DEAR DR. ROACH: My brother has low blood platelets and anemia. He will be 73 this year and has had three back surgeries. What causes low blood platelets? Can anything be done to raise platelet count? He drinks alcohol everyday — not hard liquor, but canned alcoholic mixed drinks. He is in constant pain from his back. Also, he has osteoporosis. We have told him to stop drinking, but he won’t or can’t. What, if anything, can be done for him?
Can I donate my platelets? I have donated many times to the Red Cross. — N.K.
ANSWER: There are many causes of low blood platelets. But for low blood platelets in combination with anemia, the list is considerably narrower if the low platelets and anemia have the same cause. Only a thorough evaluation by an expert, such as a hematologist, can answer your question with any certainty.
Alcohol of any type does affect the bone marrow and is one of the more common causes of low platelets and anemia. A trial off of alcohol to see the effect on the blood and platelet levels would be a very wise idea.
People who can’t or won’t stop drinking, especially when it may be adversely affecting their health, need help. His regular doctor would be a good person to help find ways for him to cut down or quit, but he may also benefit from an expert, such as an addiction specialist. There are also many resources in the community to help people cut down drinking. I wonder if his chronic back pain is one reason he is drinking; if so, better control of the pain might make it easier to quit alcohol.
Donating platelets is a community service, just as donating blood is. Platelets are often in higher demand. Most people outside the hospital with low platelets do not need transfusion, so you may not be helping your brother directly, but you will be helping people with cancer and other serious diseases.
DEAR DR. ROACH: My friend is diabetic and had to have foot surgery after cutting their own toenails. Why is this so dangerous? — T.S.B.
ANSWER: People with diabetes should know that they ought not to cut their own toenails — even a small nick can lead to an infection. Longstanding diabetes puts a person at risk for poor blood flow from both large and small blood vessels and decreased immune function. Diabetics may have poor sensation, which is necessary to let them know there is a developing problem.
Unfortunately, it is all too common that people ignore the advice and try to take care of their feet themselves. Compounding this, they often don’t do daily foot exams, like they’re supposed to. These checks are meant to make them aware of any infection so that it can be treated before it gets too dangerous.
Sometimes, by the time the foot infection needs medical attention, it can be very serious, potentially requiring amputation.
Risk of this is lowered by better diabetes control to prevent the blood vessel and nerve disease, with proper professional foot care by a podiatrist and with daily foot exams by the person with diabetes.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.
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