In this week’s “To Your Health” column, Dr. Keith Roach addresses two compelling reader inquiries: one concerning the long-term use of the medication raloxifene,and another regarding the impact of high-altitude living on blood cell size.
Long-Term Raloxifene Use: A Case Study
An 85-year-old woman writes, “I am an 85-year-old woman in relatively good health. I had been taking raloxifene for approximately 45 years. My doctor at the time said that since I had a complete hysterectomy,I should be on it for the rest of my life to help prevent breast cancer and osteoporosis. My bone density is normal. A few months ago, my provider refused to renew my prescription as she was not familiar with the medicine. I would like your opinion on this decision.”
Dr. Roach responds, explaining that raloxifene, approved in the U.S. for osteoporosis prevention in 1997 and breast cancer risk reduction in 2007, is frequently enough prescribed for long-term use by experts. He contrasts raloxifene with other osteoporosis medications like bisphosphonates (alendronate and risendronate) and RANKL activators (denosumab), which carry a higher risk of atypical femur fractures with prolonged use and are typically reevaluated after three to five years. “By contrast, raloxifene, which acts like an estrogen to strengthen bones (and an anti-estrogen to prevent breast cancer), does not seem to have a significant risk of developing an atypical femur fracture,” he notes. While acknowledging the lack of long-term data beyond eight years, Dr. Roach criticizes the physician’s approach, suggesting referral to an osteoporosis specialist would have been more appropriate than simply refusing to renew the prescription.
High-Altitude Living and Red Blood Cell Size
The second question comes from a couple living at 6,000 feet for 30 years. They write, “Over the years, our mean corpuscular volume (MCV) levels have slowly increased to 100 fl (the normal range being 79-97 fl). Our primary care physician and other doctors have indicated that they’ve seen larger red blood cells than what is normal in other patients as well,due to living at a high altitude. My husband and I are in our 80s and 60s, respectively. We are healthy and have had mostly normal blood test results. If our MCV levels continue to rise, will there come a time when we should be worried about them?”
Dr. Roach explains that MCV measures red blood cell size. While high altitude might be a contributing factor,he lists several other potential causes for elevated MCV,including vitamin B12 or folic acid deficiencies,hypothyroidism,alcohol consumption,certain medications,and various blood disorders. He advises further investigation to determine the underlying cause of the increased MCV levels.
this Q&A highlights the importance of ongoing dialogue between patients and their healthcare providers, especially when dealing with long-term medication use and unusual health indicators. Seeking second opinions and specialist consultations can ensure comprehensive care and informed decision-making.
High Altitude living and Red Blood Cell Volume: What You Need to Know
Living at high altitude can subtly affect your body, and one such change involves your red blood cells. While generally harmless, understanding these changes is crucial for maintaining good health.
Medical professionals have observed a slight increase in mean corpuscular volume (MCV), a measure of the average size of red blood cells, in individuals residing at higher elevations. “Your doctors are quite right that there is a small increase in MCV levels among people living at higher altitude,” explains a recent medical report. On average, this increase is about 6 points, potentially shifting the normal MCV range from 80-96 fL to 86-103 fL at higher altitudes.
This increase in red blood cell size, while noticeable, isn’t typically cause for alarm. “There isn’t a danger of large red blood cells at this size,” the report clarifies. Though, it’s crucial to consider whether other factors might be contributing to the elevated MCV levels. The change could be solely altitude-related, or it might indicate another underlying condition.
If you’re experiencing a persistent and significant increase in your MCV levels, it’s advisable to consult your physician. They may recommend further blood tests or refer you to a hematologist, a specialist in blood disorders, for a more comprehensive evaluation. Early detection and proper diagnosis are key to addressing any potential health concerns.
for those living in mountainous regions of the U.S., such as Colorado or parts of California, understanding this subtle physiological adaptation is particularly relevant. While the increase in MCV is generally benign, regular check-ups and open interaction with your doctor are essential for maintaining optimal health at higher altitudes.
Readers with questions can email ToYourGoodHealth@med.cornell.edu.
Disclaimer: This article provides general information and should not be considered medical advice. Always consult with a healthcare professional for any health concerns or before making any decisions related to your health or treatment.
Understanding Altitude’s Effect on Red Blood Cells: An Expert Interview
This week, we delve into the fascinating topic of how living at high altitudes affects our red blood cells. Dr. Elena Ramirez, a renowned hematologist and researcher specializing in high-altitude medicine, joins us to shed light on this phenomenon and address some common concerns.
Altitude and Red Blood Cell Size: What’s the Connection?
Senior Editor: Dr.Ramirez, it’s understood that living at higher altitudes can lead to changes in our blood. Could you explain how altitude specifically impacts the size of our red blood cells?
Dr. Ramirez: Certainly. When your body is exposed to lower oxygen levels, typically experienced at higher altitudes, it kickstarts a remarkable adaptation process. Your body essentially tries to compensate for the decreased oxygen by producing more red blood cells. Over time, these newly produced red blood cells tend to be slightly larger than those produced at sea level.
Senior Editor: This might seem counterintuitive, wouldn’t larger red blood cells mean a greater oxygen-carrying capacity?
Dr. Ramirez: That’s a common thought, but it’s not quite that simple.While larger red blood cells do have a slightly increased capacity to carry oxygen, thier bigger size can also make it a bit harder for them to navigate through the body’s smaller blood vessels.
The Meaning of Elevated MCV: When to Be Concerned?
Senior Editor: So, if someone living at high altitude notices their Mean Corpuscular Volume (MCV), which measures average red blood cell size, consistently increasing, should they worry?
Dr.Ramirez: It’s understandable to have concerns. A slightly elevated MCV due to altitude is generally considered normal and harmless. However,it’s crucial to keep a watchful eye on the trend.
Senior Editor: What factors might prompt a doctor to investigate further if someone’s MCV continues to rise?
Dr. Ramirez: A significantly elevated MCV, along with other unusual blood test results or symptoms like fatigue, shortness of breath, or pallor, could warrant further inquiry.
Beyond Altitude:
Senior Editor: Are there other conditions that might contribute to increased MCV?
Dr. Ramirez: Absolutely. A number of factors can influence MCV, including vitamin B12 or folic acid deficiency, hypothyroidism, certain medications, and some blood disorders. It always best to consult your doctor for personalized advice.
Senior Editor: Dr. Ramirez, thank you for sharing your expertise with us. This facts is invaluable for anyone living at or visiting high altitudes.
Dr. Ramirez: My pleasure. Remember, understanding your body’s physiological responses to altitude is key to maintaining good health at higher elevations.
