Question: My doctor says I have venous insufficiency. What does that mean? Does it require treatment?
Answer: Venous insufficiency means the veins don't work properly. Most people develop this condition in their legs. The veins are responsible for draining blood and fluid back to the heart. So people with venous insufficiency usually have symptoms caused by the buildup of fluid in their legs. These symptoms can include:
•Swollen or painful varicose veins.
•Swelling (edema) of the foot, ankle or calf. This swelling may get worse if you stand for long periods of time. And it usually improves when you lie down or raise the legs. Swelling may also get worse during a woman's menstrual cycle.
•A sense of heaviness.
•Throbbing, achy or crampy pain.
•Redness and irritation of the skin. Over time, the skin may get thicker or become darker in color.
•In more severe cases, skin ulcers may form or the skin may ooze fluid.
Venous insufficiency is very common. Women are affected more than men. The condition is more common as people age or become overweight. In many people, it develops after the veins have been damaged by an injury, surgery or a blood clot.
The treatment of venous insufficiency depends on why it has developed, where it develops, and the symptoms it causes:
•In mild cases, simply elevating the legs appears to help.
•Support stockings help to reduce swelling and discomfort. You can buy these at a medical supply store. Custom fit stockings are also available with a prescription from your doctor.
•A diuretic (water pill) such as hydrochlorothiazide or furosemide will control some of the fluid buildup.
•Mild steroid creams such as hydrocortisone help to reduce redness and irritation of the skin.
•Skin ulcers often need careful attention. Special bandages help speed the healing process. You may need antibiotic pills or creams if the ulcers become infected.
Question: Lately, it seems like I have a harder time following people in conversation because they seem to mumble so much. Should I get my hearing tested?
Answer: Hearing loss is very common as people get older. One in three men older than age 65 has some degree of hearing loss. Bring it up with your doctor at your regular check-up. A detailed test is not recommended for people not already experiencing trouble with their hearing.
However, you should let your doctor know if your hearing has declined. Common signs of hearing loss include difficulty hearing people on the phone or in noisy environments, or needing to turn the TV or radio volume up. Since high frequencies are often affected first, women's voices may be harder to hear.
If your hearing has diminished, an office examination may reveal an easily corrected problem, such as wax buildup in the ear canal. Doctors often use the sound of two fingers rubbing or a watch ticking to determine if the hearing impairment is in one or both ears.
Hearing loss without any apparent physical cause usually indicates a sensorineural hearing loss, or decreased function of the auditory nerve. Your doctor can arrange additional tests, called audiometry, to determine the cause of the hearing loss and assess the benefit of a hearing aid (or amplification). Audiometry does not need to be repeated unless your symptoms change significantly.
(Howard LeWine, M.D., is a practicing internist at Brigham and Women's Hospital, Boston, Mass., and Chief Medical Editor of Internet Publishing at Harvard Health Publications, Harvard Medical School. William Kormos, M.D., Editor in Chief, Harvard Men's Health Watch.)
The Ask Dr. H column by Dr. Mitchell Hecht will return next week.