DEAR DR. DONOHUE: What can you tell me about chronic lymphocytic leukemia? About three years ago, at age 57, a blood test indicated I had a high white blood cell count. I was not feeling sick. My family doctor sent me to a hematologist, who confirmed the diagnosis. At that time, my lymphocyte count was 23,000. Today it is 50,000. My doctor tells me that since the count has not doubled in a year’s time, it indicates that the disease progression is slow. I have no symptoms. My doctor says I need no treatment. I find this confusing. I keep myself in excellent condition. Should I push for treatment against my doctor’s advice? — R.H.

ANSWER: The word “leukemia” conjures up thoughts of imminent death. That’s not true of all leukemias, and chronic lymphocytic leukemia — CLL — is a case in point. It’s the most common kind of adult leukemia in Western countries. It defies another cancer principle: The one that says early treatment is best.

Lymphocytes are one of the five kinds of white blood cells. They produce antibodies and are involved in fighting off infection in other ways. Most often, CLL is discovered quite accidentally, when a person has a blood count for some unrelated reason. And most of these people have no symptoms.

If a person has no signs or symptoms, treatment for CLL can be postponed without any harm. Should a patient develop anemia as a consequence of CLL or should the patient’s platelet count fall, then treatment is instituted. Or if a patient has a persistent fever, weight loss, drenching night sweats or extreme fatigue, treatment is begun. Swollen lymph nodes and enlargement of the liver and spleen are other signs that might prompt treatment. A doubling of the lymphocyte count in six to 12 months is an indication for instituting medicines.

You have none of these factors. The doctor is safely withholding treatment. You always have the option of seeking a second opinion, but the consulting doctor most likely would agree with the first doctor. Your doctor is taking good care of you.

DEAR DR. DONOHUE: I am anxious to hear from you. I have written to you several times, but have not seen a reply.

I am 90 years old and in good health. I am concerned because my urine has an objectionable odor. It used to be very clear and without any odor. Could this be caused by medications? I take blood pressure pills and a couple of heart medicines along with potassium and magnesium. I am restricted in my fluid intake. Please answer. I am anxious to eliminate this odor. — D.T.

ANSWER: Urea and ammonia — two byproducts of normal body chemistry — impart a slight odor to urine. Usually, it’s all but undetectable. If urine is more concentrated, the odor is more prominent. I believe that’s what’s happening to you. You are on fluid restriction, so your urine is concentrated. You can tell by the urine’s color. Well-hydrated people have pale-yellow to colorless urine. Is yours dark yellow? If so, it’s so undiluted that the odor is noticeable.

Rarely is urine odor a sign of anything significant. Infected urine sometimes has an offensive odor. Asparagus imparts a bad smell to it. Fruity, sweet-smelling urine occurs with uncontrolled diabetes. Your medicines are not at fault.

DEAR DR. DONOHUE: Having started on a fiber laxative (Metamucil), I find it gives me a better bathroom schedule. It also has enabled me to lose weight without semi-starving myself. Is it absorbing food before the food is digested, and is this an acceptable method of weight control? — L.F.

ANSWER: Metamucil (psyllium) relieves constipation by keeping undigested food moist and soft during its passage through the colon. That keeps people regular. It also fills the stomach and decreases appetite, thus promoting weight loss. It slightly decreases fat absorption, and it might interfere with absorption of some minerals, but not to an extent that it causes trouble.

It’s giving you two benefits. Stick with it, and count yourself lucky.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com.