DEAR DR. DONOHUE: My legs are covered by ugly varicose veins, and my ankles are swollen in the evening. I think the swelling comes from the veins. I am only 44. My mother had them, so I guess I should have expected to have them, too. How can I keep them from getting worse? What do you suggest, as far as removal goes? — L.H.

ANSWER: Blood has to make its way from the feet and legs back to the heart, a true engineering challenge. Along this upward route, gravity pulls blood back down.

Veins are able to meet this challenge because they have valves. When blood passes a valve, the valve closes and prevents blood from returning back down the vein.

Varicose veins are dilated veins with defective valves. Blood pools in varicose veins and stretches them even more. Fluid escapes from the veins to cause ankle swelling. Some feel achiness in the leg muscles because of these veins.

Pregnancy is one factor in causing varicose veins. So is obesity. A family history of varicose veins is another factor that predisposes people to their development. Having a job that requires standing in one place for long time periods sets people up for them. So does smoking.

Self-help treatment includes taking breaks during the day during which you lie down with your legs propped up higher than your heart. That empties the veins of blood. If you have to stand for prolonged periods, move around as much as possible or contract your leg muscles. The contractions squeeze the veins and keep blood moving up and through them. Elastic compression stockings are another way to prevent vein engorgement.

Today, a variety of approaches to treatment are available. Sclerotherapy involves injecting an irritating substance into the veins to collapse them. Thermal (heat) ablation (removal) uses a probe placed in the vein that delivers heat to collapse the vein. Lasers can do the same. You have a full menu of options.

DEAR DR. DONOHUE: My most recent Pap smear shows ASCUS. I got the report from my doctor. He said another report will come soon. What is ASCUS? What might the other report be? — S.B.

ANSWER: “ASCUS” is “Atypical Squamous Cells of Unknown Significance.” ”Atypical” indicates the cells aren’t cancer cells, but they aren’t completely normal. Squamous cells are the cells lining the cervix, the lowermost part of the uterus, the place where cervical cancer starts. Often, while taking material for the Pap smear, the doctor also takes material for virus detection. If the Pap smear has ASCUS changes, then a test is done on the second material to detect cancer-causing viruses. If cancer-causing viruses are not found, then the ASCUS changes can be dismissed.

The report on Pap smears and cervical cancer explains this important test and the implications of cervical cancer. To obtain a copy, write: Dr. Donohue — No. 1102, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: We have known that my son, 30, has had keratoconus since he was a teen. He wears contact lenses and gets along fine. Does this condition doom him to blindness later on? — C.M.

ANSWER: Keratoconus is a cone-shaped bulge of the cornea, the transparent part of the front of the eye. In the early stages of keratoconus, glasses or contact lenses can correct any vision problems it causes. As it progresses, firmer contact lenses are used. When they are no longer effective, corneal transplants correct the bulging cornea. Corneal transplants are among the most successful of all transplants. Blindness is not a common consequence of this defect.

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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