Dear doctors: I had two total hip replacements about 10 years ago. I was told that I should take antibiotics one hour before undergoing dental procedures. I take 600 milligrams of clindamycin.
Recently, I read that a considerable percentage of the orthopedic medical community is of the opinion that antibiotics are NOT required after a two-year post-op period. My dentist feels otherwise, but I feel he may be reacting with an overabundance of precaution because of the possibility of litigation in the event an infection were to develop after dental work. Your thoughts?
C.H.
People with total hip replacements have hardware in their joints that is at higher risk for infection than normal, healthy joints, so it makes sense to consider using antibiotics before procedures that might cause a temporary inflow of bacteria.
The American Academy of Orthopedic Surgeons doesn't give a specific recommendation, just that clinicians consider prescribing antibiotics. Early studies show that infection of the artificial joint can happen even many years after surgery, so I'm not sure the two-year rule makes complete sense.
Your doctor has to weigh the risks of the antibiotic (low, but not zero) against the risk of infection (low, but disastrous if it occurs). Doctors and dentists do think about litigation risk, but let's give your dentist the benefit of the doubt and assume he reasoned that the possible side effects of an antibiotic you have taken before are less dangerous than the small possibility of an infected hip joint.
Dear doctors: I am a 52year-old female. About a year and a half ago, my primary-care doctor informed me that my white blood cell count was high, and she advised that I see a hema-tologist. I did as she advised, and was diagnosed with polycythemia vera.
I have been seeing my hematologist on a regular basis. He said he isn't concerned about any type of treatment because my hemoglobin and platelets are fine. My white blood cell count is always between 20-24. Do you feel I have anything to be concerned about? I am otherwise healthy, feel great and don't feel tired. I would like to know what you think.
K.M.
Polycythemia vera, also called polycythemia rubra vera (which, in Latin, means "too many red blood cells"), is an uncommon blood condition in which the body makes more red blood cells than it needs. People with the usual kind of this condition have too many red blood cells. You have too many white blood cells.
In the usual kind, the most common form of treatment is bloodletting. (Yes, there are still a few diseases that we treat with bloodletting.) But periodic blood removal is not indicated for people who have normal red blood or hemo-globin levels. That's why your hematologist isn't recommending any treatment.
A complication of poly-cythemia vera is transformation to a myelodysplastic (MY-el-oh-dis-PLAS-tic) syndrome, a more severe blood disease of the white cells, such as leukemia ("myelodysplastic" means "bad growth in the bone marrow"). Although this happens at a rate of only about 0.5 per cent per year, it is more common in women, and this is something I am sure your hema-tologist is looking out for. There are medicines to reduce the white blood cell count, but some of these seem to increase the rate of leukemia. Blood clotting can be a problem in some patients, and this can be treated and prevented with aspirin. Polycythemia vera should be managed by an expert, so keep seeing your hematologist regularly.
Drs. Donohue and Roach will be co-writing Your Good Health until the end of this year, when Dr. Roach becomes the sole writer. Dr. Donohue is retiring after 30 years of writing this column. Readers may write the doctors at P.O. Box 536475, Orlando, FL 32853-6475.
