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.

DEAR READER: Emphysema results from damage to the airways of the lungs, obstructing the flow of air on exhalation. Symptoms are exercise intolerance, loss of appetite, fatigue and shortness of breath. The most common cause for the condition is smoking. Smoke temporarily paralyzes the cilia (microscopic hairs) that line the bronchial tubes. When the effects of smoke become so severe as to interfere with their movement, irritants in the bronchial tubes infiltrate the alveoli (air sacs) and inflame the tissue. This causes the elastic fibers to break down. Once the fibers have been destroyed, a person with emphysema must almost force air out of the lungs when exhaling.

Risk factors include exposure to secondhand smoke, occupational exposure, heredity, age, HIV infection and connective-tissue disorders.
Diagnosis might be accomplished through a chest X-ray, pulmonary-function tests, arterial blood-gas analysis, sputum analysis or though a CT scan.

Treatment involves discontinuing smoking and staying away from people who smoke. As you have discovered, steroid inhalers, bronchodilators and supplemental oxygen help ease symptoms. Antibiotics might be prescribed for respiratory infections. More complex cases and last-resort tactics might require surgery or transplant. On the home front, remedies include breathing from the diaphragm while lying down, deep breathing exercises and exhaling through pursed lips. The act of exhaling through puckered or pursed lips will increase air pressure within the airways. Avoid known irritants such as toxic chemicals, people with respiratory infections and cold air during the winter. This can be accomplished simply by wearing a mask over the mouth and nose, or by keeping the area covered with a scarf when outside. Exercise and eat well. If you are overweight, the body requires more oxygen to function properly, interfering with the process of breathing. Losing weight will work toward making breathing easier. And, above all, avoid smoke.

To provide related information, I am sending you a copy of my Health Report “Pulmonary Disorders.” 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, or download an order blank from my Web site, www.AskDrGottMD.com. Be sure to mention the title.

I had my blood checked to see if it is too thin, but that test was negative. A thyroid test was slightly low, but I haven’t talked to my doctor about that yet to see if there is a connection. My medications are Spiriva, Albuterol and Armour thyroid. I was previously on Symbicort, but it made my tongue swell and become raw, so I was switched to the Spiriva that doesn’t work as well. I’ve been on the thyroid medication for 50 years and expect to have to take it for the rest of my life.
I really would appreciate your input.

DEAR READER:
Your Spiriva prescription has an uncommon side effect of rash for a very few individuals. If the rash appeared once you made the switch from Symbicort to Spiriva, you have your answer; your leg rash is drug-related. If, however, you had the rash prior to the switch, you must look elsewhere.

Your tongue swelling was an indication you could have had an allergic reaction to the components of the drug and your physician was correct to make the change to Spiriva.

While you sent a photograph of your rash the condition is difficult to diagnose since there are so many possibilities. It could be viral or bacterial in nature, a form of plant dermatitis, Lyme disease, pityriasis, Sjogrens, or other conditions.

I would rule out the Armour thyroid, because you have been on it for so long. The combination of the three drugs, however, could interact and present in the form of unexplained rash. The only true way of determining this is to eliminate one drug at a time to see if the rash disappears. Because of your COPD, I would urge you to speak with your physician or cardiologist before even considering making any changes. In the interim, you should make an appointment with a dermatologist if you haven’t already done so. See him or her while the rash is in full bloom so a diagnosis can be made.

To give you related information, I am sending you a copy of my Health Report “Consumer Tips on Medicine”. 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.