Symtphgue, chest pain, light headed, excercise intolerant, test results

[coloradoman]

I am a 47 year old former smoker of around 1/2pack -20 years. I have entered information into this forum previously. My symptoms have persisted for 2 years with worsening intolerance for excercise . Any high Aerobic excercise, running, swimming, biking results in fatiogue afterward, headaches and dizziness. I have had low back pain initially but now fatigue and flu like symtoms slow me down in the afternoon. I have several positive tests which include high CSF protein 54mg/dL, and consistentlly high Hemoblobin(18.1gm/dl) Hematocrit(52.8 %) MCH (33.7PG). I have had CT chest scans dated (12/27/03) and (3/24/05). The first showed old disease, the 2nd shows same old disease but with upper lobes showing more prominent  "ill defined centrillobular nodules". Blood gas on 5/24/05 showed PH=74.3(normal) PaC02=34L PAO2=66L HCO3=22L TCO2=23  BE=-.6 SAo2=95 COHB=.5. Recent sleep studies show no sleep Apnea. In the last week  
my neck has swollen between collar bones and neck significantlly, with no accompanied pain. My next appointment with my Pulmanary specialist is a month away. I am wondering what to do next.
I do have other pains in neck,feet,shoulders,hands and head which are transitory. I have no diagnosis, any suggestions ?
(coloradoman)

[National Jewish]

If live at an altitude less than 5,000 feet your hemoglobin is high and your oxygen level is low.  A low oxygen level can cause an increase in the hemoglobin.  Your low oxygen level could account for your low carbon dioxide level.  You should have pulmonary function tests done.  You may need a lung biopsy.  Further advice needs to come from your pulmonary specialist.

[bactitech]

http://www.emedicine.com/med/topic1863.htm

Please check out this article regarding secondary polycythemia.

I found a definition on another site

http://tinyurl.com/3kaax

"Secondary polycythemia. In secondary polycythemia, the increase in RBC counts is due to an increase in the RBC stimulating hormone, EPO. Potential causes of this include: low blood oxygen, caused by heart disease or high altitude; continual exposure to carbon monoxide (heavy smoking of cigars or cigarettes); congenital (hereditary) disorders producing an abnormal hemoglobin or an overproduction of EPO; and diseases such as kidney disease."

Going back to the first URL listed, they use a cutoff of a 52% hematocrit in men to start investigations. Secondary polycythemia is due to a non-bone marrow condition. Primary polycythemia is due to changes in the bone marrow. It would be prudent to ask your physicians about this soon. Sleep apnea is one of the differential diagnoses with secondary polycythemia.

Your body may be making more RBC's to be able to carry less and less oxygen around. An 89% oxygen saturation is on the low side. If your blood gets too thick with RBC's it will get like sludge. This is NOT a good thing. Let us know what the docs say.

As a sidebar, are you living in a high elevation, e.g. Denver or somewhere like that? High elevations cause naturally higher hematocrits in these populations vs. people who live at sea level. Labs in these places have somewhat different normal ranges on CBC levels than labs in lower elevations. Just a thought.

[bactitech]

Duh, I just noticed you post as Coloradoman. If you are living there, your high results could have something to do with your elevation, which may be why your docs are somewhat laid back about them.

I subscribe to a lab list, and have asked what panic values are for patients who live at higher elevations? I am curious as to what the answers will be. I work in microbiology, not hematology, although I trained and worked in that department for a short time a number of years ago. It's always good to keep up with other departments, though :-).

I'll let you know what they say about CBC normals at high elevations.

[coloradoman]

I just recieved the results of my sleep study. Everything appears normal from the report with a Final impression of Intrinsic Sleeping Disorder, NOS. Average REM 88% min 83% max (non-sleep) 89%  
O2 oxy saturation. These seem low according to literature I have been reading.

[coloradoman]

Additionally recent chest x-ray showed mild hyperinflation

[maxcamps]

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[bactitech]

What do docs say about that high hemoglobin? That is not normal unless you're extremely dehydrated. Men usually run 14-16 gm hemoglobins.

Have you been checked for polycythemia?

I'm a medical technologist BTW - we're the people who run all the lab work. Please realize I'm NOT a doctor but just looking at your results as posted, I'd question that Hgb result.