Dear Doctors: My friend was diagnosed with multiple myeloma 10 years ago. His chemo is no longer working, and his doctors say there’s nothing else to be done. He has accepted whatever is coming. He has lost weight, and sometimes the pain is bad. How can I help him?

Dear Reader: No matter how long someone has been dealing with a serious illness, the cessation of active treatment can be devastating. This is true not only for the person approaching the end of their life, but also for family and friends. The response to this transition often includes a rotating mix of grief, sorrow, fear, anxiety, dread and anger. However, people also often feel acceptance, peace, hope and even relief. Again, these are experienced not only by the individual who is ill, but also by the people around them.

When spending time with someone with a terminal illness, you are looking for balance. That is, you want to be supportive and helpful, but not overwhelm them with your attentions. Hospice care professionals say this can be achieved by asking the person what they need. The answer may include physical tasks and emotional or spiritual support. It is also useful to understand that the person’s needs will change from day to day, and sometimes from moment to moment.

When someone is still living at home, you can offer to help with housework, care for a pet, do shopping or run errands, deal with bills or other paperwork, or help with any medications, treatments, equipment or personnel that are part of palliative care. Small gifts, such as a pair of soft or silly socks, a pretty pillowcase, a greeting card or a small bouquet can brighten a day. Simply sitting quietly with someone or giving them a space to express their fears or worries can be a great comfort.

Some people reaching the end of life get solace from creating a wish list of the things they would like to accomplish or experience before they are gone. This may be seeing a certain film, eating a favorite meal, browsing photo albums and sharing memories, speaking with a religious or spiritual adviser, playing cards or games, writing letters or engaging in texts, phone calls or video chats with people who are unable to visit.

Always check with the person before starting a new task or a project. This keeps them in control of the events around them, which bolsters mental and emotional well-being. It is also important to separate your own feelings and needs from what the person is experiencing.

And this brings us to self-care, a crucial part of helping people who are nearing the end of their lives. You are likely to feel a wide range of complex emotions while your friend is on this journey, and it can take a toll. For that reason, it is recommended that caregivers create a support system for themselves. This is helpful for the duration of the person’s illness, and also for the often-challenging days that follow once they are gone.

(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 have recently been advised that I have peripheral artery disease. I would like to know more about what that is. What types of restrictions might the diagnosis place on me?

Dear Reader: Peripheral artery disease, which is also called peripheral arterial disease, is a condition that affects the vessels carrying blood away from the heart and to the rest of the body. These vessels, known as the peripheral arteries, bring oxygen and nutrients to the tissues of the legs, feet, arms and hands. Although the condition can affect the arms, it is seen most often in the legs. Smoking, high blood pressure, diabetes, high blood lipid levels and being age 65 or older are risk factors for the disease.

The disease is caused by a buildup of plaque on the walls of the peripheral arteries. This accumulation of plaque, which narrows the vessels, is a condition known as arteriosclerosis. Plaque is a sticky mixture of cholesterol and other lipids, cellular waste, blood proteins and calcium. It plasters the arterial walls and gradually hardens over time. Unlike healthy arteries, which have smooth and flexible inner walls, the vessels of someone with arteriosclerosis are stiff and bumpy. The layer of plaque narrows the diameter of the affected arteries, which reduces the amount of oxygen and nutrients they can deliver to the tissues they serve.

Peripheral artery disease, or PAD, is estimated to affect at least 8 million adults in the United States. Many never develop noticeable symptoms. When symptoms are present, they include pain and cramps in the muscles of the thighs, calves and hips, particularly during exercise. This is because the narrowed vessels can’t meet the increased demand by the muscles for oxygenated and nutrient-rich blood. The discomfort often eases with a few moments of rest. Additional symptoms can include a prickling sensation of pins and needles; numbness; slower rates of healing to cuts, scrapes or wounds; and a decrease in body temperature in the extremities.

Treatment includes a mix of lifestyle changes, medications and continued monitoring of the condition. Smoking is a huge risk factor for PAD, so taking steps to quit is important. Nicotine is extremely addictive, which makes smoking a difficult habit to break. If you’re a smoker, your doctor can help you craft a strategy for quitting. Physical activity is also important. However, due to the limitations to blood flow imposed by PAD, it is recommended that any new exercise program be supervised. Again, your doctor or cardiologist can help you formulate a plan.

Any form of cardiovascular disease calls for an evaluation of diet. The so-called Mediterranean diet -- with an emphasis on fresh vegetables, leafy greens, fish, legumes, lean meat, fruit and healthful oil -- has been shown to be effective. It is possible that you will also be prescribed medications to control cholesterol, lower blood pressure, reduce inflammation and manage diabetes. In some cases, surgical procedures to prop open blood vessels with a stent or to remove plaque may be recommended. The good news is that, with appropriate lifestyle changes and a comprehensive treatment plan, someone living with PAD can still have a full and active life.

(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: My blood tests show that I am prediabetic. I am puzzled because I am not overweight, I get plenty of exercise and I eat quite a bit of fiber every day. I don’t eat many sweets, but I do drink wine with meals. I am 77 years old. Is there some other preventive measure I can take?

Dear Reader: When someone has prediabetes, it means that their blood sugar levels are consistently higher than normal, but they have not yet reached the threshold that is characterized as diabetes. The diagnosis is basically a warning that they are at risk of developing Type 2 diabetes. That’s when the body either doesn’t make enough insulin or no longer has an adequate response to the hormone.

As we have discussed here before, blood sugar levels are an important metric of health and well-being. Over time, elevated blood sugar can cause serious health problems. They can lead not only to Type 2 diabetes, but also can put people at risk of nerve impairment, heart disease, kidney disease, vision loss and stroke.

The condition is often diagnosed with an A1C test, which is a blood test that estimates someone’s levels of blood glucose over the prior three months. Another approach is a fasting plasma glucose test. It is a finger stick test that measures blood sugar at a single point in time. As the name suggests, it is performed when someone has not eaten for at least eight hours, which is when blood glucose levels should be at their lowest. Blood glucose is measured in milligrams per deciliter, or mg/dL. A value below 100 mg/dL when in a fasting state is considered normal. Results between 100 and 125 mg/dL are considered to be prediabetes. If fasting blood sugar levels consistently top 125 mg/dL, a diagnosis of diabetes enters the picture.

Advice to people with prediabetes centers on the things you are already doing: Maintain a healthy weight, get regular exercise, avoid added sugars and eat high-fiber foods. Interestingly, several studies have indicated that wine, when consumed with meals, can have a positive effect on glucose metabolism. And that brings us to the question of age. Newer research has found that for older adults diagnosed with prediabetes, the risk of the condition escalating to Type 2 diabetes is fairly low. In a study by the Centers for Disease Control and Prevention, which followed 50,000 adults between 70 and 90 years of age with prediabetes, just 5% had progressed to Type 2 diabetes at the end of two years.

There is also evidence that A1C tests, which measure the percentage of glucose bound to hemoglobin, may not be as accurate in older adults. This is due to age-related changes to the life cycle of red blood cells. If your diagnosis was based on an A1C test, you might want to discuss this with your doctor. If your doctor believes you to be at risk of Type 2 diabetes, they may suggest an oral glucose tolerance test. Some people with prediabetes opt to use a wearable glucose monitor for a few weeks. The real-time results can reveal helpful information about the effect of diet, exercise and other lifestyle choices on glucose control.

(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.)