DEAR DR. DONOHUE: I am a 50-plus-year-old male. Recently I had a scare. I suffered from blood clots in my left leg and was hospitalized for them. Then about a week before Christmas, I found myself unable to catch my breath. I felt like I was dying. I called an ambulance, and they took me to the hospital. They found blood clots in my lungs. I was put on blood thinners. It took 11 days to feel better. Is there a reason for concern because this happened too many times? What medicines can the doctors prescribe? — R.W.

 ANSWER: Blood clots in the leg veins that are buried deeply in leg muscles can cause great trouble. Pieces of the clot or clots can break loose and be swept in the circulation to the lungs. A large clot in the lung — a pulmonary embolus — can cause the death of the part of the lung where it lodges, and, if really large, can cause the death of the involved individual.

 Causes of clots in the deep leg veins include recuperation from surgery, prolonged bed rest, old age and birth-control pills. Sitting for a long time in a car or airplane also promotes the formation of leg-vein clots. That’s why it’s important on a long car trip to take some walking breaks, and on an airplane to contract the leg muscles many times every hour or so. Those contractions keep blood flowing in the veins. Stagnant blood clots.

 You’re a relatively young man. Repeated episodes of leg-vein clots at your age are unusual. You might have a condition that disposes you to forming clots. Two of these conditions are deficiencies of protein C and protein S, substances that keep blood in the fluid state. A similar condition is factor V (Roman numeral 5) Leiden, another protein that favors clot formation. Your doctors probably are checking your blood for these conditions.

 At any rate, doctors prescribe anticoagulants to prevent recurrent episodes of clot formation. People with repeat episodes have to stay on those medicines for a long time, some even for life.

 DEAR DR. DONOHUE: A topic that never gets much attention but should is pilonidal cyst. My son has been suffering for a year and a half with one. He has had two surgeries. The lower portion of the incision remains open and drains. He has wound care weekly for it. His frustration is unbearable. He wants to return to a normal life. He is 18, and from what I understand about this terrible disease, it targets young people. Any ideas you have would be appreciated. — M.C.

 ANSWER: The literal translation of pilonidal is “nest of hairs.” It’s mostly but not exclusively a young man’s ailment. It happens to the skin in line with the buttock crease. Hair is driven into the skin and into the oil glands of that area. Sweating, extended sitting on hard surfaces and bouncing around on the unpadded seat of a vehicle promote formation of this kind of cyst. In World War II, it was a common problem for Jeep drivers, and got the nickname “Jeep driver’s illness.”

 The usual progression is that an infection starts with the initial introduction of hair into the skin. An abscess forms. It must be drained. If it doesn’t heal, drainage continues and creates a cyst. Surgery is the standard treatment. Often, as your son can testify, the first go-around doesn’t put an end to the trouble. Repeat surgery is necessary. One approach to resistant cases is to thoroughly clean the area and remove all dead tissue. Then the wound is covered with a dressing but not sutured. Healing takes two to five months.

 Your son has had a most unfortunate experience, and I don’t have a good answer for him. I wonder what I would do if I were in his shoes. I think I would get to a very large medical center for a second opinion.

 DEAR DR. DONOHUE: Please clarify something for me. I believe hand-washing should be done with soap and water, and the washing should last through one verse of “Happy Birthday.” My husband believes a quick splash of water and no soap is sufficient. Who is right? — D.R.

 ANSWER: You are. The length of washing ought to be 15 to 20 seconds, about two verses of “Happy Birthday,” unless you’re a slow singer.

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. Readers may also order health newsletters from www.rbmamall.com.

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