by Dr. Iain Corness
Test for everything, Doc
“Were my tests OK?” is a query
every doctor faces after sending a patient off for a blood test.
Unfortunately, patients do seem to get a little confused about “blood
tests”, or perhaps we need to explain them better.
Your ‘usual’ blood tests do not
test for “everything”. The reason for this is simple. There are so many
tests that can be done, that testing would go on for weeks if you wanted
“everything” checked. (And let’s not ask the price!) For example, the
Australian Royal College of Pathologist’s Manual of Use and
Interpretation of Pathology Tests that sits on my desk lists 150 pages
of tests that can be carried out. These include such items as a
Reptilase Time, something I have never requested in 40 years of
practice, or a red cell Galactokinase, ditto.
No, when we send you off for a
blood test, we have to try and be reasonably specific, and sometimes
even have to give the pathologists a clue as to where we are heading,
and be guided by them as to some specific testing.
However, many times we are really
just casting a ‘wide net’ to see what abnormalities we can turn up to
use as a pointer towards the definitive diagnosis. One of the commonest
is the “Complete Blood Count”, usually called a CBC, since we medico’s
love acronyms, but remember this testing is in reality very far from
The CBC does provide important
information about the kinds and numbers of cells in the blood: red blood
cells, white blood cells, and platelets. A CBC can help us evaluate
symptoms such as weakness, fatigue, or bruising and even directly
diagnose conditions such as anemia, infection, and many other disorders.
The CBC test usually includes the
White blood cell (WBC) count as these cells protect the body against
infection. If an infection develops, white blood cells attack and
destroy the bacteria, virus, or other organism causing it. White blood
cells are bigger than red blood cells and normally fewer in number. When
a person has a bacterial infection, the number of white cells can
increase dramatically. There are five major kinds of white blood cells:
neutrophils, lymphocytes, monocytes, eosinophils, and basophils. The
numbers of each one of these types of white blood cells give important
information about the immune system. An increase or decrease in the
numbers of the different types of white blood cells can help identify
infection, an allergic or toxic reaction to certain medications or
chemicals, and many conditions (such as leukemia).
The Red blood cell (RBC) count is
also part of the CBC. Red blood cells carry oxygen from the lungs to the
rest of the body. They also help carry carbon dioxide back to the lungs
so it can be exhaled. The red blood cell count shows the number of red
blood cells in a sample of blood. If the RBC count is low, the body may
not be getting the oxygen it needs. If the count is too high (a
condition called polycythemia), there is a risk that the red blood cells
will clump together and block blood vessels (thrombosis).
Another part is the Hematocrit
(HCT). This test measures the amount of space (volume) red blood cells
occupy in the blood. The value is given as a percentage of red blood
cells in a volume of blood. For example, a hematocrit of 38 means that
38 percent of the blood’s volume is composed of red cells.
Hemoglobin (Hb). Hemoglobin is the
substance in a red blood cell that carries the oxygen. The hemoglobin
level is a good indication of the blood’s ability to carry oxygen
throughout the body.
There is also the Platelet
(thrombocyte) count, which is an important part of the CBC. Platelets
are the smallest type of blood cell and play a major role in blood
clotting. If there are too few platelets, uncontrolled bleeding may be a
problem, such as occurs in Dengue Hemorrhagic Fever.
So even though the CBC does test
for many factors, there are still another 149 pages of tests that can be
done! If you want to know your blood group, or your HIV status, you have
to ask! So now you know!
The cost of living forever!
Woody Allen, a famous American comedian
said, “I’m not afraid of dying; I just don’t want to be there when it
happens.” Unfortunately, death is also inevitable, and as my dear old Mum
used to say, “What am I doing here? I’ve passed my use-by date!” However,
she certainly did make the most of her 94 years on terra firma, even winning
a medal from the Duke of Edinburgh for her work in cataloguing wild flowers
in the woods of Northern Scotland.
There are some special age-related
problems, for those who live longer. A particular type of blindness called
Age Related Macular Degeneration diminishes the eyesight to be lucky to
identify three fingers at 2 meters. And we don’t have a fix-it right now,
but we’re working on it.
Another disease prevalent in the older
age group is Osteoarthritis. Hips and knees just ‘wear out’. We have
invented artificial joints that do fairly well, but they only last about 15
years, so if you’re planning to reach 100, better wait till you’re 85.
Of course cancer is on this list.
Cancers are primarily a condition of aging. After so many years of
functioning properly, some of the cells just ‘wear out’ and an abnormal
situation occurs. Without the checks and balances in the body systems,
overgrowth of cellular tissue can turn into a malignant cancer.
So what about Dementia and Alzheimer’s
Disease? Aging of the brain producing a slowing down of cerebral function.
Now all I have to do is get my brain
hot-wired into a wireless network and I can meet the world head on, but
we’re not quite there yet, so we (you and me) have to retain as much
cerebral function as we can. And it turns out that it is not all that
We were always told that the one organ
of the body that could not reverse the wasting process was the Central
Nervous System. Once it started to fail, that was it. Dementia was just
around the corner.
That view has recently been challenged
and the results are comforting, to say the least. Experiments have been
carried out that showed that by inducing stress in an animal resulted in
chemicals being released. This on its own was nothing new, but what was new
was the fact that some of these chemicals produced a difference in the
brain’s anatomy! The idea that the brain could not change was incorrect! It
could be ‘short-circuited’ resulting in a new wiring pathway.
In turn this has led to much research
into the effects of stress and its reversal, and then on to Alzheimer’s
Disease (if I have remembered to spell it correctly)! And if it were
possible for its reversal too!
Returning to the research, we have
shown that stress can physically damage nerve cells used in storing memory.
We have also found that mindless watching of the goggle-box also produces a
decline in brain function. In fact the numbers are more worrying than that.
It has now been found that people with no stimulating leisure activities,
and who are couch potatoes instead, are nearly four times more likely to
develop dementia compared to those people who have leisure stimuli and do
not waste hours in front of the TV.
Taking that a step further, and turning
the scientific data around to be useful, it has been found that in being the
converse to the couch potato, intellectually stimulating leisure activities
had a ‘protective’ effect for the brain and its capabilities. What is more,
they have also found that if you are doing a job you enjoy, then this was
again protective, but a dull job with no stimulus or challenge was another
way to dementia.
Do we have to take up chess tomorrow?
No, because in place of intellectually stimulating hobbies, it has been
found that physical exercise itself stops memory loss and stimulates growth
of nerve cells.
Another protective factor appears to be
marriage! Those who have never married have twice as high an incidence of
dementia than those who are married. So there you are, rather than say that
your wife is driving you insane, it appears that she is driving you towards
(I don’t believe it!)
Rover the Wonder
Puppy Part 2
remember that last week I had the pre-op examination from Dr. Somchai
(Bangkok Hospital Pattaya) to see if my ophthalmic status was such that
it would be possible for me to have SuperSight surgery. After his
clearance I returned to see him, saying, “Let’s do it!”
Let me assure you
that was no throw-away decision. Like all of us, to have someone
tampering with our eyes is frightening. Are Labradors and white sticks
our futures? Is it painful? Is it dangerous? Has he done many of these
operations? What is the success rate? What is his success rate? These
were all the questions I asked of Dr. Somchai.
Let me assure you
that the future does not include tins of dog food and tripping over
kerbs. The satisfaction rate for SuperSight Surgery is over 99 percent.
The missing one percent is people who found they still felt better with
reading glasses for close work, even though middle distance and far
distance were now fine.
Dr Somchai has now
performed the SuperSight surgery over five thousand times and is
considered the world leader in this technology.
On the morning of
the op I presented myself to Dr. Somchai’s rooms (2nd floor)
where Nurse Wanida was waiting and a brief check was made, including
Blood Pressure (which was higher than usual, showing that despite my
medical knowledge and faith in Dr. Somchai, there was natural
warfare was next and consent forms to be signed and I was taken to my
room to change into hospital PJ’s, and where I used my reading glasses
for hopefully the last time, to read the paper (Pattaya Mail,
At the appointed
hour, a porter and a nurse arrived with a wheelchair. Down to the second
floor and the maze of operating theatres and change into sterile
SuperSight PJ’s. There was no turning back by then!
operating theatre is dominated by a recliner chair, similar to a dental
one, where you lie horizontal and are covered with sterile drapes. Light
tethers on the arms remind you not to rub your nose during the op!
All this time, Dr.
Somchai was there, explaining each step, administering anesthetic and
ensuring there is no sensation from the cornea.
It is actually
quite weird as when he is actually inside your eye, there is no pain,
but you know he’s there as he liquefies the old lens and prepares the
capsule for the new lens.
When the time comes
for the replacement lens it was brought out from its sterile container
and Dr. Somchai then began the exacting work of placing the lens inside
the eye, while I lay there, concentrating on looking straight up and not
moving the eye.
He told me that the
operation on the first eye was over and I was then re-draped, leaving
the left eye prepared for the same procedure of removing the old lens
and inserting the new SuperSight one. Each eye had taken about 30
minutes and I was then taken into the recovery area, a compulsory wait
to make sure I was otherwise fine.
Very shortly, Dr.
Somchai’s happy face appeared and assured me that everything had gone
according to plan and I could go back to the room.
With so many eye
drops it was difficult to know how my vision was going to be, and having
been given dark glasses to wear, it was not possible to judge, and I
just fell asleep, glasses and all.
Waking at 6 p.m. I
picked up the TV remote, which I could read for the first time in years,
and flicked through the channels. The reception was good and my vision
was not bad, but I had been warned not to try and judge the acuity for
By 9 p.m., after
another sleep, I turned the TV on again. Wow! Clear, no blurring, and
sharper picture than I was used to before.
Dr. Somchai did
warn me that some patients experience a headache post-operatively, and
simple paracetamol could be taken. Quite honestly I did not have any
headache, but I was questioned by the attendant nurses to ensure that I
Again I slept well
that evening and in the morning was taken to Dr. Somchai’s rooms again
for a final check. Everything was fine and I was given my appointment
slip for the final check in one week.
In the meantime I
have eight pairs of glasses in my top drawer which I will never need
again. Thank you Dr. Somchai.
Labradors and white sticks
I have always said that getting older isn’t necessarily fun, but it still
beats the alternative. I have been very lucky to inherit some of my mother’s
genes who lived to be 94, as opposed to the male side of the Corness family,
which, until me, nobody had ever seen their 57th birthday!
I have to admit that as 57 grew close I was taking my pulse very frequently!
Anyway, 57 has been and gone and to
make that birthday even more memorable, it was celebrated on the stage of
the Malibu Cabaret (Soi Post Office, but long gone now) with the cake
brought out by Ladyboy entertainers.
However, there has been a gradual
decline in one of my senses, which began as a nuisance until eventually I
could not ignore it any longer. My vision was deteriorating!
Medically we call it Presbyopia, the
shortsightedness of aging which happens to most people as they get to the
mid-40’s. You find it difficult to read the paper without holding it at arms
length. Eventually you run out of arms!
In poor light, it becomes very
difficult to read maps, for example. I remember standing in front of my
car’s headlights trying to read a map, but even with better illumination I
still ran out of arms.
I played around with reading glasses
for a while. The simple (read ‘cheap’) readers you can buy from market
stalls. Not really recommended, but I’ve never been one for strictly
following the rules.
It was then that I started to have
difficulties driving at night. Those of you who know me will understand just
what a problem this was becoming. Driving for me is not going from A to B,
but is an art form. I have been besotted by motor cars ever since age 11. As
an aside, I notice Evan, my newly turned 11 year old son sitting in the
passenger seat holding an imaginary steering wheel as we drive along –
perhaps it is genetic.
But back to the vision. It was street
signs first, and when out doing house calls at night, this was a big
problem. My big son in Australia (who grew to be 6’ 6") had to come with me
to assist in navigation – he could read the signs!
I tried glasses, but kept on losing
them, sitting on them, dropping them into the engine bay of the race car.
Glasses were not the answer.
My friendly optometrist suggested
contact lenses. My father had had a brief affair with contacts (the hard
ones in those days) but was never able to wear them satisfactorily, but the
technology had progressed and soft contacts were on the scene. With two
contact lenses installed by the optom I went out that night with big son. “I
can read the street signs,” I remember me saying to him. “And I can read the
numbers on the busses!”
The only problem with the contacts was
putting them in each morning. They seemed to have a mind of their own, and
more than one lens committed suicide on the bathroom tiles.
I wore contacts from 1992 until this
year, but I began to notice my distance vision was deteriorating. I began
wearing glasses again with the contacts. What is worse, one eye was worse
than the other, and night driving was becoming hazardous. I had to take the
sun film off the windows of the car, or drive with the windows down. I
couldn’t judge distances. It was time for me to be a bit more responsible!
Time for me to consult one of my
colleagues in the Ophthalmic specialty, who I thought could give my eyes the
quick once-over, prescribe stronger contacts and I would be away. That was
not how it was to be.
I consulted Dr Somchai Trakool-Satian
who spent an hour testing my eyes – corneas, retinas, pressures, lenses, the
lot. He had good news and bad news. My pressures were fine, retinas
likewise, but I had cataracts, and if I wanted to throw all my glasses away,
the answer was SuperSight surgery. I went away to consider my options and
returned to say, “Let’s do it!”
(The tale of my SuperSight will continue next week.)