Dear Dr. Roach: I recently had a urinalysis done for pain that I usually get from urinary tract infections (UTIs). The results showed that some of the tests were high. My epithelial cell count was 11; my hyaline cast count was 10; and there were both red and white blood cells. There wasn’t any bacteria, and the doctor never contacted me. So, I am assuming things are OK.
The pain subsided after a few days, and now I don’t have any. Should I be concerned about these high results?
B.J.E.
The finding of elevated white blood cells in the urine of a person with a history of UTIs and recurrent symptoms is suggestive of a urine infection. However, with no bacteria seen, this becomes less likely. Red cells are commonly seen in urine infections, while hyaline casts are nonspecific. Epithelial cells come from the lining of the urethra and surrounding area (the vulva in women).
It is primarily symptoms that drive the decision to treat a patient, and with your symptoms gone, treatment isn’t necessary. You could have cleared a UTI on your own. I would consider retesting the urine (being very careful to clean the surrounding area and let some urine drain before collecting the sample) to make sure that the urinary findings have gone. Unusually, kidney stones, tuberculosis of the kidney, and kidney inflammation can result in these findings. When no infection is found, it is prudent to do further investigation if the white cells remain high without bacteria.
Dear Dr. Roach: Six months ago, my husband had a Whipple surgery for ampullary cancer. He also received chemotherapy. He is 85 and has finally started to live again. However, he gets these shivering and cold feelings, almost like he’s been outside in subzero temperatures, to the point of putting him in bed with a pile of blankets and a heating blanket, too. We have asked the surgeon about this, and he didn’t really have an answer. So, I was wondering what you thought about this situation.
P.T.
Ampullary cancer is located at the ampulla of Vater, a structure where the common bile duct empties into the duodenum. Ampullary cancer sometimes behaves like pancreatic cancer, but it may also be derived from the bile duct or the small bowel, which has a better prognosis than pancreas cancer.
A Whipple procedure removes the gallbladder, as well as parts of the bile duct, pancreas, stomach and duodenum. Then it reconnects the remainder of the organs directly into the jejunum, the next part of the small bowel. A Whipple procedure is a technically difficult surgery, but the surgery is no longer as risky as it used to be, thanks to improved techniques and surgical expertise. Surgery is the only chance of a cure for this cancer.
There are numerous reasons why he may have this sensitivity to cold. Weight loss, which is nearly universal after this procedure and this type of cancer, makes it harder for people to retain body heat. Chemotherapy (especially platinum) can cause damage to the part of the nervous system that regulates temperature, but this should get better over time.
I suspect there are multiple factors working against him, but over time, it should improve. Nutritional support may be very helpful, and if his doctor isn’t available, a registered dietician would be a useful ally. A quick check for other medical conditions, especially anemia and thyroid disease, might be prudent.
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]
