Q. For the past six months, I've been taking aspirin at night before I go to bed. It relieves my arthritis pain, helps me sleep and is good for thinning my blood. However, I've heard that aspirin can make one's stomach bleed. Would I get the same benefits from Tylenol or buffered aspirin?
A. First, I'm glad you've discovered how aspirin and other pain relievers can be good "sleeping pills" for people with arthritis. Many times it's the discomfort of arthritis that disturbs your sleep, especially when moving or turning in bed. Rather than asking your doctor for a sedative to help you sleep, it's worth trying your usual arthritis medicine just before going to bed.
As you mention, stomach bleeding is one of the harmful effects of aspirin, especially if you take it on an empty stomach at bedtime. Tylenol is a good pain reliever, but it doesn't have the anti-inflammation actions of aspirin, nor does it thin your blood.
Having said that, however, aspirin and other arthritis medicines don't give you much of an anti-inflammation effect unless you take them regularly. In other words, to really reduce the joint damage caused by significant arthritis, you need to take your arthritis medicine whether you're having pain or not.
Buffered aspirin, although very popular and heavily promoted on television, doesn't have enough antacid effects to protect your stomach from irritation and bleeding. If you feel better taking buffered aspirin instead of regular aspirin, the effect is probably psychological. In fact, I've had many patients tell me that they can't take aspirin but do fine with Anacin, Excedrin or another aspirin-containing pain reliever disguised under a fancy brand name.
If you want to take aspirin but find that it upsets your stomach, try an "enteric" coated aspirin. Enteric refers to the small intestine, where these tablets are designed to dissolve, rather than in the stomach. Ecotrin is one brand name and is available without prescription.
Because these specially coated tablets are much more expensive than plain aspirin, I don't recommend them unless you've had problems with aspirin. Another drawback to enteric coated tablets is that in some people they don't dissolve at all.
White Blood Cell Counts
Q. I would appreciate some information on leukopenia (having a low white blood cell count). For several years, my doctor has been giving me regular blood tests because he said this condition needed to be watched.
What is the significance of having a low white count? When does it become serious? I'm otherwise healthy.
A. Many conditions can make the number of white cells in your blood low. One of the most common explanations for a low white count over many years, especially lifelong, is that it happens to be normal for you. In particular, many black Americans have a lowish white blood cell count, which turns out to be perfectly normal for them.
Sudden brief drops in your white count may follow certain infections, such as influenza (the flu), measles, viral hepatitis and chicken pox.
In addition, drugs and toxic substances can temporarily lower the white count, including anti-cancer medications, various antibiotics, medicines for an overactive thyroid gland, anti-seizure drugs and tranquilizer medicines for schizophrenia.
Several diseases may cut the production or speed up the destruction of white blood cells, including aplastic anemia (failure of your bone marrow to make blood), rheumatoid arthritis, lupus, having an enlarged spleen (which soaks up white cells like a sponge), or alcoholism.
Your doctor is checking your blood counts to make sure your white cells aren't falling to dangerously low levels and to check for evidence of any underlying disease that may be responsible.
A normal white count is between 5,000 and 10,000. White counts that are lower than 1,500, especially a neutrophil count -- a certain type of white cell -- below 500, put you at risk of serious infection.
Rarely, a low white count may be an early sign of leukemia (called pre-leukemia), a cancer of the blood.
If your doctor is concerned about something being seriously wrong with your blood production, he or she may order a bone marrow test, which examines a sample of blood from inside the bone marrow where it's made.
If your white counts remain stable over many years and you develop no new symptoms, you probably don't need frequent checks and probably don't have anything seriously wrong with your blood.
Jay Siwek, a family physician from Georgetown University, practices at the Fort Lincoln Family Medicine Center and Providence Hospital in Northeast Washington. Consultation is a health education column and is not a substitute for medical advice from your physician.
Send questions to Consultation, Health Section, The Washington Post, 1150 15th St. NW, Washington, D.C. 20071. Questions cannot be answered individually.