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To Your Good Health: Elevated White Blood Cells Sometimes Misleading

Dear Dr. Roach: My husband had his regular blood work done in 2012, and it showed that his monocytes were elevated (15 percent) and his HCT was low (39 percent). When we asked his doctor what this meant, she said, “Cancer somewhere,” and we just have to find out where it is. So he was sent for more blood work, and he had lower-organ MRIs and a colonoscopy.

All tests were negative. So we were told that they were going to monitor the monocytes and he might need a bone-marrow biopsy. He was told not to drink any alcohol, as that may be the problem.

I was very worried and contacted a cancer center by phone; they looked at his blood work and felt he may be in a pre-leukemia stage.

His doctor insists that it is alcohol-related, but when he stopped the drinking for three months his monocytes did not go down. When he resumed drinking a little, they went down. We are very concerned, as we do not know what to do. He is just told to come back every couple of months and to not drink.

I must mention that he is not an alcoholic, by any means, but he does drink beer when he is out. The average would be about six per day, with some days drinking none. Can this be just from the alcohol, or is there cancer in him somewhere? — R.P.

Answer: Monocytes are a type of white blood cell. The normal percentage in blood is around 10 percent or less, but percentages can be misleading if the total number of white cells is abnormal. For example, if your husband’s total white count were low, then 15 percent monocytes might be only mildly abnormal or not abnormal at all.

Many conditions can make monocytes go up, including infections, autoimmune diseases, cancers (such as Hodgkin’s disease, a type of blood cancer) and myelodysplastic conditions (diseases of the bone marrow).

Alcohol can cause many changes in the blood counts, including an anemia (the HCT, hematocrit is one of several measures of red blood cells).

Six beers a day is certainly too much alcohol for health, and can cause alcoholic liver disease — another cause of elevated monocytes. He unquestionably should cut down, even if it has nothing to do with these blood findings.

Leukemia means “too many white cells in the blood,” and a bone-marrow biopsy is indeed the right test to evaluate for leukemia; however, your husband’s abnormalities don’t strongly suggest cancer (including leukemia) or a myelodysplastic syndrome. I would be sure that your husband sees a hematologist, who will recommend a bone-marrow biopsy if necessary.

Dear Dr. Roach: I have been reading your column in the newspaper for some time now and have not seen anything regarding sciatica. I am 83 and recently began having sciatica pain down my right thigh. My doctor recommended using a hot-water bottle. Are there any painkillers I can use? Are there any other products I can use? — G.L.B.

Answer: The sciatic nerve is a very large nerve that runs down the back of the leg. When the nerve is pressed on in the back — from a herniated disk in the back or from spinal stenosis — then there can be intense pain that feels like it is coming from the back, or anywhere from the top of the thigh to the foot. Since other nerves besides the sciatic can be affected, the condition is called lumbar radiculopathy.

A herniated disk is when the shock-absorbing material in between the vertebrae comes out into the space where the nerve root is, on its way out of the spinal column toward the leg. Spinal stenosis is a narrowing of the bony canal through which the nerve travels.

In most cases, people get better within four to six weeks. Standard pain medications, such as acetaminophen (Tylenol) or ibuprofen, can be helpful. If pain is severe and not responsive, there are other treatments, including a short course of steroids and narcotics, which should be given only during that initial period of pain.

Pain that persists for a longer period of time, or pain with weakness, especially with progressive symptoms, needs expert evaluation.

Readers may email questions to ToYourGoodHealth@med.cornell.edu.