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DrRussMD
DrRussMD, Board Certified MD
Category: Medical
Satisfied Customers: 63989
Experience:  Board certified Internal medicine and Integrative medicine. Many years of experience all areas.
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Currently working in SE Asia, British national, aged 44 years

Resolved Question:

Currently working in SE Asia, British national, aged 44 years
Mid march Had a heavy nights drinking session with friends (mixed drinks and even cigars!) and smoking (now stopped smoking)' and next day rash on face which occurred twice in 10 days, antihistamine and cold compress seemed to work I have had same rash 3 times 3 years ago when stressed out at work. Not stressed this time though.

After rash extremely tired for 2 days this subsided. Then had intense neck paid for about 2 weeks this has reduced mainly felt pain more at night, had 3 night sweats. 3 weeks on still having aches intermittently under jaw line and left and right of my neck. So managed to do some testing, but had to use three clinics due to services offered

Would very much welcome advice on results as I cannot see a doctor for another 4 weeks and had to undertake some teasing separately. I realize for my blood work need to consider all elements to make an informed decision whether normal or not,and possible causes and treatments.
Therefore all results below, thank you in anticipation of your guidance.

HIV, VDRL, HBS ag all non-reactive
Exercise stress normal
Cholesterol high hdl 33 low and LDL 197 high
Chol HDL 7.4 high
LDL /HDL 6.0 high
Fatty liver (had for 4 years)
SGPT 88 high
Mch 31.2 norm
Mchc 36.5 high
RBC normochromic normocytic RBC

WBC 11.63 high
Neutrophil 70.8% and 8.23 high
Lymphocyte 23% and 2.67 norm
Monocyte 5.9% and 0.69 (border limit)
Eas 0.2% 'and 0.02
Basophil 0.1% and 0.01
Platelet count 196
MVP 10.3
Platelet smear adequate
ANA screening negative

Look forward to you advice
Thanks
Submitted: 2 years ago.
Category: Medical
Expert:  DrRussMD replied 2 years ago.
Hello


I am Doctor Thomas, double board certified US doctor in internal medicine and integrative medicine. I am a clinician of over 20 years experience. I will start by asking you a question or by giving you an answer based on your information provided so far. I will be here to follow up with any further questions or concerns you might have.

I don't see a problem with your labs.

All results are within normal limits or within lab error ranges and nothing really stands out.

The white cell count would not be high according to most labs, and stress or hard drinking, or a viral infection could to this.

The rash reaction can be due to binge drinking after a number of years.

Histamine release, catecholamine release, can happen as a rebound effect to withdrawal from the alcohol.

This indicates a real problem with the alcohol and the fatty liver, and is a sound indication that drinking must stop completely.

Your work up should focus on liver function at this point.

I do not see this in your labs, it is called a metabolic panel, and that should be the next investigation.

The current labs are not useful.

Use reply to let me know if you have further questions [click reply to expert].
Please do not forget a positive rating [hopefully you will click an excellent; or come back to ask me more as needed].

Customer: replied 2 years ago.
Dear doctor thank you

Does the high wbc ( high is generally >10000 is I not) and neutrophil levels, indicate a bacterial,infection? Should I consider antibiotics

I also remain concerned regarding intermittent aching in my neck left right lower and under jaw line. I believe a slight increase in right node under jaw line.

I will request urine analysis when I return to onshore

With regards
Expert:  DrRussMD replied 2 years ago.
No
As I said your WBC is essentially normal.
We don't treat a lab by that and I see no reason for antibiotics.

The node is viral until proven otherwise.

Pain in the neck would prompt me to get an EKG to make sure your heart is ok.

Use reply to let me know if you have further questions [click reply to expert].
Please do not forget a positive rating [hopefully you will click an excellent; or come back to ask me more as needed].

DrRussMD, Board Certified MD
Category: Medical
Satisfied Customers: 63989
Experience: Board certified Internal medicine and Integrative medicine. Many years of experience all areas.
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