Greetings, Dr. Roach We have spent around 30 years living at 6,000 feet. Our mean corpuscular volume (MCV), which normally ranges from 79 to 97 fl, has gradually climbed to 100 fl over the years. Due to living at a high altitude, our primary care physician and other medical professionals have reported seeing larger red blood cells than usual in other patients.
I am in my 60s, and my spouse is in his 80s. Our blood test results have been largely normal, and we are in good health. Will we eventually need to be concerned about our MCV levels if they keep rising? — S.K.A.
ANSWER: The most widely used indicator of red blood cell size is MCV levels. Red blood cells can be larger than usual for a variety of common reasons, such as low thyroid, low vitamin B12, low folic acid, alcohol consumption, certain medications, and a wide range of blood disorders.
Your doctors are correct, though, in stating that there is a slight rise in MCV levels among those who live at higher elevations. Since their levels are often 6 points higher, the typical range at high altitude could be between 86 and 103 feet.
Since huge red blood cells of this size are not dangerous, the question is whether altitude is the only possible reason. If it continues to rise, your physician may prescribe laboratory testing or recommend that you see a hematologist, a specialist in blood disorders.
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Greetings, Dr. Roach At the age of 85, I am a woman in comparatively good health. I had been taking raloxifene for approximately 45 years. My doctor at the time said that since I had a complete hysterectomy, I should be on it for the rest of my life to help prevent breast cancer and osteoporosis. I have a normal bone density.
Because she was unfamiliar with the medication, my doctor declined to renew my prescription a few months ago. I would like your opinion on this decision. — H.W.
ANSWER: In the United States, raloxifene was authorized for usage in 1997 to prevent osteoporosis and in 2007 to lower the risk of breast cancer. The majority of medical professionals who recommend raloxifene do so with the intention of long-term use.
One reason that many people are concerned about taking osteoporosis medicines is that the ones that slow down bone absorption are associated with an increase risk of atypical femur fractures if they re taken for too long. Bisphosphonate drugs, like alendronate and risendronate, are in this class. RANKL activators like denosumab are also associated with atypical femur fractures, which are devastating. These drugs are generally reevaluated and usually stopped after three to five years.
By contrast, raloxifene, which acts like an estrogen to strengthen bones (and an anti-estrogen to prevent breast cancer), does not seem to have a significant risk of developing an atypical femur fracture.
The long-term safety studies on raloxifene went on for eight years, so you are well past the published literature. Still, I don t think that refusing to re-prescribe the medicine was the best way of handling this. If she was uncomfortable doing so, it might have been prudent to refer you to an expert in osteoporosis.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions [email protected] send mail to 628 Virginia Dr., Orlando, FL 32803.
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