By Paul G. Donohue M.D. December 17, 2010 12:00 AM
DEAR DR. DONOHUE: please write something about polycythemia. My wife was just diagnosed with it. Before she was diagnosed, she complained about severe itching and tried many different creams, lotions and ointments without any relief. Finally a doctor made the diagnosis. she has blood taken periodically. The itching has stopped. how did she get this?
“Polycythemia” (POL-ee-sigh-THEME-ee-uh) literally means “too many blood cells” — poly, many; cyt, cells; emia, blood. no one is able to say how people get it. That’s still being worked on.
All varieties of blood cells — white, red and platelets — are produced in overabundance. Platelets are tiny blood cells whose function is to form a clot when a blood vessel breaks.
Blood, packed with too many cells, becomes thick and moves sluggishly. That gives rise to symptoms such as headache, dizziness, ear ringing and a rise in systolic blood pressure (the first number of a pressure reading). Itching is another sign. A warm shower or warm bath greatly increases itchiness. another polycythemia sign sometimes seen is redness and burning pain in the feet and hands.
One of the most serious consequences is clotting. A clot in a brain artery is a stroke. Bleeding and easy bruising are other common signs. That sounds paradoxical — clotting and bleeding. And bleeding shouldn’t happen with an excess of platelets. it does because often the platelets are of inferior quality.
Treatment is blood removal. once the blood count has been lowered and symptoms have gone, removal can be done less frequently, every three months or so.
If blood removal does not achieve control, medicines can be added to the regimen.
DEAR DR. DONOHUE: I read what you had to say about gallstones for the woman who didn’t want to have her gallbladder removed. I have gallstones too, and want them out. My doctor insists I don’t need an operation. what if I were to have an attack at some inopportune time? I’d rather plan for surgery. is this a rational approach?
Yes, your approach is a good argument for surgery. however, the odds are that you will never need an operation. You have what is called incidental gallstones, gallstones not kicking up any trouble, discovered by chance. The percentage of people with silent gallstones in the years from 50 to 59 is 12 percent for women and 7 percent for men. between the ages of 60 and 69, the percentages are 16 for women and 17 for men. Most of those gallstones are discovered when people happen to have an ultrasound of their abdomen for some unrelated reason. Only a few of these people will ever have a gallbladder attack. Surgery for silent stones isn’t recommended.
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