Invasive testing may be necessary

Dear Dr. Gott: I have an ongoing problem that doesn’t seem to have an easy answer. Every month for about a week, I have blood in my urine. My white blood cell count isn’t up enough to indicate infection. Because I’m generally healthy and have no kidney pain, I’m unwilling to have invasive tests done. I had a hysterectomy for endometriosis 10 years ago. Could that be the problem?

Dear reader: I doubt it.

Blood in the urine (hematuria) is never normal in women or men. Most often it reflects a kidney stone, a urinary infection or a growth in the urinary tract, none of which may influence the white blood cell count.

In my opinion, you need testing, but I am mindful of your reluctance to have invasive procedures. So, the first step is a urine culture to identify bacteria that may be in your bladder.

If this test is normal, you should progress to a kidney/bladder ultrasound exam, a painless, safe and noninvasive examination.

If this is unremarkable, you need a referral to a urologist who will, unless I miss my guess, recommend cystoscopy (a technique to examine the bladder with a lighted tube) plus a CT scan of your urinary tract.

While I understand your hesitancy to have invasive testing, I believe that such testing may be necessary. Endometriosis (growth of uterine tissue outside the womb) does not usually cause hematuria; however, if present the condition could be diagnosed during cystoscopy.

To give you related information, I am sending you a copy of my Health Report “Bladder/Urinary Infections.” Other readers who would like a copy should send a long, self-addressed, stamped envelope and $2 to Newsletter, P.O. Box 167, Wickliffe, OH 44092. Be sure to mention the title.

Dear Dr. Gott: Please discuss cirrhosis of the liver. My husband doesn’t drink but has been diagnosed with it.

Dear reader: Cirrhosis is scarring and contraction of the liver, so anything that causes liver inflammation can lead to this chronic complication. Although in the United States alcohol abuse is the most common basis for cirrhosis, hepatitis and other liver disorders can also cause it.

Patients with cirrhosis experience loss of appetite and weight, itching, jaundice, malnutrition, swollen abdomen and (late in the disease) intestinal bleeding.

Cirrhosis is diagnosed by blood tests, ultrasound studies and biopsies.

The treatment is, to say the least, challenging, unless the condition is diagnosed early on, before permanent hepatic damage appears. For example, heavy drinkers must abstain if their livers show signs of early damage. Once scarring sets in and the liver shrinks, therapy is largely supportive (vitamins, nutritional diets and treatment of complications). Liver transplant must be considered an option in patients in the advanced stages of the disease.