cancer. Is that really true? How does stuff like that even get researched?

Dear Reader: It’s true that recent research has shown that an active component found in the venom from honeybees is toxic to certain types of cancer cells. Before we get any deeper into this topic, though, it’s important to note these results were obtained in laboratory tests. So, while bee venom has indeed shown promise in killing a range of cancer cells, a treatment based on these findings that can be used in humans will take years more study and testing.

It may seem that using bee venom to fight cancer comes out of left field, but the idea actually reaches back to the dawn of medicine. The pharmaceutical use of honeybee products, known as apitherapy, dates back at least 5,000 years to ancient Egypt, China and Greece. Medical practitioners of the time used honeybee venom to treat joint inflammation and pain, and the antibacterial properties of honey were harnessed in approaches as various as treating wounds, easing indigestion and embalming the dead. In modern medicine, bee venom has become a subject of interest in the treatment of rheumatoid arthritis.

The venom that honeybees inject when they sting is a complex mixture of proteins, enzymes, sugars, lipids and other bioactive agents. The bulk of it is made up of short chains of amino acids, known as peptides, which are the building blocks of proteins such as collagen, elastin and keratin. The most abundant of these is a peptide called melittin, which is responsible for most of the medicinal effects of bee venom. (Don’t worry, bee lovers: Melittin can be synthetically produced.) Scientists have been interested in the anti-tumor properties of melittin for many years, including in the fight against melanoma, the most virulent and deadly of the skin cancers.

The study you’re asking about was conducted by scientists at the Harry Perkins Institute of Medical Research in Western Australia and was recently published in the journal Precision Oncology. The researchers evaluated the venom from 312 honeybees and bumblebees and found it to be surprisingly effective at destroying certain types of cancer cells, including those in some subtypes of breast cancer. These include triple-negative breast cancer and HER2-enriched, each of which has limited treatment options.

At a certain concentration, the serum formulated from the bee venom killed the cancer cells within an hour, and at the same time did limited damage to the surrounding healthy cells. The peptide melittin, which is already known for its ability to break down lipid membranes, was also able to disrupt the growth of the cancer cells. The researchers found that the peptide achieved this by disrupting the signaling pathways that cancer cells use to replicate, thus significantly slowing tumor growth.

These findings hold promise, but challenges remain. Compounds that kill cancer in a petri dish don’t always translate into successful medications. More research is needed to create a safe and effective drug.

(Send your questions to askthedoctors@mednet.ucla.edu. Owing to the volume of mail, personal replies cannot be provided.)