Why do our legs swell, ache, and often get red and sore? Many of you have written to ask about leg problems. There are a number of conditions of the lower legs that affect large people and I am going to focus on some of the more common flesh and skin maladies in this edition's column.

Whether you are fat or thin, 40% of women suffer at some point from varicose veins. The heart is a powerful pump that pushes oxygen-rich blood to the tissues. However, once the oxygen is used up, the veins have to carry the blood back to the heart and lungs on their own. In order to fight gravity, to get blood from the feet, leg veins use a shrewd system of one-way valves, just like an oldfashioned hand pump you may have seen on your grandmother's farm. As we walk, our leg muscles intermittently bulge, squeezing the blood in the veins upward. In between steps, when the muscles relax, we would expect the blood to just fall back down, but the one-way valves close, preventing this.

People who stand for long periods, or live sedentary lifestyles, tend to leave the blood in their leg veins bulging until the little valves get so stretched that blood starts to leak backwards. The worn out, stretched veins and valves eventually become permanent varicosities (from the Latin meaning "swollen"). The term usually refers to visible engorged and twisted veins. Because the blood stagnates in varicose veins due to gravity, little fresh oxygen is around to feed the tissues. Skin and muscle may begin to get sick. Sensations of heaviness, itching and soreness are the body's way off trying to stimulate you to get moving and improve circulation.

Some are bothered by what they consider the ugly appearance off snake-like blue veins on the legs. Others fear the potential development of blood clots that might break off and go to the heart or brain. Blood clots, however, are only a concern when the veins deep inside the leg are affected.
Varicose veins are more bothersome after long hours of standing when the blood begins to pool. People who do heavy lifting, or are very large or pregnant, or even those who are chronically constipated, are in essence putting downward pressure on the veins. Straining during a bowel movement for example (bending forward and grunting, etc.) tends to back up the blood in the veins.

In very large folks a number of other factors make the legs even more swollen. As we get older and our hearts work "overtime" to pump blood through a larger body, they may begin to weaken. Blood then backs up and the fluid creates swollen ankles and feet. You may have noticed a ring of indentation where your socks or shoes fit, especially after a long hot day. If the swelling is such that you can leave a doughy thumbprint in your skin, it may mean a case of a mild heart problem. This swelling, combined with naturally larger legs needed to support a heavier frame, leads to stretching of the skin. If you notice that the skin of your shins is shiny and itchy, or especially if it is red or warm, an infection might be brewing. Bacteria love to proliferate in stretched and swollen tissues. If left untreated the skin may even acquire sores or ulcers, especially if you are a diabetic.

Sounds devastating? Well it doesn't have to be. For most varicose veins, conservative, non-surgical treatment includes adding fiber to your diet if constipation is a problem. Don't strain when you have a bowel movement, let nature take it slow and easy. Cool water baths shrink throbbing vessels. Support hose or special stockings help squeeze the blood upward and prevent painful swelling of ankles and feet. These should be fitted to you properly, and should never be worn to bed at night (no kinky remarks please).

If you must stand for long periods, walk around from time to time to stimulate blood movement and elevate the legs whenever possible. Try to actually lie back and put legs up on a pillow, rather than just sitting with your legs bent, which only kinks the vessels and prevents flow-back to the heart. Avoid tight high-heeled shoes (you disco throwback you!)... go for comfort, you'll walk more, boogie down, and improve circulation.

If tiny "spider-like" veins bother you, these can often be injected with a solution that permanently collapses vessels although this is more of a cosmetic procedure. Don't ever try this yourself; bleeding varicose veins can be difficult to stop. Larger veins are often pulled out carefully, like roots off a plant from the ground, in an operation called "vein stripping." New or normal veins take over pumping blood back to heart. Many doctors prefer a slightly more conservative stripping of just a part of the veins under local freezing.

If the skin on your legs gets "beefy" red, is warm to the touch, or forms little ulcers, get medical attention. Antibiotics and special antiseptic creams can stop the infection known as cellulitis if it is caught early. If you follow all this advice, you'll be fine and able to dance the night away with me... I'll be waiting. ß

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Heretic Physician