San Antonio Express-News (Sunday)
Any history of hepatitis C makes blood donation a no-go
Q: I am a 70-year-old with O-negative blood type. When I was 40, the Red Cross notified me that antibodies of hepatitis C had been detected in my blood and they would no longer accept blood donations from me.
Following this discovery, I was lucky to enroll in a twoyear study at my local Veterans Affairs hospital that tracked my antibody “copies.” My test results always showed “no detection.” The study ended with a liver biopsy, which detected only inflammation of my portal vein with no evidence of cirrhosis. I was told then that 7 percent to 15 percent of individuals who contract hepatitis C spontaneously get cured of the virus. I have always remained asymptomatic. With all the latest advances in medicine to combat and treat hepatitis C, do you think the Red Cross would again accept donations of my “universal donor” blood?
B.P.
A: No, you can never give blood again if you tested positive for hepatitis C. Even people who have undergone successful treatment for hepatitis C cannot donate blood afterward. The blood banks are very cautious to keep the blood supply as safe as possible.
The first screening test for hepatitis C became available in 1992, which corresponds exactly to when you were told you could not donate.
You can, however, still be an organ donor (the organs are donated to a person living with hepatitis C). People of any age may be organ donors.
Q: In December I had a bicycle accident. When they did a CT scan of my ribs, they discovered a large amount of urine that had overflowed my bladder. They removed over 7 pints with a catheter. It destroyed half my kidney function. I had taken Flomax for years and thought I was urinating sufficiently. One question I have is why none of my doctors had mentioned this possibility. Another question is:
Now that I had prostate reduction surgery, how do I know I’m urinating enough now? I do urinate, but I usually have to really push to make it work.
D.R.
A: Obstruction of the urine flow is a well-known cause for kidney failure, but it is quite unusual to happen as it did in you.
There doesn’t need to be a complete blockage of urine to damage the kidneys: It’s the high pressure that damages the kidneys, and if it goes on long enough, the damage is permanent.
Blockages can happen within the kidney, in the tube between the kidney and the bladder (ureter), in the bladder itself or in the tube that drains the bladder (urethra). Stones and tumors are frequent causes. Damage to the nerves to the bladder is another cause of urine obstruction that can cause kidney damage.
In men, the urethra goes right through the prostate. Enlargement of the prostate frequently causes partial obstruction of the urethra, and having to push to begin urinating is a common symptom of prostate enlargement in men. Medications like Flomax shrink the prostate and normally help relieve the pressure, but no medication is perfect. Surgery is still sometimes necessary. It is disturbing to hear you are having this symptom after surgery.
A periodic check of kidney function through blood testing is important, but I would recommend that your urologist look at whether you are completely emptying the bladder.
Q: I have had bad experiences with my local trauma center. Mainly, they will not consult with my doctor or my hospital, and vice versa. Things would move more quickly and safely if they got my medical history rather than starting from scratch. As a result, I ask the EMTs or paramedics to take me to my hospital, which is not that much farther away. Most times they refuse. Can I insist? I am so adverse that I ask a friend to take me to the emergency room instead of an ambulance.
C.S.
A: I agree that it is best to get all your care, including emergency care, from the same hospital system. Unfortunately, it doesn’t always work out that way.
The first thing I would say is that in a true emergency, you should call an ambulance, not a friend to drive you. This is true for any life-threatening condition or one that could become life-threatening during transport to the hospital, such as a possible heart attack, or if moving the person is dangerous, such as a neck injury. Those situations should prompt a 911 call.
When the ambulance comes, you can certainly ask to be taken to your hospital of choice, but the paramedic crew has the judgment to determine whether this is safe or violates state or local protocol.
Electronic medical records, despite severe shortcomings, do hold promise for improved communication between different hospital systems. In the meantime, person-to-person communication between your attending physician at the trauma center and your regular doctor is still critical, but it takes both parties to be willing to do this.
Q: At my annual physical this year my white blood cell count came back low (3.4, with normal being 3.8-10.4). All other labs were normal. My doctor had me repeat the lab after six weeks, and it came back with the exact same result. He now wants me to wait six to eight months and repeat again. Why? What could be the cause of this low lab value, and should I be worried while waiting a half year to repeat it? I’m a 61-year-old male who is 6 feet tall, weighs 185 pounds and is in otherwise good health.
R.C.
A: White blood cells fight off infection and play other roles in protecting the body. The biggest proportion of white blood cells numerically are the granulocytes, which are also called neutrophils. Most people with a low overall white blood cell count have low numbers of neutrophils.
The first part of evaluating a blood cell count is to get a breakdown of the different types. In our medical shorthand, we often will say “get a CBC with diff.” Translate this to “get a complete blood count, which includes red cells and white cells, and identify the differential, which is the proportion of each type of white cell, such as lymphocytes and monocytes, in addition to the granulocytes.”
There are many, many causes of low neutrophils. It ranges from benign (ethnic and familial low levels, which do not cause any problems) to lifethreatening (leukemias). The fact that yours has been stable and you are healthy is reassuring. Periodically checking your CBC and differential is reasonable. However, a visit to a hematologist would be the best way to get more information on whether you need to be concerned about this.
Q: I need your guidance about paroxetine CR 25 mg, which I currently use and have used regularly for the past two years. When I decrease my dosage to below 12.5 mg, I experienced symptoms such as loss of appetite, mood disorder, pervasive worry and a skin sensation like pricking of a needle.
Can you help advise how to completely get rid of this medicine?
S.H.
A: Withdrawal symptoms in people stopping depression medications of the class of paroxetine (Paxil) are common. However, paroxetine tends to be the most difficult of these.
The first thing you need to know is that the CR (controlled release) formulation makes it impossible to slowly reduce the dose, since it cannot be cut in half (or smaller). For a regular release formulation, the 10 mg dose can be cut in half to make it easier to taper off. If you are doing OK on 12.5 mg, I would go to 10 mg for one to two weeks, then 5 mg for another one to two weeks, then off completely. Some people need even longer tapers to avoid the kinds of symptoms you mention (“brain zaps” is another symptom I hear about in particular with people getting off of paroxetine).
Other approaches include switching to an easier medication to stop, such as fluoxetine (Prozac), which lasts a long time in the body, and so it usually is easier to stop.