DEAR DR. GOTT: I was wondering if you could shed some light on something for me. My daughter is 24 and has suffered five heart attacks, is diabetic, and has had a collapsed lung and numerous blood clots. None of her doctor can really explain these problems but don’t think it is attributed to the diabetes. What do you think? Is diabetes enough to cause all her ailments?
She was never a drug user although she did use to smoke quite heavily. She has now quit after being put in the hospital for pneumonia and needing to be on life support for a month. During that time she also got foot drop which I understand is from being stationary in bed with no foot board. Is this permanent?
DEAR READER: Given the nature and severity of your daughter’s problems, I believe she may be suffering from some type of clotting disorder or a heart disorder. However, before I go into her primary problem, I will first answer your question about foot drop.
Foot drop is a condition in which the muscles at the top of the foot become weak or paralyzed, causing an inability to lift the front part of the foot. For some, the top of the foot and toes may also be numb. This makes walking very difficult because the toes may drag on the floor. To compensate, sufferers often lift the foot higher, similarly to walking up stairs.
Foot drop can be caused by nerve injury or by muscle, nerve, brain or spinal cord disorders. Diabetes, hip or knee surgery, stroke, and more may play a role or be directly related. It may also be the result of her extended hospital stay due to being on life support for a month. If she was in bed without the ability to move adequately or was without proper equipment to assist the circulation in her legs, she may have developed a clot which put pressure on the nerve that controls the responsible foot muscles.
The condition may be permanent but there are several steps your daughter can take to regain as much mobility back as possible and to assist her with walking. A brace which holds the foot in a comfortable walking position may be beneficial, as might physical and/or occupational therapy. If the cause is a blood clot, medication to dissolve the clot may relieve the pressure and possibly restore function.
Now to your main concern, your daughter’s repeated heart attacks and clots. Without being able to review her medical record, test results and to exam her myself, I can only give you my theories but they may prove helpful in getting to the bottom of this situation. First, while I don’t believe your daughter’s diabetes alone is to blame, the disease significantly increases her risk of cardiovascular disease, nerve and foot damage if it isn’t under strict control. Complications are more common in those with poor or no control and who have had diabetes for an extended period of time. When combined with other risk factors such as obesity, smoking, pre-existing cardiac conditions and more, her risk of heart attack and stroke rises even more.
As for her collapsed lung, I cannot give you an exact cause. If it occurred while she was in the hospital due to pneumonia and/or on life support, either or both may be to blame. Smoking and abnormal clotting can also play a role.
Now comes the most puzzling aspect. Were her heart attacks caused by abnormal clotting or did her heart attacks lead to her blood clots? If your daughter had a known heart beat abnormality, such as atrial fibrillation, her risk of developing a blood clot increases, especially in or near the heart. If she was so diagnosed, she should have been put on an anti-coagulant medication such as aspirin or warfarin to reduce the clotting ability and perhaps an anti-hypertensive drug as well to reduce the blood pressure and help ease the work of the heart.
On the other hand, her heart attacks may have been caused by a clot that formed somewhere else in her body because of a clotting disorder. Blood disorders, especially mild-to-moderate clotting disorders, can often go unnoticed for years. Clotting disorders also commonly bring to mind conditions such as hemophilia which can cause excessive bleeding, but there are also many disorders that cause blood to clot too easily, leading to clots. Often the clots form in the legs and once dislodged, can travel to the lungs (pulmonary embolism) causing significant damage or even death. Clots that form near the brain or heart can lead to heart attack and stroke.
Because your daughter has had so many heart attacks and clots, I am curious why no one has thought to do coagulation testing. If it has been done, why were the results not shared with you? In my opinion the next step is to request an appointment with a top-notch facility such as the Cleveland Clinic (www.my.clevelandclinic.org) or the Mayo Clinic (www.mayoclinic.org). Your daughter’s life truly is at stake if proper treatment isn’t received and a cause is not found.
Readers who are interested in learning more can order my Health Reports “Coronary Artery Disease” and “Diabetes” by sending a self-addressed, stamped envelope and a $2 (for each report) US check or money order to my attention at PO Box 433, Lakeville, CT 06039. Be sure to mention the title(s) when writing or print an order form from my website, www.AskDrGottMD.com.