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Query about medication for sinusitis - Online Doctor Chats

Date : 21-Feb-2012
User rating for this question
Excellent Posted in: Ear, Nose and Throat Problems
Answered by

General & Family Physician
Practicing since : 2008
Answered : 3365 Questions
Doctor :   Hi
User :   Hi.
User :   Background: I am a 33 year old male. In November of last year, I had a prolonged fever (nearly 3 weeks) that went away, thank goodness. The Infectious Disease specialist I was referred to thought it was a virus. I also have anxiety for which I take, when needed, Lorezepam. Also, I have a fatty liver and slightly enlarged spleen (14.4). My liver enzymes (ast, alt) were slightly high since checked in November (appeared during blood work when I had the fever), but have returned to normal range. Hepatitis has been excluded, and thyroid test was normal. I've also had some other yet to be determined gastro issues for which I'm now seeing a specialist--mainly varying constipation and diahrrea. And, I have also been diagnosed recently with a chronic sinus infection for which I am taking Levaquin anti-biotic for 21 days--currently on day 7. Recent bloodwork showed a WBC of 5.7 (lower end of normal) and monocytes of 10 (higher end of normal). This made me worry a little. Also, just got results of some other tests, and not sure what they mean or if they are high. ESR is 25; ANA titer is speckled and 1:40; Ferritin is 285.
Doctor :   Let me read your query
Doctor :   The recent test readings are normal
Doctor :   the wbc though touching the lower limit , its fine there
Doctor :   Monocytes are the ones you have to concentrate
User :   also the wbc has fluctuated over the last couple of months (and have noticed because i have had several blood draws recently). the rbc has remained consistent. the monocytes were the same (between 9.5 and 10)
Doctor :   well monocytes increase can be seen in conditions which alter the whole wbc count
User :   wbc was highest at 8.3, then to 6.9, then to 8.9, then to 5.7, but I read those can fluctuate.
User :   that was over a 3 month span.
Doctor :   yes, in chronic infections ( subclinical infections too )
User :   so, even though the monocytes are at the high end of normal range, i should worry about those?
User :   oh, and all other blood work results were normal and within the ranges.
Doctor :   ye, ferritin is fine, and ANA is ok
User :   ye?
User :   oh, yes, i'm sorry.
Doctor :   YES*
User :   ESR range said 0-15. Is that high at 25?
Doctor :   such a level can be obtained in mild allergic reactions too, ( like one after sneezing )
Doctor :   the range has to be more than 50 mm to consider its importance in you
User :   understood.
User :   that had me worried. more than the ANA being "positive" and "speckled."
Doctor :   since the monocytes are more such a reading can be expecxted
Doctor :   but once the cause of monocytosis is made then the ANA can be considered
User :   so, even at "10," it's monocytosis?
Doctor :   no, i meant it as a synonym
Doctor :   i am sorry, it could not be called monocytoisis unless diagnose with a cause
User :   so 10 is okay?
User :   i'm not sure why i'm so caught up with it being on the "high" end of normal.
Doctor :   No , we can consider it to be more but not a disease unless diagnosed
User :   what should the monocytes be at?
Doctor :   0 to 2%
User :   ok.
User :   what can i do to help bring that # down?
Doctor :   since you have history of variable WBC and a chronic infection , its importance arises
Doctor :   get yourself screened for any chronic infections , Sarcoidosis, mononucleosis
User :   mono was negative; so was strep.
Doctor :   And a good diet and avoidance of infections will take care of it in first line
User :   can the fact that i have chronic sinusitus have anything to do with it?
Doctor :   good , that rules out half the chances
Doctor :   yes, it can be a reason
User :   what are the other 1/2?
Doctor :   chronic inflammation can lead rise in the count
Doctor :   I mean chronic infections , stress , viral fevers .
User :   but nothing "serious," right?
Doctor :   not at al ,
Doctor :   its just the number
User :   ok. so the ANA, ESR and Ferritin are good?
Doctor :   yes,
User :   and what would be a "high" monocyte number, i.e. one that its importance would be of siginificance?
Doctor :   50 to100
User :   okay. you mentioned the variable wbc was something to consider?
User :   i read somewhere that in any given moment in can range from as much as 3500 or more.
Doctor :   yes, it can also be due to the chronic sinusitis
User :   and time of day, etc.
Doctor :   yes, it varies , but not the range you mentioned
User :   i meant 3.5
Doctor :   ok,
Doctor :   i get it
User :   ok, in the end, it sounds like i have some slight inflammation somewhere.
User :   accurate?
Doctor :   you are right
Doctor :   Accurately
Doctor :   most considered is sinus infection
User :   thank you very much.
Doctor :   you are welcome
User :   bye.
Doctor :   Bye take care
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