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December 1, 2005
Polycythemia is the opposite of anaemia
Q: Please explain why I keep having a build-up of red blood cells. I have a quart of blood removed every month or so. The doctor tells me I will have this problem for the rest of my life. I am 82. Is there anything I can do to ease this condition?
A: You describe polycythemia. In this condition, bone-marrow cells have shifted into overdrive and are producing far too many blood cells –– red, white and platelets (Platelets are the smallest blood cells which form clots when a blood vessel breaks). The trouble mostly focuses on the overproduction of red blood cells. You can think of this as the opposite of anaemia.
The blood of a person with polycythemia becomes very viscous, like engine oil that thickens. It’s hard to circulate. It can cause symptoms like dizziness, ear-ringing and headaches, and it often raises blood pressure. Clots can form. Paradoxically, bruising and easy bleeding are also possible. The spleen enlarges. People with polycythemia are apt to develop gout and ulcers. They might also develop an intolerable itch after taking a shower or a bath.
The gravest danger of polycythemia is a clot in a brain artery causing a stroke or in a heart artery causing a heart attack.
Treatment is lifelong, but it is simple, inexpensive and not painful. It’s removal of blood from time to time. Once the blood count has returned to near normal, then blood-taking can be deferred to about every three months.
There isn’t anything you can do to get rid of the condition. You can expect to live the rest of your life with few problems from this condition now that the diagnosis has been made and treatment has begun.
Q: What is spondylolisthesis? I have a grade two slippage. I have back pain as a result of it, and the pain sometimes travels down my legs to my feet. I can lie down without pain, but coughing, sneezing, blowing my nose, sitting, standing, bending and lifting, when done without forethought, are torturous.
A: Spondylolisthesis (SPAWN-duh-low-liz-THEE-sis), an unfamiliar word, is not an unfamiliar condition. The backbones are stacked upon one another like a column of blocks. With spondylolisthesis, one backbone block has slipped over the one below it. This causes at least two per cent of all cases of back pain. When Finnish ballet dancers were examined in a study, a surprizing 25 per cent had it. Sometimes it’s there from birth. Sometimes it results from trauma to the back. Sometimes it happens with ageing. And sometimes it happens without an explanation.
The amount of slippage is indicated by “grade.” Grade one is the least displacement, and grade five, the worst.
What to do for it depends on a person’s age, the severity of symptoms and the amount of slippage. A programme of physical therapy can bring respite from pain. Occupational therapists can show you how to reach and lift and how to use devices that spare your back. You should seek help from both physical and occupational therapists.
A brace, used only intermittently, is another measure that can lessen the discomfort.
For cases that resist these conservative measures, surgical intervention might be the answer.
Q: My 12-year-old cousin eats very few fruits and vegetables and doesn’t drink milk. He eats lots of packaged snacks. I tell him to eat better, but he says that’s for old people. How can I persuade him to change?
A: Give him just one example. The number of broken bones in children is on the rise. One of the reasons given for this is that they have given up milk and the calcium in it in favour of soft drinks. That’s just one reason for him to adopt a better diet. n
Dr Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P .O. Box 536475, Orlando,FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com.
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