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911DOC
911DOC, Board Certified Dr.
Category: Medical
Satisfied Customers: 5086
Experience:  Emergency Medicine Physician
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Hi, my doctor just ordered a blood test and i can see two items

Resolved Question:

Hi, my doctor just ordered a blood test and i can see two items out of range here
absolute monocytes: 164
d-dimer: 0.61
Would you be worried about any of those numbers?
Submitted: 11 months ago.
Category: Medical
Expert:  911DOC replied 11 months ago.

911DOC :

Welcome, My answers are for educational purposes only. Remember please, that we do not get paid if you do not click 'accept' / give positive ratings!

911DOC :

why were the blood tests ordered?

911DOC :

what are your symptoms?

Customer:

I went to him saying that I lately experienced some pain behind my knees

911DOC :

i see

Customer:

and I it felt a little stiff behind the knees

Customer:

And I haden't seen the doctor in a year anyway...

911DOC :

okay

Customer:

I also went to him because I have a pain in the left shoulder...

Customer:

There are some movements I can't make with my left arm...

911DOC :

so the monocyte result is only significant if your white blood cell count is completely out of bounds.... it is of very little significance in most cases, and yours would be a case in which I think the monocyte count (a type of white blood cell) is of no help at all, and an abnormal value does not help to get to a diagnosis in your case

911DOC :

the d dimer is a test to assess for clotting

911DOC :

and it's very non specific

911DOC :

meaning a slightly positive test

911DOC :

which I believe yours is

911DOC :

depening on the normal range for that lab that did the test

Customer:

Ok, may I ask another question?

911DOC :

is also very non specific

911DOC :

your doctor ordered it to get an idea bout the possibility of you having a blood clot

911DOC :

it's slightly abnormal

911DOC :

so now I think he will have to do ultrasounds of your legs to check for clot

911DOC :

standing by

Customer:

He did the ultrasound and didn't find anything...

911DOC :

then the d dimer is a not significant in your case

911DOC :

and you can likely ignore both these results

911DOC :

they do not lead to a diagnosis

Customer:

So, he put me on nabumetone.... I'm a little concerned about the possible side effects of that medication...

Customer:

nabumetone 750

911DOC :

it's very similar to motrin

Customer:

what do you know or think about that medication?

911DOC :

what side effects are you concerned with?

911DOC :

i think it's a good choice

Customer:

I looked online and they said it can cause heart attack or something like that

911DOC :

no

911DOC :

it does not cause heart attacks

911DOC :

it has some irritating effect on the stomach

911DOC :

and can be hard on the kidneys if used for a long time

911DOC :

but it's very much like taking motrin (ibuprofen)

911DOC :

standing bhy

911DOC :

'by'

911DOC :

i see what you are talking about now

911DOC :

the warning re heart attack and stroke is there

911DOC :

and it is for people who already have problems with their heart

911DOC :

this medicine is very safe

911DOC :

you must understand that the reporting requirements for drug side effects are such that

911DOC :

if there is ANY evidence, even one in ten thousand chance, that a drug may have a side effect... then it is required to be reported

Customer:

ok

911DOC :

obviously you can not do studies on humans

911DOC :

and give one group a certain drug

911DOC :

and one group another

Customer:

So if I don't have previous heart problems, this is not likely to create any new condition to me?

911DOC :

so these side effect warnings are often developed 'retrospectively'... in other words... scientists use statistics and look at thousand of people who have been on a specifiic medicine

911DOC :

if they see a patern they report it

911DOC :

which is why even aspirin

911DOC :

has a warning label that would scare you silly

911DOC :

and 'yes' to your last question

Customer:

It did scare the hell out of me !

Customer:

so... I hurt my left shoulder and that's why i got to this point...

911DOC :

let me show you something.... are you willing to take a little test for me?

Customer:

what kind of test?

911DOC :

a simple question

Customer:

go ahead

911DOC :

okay, give me one secone

911DOC :

what do you think cause the following in overdose....

911DOC :

stand by one second

Customer:

?

Customer:

Are you still here?

911DOC :

the following substance, when consumed in excess can cause

911DOC :

http://www.mayoclinic.com/health/drug-information/DR602191/METHOD=print&DSECTION=all

911DOC :

sorry

911DOC :

that link came up as a copy

911DOC :

the following subtance when consumed in excess can cause

911DOC :

Hyponatremia symptoms include:



  • weakness

  • dizziness

  • nausea

  • muscle cramps

  • slurred speech

  • confusion

  • loss of consciousness

  • seizures in severe cases

911DOC :

and death

911DOC :

do you know what it is?

Customer:

no, I don't

Customer:

what is it?

911DOC :

it's water

911DOC :

my point being

Customer:

WATER?

911DOC :

yes

911DOC :

my point is that

911DOC :

the side effect profile of most drugs will scare you to death

Customer:

ok, understand

911DOC :

because they have to list all POSSIBLE side effects

911DOC :

If you are afraid of the Relafen

911DOC :

there is really no difference between it and motrin

911DOC :

so you could simply take motrin instead

Customer:

Well, I've never taken any of those medecines... and I'm very suspicious of taking any medecine as I've always been very healthy...

911DOC :

okay

Customer:

that's why when I have to take anything new I go look it up on the internet to get any info I can...

911DOC :

good for you

Customer:

Now I still need to see what my doctor is going to do for my left shoulder

911DOC :

yes

Customer:

when I lift it up it's painful

911DOC :

yes

Customer:

I took one of the nabumetone yesterday, but it doesn't seem to be taking care of that pain...

911DOC :

it is not the kind of medicine you take one time

Customer:

I used to push very hard on my left arm trying to wash my back during my showers...

911DOC :

the NSAID class needs to be taken as directed, every day, on a schedule, to achieve it's maximum anti-inflammatory potential

911DOC :

tylenol works soon after you take it

Customer:

And I think that's where that pain is coming from.... any idea?

911DOC :

relafen and similar drugs need to be taken consistently and as directed

911DOC :

yes,

911DOC :

sounds very much like a rotator cuff problem, perhaps a shoulder joint problem. does not sound like surgical problem, sounds like something that physical therapy and rehabilitation will make better.

Customer:

physical therapy? rehabilitation? ... lot of money? long time treatment?

911DOC :

have no idae

911DOC :

'idea'

911DOC :

you are asking me to guess

Customer:

ok.

911DOC :

because i can't see your xray and can't do an exam

911DOC :

educated guess on my part

Customer:

The problem is my doctor didn't even order an xray....?

Customer:

should I suggest it?

911DOC :

you can

911DOC :

the thing is an xray only looks at bones

911DOC :

and bones are usually normal unless there is a specific injury

Customer:

But what I like is the "not surgical" part of your answer...

911DOC :

so an Xray may be good to have as a baseline study

911DOC :

but it will likely be normal

911DOC :

and your doctor has the benefit of being able to examine you

911DOC :

so if he chose not to do an Xray he is likely right

Customer:

you're right...

Customer:

But when I talk to him next time I'll bring it up

911DOC :

good

911DOC :

do you have any final questions for me about this?

Customer:

rotator cuff.... is that a very serious problem?

911DOC :

no

911DOC :

not unless you have a complete tear

Customer:

but there will be pain...

Customer:

ok,

911DOC :

and if you can raise your arm above your head you do not

911DOC :

let me send you some info

Customer:

thanks for your support today!

911DOC :

stand by

Customer:

ok

Customer:

I'm here

911DOC :

i think you will find this interesting

Customer:

go ahead

911DOC :

anything else tonight?

Customer:

No, I think we discussed it all

911DOC :

good

Customer:

Thanks a lot!

911DOC :

if this has been helfpul to you

911DOC :

please do leave positive feedback

911DOC :

and good luck

911DOC :

in your recovery

911DOC :

thanks for your question

911DOC :

ask for me anytime if you choose to use this service again

911DOC :

very enjoyable speaking with you

911DOC :

good night

Customer:

I definitely will!

911DOC :

great

911DOC :

:)

Customer:

is there a way to save this chat session?

911DOC :

you can cut and paste it into a word document or email

911DOC :

you can also retrieve it

911DOC :

at any time

911DOC :

by clicking on the 'my questions' link at the upper right of your screen

Customer:

ok.

Customer:

you got excellent!

911DOC :

awesome!

911DOC :

thank you

911DOC :

I will sign off now

911DOC :

and go get a bite to eat

911DOC :

good night

Customer:

Save & Exit

911DOC, Board Certified Dr.
Category: Medical
Satisfied Customers: 5086
Experience: Emergency Medicine Physician
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