Dear Doctors: I was in a car accident, and an X-ray showed I had two broken ribs. A second X-ray taken a month later showed I also had a cracked rib. Why didn’t that show up the first time? Why isn’t there more that can be done for a broken rib other than being told to rest? It’s very painful.

Dear Reader: Fractured ribs are one of the most common traumatic injuries. More than 300,000 people visit the emergency room each year with a broken rib, and up to 45,000 wind up spending time in the hospital as a result. The most common causes are a car accident, as happened in your case, or collisions during contact sports. Older adults, whose bones can become frail, are at increased risk of a rib fracture during a fall.

As with any bone in the body, ribs can be bruised, cracked or broken. When this occurs, the muscles and cartilage that hold the rib cage together can also be damaged. The most common site of a rib fracture is the outer curve of the rib, where the bone is weakest. The ribs in the middle of the chest are most likely to be broken. In severe trauma, it is possible for a broken rib to injure the lung. Breaks in the lower ribs can injure the spleen, liver or kidneys, which can be life-threatening.

Diagnosis begins with a physical exam, and can often also include an X-ray. A cracked rib, also known as an incomplete fracture, may not be immediately visible. It is only once the damaged bone has begun to heal, which involves the deposit of specialized cells known as osteoblasts, that the damage to the rib may become visible on an X-ray.

Symptoms of rib injury include localized pain that can be severe. The rib cage glides open a bit with each breath and flexes in response to motion, each of which can also trigger pain or discomfort.

The fracture you are now dealing with shows your rib cage was doing its job. It protected your heart, lungs, liver and other vulnerable tissues from the blunt-force trauma of the car accident. However, the architecture of the rib cage, a light and flexible lattice of bone, muscle and connective tissue, puts limitations on caring for a fracture. Your rib cage needs to be able to expand and contract in order to permit breathing. Unlike a broken arm or leg bone, fractured ribs cannot be stabilized in a cast.

The primary treatments for rib fractures are medications to help manage pain and inflammation and instructions to limit movement. Depending on the severity of someone’s injury and the number of ribs involved, healing can take from six weeks to several months. Once the initial pain has been managed, the challenge becomes limiting motion and activity so that the affected bones are not reinjured.

Recently, researchers have been looking into using an injectable adhesive to stabilize the broken bone. As healing takes place, the adhesive would be absorbed by the body. The approach remains in the research phase and is not yet available.

(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’ve been seeing a lot of news stories about whooping cough. Is there really another illness that we need worry about? What is whooping cough, and how do you get it? What is the treatment? I thought this was something that had pretty much gone away.

Dear Reader: Whooping cough is a highly contagious upper-respiratory infection. Also known as pertussis, it poses a particular threat to infants.

You’re hearing about it right now because the disease is on the rise. As of mid-September, there have been more than 14,500 confirmed cases of whooping cough in 2024. That’s more than four times higher than at this same time last year. The illness is also spreading at its fastest rate in five years.

The precautions observed throughout the COVID-19 pandemic led to a marked decrease in several common upper-respiratory infections, including whooping cough. However, now, with those safeguards largely relaxed, the United States is seeing a resurgence of those illnesses. Missed vaccines during the pandemic years, along with a recent increase in vaccine hesitancy, have led to a significant drop in protection against the disease.

Unlike the flu, the common cold and COVID-19, which are all caused by viruses, whooping cough is a bacterial illness. The culprit is a type of bacteria known as Bordetella pertussis. It typically spreads via the droplets emitted when an infected person coughs or sneezes. It is also possible to become infected by touching a surface contaminated with live bacteria, and then touching your nose or mouth.

Symptoms of whooping cough, which range from mild to severe, begin anywhere from five days to three weeks after exposure. The disease often begins with a runny nose, watery eyes, slight fever, sneezing and a sore throat. The distinctive cough that gives the disease its name usually appears about a week later. The Bordetella pertussis bacteria binds to and paralyzes the cilia, which are the fine, hairlike structures that line the airways leading to the lungs. This not only permits the buildup of mucus, but leads to inflammation that causes the airways to swell. The end result is a deep, hacking and frequent cough that can last for several months.

Infants 1 year old and younger are at highest risk of infection. They are also more likely to develop severe illness, which can require hospitalization. Older adults, people with preexisting health conditions and those with compromised immune systems are also at increased risk. Some people who become infected may not get sick at all. However, even without symptoms, or only mild illness, they remain infectious and can spread the disease for at least two weeks.

Treatment typically focuses on several antibiotics that target the bacteria. In order to be effective, though, treatment needs to begin as soon as possible after infection. Unfortunately, nonprescription cough medications are not effective in easing the hacking cough.

Vaccination remains the best safeguard against whooping cough. Vaccines known as DTaP and Tdap are effective against a trio of targets: whooping cough, diphtheria and tetanus. It is important not to allow these to lapse.

(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 to the first letters column of autumn. How quickly the summer flew by. That means it’s time to schedule vaccinations and boosters, and to stock up on COVID tests -- yes, it’s still with us. Speaking of which, the new COVID-19 vaccine addresses the newest crop of variants, so don’t skip that one. And now, your letters.

-- The importance of staying hydrated comes up in a lot of columns. This may be a challenge for older adults, who can experience a decrease in the signals that indicate thirst. A reader with a tip to share also had a question. “I fill a pitcher with five glasses of water, which makes it easy to remember to drink enough each day,” she wrote. “I figure that’s plenty because I’m getting water in my food, and also in my daily cups of coffee. Is that right?” Yes, both the food we eat and the coffee, tea and other beverages we drink contribute to daily water intake. Food typically delivers about 20% of the water we get. This is particularly true of fruits and vegetables, yet another reason to include plenty of produce in the diet.

-- A recent column discussed the challenges some people face in keeping their skin moisturized. Dry skin can be caused by a dry environment, sensitivity to chemicals in soaps and cleaning products, frequent hand-washing, inadequate hydration and as an effect of aging. We heard from a reader with concerns about their solution to dealing with dry skin. “I like to use Vaseline to help me deal with dry skin. It is amazing how well it works, and how quickly it disappears into my skin,” he wrote. “But I also have a problem with weight control. Is it possible that this is contributing to my weight?” Vaseline, also known as petroleum jelly, is safe for most people to use on their skin. The main caveat is it can contribute to acne in people prone to breakouts. Regarding your question about Vaseline being absorbed by the body and contributing to weight gain, the answer is no. Our skin can absorb oils and fatty acids, but it does not metabolize them. They do not contribute to calorie counts or to weight gain.

-- A column about resistant starch, a carbohydrate that resists digestion and thus reaches and helps feed the gut microbiota in the large intestine intact, continues to generate letters. Cooking and then cooling foods like potatoes, pasta, legumes and beans creates resistant starch. A reader wondered how much is lost when cooked carbohydrates are frozen and then reheated. “I can imagine how freezing the pasta or rice might affect the resistant starch,” they wrote. The good news is researchers have found that although further manipulation of food, such as freezing or reheating, does diminish the total amount of resistant starch, that decrease is negligible.

As always, we appreciate your taking the time to write to us. We have recently had some very kind letters -- thank you! -- and we are very glad to know these columns are useful.

(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.)