DEAR DR. DONOHUE: My husband, 57, has varicose veins. He has seen three doctors, spent a bunch of money and says the doctors said there isn’t much they can do and that he isn’t likely to have a serious problem with them. His legs look bad to me. I am concerned he could develop a clot or a skin ulcer. — L.S.

ANSWER: If three doctors have said that he doesn’t need any kind of intervention or surgery now, you can be certain they’re telling him the truth. The veins you see on his legs are superficial veins, ones just beneath the skin. These veins don’t cause as much trouble as the veins buried deep in leg muscles. It’s the deep veins where most clots form. He can do some simple maneuvers for the superficial veins that will prevent a skin ulcer.

He must elevate his legs for as long as he can and as often as he can. Elevation means his legs have to be higher than his heart. He has to lie down with his legs propped up. That position drains the legs of pooled blood and fluid.

He should never stand in one spot for a long time. If he must, then he must also keep contracting his leg muscles. Muscle contractions pump blood out of the leg veins. He should never sit for long, and shouldn’t sit with one leg crossed over the other.

He has to adopt a walking program. Walking activates the muscle pump that keeps blood from stagnating in leg veins. Weight loss, if applicable, also will help.

Compression stockings (elastic stockings) are effective in promoting blood flow out of leg veins. Stockings that run the full length of the leg are best. They should be fitted to his legs, and they should have graded pressure — more pressure in the feet and ankles, with less pressure the farther up they are on the legs. You can find retailers of these stockings by looking online. Jobst stockings are one brand that has been around for many years.

DEAR DR. DONOHUE: I have been diagnosed with a condition called lichen sclerosus.

Would you please inform me what causes it and what will happen in the future? Is this a fatal disease? — J.R.

ANSWER: Lichen sclerosus occurs at any age, but most often happens to women after menopause and to girls before puberty. It is a change in the genital and sometimes anal skin where white patches with a crinkled surface arise. The patches are intensely itchy.

The cause hasn’t been established with certainty. It might be another of the autoimmune diseases, one of those illnesses where the body’s immune system turns on its own body, here the genital and anal skin. A larger number of people with psoriasis, vitiligo (a patchy loss of skin pigment) and pernicious anemia, all autoimmune diseases, also have lichen sclerosus.

Creams and ointments of the cortisone family of drugs usually can control it.

Lichen sclerosus should not be a fatal disease when followed by a doctor. Sometimes it evolves into skin cancer, but not as frequently as once believed. The doctor watches for any cancer changes.

DEAR DR. DONOHUE: I notice advice you gave regarding nasal irrigation with buffered saline solution. I had a friend who dreaded the shock of snuffing this liquid. When I told her to inhale the mist from the nozzle of the spray bottle, the problem was solved. The penetration into the nasal passages is enhanced. — J.B.

ANSWER: J.B., you’ve hit a home run. I like your idea.

For others using a bulb syringe to irrigate the nose, don’t squeeze with great force. An easy squeeze is less traumatic to the nasal lining.

And if that is too much, adopt the J.B. method. It sounds like a real winner.

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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