Dear Dr. Roach: My daughter, who is 50, recently went to a urologist for bladder retention issues. She had several tests performed. My daughter鈥檚 doctor told her that the diagnosis is 鈥渙veractive stable bladder.鈥� The doctor said that she would benefit from a procedure called Medtronic bladder control therapy. A device is implanted through the lower back. It is supposed to stimulate the bladder to aid in urination. We had not known of this particular treatment. We have questions about this: Is this safe? How long will the device last? Will it be necessary to use this for the rest of her life?
Anon.
Medtronic is a medical-device company that makes the Interstim system, which delivers electrical impulses called 鈥渟acral neuromodulation.鈥� The theory is that it helps the brain connect better with the bladder. In practice, 86 per cent of people who got this device were 鈥渋mproved鈥� or 鈥済reatly improved,鈥� compared with 44 per cent of those on medical treatment. People considering this treatment undergo a two-week trial to see if it鈥檚 likely to work. About two-thirds of people respond favourably during the trial and have the device placed.
The procedure does involve surgery, and surgery always involves risks, including bleeding, infection, migration of the electrical wires and pain at the implant site. About one third of people undergoing the procedure had at least one of these adverse events, most commonly pain. As the procedure becomes more common, complication rates are going down.
I don鈥檛 know how long the device can stay in. Trials have reported continued response even after three to five years.
Dear Dr. Roach: I am a 22-year-old man. I recently had a 103-degree fever with cold and cough symptoms, and my doctor ordered a complete blood count. After my results came back, he said it is normal, but there is 10.6 per cent lymph (normal is 20 to 40 per cent), and a total white blood cell count of 5.6. Should I be worried?
D.A.
The lymphocytes are one of the types of white blood cells. In some types of illnesses, they can dip down from their normal level.
A normal level of a lymphocyte count is 1,500 to 2,000; your result is 10.6 per cent of 5,600 (the 5.6 refers to thousands), so about 600. This is common to see in some people with viral infections, and your doctor probably will want to recheck it after you recover from your flulike illness.
HIV is a virus that can infect the lymphocytes themselves. The U.S. Centers for Disease Control and Prevention recommends that HIV testing be routine for adults, and I agree. You should have an HIV test, especially since one possibility for low lymphocyte count is HIV infection.
Dear Dr. Roach: In a recent column, you advised someone to get the shingles shot unless she had an immune system disease. I am 63 and have been considering getting the shot. Now I am hesitating because I have lichen planus. I believe this is immune-system related. Is it? Should I not get the vaccine?
R.M.
Many conditions, including lichen planus, are thought to have a disordered, overactive immune system as part of their cause. However, what I meant as far as getting live vaccines like shingles was caution from those with serious damage to the immune system. In your case, I would recommend to get the vaccine.
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 [email protected].
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