Dear Doctors: A man I have been dating had a stroke a few weeks ago, and now he has aphasia. When I visit him at the rehab, he’s ready for me to leave after a short time. Is this normal? He seems to be happy I’m there, but he dismisses me quickly. I’m trying not to feel hurt.

Dear Reader: A stroke occurs when something prevents blood from reaching the brain. The most common cause is a blockage in the blood vessels that serve the brain. Known as an ischemic stroke, it is often due to the presence of a blood clot, but it also can occur due to a narrowing of the blood vessel itself. In the other major form of stroke, known as a hemorrhagic stroke, a blood vessel develops a tear or completely ruptures.

Any type of stroke deprives the brain of oxygen and nutrients. In a short period of time, brain cells begin to die. This can cause a wide range of symptoms, including aphasia. This is a disorder in which it becomes difficult to understand and engage in spoken and written language. Someone with aphasia may speak in garbled sentences, be unable to find the proper word, speak in halting or choppy sentences and be unable to follow a conversation. These same difficulties can apply to writing and reading.

The physical effects of a stroke are typically the most obvious. However, our brains are also home to various regions that oversee emotion, behavior and cognition. It means this type of brain injury can cause a wide range of emotional and behavioral changes, as well. These include confusion, inattention, irritability, forgetfulness and carelessness. People who have experienced any type of catastrophic health event can be overwhelmed by the sudden change to their circumstances. That often leads to feelings of depression, grief, fear, anger and frustration.

It is important to remember that someone who has had a stroke tires quickly. That means not just physically, but emotionally and mentally, as well. It is also easy for them to experience sensory overload. Situations and settings that previously had been effortless, including a visit from a loved one, can quickly become a burden. After a stroke, the brain is physically healing and rewiring. This is particularly true with recovery from aphasia. As a result, it is entirely possible for this man to be genuinely glad to see you, and also to need your visits to be brief. If possible, ask the staff for guidance on the length of a visit and what interactions will be the most beneficial.

If you find these visits to be difficult or emotionally upsetting, you might consider seeking out a stroke recovery support group for family and caregivers. You will meet other people who are facing the same challenges as you. It can help you navigate your own feelings during this stressful time and understand what comes next. A wealth of information about stroke, as well as a searchable database of support groups, is available at the American Stroke Association website, stroke.org.

(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: It’s time for my daughter to have a Pap smear, but she’s putting it off because it was so painful last time. I wonder if switching to a female doctor might help? It’s a very unpleasant test and I do sympathize, but it’s also important and I’m worried.

Dear Reader: A Pap smear is a test used to screen for cervical cancer. During the procedure, a small brush is used to collect cells from the surface of the cervix. Those cells are then examined under a microscope for signs of cancer, or the types of changes that may indicate a precancerous condition. As women who have undergone this procedure know, it is uncomfortable at best. But, as you point out in your letter, Pap smears are an important part of preventive care. It is recommended that women start getting tested for cervical cancer at age 21 and have a Pap smear every three years.

When it comes to gynecological care, some patients do prefer it when their doctor is a woman. By its very nature, this type of medical care is quite sensitive, and patients can feel more comfortable when being examined by someone of the same sex. Having undergone the various procedures and exams herself, a female doctor may have a better understanding of what her patient is experiencing. This can make it easier for the patient to share concerns, and that can translate into more empathetic care.

Regarding Pap smears, there has been a new development that will make the procedure easier. Last spring, the Food and Drug Administration approved a test that allows a woman to perform this test herself. This involves collecting a sample of cells from the inside of vagina using a narrow swab. The swab is then sent to a lab, where it is screened for the presence of the human papilloma virus, which is the cause of virtually all cases of cervical cancer. The reason this change is possible is that labs are now able to analyze cells taken from the vagina, and not only the cervix itself.

For now, this test will be done by the patient in a doctor’s office or other health care setting. But in the future, the plan is for an at-home test to become available. This is the first change to cervical cancer screening in the U.S. since the 1940s, which is when the Pap smear was first adopted. Self-collection tests have been available in Europe and elsewhere for several years.

The self-collection test makes cervical cancer screening far less unpleasant. It also removes the barriers that have prevented many women from having this test. This includes living in an area with limited access to health care, a lack of insurance and being unable to take time off work. A self-test will also help women like your daughter, who are avoiding a procedure they dread.

(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.)

Hello, dear readers, and welcome back to the monthly letters column. Even with autumn on the horizon, we will once again urge everyone to please take the risk of heat-related illness seriously. It’s all too easy to pass the tipping point from being overheated to developing heat exhaustion. And that brings us to our first letter.

-- A reader in Arizona, who ran into trouble on a hike, wonders if his experience with heat-related illness is typical. “I know now that what happened to me when we went hiking on the Fourth of July was heat exhaustion,” he wrote. “I was able to get home, have water and cool off, but it took almost the whole weekend to feel completely OK again. Is this normal?”

The length of time it can take to fully recover from heat exhaustion depends on the severity of the episode and the length of time that you experience it. Typical recovery time is 24 to 48 hours. But if you were close to experiencing heat stroke, it can take longer for the body to recover. Additional factors include being older, carrying extra weight or having underlying health conditions. With warmer temperatures becoming the new normal across the globe, we think it is important to know how to recognize the symptoms associated with the onset of heat-related illness.

-- We recently wrote about creatine, a compound found mainly in the muscles. It is present in red meat, seafood and some dairy. Because creatine helps make energy available to the muscles, it has become a popular supplement. A reader in California wondered if she should keep track of creatine in her diet. “I am always considering my blood pressure and blood glucose levels in reference to food. Does creatine affect either?” she wrote. “I am 68 years old, I exercise about 250 minutes per week, and I eat a little red meat, some fish and much chicken.” Unless someone is living with kidney disease, the creatine in a balanced diet should not have an adverse effect on blood pressure or blood sugar management. It’s when people misuse creatine supplements that problems can arise. And a big congratulations on your 250 minutes of exercise per week, which helps keep both blood sugar and blood pressure in healthful limits.

-- Sunscreen is the subject of several recent letters, including this one: “The sunscreen aisle in the drug store is confusing,” a reader wrote. “What’s better: chemical or mineral?” Both forms of sunscreen block the harmful rays of the sun, they just do it differently. Mineral sunscreens form a physical barrier that reflects the sun’s rays. Chemical sunscreens convert the UV rays to heat and release them. Each is effective, so it’s a personal choice. Look for brands that protect against both UVA and UVB rays, pay attention to the SPF ratings, and be sure to apply -- and reapply -- according to directions.

Thank you, again, for taking the time to write to us -- we love hearing from you. We have had a bumper crop of mail and will be back with a bonus letters column next week.

(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.)