Dear Doctors: My husband is having an elective surgery soon. It requires full anesthesia, so he has had a lot of pre-op tests. One of the blood tests showed that his red blood cells are too big. The nurse said it happens when you drink too much. What causes that? Is it dangerous?

Dear Reader: When someone’s red blood cells become abnormally large, it is a condition known as macrocytosis. These enlarged blood cells are nutrient-poor and break down faster than normal cells. The name of the condition derives from Greek, with “macro” meaning large in scale, “cyto” referring to cells and “osis” indicating an abnormal condition.

Unless it is quite severe, macrocytosis usually does not cause any noticeable symptoms. As a result, it is often discovered in the course of routine blood tests, such as the pre-operative workups your husband was asked to undergo. Those workups typically include a test known as a complete blood count, or CBC. The size of someone’s red blood cells is one of the findings included in a CBC.

Macrocytosis isn’t a disease or disorder. Rather, it is a sign that an underlying health condition may be present. It is often linked to a deficiency of vitamin B12, which is absorbed from the blood and stored in the liver. B12 deficiency is common in people who abuse alcohol. Chronic alcohol abuse leads to widespread inflammation of the liver, and over time it will cause liver damage. That damage reduces the body’s ability to absorb, store and release B12, which in turn can result in macrocytosis.

Malabsorption of B12 can have other causes, as well. These include conditions such as Crohn’s disease or celiac disease, hemolytic anemia, bacterial overgrowth, bariatric surgery, certain cancers and intestinal parasites. The use of certain medications can also impair absorption of B12 and lead to a deficiency. These include proton pump inhibitors and H2 blockers, which are used to manage acid reflux; some chemotherapy drugs; and colchicine, which is used to treat gout. It is also possible to become deficient in vitamin B12 when following a vegan diet, which excludes food products made from and by animals. Because B12 is not produced by plants, vegans must be vigilant about using supplements and eating foods fortified with the vitamin to maintain adequate levels. Generally poor nutrition in any type of diet can lead to low folate levels, also a factor in macrocytosis.

If alcohol use is suspected as a cause of this condition, the person may be asked to undergo a liver function test. It can either pinpoint or rule out the liver as the source of the individual’s B12 deficiency. Other types of blood tests can identify whether the condition is linked to problems in blood cell development. A bone marrow biopsy can also reveal issues with red blood cell production.

If macrocytosis is linked to B12 deficiency, steps are taken to improve the individual’s diet and address any issues of malabsorption. And when alcohol abuse plays a role, a conversation about either moderation or abstinence is likely to take place.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctors: A man I have been dating had a stroke a few weeks ago, and now he has aphasia. When I visit him at the rehab, he’s ready for me to leave after a short time. Is this normal? He seems to be happy I’m there, but he dismisses me quickly. I’m trying not to feel hurt.

Dear Reader: A stroke occurs when something prevents blood from reaching the brain. The most common cause is a blockage in the blood vessels that serve the brain. Known as an ischemic stroke, it is often due to the presence of a blood clot, but it also can occur due to a narrowing of the blood vessel itself. In the other major form of stroke, known as a hemorrhagic stroke, a blood vessel develops a tear or completely ruptures.

Any type of stroke deprives the brain of oxygen and nutrients. In a short period of time, brain cells begin to die. This can cause a wide range of symptoms, including aphasia. This is a disorder in which it becomes difficult to understand and engage in spoken and written language. Someone with aphasia may speak in garbled sentences, be unable to find the proper word, speak in halting or choppy sentences and be unable to follow a conversation. These same difficulties can apply to writing and reading.

The physical effects of a stroke are typically the most obvious. However, our brains are also home to various regions that oversee emotion, behavior and cognition. It means this type of brain injury can cause a wide range of emotional and behavioral changes, as well. These include confusion, inattention, irritability, forgetfulness and carelessness. People who have experienced any type of catastrophic health event can be overwhelmed by the sudden change to their circumstances. That often leads to feelings of depression, grief, fear, anger and frustration.

It is important to remember that someone who has had a stroke tires quickly. That means not just physically, but emotionally and mentally, as well. It is also easy for them to experience sensory overload. Situations and settings that previously had been effortless, including a visit from a loved one, can quickly become a burden. After a stroke, the brain is physically healing and rewiring. This is particularly true with recovery from aphasia. As a result, it is entirely possible for this man to be genuinely glad to see you, and also to need your visits to be brief. If possible, ask the staff for guidance on the length of a visit and what interactions will be the most beneficial.

If you find these visits to be difficult or emotionally upsetting, you might consider seeking out a stroke recovery support group for family and caregivers. You will meet other people who are facing the same challenges as you. It can help you navigate your own feelings during this stressful time and understand what comes next. A wealth of information about stroke, as well as a searchable database of support groups, is available at the American Stroke Association website, stroke.org.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctors: It’s time for my daughter to have a Pap smear, but she’s putting it off because it was so painful last time. I wonder if switching to a female doctor might help? It’s a very unpleasant test and I do sympathize, but it’s also important and I’m worried.

Dear Reader: A Pap smear is a test used to screen for cervical cancer. During the procedure, a small brush is used to collect cells from the surface of the cervix. Those cells are then examined under a microscope for signs of cancer, or the types of changes that may indicate a precancerous condition. As women who have undergone this procedure know, it is uncomfortable at best. But, as you point out in your letter, Pap smears are an important part of preventive care. It is recommended that women start getting tested for cervical cancer at age 21 and have a Pap smear every three years.

When it comes to gynecological care, some patients do prefer it when their doctor is a woman. By its very nature, this type of medical care is quite sensitive, and patients can feel more comfortable when being examined by someone of the same sex. Having undergone the various procedures and exams herself, a female doctor may have a better understanding of what her patient is experiencing. This can make it easier for the patient to share concerns, and that can translate into more empathetic care.

Regarding Pap smears, there has been a new development that will make the procedure easier. Last spring, the Food and Drug Administration approved a test that allows a woman to perform this test herself. This involves collecting a sample of cells from the inside of vagina using a narrow swab. The swab is then sent to a lab, where it is screened for the presence of the human papilloma virus, which is the cause of virtually all cases of cervical cancer. The reason this change is possible is that labs are now able to analyze cells taken from the vagina, and not only the cervix itself.

For now, this test will be done by the patient in a doctor’s office or other health care setting. But in the future, the plan is for an at-home test to become available. This is the first change to cervical cancer screening in the U.S. since the 1940s, which is when the Pap smear was first adopted. Self-collection tests have been available in Europe and elsewhere for several years.

The self-collection test makes cervical cancer screening far less unpleasant. It also removes the barriers that have prevented many women from having this test. This includes living in an area with limited access to health care, a lack of insurance and being unable to take time off work. A self-test will also help women like your daughter, who are avoiding a procedure they dread.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)