To Your Good Health
DEAR DR. ROACH: 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.
ANSWER: 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. You don’t want your untrained friend to be the only person there if you need emergency intervention.
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.
DEAR DR. ROACH: 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. I exercise regularly and consider myself very active. — R.C.
ANSWER: 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 life-threatening (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.