To Your Good Health
Dear Dr. Roach: My husband is a smoker. I have begged him to quit, but he wont. He sleeps sitting up, with his legs hanging, because he has trouble breathing. This way of sleeping causes his feet and ankles to swell. His doctor ordered diuretics and urged him to quit smoking. He also recommended that he sleep in a bed, with his legs elevated that would help with the swelling. My husband doesnt agree. My husband reads your column every day. Maybe you can convince him. G.U.
Answer: Smoking is one of the hardest habits to break. Many people who have stopped using heroin have told me that quitting smoking is harder. However, anyone can do it, and he needs to.
Sleeping with the legs hanging off the bed is a serious red flag. The first thing we are taught to look for in people who demonstrate this behavior is critical blockages in the arteries of the legs. People find that they dont have leg pain when they do this, but blockages could be so severe that urgent treatment is needed a surgical repair or an alternative procedure, like angioplasty, where blockages are opened with a balloon.
However, your husband also is noting shortness of breath, and this should prompt concern about both blockages in the arteries to the heart and heart failure, which is the inability of the heart to squeeze out enough blood AND relax under low pressure. Heart failure causes foot and ankle swelling, but sleeping with the feet dangling could do that in absence of heart failure.
Quitting smoking will help with all of the three potential problems (and many more), but right now he needs urgent evaluation of his heart (probably starting with an echocardiogram), and if he has any symptoms of leg pain or heaviness, especially with exercise, he also should have a vascular study to look for blockages in the arteries of the leg.
Dear Dr. Roach: I have a grandson with muscular dystrophy. He is 17 and is not yet in a wheelchair. We are thinking of going to Mexico for a stem cell injection. This is a long trip. Do you have any information on this kind of treatment closer to home? L.O.S.
Answer: Muscular dystrophies are a group of genetic diseases that cause progressive muscle weakness and atrophy.
There have been some case reports of people being treated with stem cells for Duchennes muscular dystrophy the most common and most serious cause for someone in your grandsons age group but research into this type of treatment is still preliminary, albeit hopeful. In the few cases for which there is information, the stem cells began to lose effectiveness after a few months, requiring multiple injections yearly. So, it isnt as good a treatment as could be desired. Many researchers are working on this, and you can find out where the research is going on at clinicaltrials.gov.If possible, I would encourage enrollment into a trial, so that your grandson can be part of the process that gathers knowledge about the best way to treat this condition. I found trials using gene therapy that are recruiting people now.
There is one new treatment, eteplirsen, which provided modest benefit in muscular dystrophy. Steroids are commonly prescribed. Still, better treatments are urgently needed, and hopefully stem cells or gene therapy may be much better.
