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.

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 don’t do much at home but really feel good. I don’t even have chest pain. I have been to the hospital five times but only for three or four days at a time to have tests. They told me it was to check my lungs and heart valves.

I started smoking when I was 14 but quit in 1982. As long as I take all my medicine, use the oxygen and don’t get out of breath, I‘m okay. I am still able to work in the yard raking leaves. I always work slowly and use my oxygen.

My reason for writing is that a friend told me that emphysema is incurable. Is this true?

DEAR READER:
Based on your brief letter, I can only give you general information about emphysema. Since you do not give you age, gender, how long you have had the condition, what medications you are on and what procedures and treatments you have had before, I ask that you forgive me if I repeat anything you may have already tried.

First, I’ll answer your question. Yes, emphysema is incurable; however, it is treatable. But before I get into that, I will explain a bit about the condition, causes and symptoms.

Emphysema is a progressive lung disorder. It results from damage to the small air sacs and airways within the lungs that reduces airflow when breathing out. This means that “bad” air cannot be completely exhaled which causes an inadequate amount of “good” air to be inhaled. The final result is shortness of breath, even during minimal exertion.

Symptoms in the early stages are generally so mild, that they go unnoticed. Once they become more persistent and annoying, irreversible damage may have already been done. The primary symptom is shortness of breath. Others include fatigue (due to lack of oxygen), loss of appetite and weight loss (due to difficulty breathing while eating) and, uncommonly, a mild, chronic, dry cough.

Because the shortness of breath worsens as the disease progresses, most physical activity is difficult, if not impossible. In later, more severe stages, even breathing while lying down can be compromised. It is at this point that breathing requires most of the body energy, leaving little for other activities such as walking or even eating.

The most common cause for emphysema is smoking. This means that by not smoking (and avoiding second hand smoke), your chances of developing emphysema are incredibly low.

Another cause is alpha-1 antitrypsin protein deficiency which is an hereditary condition. It only occurs when two defective genes (one from each parent) are passed on to a child. Millions of people are carriers, meaning they only have one of these genes. Often they do not have problems but some may develop mild to moderate symptoms or other lung or liver disorders.

The type of emphysema caused by this condition generally develops earlier than the more common form of emphysema. Anyone who develops emphysema before the age of 40 should undergo genetic testing. Those found to be positive for the protein deficiency should inform close family members so they, too, may undergo testing. Early treatment can prevent or reduce symptoms.

Treatment includes supplemental oxygen, bronchodilators and inhaled steroids. Antibiotics may be given if bronchitis, pneumonia or influenza are also present. It is also important to get flu and pneumonia shots to reduce or prevent the chance of getting these disorders. Rarely, surgery or lung transplant are recommend only as a last resort if other options do not work.

Many individuals may experience improvement when enrolled in a pulmonary rehabilitation program. It is also important to quit smoking as this will only worsen symptoms at an accelerated pace.

As for your use of Viagra, I assume you are mistaken about the name of your medication. I am unaware of any off-label use of the impotence drug for emphysema. I recommend you return to your pulmonologist. It is important that you understand your condition and what treatments you are getting. An informed patient is a good patient. He or she will also be able to give you more information about other or newer treatment options that may be beneficial to you.

To give you 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 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

When I visited my heart specialist following my surgery and told him about the situation, he would only say it was anxiety. He continued to ignore my list of incidences and maintained it was anxiety. I have had anxiety before on various occasions such as when my car was totaled but I never had to stop and take deep breaths. I explained that this only began after my stent surgery and that I thought it was something other than anxiety.

Should I ask for a second opinion or is this normal after receiving a stent? Do I just have to live with it?

I have had a “chemical” thallium chloride stress test. To quote from my family doctor’s report it said “No definite evidence for ischemia on today’s examination”. I hope this helps you to help me.

DEAR READER:
Shortness of breath can be a sign of ineffective contractions of the heart muscle, known as congestive heart failure. It can also reflect anemia and lung problems such as blood clots, emphysema and other disorders. Although your heart workup was normal, I believe that you need further testing and agree that a second opinion is in order. Ask your family doctor to refer you to an internal medicine specialist.

To give you related information, I am sending you a copy of my Health Report “Coronary Artery Disease”. 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.