Bone mar­row pro­duces the many kinds of blood cells

The Western Star - - LIFE - Keith Roach Dr. Roach re­grets that he is un­able to an­swer in­di­vid­ual let­ters, but will in­cor­po­rate them in the col­umn when­ever pos­si­ble. Read­ers may email ques­tions to ToYourGood­[email protected]­nell.edu or re­quest an or­der form of avail­able health newslette

DEAR DR. ROACH: You have men­tioned dis­eases of the blood mar­row in the col­umn be­fore, but what does the bone mar­row ac­tu­ally do? — T.S.B.

AN­SWER: The main job of the bone mar­row is to pro­duce the dif­fer­ent blood cells: red blood cells to carry oxy­gen; white blood cells to fight in­fec­tion and can­cers; and platelets to stop bleed­ing. Dis­eases of the bone mar­row can cause prob­lems by mak­ing some­thing ab­nor­mal (such as leukemia cells), but also by fail­ing at its job and not mak­ing what it is sup­posed to. Low red cell counts lead to ane­mia; low white cell counts in­crease risk of in­fec­tion; and low platelet counts con­trib­ute to ab­nor­mal bleed­ing.

Bone mar­row dis­eases some­times can be treated di­rectly, but of­ten treat­ment in­volves re­plac­ing blood prod­ucts, and pos­si­bly us­ing growth fac­tors to make the bone mar­row work bet­ter.

DEAR DR. ROACH: Sim­ple question: Why can’t I hear well when I am hav­ing a big yawn? Is this nor­mal? — J.C.A.

AN­SWER: This is nor­mal; in fact, it’s a uni­ver­sal find­ing with a yawn that hear­ing de­creases (but doesn’t go away en­tirely). This is be­cause the Eus­tachian tube closes, and there is a pres­sure dif­fer­ence inside ver­sus the out­side of the eardrum, re­duc­ing the abil­ity of the ear to trans­mit sound.

In­ter­est­ingly, af­ter a big yawn, hear­ing may be im­proved; when the Eus­tachian tube reopens af­ter the jaw po­si­tion changes, it can equal­ize the pres­sure and im­prove sound trans­mis­sion.

DEAR DR. ROACH: I know women who have had dou­ble mas­tec­tomies in or­der to re­duce the risk of can­cer. It seems ex­treme, but I guess it de­pends on the eval­u­a­tion of risk. Are pro­phy­lac­tic hys­terec­tomies done for sim­i­lar rea­sons? It used to be rou­tinely done when a woman had passed her re­pro­duc­tive years. I’m in­ter­ested in your take on this. Will health in­sur­ance cover these types of surg­eries, and if not, how ex­pen­sive are they? — S.B.

AN­SWER: Pro­phy­lac­tic mas­tec­tomies — that is, surgery to re­move the breasts in or­der to avert a breast can­cer di­ag­no­sis — are a rea­son­able choice for some women at very high risk of breast can­cer, es­pe­cially those with a fam­ily his­tory of breast can­cer who have an iden­ti­fi­able ge­netic pre­dis­po­si­tion, such as one of the BRCA gene mu­ta­tions. This de­ci­sion should be made care­fully and in con­sul­ta­tion with her doc­tors, usu­ally an on­col­o­gist and a ge­netic coun­selor. I have very lit­tle ex­pe­ri­ence with this in my own pa­tients, for­tu­nately, but I un­der­stand that in the case of women with very high ge­netic risk, it usu­ally is cov­ered by in­sur­ance, if it is the con­sen­sus of the treat­ing physi­cians and the pa­tient that she should pro­ceed.

Hys­terec­tomy — the re­moval of a uterus — is not done rou­tinely to­day, the way it was decades ago. They are re­moved for dis­ease, ei­ther be­nign or ma­lig­nant. How­ever, the re­moval of both ovaries and Fal­lop­ian tubes, called a bi­lat­eral oophorec­tomy and salp­ingec­tomy, is per­formed in some women at high risk for ovar­ian can­cer. In fact, women with the BRCA mu­ta­tions may con­sider both a pro­phy­lac­tic dou­ble mas­tec­tomy and a pro­phy­lac­tic bi­lat­eral oophorec­tomy and salp­ingec­tomy, since BRCA mu­ta­tions in­crease risk of breast can­cer and ovar­ian can­cer (as well as other can­cers).

The cost of surgery in the United States varies dra­mat­i­cally de­pend­ing on where it is done, but in gen­eral it is very ex­pen­sive.

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