Dear John:

Oh my—your dear dad has an awful problem to contend with.  First of all, I take Coumadin and am checked weekly to keep an INR range of between 2 and 3.  I first developed a blood clot so many years ago now that I can’t remember.  But I did trip and fall, and within the week, I developed a blood clot.  So I had an ultrasound that resulted in a series of Lovinox shots and then a daily regimen of Coumadin for 6 months.  Now that was just from a fall, unrelated to the Stage IV Ovarian Cancer that I have been diagnosed with since November of 2012.  Since then I have twice developed blood clots that just came as a result of chemotherapy.  Recently I had a third blood clot caused by an “inexperienced” nurse who didn’t know how to use a blood pressure cuff.  She put it on my leg, and tightened it so tight prior to turning on the machine to inflate the cuff that I felt like I was going into orbit.  Then she didn’t know how to “regulate the amount of times that the machine would automatically inflate on its own, and it went off 3 different times within 10 minutes.  I was off Coumadin at that time because of some needed minor surgery.  She was “awful.”   I complained to the staff there and told them “this lady should not be left alone with patients.  She doesn’t know what she’s doing.”  So now I’m on Coumadin again, and I’ll be on it from now on I suppose because of past clots and my Stage IV diagnosis.  I’ve had 3 different regimens of Carboplatin/Paclitaxel (Taxol) treatments in the last 4 years along with other treatments.  Thankfully, I am not diabetic.  I’m really sorry your dad is having these problems.

In case you’re wondering, I monitor this site because my husband is a cancer survivor of Esophageal Cancer, Stage III (T3N1M0) (Adenocarcinoma at the Gastroesophageal Junction (GE).  If you read my “about me” page, you will see that William had the Ivor Lewis Minimally Invasive Esophagectomy on May 17, 2003, at the University of Pittsburgh Medical Center.  (UPMC)  My husband is a miracle having now entered into his 15^th year of survival with no recurrence.   However, recurrence is always a possibility so we just thank God that my husband is free for this long period of time.  I always like to mention this laparoscopic EC surgery aka (MIE) because “newbies” have to start out in “Esophageal Cancer Kindergarten”, or at least we did, and learned by experience along the way.  There are different ways to perform an esophagectomy but this is the “top of the line” surgery.  But I’m making this notation here for those who might be reading here and are just starting out with the EC diagnosis and wondering what to do, and where to go.  This, of course, is not applicable to your Dad but we do have many people who read through these posts to learn from the experiences of other EC patients.

That said, I realize that there will be no surgery for your 83-yr. old dad because of his Stage IV diagnosis in May of this year.  But I take it that palliative chemo had been ongoing until he developed this blood clot.  Now since reading your letter, I started looking around on the web, and can see that being a diabetic, in addition to being a cancer patient, poses more difficult problems.  I will say that in my several years now of monitoring this site, I have not read of another problem specifically like your dad’s.  But after reading some of the sites listed below I see that it is a very real possibility for those who’ve been diagnosed with cancer and are diabetic as well. 

I note that Dad is having daily injections of an anti-coagulant.  I read that it is one of the recommendations for those who have blood clots in the toe.  You state that your dad was active up until this diagnosis.  But when reading through several links listed below, I see that physical activity, especially for diabetics is encouraged.  I hope he is able to have some daily activities that will aid the circulation in his lower extremities.  It is unfortunate that cancer patients often have to cope with blood clots and that’s bad enough, but added to that is your dad’s diabetic situation.  I am so sorry for him, and I know it hurts you to know that he is hurting.  I do wish there was some “magic solution” that can be found, but this is a dangerous situation that Dad is contending with.  And I certainly hope that the clot can be dissolved, and that amputation of those 3 toes will not become a reality.  But no doubt Dad will be on an anti-coagulant of some kind even if this is cleared up.  I see that age plays a part and once we have a blood clot, we are prone to have more according to what I have read. 

So John, this letter is mainly one of empathizing with your dad and his problems.  The most I can do is pray for you and your dad that this clot will dissolve, and that he will be able to continue with the chemo, even though that comes with its own side effects.  One thing all chemo patients need is routine hydration and I hope that is being included in Dad’s routine regimen, even though the chemo treatments have stopped for now.  Feel free to write anytime, and those of us who monitor this site will try to help when we can.  I’ve listed several sites below trying to find something specifically related to your dad’s problem.  I found out that it’s an awful problem for your dad, but I didn’t find any specific “magic bullet” to make it go away.  However, I’ve included some sites relating to Esophageal Cancer that will be beneficial if you’re not already familiar with them.  Diabetes is certainly complicating your dad’s problem. 

Here’s hoping the anti-coagulant allows the clot to dissolve.

Here is a good site for learning about the chemo drugs that your dad was taking.

1.  https://www.youtube.com/watch?v=kqvBwFD_W48

 2.  http://chemocare.com/

[John:  You can find the chemo drugs listed here with their possible side effects as well as ways to help cope with the side effects]

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3.  http://www.cancer.net/navigating-cancer-care/how-cancer-treated/chemotherapy/understanding-chemotherapy

[This is a good site to learn anything you need to know about a certain type of cancer.]

“Understanding Chemotherapy

Approved by the Cancer.Net Editorial Board, 09/2016

Chemotherapy is the use of drugs to destroy cancer cells. It works by keeping the cancer cells from growing and dividing to make more cells. Because cancer cells usually grow and divide faster than healthy cells, chemotherapy destroys them more quickly than it destroys most healthy cells.

4.  http://www.cancer.net/cancer-types/esophageal-cancer

“Esophageal Cancer

 5.  https://www.stoptheclot.org/faq_blood_clots_cancer.htm

“Blood Clot FAQs – Cancer and Blood Clots

By Elizabeth Varga, MS; Chair – Education Committee, NBCA

Q. I have heard that often people diagnosed with deep vein thrombosis (DVT) are evaluated to see if they have an underlying cancer that triggered the clot. Why is that?

A. This does not happen often, because testing to detect cancer is done only in those patients who show signs that suggest cancer may be present, such as unexplained weight loss or infection. About 10% of people who have DVT/PE will be diagnosed with cancer within 12 months after a DVT or PE. In some cases, with blood clots that do not seem to have any known cause, there may be a need for a more extensive work-up to look for an underlying cancer.

 Q. Why does having cancer increase the chance of developing a DVT/PE?

A. While this is not fully understood, it is thought that cancer may lead to tissue damage and inflammatory responses that lead to activation of the blood clotting (coagulation) system. Tumors also release chemicals which trigger clotting.

 Q. Are certain cancers more likely to result in DVT/PE?

A. Yes. Cancers of the brain, ovary, pancreas, colon, stomach, lung and kidney have the highest risk of DVT/PE. Lymphomas, leukemia, and liver cancer are also more likely to lead to DVT/PE.

 Q. Do cancer treatments, like chemotherapy, increase the risk for DVT/PE?

A. Yes, some chemotherapies are associated with a higher risk of blood clots. Some examples include Thalidomide and Lenalidomide to treat multiple myeloma, Avastin® to treat colon cancer, and certain chemotherapies that may be given in combination with others, including cyclophosphamide (Cytoxan®), chlorambucil (Leukeran®) and nitrogen mustard (Mustargen®). It is not well known why chemotherapy increases risk of DVT/PE, but it is suspected that this could be because they cause damage to blood vessels or reduce the production of proteins that protect us from clots. Women treated with tamoxifen to prevent or treat breast cancer are also at increased risk. Erythropoietin, which is sometimes used to treat anemia and improve quality of life in cancer patients receiving chemotherapy, may also increase the chance of developing a blood clot.

 Q. What other risk factors might make it more likely for a cancer patient to clot?

A. Having surgery to remove the cancer, particularly abdominal and pelvic surgery increases risk. Being hospitalized, immobile, or having a central venous catheter placed (for chemotherapy or other reasons) also increases risk. Risk goes up as age increases, and having a family history of DVT/PE or a pre-existing inherited or acquired thrombophilia makes it more likely for a cancer patient to clot.

 Q. What can be done to help prevent DVT/PE in cancer patients? 

A. Clotting risk should be assessed in all patients with cancer. Whenever a patient with cancer is hospitalized, s/he should ask about treatment to prevent DVT or PE. Treatment to prevent blood clots should be routine in any hospitalized patient, and usually consists of injections of heparin or low molecular weight heparin. Compression stockings or pneumatic devices are also used to help prevent blood clots. Patients with cancer who are home and can move around have a lower likelihood of developing DVT/PE. However, patients should be aware of signs and symptoms of DVT/PE and seek immediate attention when they notice them.

 Q. If I have cancer and develop a blood clot, how is it treated? Am I at higher risk to develop a second blood clot?

A. Once a cancer patient develops a first episode of DVT/ PE, he or she is typically treated with “blood thinners” (injections of low molecular weight heparin or with the oral drug warfarin) as long as the cancer is active, because the risk for another episode of VTE is high if blood thinners are stopped.

 Reference: The Surgeon General’s Call to Action to Prevent Deep Vein Thrombosis and Pulmonary Embolism, 2008.

Return to our FAQs Page

 6.  https://medlineplus.gov/diabeticfoot.html

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7.  https://www.aofas.org/footcaremd/conditions/diabetic-foot/Pages/Diabetic-Foot-Problems.aspx

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8.  https://my.clevelandclinic.org/health/articles/diabetic-foot

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9.  http://www.livestrong.com/article/339751-a-blood-clot-in-the-big-toe/

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10.  https://www.youtube.com/watch?v=1gT5l-XW2xM

Published on Apr 5, 2017

“Learn more about blood clots and cancer. Click here ➤ http://cancerclot.info/ 

Venous blood clots are frequently seen in people with cancer. The risk is increased in people where the cancer is growing, where the cancer has spread to other parts of the body (metastasis), during some chemotherapeutic treatments or in people who have undergone surgery. Other medical conditions such as infections or periods of prolonged bed rest can also increase the risk.”

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 11.  http://cancerclot.info/

“Learn about the link between cancer and deep vein thrombosis (DVT)

It can come as an unpleasant surprise that cancer patients need to be aware of the risks and warning signs of deep vein thrombosis (DVT). After all, the two diseases seem worlds apart. So why does the link exist? We do not know all the reasons but can identify three main factors that impact your likelihood for developing a blood clot (DVT): the type of cancer you are diagnosed with, how it is being treated, and your level of physical activity.

Types of cancer

Certain types of cancer are associated with a higher risk of DVT than other cancer types¹. The reason for this is unclear.

Cancer treatment

While your treatment is vital to fight your cancer, it may also increase your risk of blood clots (DVT) ². Chemotherapy and surgery can damage the walls of your blood vessels affecting the way they function. This can also lead to a blood clot³. When chemotherapy kills cancer cells, certain substances that can cause clotting are released into the blood stream⁴. Some types of chemotherapy drugs are less likely to promote clotting than others³. It’s a good idea to ask your doctor about this so that you can be informed of any risks associated with the treatment you have been prescribed…”

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12. http://cancerclot.info/blood-clots-and-cancer

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13. http://cancerclot.info/blood-clots-and-cancer/dvt-why-are-cancer-patients-at-risk

“Cancer treatment

14. https://www.youtube.com/watch?v=dDMrq1hKAvI

“Subungual Hematoma Blood Clot under Nail Removal | Auburn Medical Group

 Published on Jul 1, 2016

15.   https://www.youtube.com/watch?v=WYjo9tZnoak

 16.  http://www.diabetes.org/

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17.  http://www.cancerresearchuk.org/about-cancer/cancer-in-general/treatment/cancer-and-the-risk-of-blood-clots

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