DEAR READER: Yes. Initially, you should request a referral to a rheumatologist. Lupus, a serious inflammatory autoimmune disorder, can affect the joints, kidneys, lungs and several other parts of the body. Many of the symptoms, such as fatigue, joint pain, anxiety, depression and variations in weight, cross over to those of fibromyalgia. Therefore, you should confirm that you do suffer from both conditions.

You should also be under the care of a pulmonologist for control of your chronic cough, asthma and bronchiectasis. The cough could be medication-induced or a result of your asthma. In order to determine what triggers your attacks, it may be necessary for you to undergo testing and to see several other specialists. This may appear daunting but once your textbook complaints of fibromyalgia are better controlled, you will then be able to lift your veil of depression and get on with your life. There is help. The fact that you have written to me is a genuine indication you are ready to get to the bottom of things.

My white blood count has been high for years, and a year ago I was referred to an oncologist, who promptly performed a bone-marrow biopsy. My count has been in the 15,000 to 17,000 range but never higher than 22,000. The oncologist wants to do another biopsy. He doesn’t say exactly what he is looking for but implies that it might be leukemia.

Dr. Gott, I am trying to be a good patient, but this procedure is very painful, and I don’t want to go through it again if it is uncalled for. My blood count is checked every month. Will I be required to have a yearly bone-marrow biopsy also? Please let me know your opinion on this.

DEAR READER: Sadly, smoking can lead to many respiratory conditions, and the 40-year-long habit has obviously left its mark. Many of today’s lung disorders are caused or worsened by smoking. While a number of disorders affecting the lungs are chronic and incurable, most can be treated. You have taken a positive initial step to improve things, since the habit is now behind you.

There are five types of white blood cells — lymphocytes, monocytes, basophils, eosinophils and neutrophils. Your oncologist is determining on a periodic basis how many white blood cells you have. The normal range is between 4,500 and 10,000 per microliter. An abnormally high count known as leukocytosis might indicate such conditions as leukemia, rheumatoid arthritis, tissue damage or infection. An abnormally low count known as leukopenia might indicate bone-marrow failure, a disorder of the liver or spleen, lupus or exposure to radiation.
The bone-marrow biopsy is commonly ordered if a person has an abnormal number of red or white blood cells on lab testing. The results can help a physician zero in on or exclude such conditions as cancer, anemia, leukemia, Hodgkin’s disease and a great number of other possibilities. Because you had the test a year ago, my guess is that your oncologist may not have obtained a clear diagnosis then or wishes to determine any progression. To the best of my knowledge, this test is not performed annually. Because each case is different, that question should be presented to your oncologist or primary-care physician.

While there is discomfort involved during the procedure, it is likely the best means of obtaining vital information necessary for your continued care. Therefore, sadly, I recommend that you undergo the procedure one more time to get to the bottom of the issue. Many patients request conscious sedation, which may alleviate a great deal of the anxiety and pain associated with the procedure.

To provide related information, I am sending you a copy of my Health Report “Pulmonary Disease.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.

My breathing is shallow, and I often count 20 or more intakes per minute. I quit smoking 24 years ago, and the problem was not there then. My wife often hears my breath from another room, and my camcorder microphone picks it up easily. I have grown used to it and often don’t realize the noise I make.

I have had a series of laboratory tests that all say there is nothing, but this condition can’t be right. My doctor says I definitely don’t have asthma, and he doubts that it’s pulmonary hypertension, though after reading about it, I do have some of the symptoms that are mentioned.

I work at a plastics plant that often “cooks” the plastic, which smells and tastes nasty, but no one else there — some 700 employees — has had this trouble. I also operate an EDM machine that uses chemicals known to cause skin irritations, but again, no other person has had this breathing disorder.

I am active for a 60-year-old. I swim and hike regularly but now have to stop more frequently to catch my breath. I tire a lot more easily and usually sleep when I get back from what was once a routine walk. I suppose age must play a part here, but the relative suddenness of this tells me this isn’t normal. Can you help me, Dr. Gott?

DEAR READER: A normal breathing rate for healthy adults is between eight and 16 breaths per minute. At a rate of 20, this is slightly abnormal, but given your claim that it is progressing, I believe you need further examination and testing.

Rapid, shallow breathing is known as tachypnea and is associated with several pulmonary disorders, including asthma, pneumonia and other lung infections, pulmonary embolism (blood clot) and chronic obstructive pulmonary disease (COPD).

Pulmonary hypertension is high blood pressure that affects the arteries in the lungs and the right side of the heart only. It causes the heart to weaken over time and eventually causes it to fail completely.

Symptoms include shortness of breath while exercising that eventually occurs during rest, fatigue, chest pressure or pain, a racing pulse or heart palpitations, dizziness or fainting spells, cyanosis of the lips and skin, and edema of the legs and ankles, which eventually affects the abdomen.

Potential difficulties from pulmonary hypertension include blood clots, irregular heartbeat, right-sided heart failure and bleeding into the lungs. Inadequate treatment or postponing treatment increases the risk of developing a complication.

Request a referral to a pulmonologist (lung specialist), who can examine you and order further testing, which may include a chest X-ray, CT scan or MRI of your lungs. You may also need additional blood testing.

To provide related information, I am sending you a copy of my Health Report “Pulmonary Disease.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order to newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.

Now to my question. I have type 2 diabetes. A few months ago I read that cinnamon was good for lowering sugar levels. I decided to try it mixed with Splenda on toast several times a day and it seemed to work. I then purchased 500 mg cinnamon capsules and started taking them twice a day, after breakfast and dinner.

Before the cinnamon, I was trying to control my diabetes with diet and exercise but it wasn’t really working. I would often have spikes of 250 or higher (before a meal) for no apparent reason. After the cinnamon, I have not had a reading over 130 before a meal.

Is there anything wrong with this treatment? Are there any side effects? I have also told a friend with severe diabetes about this. It seems to work for him as well.

DEAR READER:
I have received several letters from readers, such as you, who have had a favorable response to cinnamon therapy for diabetes. At the time cinnamon was first mentioned in my column by a reader who was using it for diabetes, he also claimed it lowered his cholesterol levels as well. Cinnamon for cholesterol does not appear to work for the number of readers who wrote to me with their results.

The one side effect I have heard about from my readers is diarrhea. It appears to be dose related. I do not know if this is common in the general public, however. Therefore, I see no reason why you shouldn’t try it (with doctor’s permission, of course).

That being said, there have been a couple of studies on the subject. One of note is found on www.WebMD.com. A researcher with the NWFP Agriculture University in Peshawar, Pakistan says that cinnamon, cloves, bay leaves, and turmeric have shown promise in improving insulin’s action in lab studies. He also says that cinnamon can improve glucose and cholesterol metabolism, improve function of small blood vessels and remove artery-damaging free radicals from the blood. Korean ginseng, flaxseed, garlic, and onions have similar effects.

The best results were achieved in individuals who took three to six grams (6-12-500 mg capsules or 1-1 ¾ teaspoons) each day. This is by no means a small amount and favorable results diminish soon after the cinnamon is stopped. For those people who participated, insulin sensitivity improved, triglyceride and LDL “bad” cholesterol levels were reduced and changes to the HDL “good” cholesterol levels were minor.

If you would like to read the WebMD article it can be found at http://diabetes.webmd.com/news/20031205/cinnamon-helps-type-2-diabetes.

To give you related information, I am sending you copies of my Health Reports “Living with Diabetes Mellitus” and “Understanding Cholesterol”. Other readers who would like copies should send a long, self-addressed, stamped envelope and $2 (per report) to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.