Too many platelets often can safely go untreated
DEAR DR. DONOHUE: My platelet counts have been high. I take hydroxyurea for this. My diagnosis is essential thrombocytosis. Is there a danger of clotting?
Why have they told me not to hold the hydroxyurea capsules in my hand, but to take one directly into my mouth from the bottle? I was told to wash my hands if I accidentally touched one. — J.P.
ANSWER: Platelets also are called thrombocytes. Essential thrombocytosis is an overproduction of these clotting cells. No one can say with certainty why the bone marrow starts producing them in profusion. It’s logical to think that the biggest danger from overproduction would be clotting. Strangely, the high count is more often associated with bleeding. The mass-produced platelets are poorly assembled.
If people with high platelet counts have no symptoms and no hint of heart disease, often treat- ment is deferred. If platelet reduction is deemed necessary for health, hydroxyurea is one drug often employed. Your current platelet counts are not in dangerous territory.
In a deleted part of your letter, you ask about your hemoglobin and red blood cell counts. They are a bit low, indicating anemia. They’re not so low that you need quick attention to this matter. You’re only borderline anemic. Your personal physician has to explain these changes. I can’t. There are too many possibilities.
Hydroxyurea can be absorbed through the skin and can create skin problems. The manufacturer says to handle only if you wear gloves, or to take it directly from the bottle with a glass of water.
About your pamphlet order: Please write me again, explaining the situation. Put your address in the letter. I don’t get the envelopes sent to me.
DEAR DR. DONOHUE: You never seem to address the kind of calcium I take: calcium phosphate. You mention only calcium carbonate or calcium citrate.
The brand name of my calcium is Posture-D.
Must it be taken with food? — M.H.
ANSWER: Calcium carbonate and calcium citrate are the two most widely used calcium supplements. Calcium citrate can be taken at any time of the day. Calcium carbonate is better absorbed if it is taken during or after a meal. The high stomach acid concentration at that time renders it more easily taken into the blood. Other calcium prepara- tions, like calcium phosphate, are digested more readily at or after meals too.
People should realize that there are food sources of calcium. Dairy products are the richest source. An eight-ounce glass of low-fat milk has 300 mg; one ounce of cheese, between 200 and 300 mg; one cup of yogurt, 450 mg. A cup of spinach has 245 mg; a cup of collard greens, 266 mg; a cup of navy beans, 126 mg.
DEAR DR. DONOHUE: We’re told to get five servings of fruits and vegetables daily. Just what is a serving? — L.L.
ANSWER: For fruits, a serving is the equivalent of a medium-size apple, banana or orange. A half a cup of chopped canned fruit or three-fourths of a cup of fruit juice also constitutes a serving.
For vegetables, one cup of leafy greens is a serving, as is half a cup of cooked vegetables or threefourths of a cup of vegetable juice.
DEAR DR. DONOHUE: Some months ago, you reported on a pain in the upper thigh in the area of a man’s pants pocket. Will you please run that item again? — M.L.
ANSWER: One cause of pain in that area is meralgia paresthetica. It comes from pressure on a nerve in the upper thigh. The result is pain.
Tight jeans, obesity, a too-tight belt or an inner scar can press on the nerve. Weight loss, belt loosening or surgical removal of whatever might be pressing on the nerve solves the problem.