DEAR DR. GOTT:
I’m a 43-year-old male with enough medical problems to last me until I am 90 years old. I’ve had kidney stones nine times, auto-transplant of my left kidney, have had both melanoma and basil cell skin cancers, seven mini-strokes in a year, had pulmonary embolisms, and stent replacement. I forget people’s names that I have known for years and also have a factor V clotting disorder. As if that weren’t enough, now when I laugh hard, I pass out.
I am the youngest of 10. My mother passed away at the age of 44 when I was four years old. I’m approaching her age quickly and want to take steps to prolong my life.
First, let’s review your conditions.
Kidney stones are a common but extremely painful disorder. Most pass without intervention by physician assistance. Others don’t.
Auto-transplant means relocation of an organ, in your case it was your left kidney. There are a number of reasons that would warrant having this dramatic procedure performed, such as complex renal artery disease.
The most common cause for skin cancer is sun exposure in areas unprotected by sun block or clothing during outdoor or work activities.
Your mini-strokes resulted from blood vessel blockage in the brain. Similarly, a pulmonary embolism is blockage of the pulmonary artery or one of its branches. Both conditions are the result of one or more clots traveling from any part of the body to another.
The pulmonary embolisms likely led to stent replacement when a surgeon attempted to improve blood flow. A stent is simply a mesh tube that helps keep the artery open.
So far, your conditions are fairly easy to explain. Now comes the tricky part.
You say you have a Factor V (FV) clotting disorder. Do you truly mean that or do you mean that you have a Factor V Leiden (FVL) clotting disorder? The process of coagulation requires a delicate balance to ensure just the right amount of clotting power in the blood. Too little leads to bleeding problems; too much can lead to dangerous blood clots.
While both conditions have similar names, they are entirely different. FV is actually a bleeding disorder. It is rare and results from a lack of the protein Factor V which can cause excessive bleeding.
Factor V Leiden is not a lack of the protein but rather, a normal amount of abnormal versions of Factor V. This causes the proteins to work in the opposite way, causing “stickier” blood and, for some individuals, abnormal blood clots. These clots are especially common in the legs (known as deep vein thrombosis) or in the lungs, such as you have experienced during your many attacks of PEs.
With your history, it appears to me you are suffering from a factor V Leiden disorder. This condition can either develop during a lifetime or else it is inherited. A hematologist should be consulted immediately in an attempt to bring the disorder under control. By doing so, he or she should reduce or eliminate a lot of your problems.
Finally, as crass as it may sound, your forgetfulness may be the least of your many problems. Perhaps you are simply over-loaded with so many medical issues you are blanking out on names. Another cause could be damage to the memory storage areas of your brain as a result of your several mini-strokes. I recommend you see a neurologist who can perform appropriate testing to determine the cause.
You should be seeing a top notch primary care physician you trust implicitly who can orchestrate this plethora of problems. He or she should refer you to a number of specialists, including a hematologist, neurologist, pulmonologist, nephrologist, urologist, and/or dermatologist, all of whom can work together to provide you appropriate treatment for each of your problems.
Now, on to your laughter and passing out. Laughing predisposes an individual to an increase in venous pressure within the thorax. That pressure is a mechanism for syncope, a transient form of unconsciousness. Known as laughing syncope, the condition is seen in patients with arterial/vascular disease and not in those who are healthy. Since you have a great deal on your plate already, I’m extremely reluctant to suggest you refrain from laughter. Perhaps moderation is the key. Smile a lot, laugh with a little less vigor, get tapped in to the system of specialists who can provide you the best care possible, get that clotting factor under control, and approach and move beyond your 44th year with the knowledge you are doing all you can to keep things under control.
To give you related information, I am sending you a copy of my Health Report “Medical Specialists”. Other readers who would like a copy should send a self-addressed, stamped, number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.