DEAR DR. DONOHUE: Please help me understand platelets. Mine have been steadily rising for years. They are now more than 1 million. My doctor has prescribed hydroxyurea. The information on that medicine says it is used to treat certain types of cancer. The doctor didn’t mention cancer to me. He said I could have a stroke or other things. – N.P.

ANSWER: Platelets are tiny blood cells that form a clot when a blood vessel breaks. Platelets have another name – thrombocytes – and too many of them is the condition called thrombocythemia (THROM-boh-sigh-THEME-ee-uh). These cells are made in the bone marrow with all the other blood cells. For reasons not completely understood, the marrow shifts its production of platelets into high gear, and large numbers of platelets flood the blood. The normal platelet count ranges from 150,000 to 450,000.

High numbers of platelets can cause clots to form within arteries. When that happens in a brain artery, a stroke results; when it happens in a heart artery, a heart attack follows.

Paradoxically, the opposite can also occur – bleeding. With such high platelet numbers, that sounds illogical, but the platelets the marrow is making so prodigiously are not always of good quality, so bleeding is a danger for some people.

Iron-deficiency anemia, ulcerative colitis, Crohn’s disease and polycythemia are illnesses where thrombocythemia can be part of the picture. Most of the time, however, no associated illness is found, and the condition is then called essential thrombocythemia.

A high platelet count alone is not the sole criterion for treatment. A patient’s risk for stroke or heart attack influences the decision to treat. Hydroxyurea is standard treatment. It is also used for some cancers, as well as for psoriasis — an example of a drug with many applications. You do not have cancer.

DEAR DR. DONOHUE: My niece, 35, has unsightly varicose veins. I read that there is a new procedure to get rid of them. Would you discuss this, please? – P.S.

ANSWER: There are many new ways to solve the varicose vein problem. One new technique is endovenous laser treatment. A soft, pliable tube – a catheter – is inserted into the main varicose vein. Then the doctor threads a slender laser fiber through the catheter. The laser fiber creates heat, which collapses the main vein and its branches. In time, an undetectable scar forms.

A similar procedure involves radio waves to create heat and seal varicose veins.

A person doesn’t have to get rid of varicose veins if they are not causing trouble, such as a heavy feeling in the legs or swelling of the legs from fluid seeping out of the veins. In some instances, varicose veins promote the formation of an open sore on the lower leg. The fluid that has oozed out of the veins makes it difficult for oxygen to reach skin cells. Deprived of oxygen, the cells die, and a gaping sore evolves. Such a problem is a strong argument for vein removal.

Varicose vein questions are among the most frequently asked. Readers can find answers to their questions in the varicose vein pamphlet. They can order a copy by writing: Dr. Donohue – No. 108, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.50 U.S./$6.50 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: After reading your column on restless leg syndrome, I decided to let you and your readers know my remedy.

The person lies on his or her stomach with a pillow under the lower part of the stomach. Give it five minutes to take hold, but it usually doesn’t take that long for the sensation to leave the legs. Then go to the most-favored sleep position, but keep the lower back as flat as possible. I am a retired R.N. – D.L.

ANSWER: Thanks. I’ll let you know if readers find that your treatment works for them.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475.

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