DEAR DR. ROACH: For the second time in two years, I've had bloodwork done due to massive headache, general tiredness and body pains. Both times, I also had very minor signs of a cold (post-nasal drip). My recent test shows elevated neutrophils of 89 percent (normal range is 40-80 percent), with high normal absolute neutrophils. My lymphocytes are more concerning, at 4 percent lymphocytes (range 20-40 percent), with absolute lymphocytes of 272 (range 1,000-3,000).
I'm having recurrent low-grade fevers (99.6-100.3) that seem to last only a few hours; night sweats; and am generally exhausted all the time. I am currently in a tropical country, and am concerned at times about the care I receive here.
What follow-up care, if any, should I request, and with what kind of doctor? I am concerned about lymphoma, as both my mom and brother have had it. -- M.H.
ANSWER: It is difficult to evaluate your blood counts, as both times you had it done, you were sick. A complete blood count (CBC) in a person who is sick with an acute infection often shows elevated neutrophils and low lymphocytes, so I would recommend evaluation during a time when you are well, if possible. A hematologist is the expert in reviewing results of white blood cell (as well as red blood cell and platelet) abnormalities.
Lymphoma can cause fevers and fatigue, so it is a diagnosis that is worth considering, especially with your family history. However, being in a tropical country, you are at risk for many different infections, which may have very similar symptoms and are far more likely. If you are concerned that your regular doctor lacks the expertise, you might consider an expert in infectious diseases to help evaluate your current situation. A local expert certainly will know what is common where you are.
DEAR DR. ROACH: I recently had a cataract removed in my left eye and lens-replacement surgery in both eyes. Upon completion and before the first two-week follow-up appointment, I noticed visual abnormalities -- quite different in each eye -- which were subsequently diagnosed as macular puckers, neither of which had been present during presurgical screening. Since there is a history of macular degeneration in my family, this outcome was said to be an "age-related" phenomenon unrelated to the surgery. Vitrectomy has been recommended for both eyes.
I'm having difficulty making the decision to go ahead with another surgical procedure. Would you please explain the mechanics or relationship of how cataract and lens-replacement surgery can lead to the condition of macular puckers? Without this information, I am thwarted in my ability to make a clear decision. Yet the condition is worsening, and the nature of the differing visual abnormalities in each eye (wavy distortion in my left and triple image in my right) makes prescription lenses ineffective. -- J.W.
ANSWER: Macular pucker, also called epiretinal membrane, is essentially a scar over the macula, the very center of the retina, where our vision is sharpest. It is not related to macular degeneration, and it probably had nothing to do with the cataract surgery. Rather, it is more likely that removal of the cataract made it possible for your ophthalmologist to see the macula clearly enough to make the diagnosis. The surgery, vitrectomy (removal of the vitreous fluid), usually restores about half of the lost vision. I don't know of any other effective treatment besides surgery.
The booklet on macular degeneration explains this common eye ailment. Readers can order a copy by writing:
Book No. 701
628 Virginia Dr.
Orlando, FL 32803
Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient's printed name and address. Please allow four weeks for delivery.
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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected] or request an order form of available health newsletters at 628 Virginia Dr., Orlando, FL 32803. Health newsletters may be ordered from www.rbmamall.com.
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