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question:Hi, I have recently had a very low Platelet count of 25.000, i also have a very large mass of very dark large bruises predominantly to the back of my left thigh although there are others in different areas. I am 48 years old and weight 13.5 stone. I was previously diagnosed with breat cancer on 7th July 2015 resuting in surgery, chemotherapy and Raiotherapy. How high is the risk on me having developed cancer of the blood or bone. I have tried to speak to the Haematology department to get some reassurance but have been told noone will talk to me.
answer:Dear Madam, I am pretty much worried about the low platelet counts that you have and bruises the you are developing. There are several causes for this problem, but as you were earlier treated with chemotherapy and radiation, there is high probability that you may be have a blood cancer or a precursor of cancer (we call this condition as therapy related Acute myeloid leukemia/ Myelodysplastic syndrome). Risk of developing this problem depends on type of chemotherapy agents used during the prior treatment and dose of radiation. Hence exact figures cannot be given and it is not necessary also. I suggest you to get your bone marrow tested at the earliest to know the reason for low platelet counts and also get admitted for platelet transfusions. Remember that blood cancers can be treated and with proper treatment many get completely cured of disease. Hope I have answered your question. If you have any further questions I will be happy to help. With regards, Dr. Girish Kamat
question:I was severely anemic due to fibroids. Was transfused 2 units of blood. Had a hysterectomy in June. Am currently taking iron once a day. My H&H is normal and my ferritin level is now a low normal I think about 31, iron studies are normal. How long should I continue taking iron for? I feel really good when I take it; energy levels increased almost overnight when I resumed taking it again (I had stopped due to post-op sluggish bowel/constipation). I m afraid now that I m not getting my period, I may be taking too much iron; am afraid of overdosing.
answer:Dear madam, Duration for which iron supplementation should be given is not clear in any of the recommendations. But it is very clear that, after hemoglobin is normalized iron supplementation should be continued for certain duration, to refill our iron stores. Generally hemoglobin level normalizes after 2 months of starting therapy. I give iron supplementation for a total duration of 6 months for all my patients. I do not monitor ferritin levels or iron profile. Lack of having periods is certainly not due to iron overload, but it is because, your uterus has been removed as you had multiple fibroids. So don't worry of about not having periods. Hope I have answered your question. If you have any further questions I will be happy to help. With regards, Dr. Girish Kamat
question:so you would not recommend taking Aspirin as replacement for warfarin if you have protein S deficiency, laden 5 factor? what is there besides warfarin, that s safe and are there any studies or labs working on other ways to combat the clots? Gene technology or maybe stem cells that can target the deficiency?
answer:Aspirin is not a effective alternative to warfarin, especially if you have Protein S deficiency/ Factor 5 Leiden. Alternativeto warfarin is Revaroxaban, which can be taken without monitoring PT/INR. Other option is to continue on Inj. Enoxaparin subcutaneously. At present there is no gene therapy or stem cell therapy available to combat clots. With regards, Dr. Girish Kamat
question:I have a relative recently diagnosed with hypoglycemia. She is 64 years old and about 5 2 and weighs 88 pounds. She had always strived to eat only healthy and does not believe in medication. Several days ago she became incoherent. She was hospitalized and put on iv. She had low glucose and low potassium. When they take her off the iv she crashes. She refuses to eat or take pills. How can the family help?
answer:Hi ThereAfter going through your query I understand your concern.I would like to tell you that hypoglycemia can be managed wily on healthy food. Give her something to eat every two hours. Foods and fruits rich in sugar and potassium are- Banana- Kiwi- Apple - Pumpkin seeds- Balanced food for low blood sugar individuals like meat, dairy products, fresh vegetables - Drink plenty of Water- small frequent meals- good SleepHope this will HelpKind Regards Dr. Navneet Mahajan
question:My hemoglobin has dropped to 7.8 and the doctors have not found out where the blood is coming from or where it s going. They do know that my stool sample is negative for blood. What could be causing this? I am on iron pills and had a iron infusion when in the hospital recently with a kidney infection.
answer:Hi thereI understand your concern.I would like to tell you that when kidney is diseased then it doesn't produce Erytheropoitin and as a result bone marrow doesn't produce enough red blood cells and result into anemia. Kindly get your proper kidney work-up done and consult with a Nephrologist. Consultation with a hematologist is also Recommended for further management.Hope this has answered your query.Kind RegardsDr. Navneet Mahajan
question:I had a TIA about 13 years ago and am taking clopidigrel. I will have a thyroidectomy soon. My doctor will probably want me to stop taking my blood thinner 5 days before surgery and then take lovenox after surgery. Is this the correct protocol? How do I inject lovenox?
answer:Hi ThereAfter going through your query I understand your concern.I would like to tell you that yea this is the correct protocol. You can stop taking clopidogrel 5days before your surgery. After surgery get a neurological consultation done and start Clopidogrel again.Injecting Lovenox is similar as injecting in insulin in subcutaneous.Hope this will helpKind Regards Dr Navneet Mahajan