DEAR DR. DONOHUE: I have very bad varicose veins, and now I have peripheral vascular disease. I am considering having my veins stripped. Will a varicose vein operation clear up the peripheral vascular disease? Is there any help for it? – M.S.

ANSWER:
Varicose veins and peripheral vascular disease are two quite different and unrelated problems.

Varicose veins are veins that are stretched out of shape because the vein valves have become incompetent. Vein valves keep blood flowing back to the heart from leg veins. Incompetent valves allow blood to pool in the leg veins and distend them.

There is help for varicose leg veins. An older method was vein stripping. It’s an operation where incisions are made in the legs, and an instrument is inserted into the varicose veins that permits the surgeon to pull those veins out of the legs. Stripping is not done so often now. There are other, newer procedures. Phlebectomy, for instance, removes the varicose veins through a series of tiny incisions that are barely noticeable after the procedure. Doctors can also eliminate varicose veins by injecting them with solutions that cause them to collapse and scar. That procedure is sclerotherapy. Endoscopic surgery is a new way of attacking varicose veins. The doctor inserts a viewing device into the varicose vein. The tip of the scope can be heated, and the heat obliterates the vein.

Peripheral vascular disease is a different problem. It involves leg arteries. They have become clogged with cholesterol and fat buildup, and sufficient blood cannot reach leg muscles to fuel them when a person walks. After a short time walking, the leg muscles — usually the calves — begin to hurt and force the person to stop and take a rest. Rest relieves the pain, and the person can resume the walk.

Lowering cholesterol and fat in the diet prevents further buildup. Trental, Pletal and Plavix are three medicines that can sometimes increase blood flow to leg muscles. Bypassing clogged sections of the artery is another way to re-establish flow.

The pamphlet on varicose veins provides answers to the many questions people frequently ask. Readers 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 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: I love carrots. The problem is, they turn my skin orange. I stopped eating them, and my skin color returned to normal. I began eating them again, and my skin turned orange again. Is there any way to avoid this without giving up my favorite snack? – L.M.

ANSWER:
Carotene, a pigment found in carrots, turns the skin orange when a person eats lots and lots of them. It’s not going to do you any harm.

If you stop eating carrots, your skin returns to its normal color in one or two months. You might not have stayed off them long enough to clear all the carotene from your body.

Carotene is a precursor of vitamin A. The body converts it into the vitamin. You are not going to suffer a vitamin A overdose from carotenemia, the name for your orange skin condition. When there’s enough vitamin A in the body, it stops converting carotene into the vitamin.

DEAR DR. DONOHUE: Last month my daughter gave birth to her first child. She had a difficult delivery. The placenta was so firmly attached to the uterine wall that it would not come out. The doctor had to remove it. He called the condition placenta accreta. Will it recur in future pregnancies? – M.M.

ANSWER:
Normally there is an intervening layer between the placenta and the uterine wall. With placenta accreta, that intervening layer is not present. The placenta invades the uterine wall muscle and adheres to it after the birth of the baby. The doctor has to intervene to separate the placenta from the uterus. It happens not infrequently — about once in every 2,000 to 3,000 deliveries.

There is no way to predict if it will occur in subsequent pregnancies.

DEAR DR. DONOHUE: About six months ago my husband had bypass surgery. He has done fine, but I think the surgery has affected his brain. His memory is not like it used to be, and he has appeared confused when doing things he used to do with ease. Is this the effect of surgery? – A.W.

ANSWER:
The bypass surgery spoken of is heart bypass surgery. Vein or artery grafts bypass sections of clogged heart arteries to restore blood supply to heart muscle.

Most bypass surgery is accomplished with a heart-lung machine that pumps blood while the heart remains still so the surgeon can insert the grafts into heart arteries that are not jumping around with each heartbeat.

Postoperatively, many bypass patients suffer some loss of memory and mental sharpness. Small clots — microemboli — travel to the brain during the surgery due to the working of the heart-lung machine or because the aorta, the large artery arising from the heart, is jostled and sends a shower of small clots to the brain.

Heart surgeons try to limit formation of clots by working as quickly as possible. The less time on the heart-lung machine, the less chance of forming emboli.

New surgical techniques help reduce clot formation. A so-called minimally invasive operation is an example. Only small incisions are made in the chest, and the surgery is performed without resorting to the heart-lung machine. Heart stabilizers are another new approach. The stabilizer keeps still the small area of the heart being repaired, while the rest of the heart continues to pump. Again, there is no use of the heart-lung machine.

I have a hunch you will notice an improvement in your husband’s alertness and memory in a few months.

Let me also add that this fate does not fall to every patient who has a bypass. And let me also add that the innovations I mentioned are not available everywhere.

This information should not frighten anyone scheduled for a bypass. It’s an operation with gratifying results.

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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