DEAR DR. DONOHUE: My legs, above the ankle, started swelling about a year ago. They didn’t hurt, so I didn’t pay much attention to them. They always went down after a night’s sleep. A month or so ago, I noticed the skin in the area of swelling was sprinkled with red and brown specks. It’s a little itchy. My sister who was visiting was quite alarmed about this. She thinks it means I am in big trouble. What does it mean? — P.M.

ANSWER: What you describe is stasis dermatitis and leg edema (swelling). “Stasis” implies that blood isn’t moving in the leg veins like it should. Dermatitis is skin inflammation secondary to the stasis.

Your leg veins have become stretched out of shape. Their valves, which keep blood moving upward to the heart, are no longer functioning. These veins, which you cannot see, are distended with blood. They’re leaking fluid from the circulation along with red blood cells. If you press your thumb against the skin above the ankles, you’ll leave an indentation, proof that fluid has seeped into the tissues. The specks come from disintegrating red blood cells that have leaked out of veins along with the fluid. The brown specks are deposits of iron that was contained in the red blood cells.

You can minimize the process by elevating your legs as often as you can. Elevation means the legs should be at or above heart level. The only way to accomplish that is to lie down with the feet and legs propped up. Fifteen minutes every two hours will effect a change. Compression stockings also stop the oozing.

You have to see a doctor about the swelling. A large number of conditions can bring it on. Some are dangerous, such as heart failure. Some are less significant, but the only way you’ll find out is through a doctor’s exam. You need to see the doctor about the stasis dermatitis, too. An ulcer can form on the involved skin. It’s very hard to cure once it forms.

DEAR DR. DONOHUE: My niece, a student in nursing school, just left after a brief visit. She eyed the funny-looking things on my bald head and my neck. She said they were actinic keratoses (spelling compliments of my niece). She said they ought to be removed.

I am fit in all other respects. I’ll do what my niece says if you think it’s necessary. I’m her only living uncle. — M.F.

ANSWER: Actinic keratoses are another gift from the sun. They’re red and scaly skin blotches that can reach an inch in diameter. They are either flush with the skin or slightly raised.

Places most exposed to sunlight are the places where they pop up: the scalp, the face, the ears, the neck, the backs of the hands and the forearms.

Actinic keratoses have to be removed. They can evolve into skin cancer. The doctor can freeze them, scrape them off or have you apply 5 FU (fluorouracil) cream to them.

DEAR DR. DONOHUE: My right testicle has swollen to about twice its normal size. I am 73 years old and never had a serious illness to date. It doesn’t hurt. It isn’t warm. What is it? My wife thinks it might be cancer. — W.W.

ANSWER: In all probability, it’s a hydrocele (HI-druh-seal), a fluid-filled sac within the scrotum and adjacent to the testes. These sacs can be small or huge. They aren’t painful. You can prove they’re fluid-filled by going into a dark room with a flashlight and putting the light behind the testicle. Light will be transmitted through the hydrocele to the front of the scrotum. For hydroceles that are not symptomatic, nothing need be done.

In younger men, in rare instances, hydroceles might accompany a tumor of the testicle.

Large hydroceles that make walking difficult can be surgically removed.

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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