Q: What can you tell me regarding laser surgery for varicose veins? Also, I understand it is great for removing wrinkles. Does it work? Is it safe? Is there danger of scarring?
-- C.M., Corpus Christie, Texas
A: Laser surgery is one of many ways to control varicose veins. Selection of any treatment is based on severity of the problem and other factors and should be decided after weighing the pros and cons of each option.
Varicose veins are enlarged veins close to the skin, usually in the legs. The cause of this disorder is unknown, but it is associated with weakness in the vein walls or valves within the veins. Risk factors include family history, trauma, obesity, prolonged standing or heavy lifting and hormonal influences like pregnancy.
Many people don't like the way varicose veins look, but they also can make the legs ache. Although about 15 percent of people will eventually develop some varicose veins, fortunately, only a small percentage of people have serious complications such as swelling of the legs, skin infections and ulcers.
A number of treatments are available. Non-surgical treatment includes elevating the legs whenever possible and wearing elastic stockings. This is the recommend approach for early or minor cases. It does not usually make the varicose veins go away, but it is an attempt to prevent them from getting worse.
Surgical treatment seeks to remove or block the blood flow to the affected vein. This is not as severe as it sounds. Unlike deep veins in the legs that are critical to returning blood to the heart, these "superficial" veins are much less important.
Injection therapy entails using a needle to put an irritating chemical into the faulty vein. Scar tissue then forms in response to the irritation and blocks the vein. This is the simplest surgical approach.
In a surgical procedure called vein stripping, two ends of the vein beyond the diseased area are tied off and the part in between is removed or stripped out. This is a much more complicated procedure that may require removal of other veins, including deeper parts, to be successful. Although it has more risks, it may be recommend, especially in more severe case, because it provides more lasting benefit.
Lasers are being used widely in medicine, and especially in cosmetic surgery. Lasers are indeed used to remove wrinkles, as well as to remove tattoos, perform hair transplants and even reduce stretch marks.
The laser uses a small, intense beam of light to "vaporize" the tissue to be removed. It is often used in surgery, as in this case, as a better scalpel or cutting device. It has the advantage that it seals off blood vessels as it cuts.
As usual, it's important for you to discuss the risks, benefits and costs of your options with one or more physicians before deciding which way you want to go.
Update on prostate cancer: If a man lives long enough, the chances are high that he will develop non-cancerous enlargement of his prostate (BPH). For millions of men, the BPH is enough to block urine flow, requiring medications or surgery to minimize symptoms.
But does having BPH mean an increased risk of cancer? A recent report in the Journal of the National Cancer Institute supports previous epidemiological studies at the cellular level. This additional information can give health professionals even more confidence in counseling patients with BPH.
The study found important information for men who develop prostate cancer. They found that a lower level of a protein called p57 in cells of the prostate made the cancer even more aggressive.
Knowing the level of p57 can help a person and his doctor better decide to treat the more aggressive cancers more aggressively. Knowing that the risks of recurrence of a cancer is higher will motivate someone to endure more side effects of more treatment and monitor more closely for possible return of the cancer.
Dr. Allen Douma welcomes questions from readers. Although he cannot respond to each one individually, he will answer those of general interest in his column. Write to Dr. Douma in care of Tribune Media Services, 435 N. Michigan Ave., Suite 1400, Chicago, Ill. 60611. His e-mail address is DRFamily@aol.com.
This column is for informational and educational purposes only. It is not intended to provide medical advice or take the place of consultation with a doctor or other health-care provider.