Dear Dr. Roach: Last year, I had an abnormal Pap smear. My follow-up colposcopy did not show anything. Two weeks ago, I had another abnormal Pap smear, and I am scheduled for another colposcopy next month. I am scared and nervous that precancerous cells will be found. I am 51 years old.
O.K.
In the majority of cases of cervical cancer, the cells in the cervix go through a progression from normal to precancerous to invasive cancer. It takes a long time for precancerous cells to become cancerous 鈥� seven years, on average, so there is plenty of time to find it and remove it before it becomes a problem. Very few women who get regular screenings will develop invasive cancer, and those few who do almost always are found in the very early stages of disease. Treatment at an early stage is effective and is much easier than treating more advanced cancer.
We already are seeing the incidence of precancerous cells and cervical cancer decreasing since the introduction of the HPV vaccine. I am hopeful that future generations of physicians will seldom or never see a case of cervical cancer. For years I have heard people wish for a vaccine against cancer. While cancer isn鈥檛 one disease, there is a vaccine that can almost completely eliminate the risk for cervical cancer, so I strongly recommend it for females age nine to 26. Males age 13-21 likely will reduce their risk for other kinds of cancer by getting the HPV vaccine, in addition to protecting their future partners.
You should go to the colposcopy, and I hope the results will be favourable.
Dear Dr. Roach: My wife and I were quite puzzled by a recent column, in which you advised a man you diagnosed as suffering from SIADH, the syndrome of inappropriate antidiuretic hormone secretion. After he was given additional water, then later a saline IV drip to maintain his sodium level, and achieved only marginal results, he was given a single pill of tolvaptan. He reported that the single pill caused him to 鈥渞elease 6.7 litres of urine鈥�! That鈥檚 more than seven U.S. quarts, or 14 pints, but the maximum capacity of the human bladder is generally accepted as two to three pints. How do you explain this apparent monster discrepancy?
B.A.
The bladder normally sends a signal when it鈥檚 time to empty, at about 150-200 cc (five to seven ounces or so), but it can hold maximally perhaps 600 cc (about one pint) under normal circumstances. People with larger amounts than that in the bladder generally have a problem with nerve function of the bladder.
In the case of D.L., who had what I thought was SIADH, he released the 6.7 litres overnight. The kidneys can filter about 40 litres of urine a day, so what he reported was well in the range of normal physiology (although, as I said, I worry about correcting the abnormally low sodium level too fast).
I recall a woman during my training who had a rare complication of pregnancy 鈥� peripartum cardiomyopathy, in which the mother鈥檚 heart goes into heart failure, unable to squeeze properly. Although we treated her as best we could, one day her heart just started working again suddenly, and she was able to get rid of 20 litres of extra fluid in a day (that鈥檚 a 44-pound weight loss) without any medication. It was a remarkable display of the power of a healthy heart and set of kidneys to restore equilibrium. With normal bladder capacity, that would have been over 100 trips to the bathroom!
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected].
