DEAR DR. DONOHUE: I am a 36-year-old woman whose legs have ugly varicose veins. Is surgery the only treatment? What happens if I leave them alone? What causes them? They must run in families, because my mother and my two sisters have them. – R.R.

ANSWER: Up to a third of adult women and a fifth of adult men are afflicted with varicose veins. For some, they are more than a cosmetic nuisance. Often they cause a heavy sensation in the legs, can bring on leg fatigue, and can produce leg swelling. If none of these applies to you, you can safely leave them alone.

Family history is one factor in their appearance. The major problem is defective vein valves. As blood flows back to the heart through leg veins, vein valves close to keep the blood from dropping down. If the valves aren’t functioning, blood does fall down the vein, expands it and eventually leads to a distorted, engorged vein.

You can keep matters from getting worse by elevating your feet as often as you can and by not standing still in one place for any prolonged period of time. Compression hose keep blood flowing upward in leg veins, and the best ones are custom-fitted.

The number of treatments for varicose veins increases yearly. I can’t describe all of them, but I can give you a sample from the large menu available. Sclerotherapy consists of injections of slightly irritating substances, like very dense salt water, into the vein. The irritation causes the vein to collapse, and its walls stick together. With a similar result, laser or radio waves heat the inside of the vein and seal it. Another procedure, transilluminated power phlebectomy, painlessly breaks the varicose vein into small pieces that can be suctioned out.

Of course, standard surgical removal is still used, and there have been many major refinements to that technique.

The pamphlet on varicose veins details the problem and its treatments. 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 $4.75 U.S./$6.75 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: I have a favorite aunt who has a sleeping disorder that really scares me terribly. When she’s asleep, she stops breathing for a time, and then suddenly she begins again. She has not been given any treatment for it. Do you have any idea what this is and how it can be helped? – T.J.

ANSWER: You describe sleep apnea well. During sleep, people with the condition have periods when they stop breathing for 10 or more seconds. Toward the end of a no-breathing spell, the person struggles and gasps for breath and successfully gets some air, and sleeping resumes until the next apnea spell.

Quite frequently these people are loud snorers, and the loudness of snoring grows and grows until the no-breathing period strikes.

A major part of the problem is a laxity of the throat tissues. They are so loose and redundant that they block the passage of air from the nose into the lungs. Quite often these people are overweight, and weight loss can go a long way toward solving the problem.

In other instances, air under pressure keeps these people breathing regularly throughout the night. The air is delivered through a mask that fits over the nose and mouth. The treatment is called CPAP – continuous positive airway pressure.

Sometimes devices worn in the mouth can reposition the jaw to keep the airway open.

In cases that resist all treatment, surgically paring away redundant throat tissue creates an unobstructed passageway for air to reach the lungs. Often this can be done with a laser.

DEAR DR. DONOHUE: I had two lumps on each side of my neck removed two years ago. They have come back. The surgeon doesn’t know what causes them. Should I have surgery again? – V.K.

ANSWER: You must find out what those lumps were. Almost all removed tissue is subjected to microscopic examination, and you need to get a copy of that report to make any decision about repeat surgery. If you can’t get the report, you need a second opinion.



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.