My question to you is, what do I do now?

DEAR READER:
Abdominal aortic aneurysms (AAA) are potentially fatal areas of bulging or ballooning of the large blood vessel that supplies the abdomen, pelvis and legs. They can occur in anyone but are most common in males over 60 with one or more risk factors.

Those factors include emphysema, smoking, high blood pressure, obesity, high cholesterol, being male, and certain genetic factors. There is no known cause.

In most cases, the aneurysm is found during routine screening tests or imaging studies for other conditions. Most aneurysms do not cause symptoms. They usually develop slowly over time but occasionally expand rapidly leading to rupture, dissection (bleeding from the inner wall into the outer wall of the vessel) or other symptoms. All aneurysms carry risks but small ones generally go unnoticed. Large aneurysms are more serious and are more likely to rupture spontaneously and cause symptoms.

Symptoms are usually the result of rupture or dissection and include nausea, vomiting, back or abdominal pain, anxiety, clammy skin, an abdominal mass, abdominal rigidity, rapid heart rate upon standing, a pulsating sensation in the abdomen, and shock. Rupture is a medical emergency and immediate attention is necessary.

Treatment is available. Small, non-symptomatic aneurysms should be monitored on a yearly basis to check for expansion. If the aneurysm causes symptoms, rapidly expands, or is larger than 5.5 centimeters, surgery is often done to prevent complications such as leaks or rupture.

There are currently two types of surgery available. The first is a traditional version which involves making a large incision. The damaged vessel is then replaced with a synthetic material. The second is called endovascular stent grafting which uses several smaller incisions in the groin to access the vessels. The grafting material is then snaked up the artery and put into place in the abnormal area. This type of surgery may have a faster healing time but is not recommended for every sufferer.

If surgery is successfully performed before rupture, the outcome is generally favorable. However, if rupture occurs, less than 40% of patients survive.

I urge you to follow your surgeon’s advice. If you smoke, are overweight or have other risk factors, take steps to reduce or eliminate them. If you are still concerned, request a referral for another opinion.

To give you related information, I am sending you copies of my Health Reports “An Informed Approach to Surgery” and “Blood — Donations and Disorders”. Other readers who would like copies should send a self-addressed, stamped number 10 envelope and $2 per report to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title(s).

DEAR READER:
Your daughter has been diagnosed with a condition in which her own immune system is destroying red blood cells. It is a chronic disease.

Treatment generally starts with the use of corticosteroids such as prednisone. If the steroids fail to provide positive results, removal of the spleen is then considered . After that, if there is improvement, immunosuppressive medications are given in an attempt to stop the destruction. Blood transfusions are only given with extreme caution because of the risk of worsening the condition.

Unfortunately for most adults, the condition is chronic or relapsing. Infection or severe anemia can result from unsuccessful treatment options.

Your daughter needs to be under the care of a blood specialist (hematologist) who is familiar with this disorder. He or she can also review the condition, determine what is expected without further treatment and determine what possible treatment options she has left.

To give you related information, I am sending you a copy of my Health Report “Blood — Donations and Disorders”. Other readers who would like a copy should send a self-addressed, stamped number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

Do you have any idea as to the cause?

DEAR READER:
Bruising is generally the result of injury. Minor trauma such as hoisting a heavy box and resting it on your thighs. The process doesn’t appear to cause damage, yet it can be extreme enough for blood to clot beneath the surface of the skin and result in a bruise.

Aspirin, Advil, Naproxen, Motrin and other non-steroidal anti-inflammatories can also cause contusions, as can physician-prescribed corticosteroids and prednisone.

Recap your activity prior to the first bruising. Did you lean into a porch railing, over the hood of a car to work on it, or carry debris from your basement up a set of stairs? If so, you may have a harmless cause you can identify.

If you are on new medication, I recommend you ask your physician if it carries a side effect of bruising. If not and your bruising is spontaneous, speak with him or her about testing you for a blood workup. In this way, disorders such as von Willebrand’s disease or hemophilia can be ruled out. These hereditary disorders are marked by slow blood clotting that can result in nose bleeds, excessive bleeding of the gums and more.

Another possibility is the aging process. As we get older, our bodies take longer to heal, from even minor injuries. We also tend to have thinner skin which causes, what were once, trivial bumps and scrapes, to turn into larger, more serious cuts, bruises and tears. If your health checks out (as I suspect it will), you may simply need to be more cautious and try to avoid getting hurt.

To give you related information, I am sending you a copy of my Health Report “Blood: Donations and Disorders”. Other readers who would like a copy should send a self-addressed, stamped, number 10 envelope and $12 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

I am a practicing gynecologist and do not order a routine CA125. This is a non-specific test that can generate abnormal results for a number of reasons, to include fibroids and endometriosis. If I referred each abnormality to my local oncologists, they would throw up their arms in dismay, having to sort out a plethora of possibilities in an attempt to determine the real cause for the elevated readings. This is an expensive process and would take precious hours.

I implore you to write a retraction.

DEAR DOCTOR: I am fully aware a CA125 is normally drawn prior to a patient beginning treatment for ovarian cancer to provide a marker for comparative purposes against future readings. The testing is also generally recommended because of a strong family history of ovarian cancer or because of questionable symptoms such as a change in bowel habits, fatigue, low back pain, loss of appetite, gastrointestinal upset, and more.

As you pointed out, abnormalities in the testing can occur for a number of reasons and, therefore, it may not be useful as a screening test for everyone. The early, unrecognized symptoms of ovarian cancer can be overlooked all too easily. In fact, some 20,000 American women are diagnosed with ovarian cancer every year.

After a given age, men are routinely screened for prostate cancer as part of their annual testing. This PSA test more often than not results in abnormal results that must then be sorted out by a urologist or oncologist. Does this seem fair that men are allowed to “waste” the time of medical personnel but women are not? Certainly not, in my opinion, but I guess I was being too cautious in recommending each woman include a CA125 as part of an annual test.

If I owe an apology to all oncologists for causing unnecessary investigation, then consider it done. However, I cannot stress too strongly that those women with a family history or questionable symptoms request the test. They can first apologize to their oncologist for all efforts in getting to the bottom of a benign condition but can then rest more easily knowing they have a clean bill of health.

I was diagnosed with this condition but cannot find much information about it. I was given another name for it but don’t remember it.

DEAR READER:
Myelodysplastic syndromes are a group of disorders that affect the bone marrow and stem cells. There are eight subtypes but because of space restrictions I cannot list and explain each type. Without knowing which subtype you have, I can only give general information that is relevant to each type.

Symptoms include fatigue, shortness of breath, frequent infections, petechiae (pinpoint bruising), unusual paleness due to anemia, easy or unusual bruising, and unintentional weight loss. Early in the disorders, symptoms are generally mild, if present at all.

The cause is abnormal production of stem cells that fail to mature or function properly. It is, therefore, considered by many experts to be a type of blood and bone marrow cancer. What causes these abnormal cells to develop first varies; reasons include prior cancer therapies (namely those for non-Hodgkin’s lymphoma, Hodgkin’s disease, and acute lymphocytic leukemia) and environmental toxins such as massive exposure to ionizing radiation, benezene and more. There also may be a link between myelodysplastic syndromes and long-term exposure to pesticides, heavy metals, herbicides and chemical fertilizers.

Risk factors include age (most cases occur in those over 60), gender (men are slightly more affected than women), smoking (which increases exposure to benezene and other toxins) and some congenital disorders (Fanconi’s anemia and Down syndrome).

Treatment depends on which subtype you have. There is no definitive treatment or cure but there are some medications and procedures available. Transfusions can be used to relieve symptoms of anemia. If used too frequently or over a long-period of time, however, the body may develop antibodies against the transfused blood cells which can lead to liver and heart damage. Another option is drug therapy using hematopoietic growth factors. These medications stimulate the production of blood cells that reduces or eliminates anemia. They may be used in conjunction with transfusions. Some affected individuals may require chemotherapy or stem cell transplant.

Once you have been diagnosed with one of the myelodysplastic syndromes, it is important to be careful. It is vital to avoid sick individuals, wash your hands frequently and thoroughly wash and cook foods to avoid infection. Because these syndromes affect blood and bone marrow, they can also suppress the immune system and lead to prolonged or severe infection.

I recommend you or a family member go online to www.MayoClinic.com/health/myelodysplastic-syndrome/DS00596 for more in-depth information. It is also important to be under the care of an oncologist or hematologist familiar with the syndromes. He or she will be your best source for new information and treatments.

To give you related information, I am sending you a copy of my Health Report “Blood — Donations and Disorders”. Other readers who would like a copy should send a self-addressed, stamped number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

I donated blood for some 30 years but must confess to some apprehension about the possible side effects of my daughter’s altruism. I look forward to more information about this in your column.

DEAR READER:
Apheresis is a process by which an individual can donate specific blood components. Depending on the donor’s blood type and the needs of an individual or community, a person can donate red cells, white cells, plasma, or platelets. This procedure is commonly used to collect plasma and platelets.

An individual simply registers with the appropriate facility, gives a health history, undergoes a brief exam, is typed for human leukocyte antigens (HLA), and donates the necessary component. This process allows for as close a match as possible between the donor and recipient. The mental reward can be unique for your daughter, knowing her specific platelets are helping an individual in need. Cancer, leukemia and bone marrow transplant patients have compromised immune systems. They stand to benefit greatly from single donor platelet transfusions.

Similar to the blood you donated for more than 30 years, a donor sits in a comfortable reclining chair while a machine draws blood from an arm through sterile tubing into a cell separator centrifuge. After the platelets are collected from your daughter‘s blood, the remainder of the blood is returned back to her through the same sterile tubing. The procedure is safe, the instruments are sterile, and those individuals who provide platelets only, as your daughter does, can donate every three days up to a maximum of 24 times a year.

Requirements are similar for apheresis as they are for routine blood donation. An individual must be at least 17 years of age, in good health and weigh 117 pounds or more. There are health standards and screening procedures in place. Obviously your daughter is well enough to qualify.

The last bit of good news I’ll provide is that a single apheresis donation of platelets can provide as many platelets as can five whole blood donations. And, a donation of platelets from a single donor vastly reduces the probability of an immune system reaction to the transfusion.

I appreciate your concern. However, I suggest you sit down at your desk to make a blue ribbon to pin on the shirt of this level-headed gal. Then sit back with a smile on your face. You must have instilled some pretty intense values over the years. Congratulations to you both.

Other readers who might be interested in obtaining more information or donating should telephone 1-800-GIVE LIFE to find the nearest facility. Donations for this procedure are scheduled by appointment only.

To give you related information, I am sending you a copy of my Health Report “Blood – Donations and Disorders”. Other readers who would like a copy should send a self-addressed, stamped, number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

I recently had a couple of pre-cancerous lumps on my head removed and treated. They healed well.

Lately any cuts I get, whether they are big or small, seem to get infected. I am not diabetic and my weight is normal. Is there a cause for low A cells? Is there something I can do make them rise?

DEAR READER:
First, I feel I must explain what type A cells means, as you appear to be slightly confused. Type A simply refers to your blood type. There are four blood types, A, B, AB and O. The reason for knowing a blood type is only so that should you need a blood transfusion, doctors would know what type to give you. Type A cannot receive blood from a person who is type B or type AB as this would cause the body to fight the abnormal blood leading to severe illness or death. Type O is a universal donor which can be given to any blood type as it lacks the markers that the other three have.

Now to your blood cell number of 3.1 to 3.6. I assume this is referring to your red blood cells which carry oxygen to the various parts of the body. When red blood cell counts are low it is known as anemia. There are several causes for this. However, based on your letter, I believe your anemia is simply due to a lack of iron in your diet. Iron is found in several foods but is abundant in red meat which you say you rarely consume. I urge you to speak to your physician about this and ask if he or she agrees that an iron supplement is appropriate. This should eliminate the anemia. If it does not, I recommend further testing. If your physician refuses, ask to be referred to a hematologist (blood specialist) who can perform further testing and recommend treatment.

Also, I would like to add a small comment on your fish consumption. While fish is highly beneficial, your should limit your intake. Studies have found that mercury levels in the ocean is rising and several types of fish are accumulating it in their bodies. Swordfish, shark and similar large fish, if eaten in large quantities, may, in theory, lead to mercury poisoning. Continue to eat fish but consume farm-raised or small ocean fish. Salmon, cod, haddock and similar fish contain all the benefits but have limited exposure to ocean mercury levels.

To give you related information, I am sending you a copy of my Health Report “Blood — Donations and Disorders”. Other readers who would like a copy should send a self-addressed, stamped number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

The insertion was done twice, both times without lubricant. One of the results was bloody urine. My poor father said “Just imagine being 82 years old and having somebody do something like that to you”. When he told his hometown doctor she just abut came unglued. A male nurse also informed him that he always “lubes the tubes”.

My father is now unable to urinate on his own because of a blockage which his urologist says may have been due to damage caused by the dry insertions. He now has to live with the catheter.

I cringe whenever I think about his experience and wonder how many other elderly people have been subjected to this kind of abuse. Please print this letter so the word can get out about this torturous practice.

DEAR READER:
I was appalled by your father’s experience and as an elderly gentleman cringe at the thought of how painful that must have been.

There is no excuse to put someone through that pain, especially an older individual who was already feeling unwell because of another condition. There is no reason in my mind why a lubricant could not have been used.

I urge you and your father to contact the hospital for an explanation of why a dry insertion was done twice and explain that his current situation is likely due to them. Doctors today are often told to never apologize to patients because it admits fault. In this situation, your father deserves an apology from the nurse and/or physician who performed the catheterizations and perhaps even the hospital that allowed it to happen twice!

I know that most people reading this would believe that legal action is best, but in most cases, this one included, it is not appropriate. Unless medical neglect is undeniable, the expense and hassle are not worth it. First, this case may have been caused by the insertions (and my hunch is that it was) but there is no proof that this is the case. Second, at your father’s age, the stress of a court case is ill advised, especially since he is already ill with a blood disorder. However, someone needs to understand what was done was wrong, traumatic and unacceptable in the future.

I have printed your letter because others need to know this is not standard practice. You stated that this is abusive behavior and I must agree.

To give you related information, I am sending you copies of my Health Reports “Blood — Donations and Disorders” and “Bladder and Urinary Tract Infections”. Other readers who would like copies should send a self-addressed, stamped number 10 envelope and $2 per report to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title(s).

The problem is now starting to happen on the top of the lower right arm. I have also noticed that following treatment for a blood clot in his leg (after hip replacement in 2006) with Coumadin, the blotches seem to be worsening. He also has some minor bleeding. He is tested once a month to ensure his Coumadin is working. The spots are not itchy or painful, they are only unsightly.

Aside from the Coumadin (2.5 mg four times a day, five days a week and six times a day, two days a week) he is taking Celebrex 200 mg, Sular 20 mg, Clonidine 0.2 mg, B6 50 mg, B12 500 mcg, folic acid 400 mcg, one calcium plus D pill, one multivitamin/mineral and one glucosamine/chondroitin pill (1500mg/1200mg). These were all started at different times but he has been on the clonidine since 1991. Please help us figure out what is happening.

DEAR READER:
Your husband is on several prescription and over-the-counter medications. Judging from what he is taking, it appears he has arthritis, high blood pressure and a clotting disorder.

I believe that he may be suffering the side effects of one of his medications. You do not say when the skin condition started but based on your letter, it was sometime before 2006. Had these blotches appeared after the Coumadin was started, I would have immediately recommended your husband return to his physician for testing that would have most likely shown that his levels were too high.

Because Coumadin is an anti-coagulant, doses that are excessive can cause bruising, slow healing wounds, easy or hard to stop bleeding and more. Because the spots worsened after the Coumadin was started, its leads me to believe that they are somehow related to the vascular system.

You claim your husband has had some minor bleeding but don’t say if it is spontaneous or caused by simple bumps, scraps or minor injuries. He should be seen by his physician because the Coumadin may still be to blame for at least worsening the condition. The physician is correct to monitor his INR (a type of clotting) levels, but if your husband is having symptoms, it is indicative that the dose is too high, meaning the blood is unable to clot quickly enough. Make an appointment to discuss this possibility right away.

Following the Coumadin review, I urge you and your husband to also review his other medications, including the OTCs. Clonidine, Celebrex and Sular can all cause various types of rashes. Sular can also cause skin discoloration, bruising, petechiae (pinpoint, round, purplish red spots caused by tiny hemorrhages in the skin) and maculopapular rash (stains or spots on the skin distinct from the surrounding tissue, usually not raised or painful).

I would also be curious to know his physicians stance on the OTC meds. Your husband is taking a multivitamin daily which by itself is good but he is also taking B6, B12, folic acid, and calcium plus D which is likely in the multivitamin already. I would suggest he stick to just the glucosamine/chondroitin and the one multivitamin unless he was directed by his doctor to take the additional supplements.

If this approach fails to provide positive results, I would recommend your husband be seen by a blood specialist who can determine if the blotches are caused by an abnormality in the clotting factors or other component of the blood.

Your husband needs to know what is causing his skin discoloration. If he has had it for more than 3 years, chances are it is harmless and benign. But, it is always better to be on the safe side. Don’t give up and remember to see as many doctors as it takes to get the answer you need. If dermatologists have failed, try another type of physician; someone out there will be able to help, even if it means a bit of hunting.

Let me know how this turns out.

To give you related information, I am sending you a copy of my Health Report “Blood — Donations and Disorders”. Other readers who would like a copy should send a self-addressed, stamped number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

Have you ever heard of such intense itching associated with leukemia? Is there any relief to be had? He is about to lose his mind.

He is also constantly cold because of his low red blood count but doesn’t wear wool, preferring layers, sport silk underwear and fleece jackets. At night he uses an electric blanket.

DEAR READER:
Your husband has is a type of cancer that affects the blood and bone marrow. Chronic lymphocytic leukemia (CLL) is a slow, progressive form of leukemia that affects a specific type of white blood cells known as lymphocytes.

Chronic lymphocytic leukemia is caused by damage to the DNA of newly forming cells in the bone marrow. Leukemia can develop for two reasons; one is due to damage that turns on oncogenes which control cell division and the other is due to damage that turns off tumor suppressor genes that tell cells when to die. In either way, the affected cells cease to function properly. In your husband’s case, the lymphocytes then gather in the blood and other organs and interfere with the normal blood cell production.

The reason this happens is unknown but doctors and researchers have found that many people with CLL have chromosome deletions (loss of part of one of the 23 pairs of chromosomes that make up DNA). Some individuals have an extra chromosome or other type of chromosomal abnormality. Most cases of CLL aren’t inherited but a small percentage of sufferers have a family history of the disorder or of lymphoma.

Often, there are no early signs or symptoms but in some cases fever, weight loss, night sweats, fatigue, lethargy and/or loss of appetite can be present. The disorder is often an incidental finding during normal blood testing. Symptoms of advanced CLL stages can include anemia (which can lead to paleness, fatigue, shortness of breathe and more), low white blood cell count (may cause frequent infections) and low platelet numbers (leads to bruising, abnormal blood clotting, etc.). Chronic lymphocytic leukemia may also cause bone or joint pain, liver and spleen swelling and enlargement of lymph glands in the stomach, groin, neck or underarm.

There are procedures and new medications available for treatment of aggressive or advanced CLL; however, there is no known cure.

I urge your husband to return to his oncologist for further testing and to discuss the possibility of treatment. While no one seems to know the cause of your husband’s skin issue, perhaps it will subside if the CLL is treated.

I would also like to add that persistent itching may also be a sign of kidney damage. Perhaps your husband’s condition has now progressed to a point where it may be causing organ damage. Another possibility is if your husband has recently undergone radiation treatment.

I believe your best chance of finding a solution will to be to start with the oncologist. Your husband needs answers, especially since his chronic lymphocytic leukemia appears to be worsening. If he or she cannot help, it may be time to turn to the super-specialists of a teaching hospital or clinic such as the Mayo Clinic or others. Let me know what happens.

To give you related information, I am sending you a copy of my Health Report “Blood — Donations and Disorders”. Other readers who would like a copy should send a self-addressed, stamped number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.