DEAR DR. ROACH: The lab results from my last checkup showed an out-of-range number of 1.5 for neutrophils. I questioned my doctor on this low number, and he said we should just keep an eye on it. Looking back on the past five years, the number has been consistently low — 1.5 or 1.6. I would like to know what this means. Also, my hemoglobin is around 12.5. Are these numbers related?

I’m a 76-year-old active lady. I walk, swim and do Pilates. I take pantoprazole and ranitidine for heartburn. — B.T.

ANSWER: Neutrophils are a type of white blood cell, the ones that first respond to infection. Very low levels are dangerous because your body can’t fight infection without them. Your level is borderline, not in the dangerous area. Hemoglobin is contained in red blood cells, and this level is also borderline. It’s possible that this is normal for you, but also possible there is something wrong with your bone marrow. Both ranitidine (Zantac) and pantoprazole (Protonix or Tecta) occasionally can cause low neutrophil levels.

Given how long it has been going on, and especially because both the hemoglobin level and the neutrophil count are low, I think it might be wise to discuss this with a hematologist — an expert in blood conditions. The hematologist may agree that it is reasonable to just watch it or may decide to do some additional testing. You may need a bone marrow biopsy, the removal of a small amount of bone marrow through a needle in the hip. Please let me know what happens.

DEAR DR. ROACH: I am a 78-year-old woman. A CT scan showed I have a prolapsed bladder. I have occasional discomfort in the morning. What is the best treatment? Should I see a urologist or an OB/GYN doctor? Is this a very common problem? — M.M.

ANSWER: A prolapsed bladder, also called a cystocele (SIST-o-seel), is when the structures between the bladder and the vagina weaken and allow the bladder to bulge downward into the vagina. The damage often happens during childbirth, but no symptoms may occur until well after menopause due to the effect of estrogen. It is quite common.

Both urologists and gynecologists treat this condition, and there are doctors with expertise in both fields, predictably called urogynecologists. Treatment depends on how bad the prolapse is anatomically (that is, how far the bladder drops into the vagina) and how bad your symptoms are. Treatment options include doing nothing if symptoms aren’t so bad, using estrogen cream and doing pelvic strengthening exercises (best done in conjunction with a physical therapist who can help you figure out the right muscles to exercise).

More-advanced cases may need a pessary (a plastic or rubber ring that is inserted into the vagina to help support the bladder) or surgery. If you need surgery, as I have often said, it pays to find the most experienced surgeon around, whether she or he is a gynecologist or a urologist.

Most women with mild symptoms do very well with exercises and/or vaginal estrogen. I certainly would not rush to have surgery.

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 ToYourGoodHealth@med.cornell.edu or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Health newsletters may be ordered from www.rbmamall.com.

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