Blood can travel by several routes

Dear Dr. Roach: If two of the major veins in your leg were removed, what would happen to the blood flow? Would you get enough to your heart and brain?

Anon. The veins of the body return blood to the heart. There are many veins in the limbs, so blood has several routes that it can take on its journey. Moreover, the body can increase the size and capacity of veins, so if one vein is damaged or surgically removed, the others increase their size and flow capacity.

This is the reasoning behind a treatment for a common chronic problem, venous insufficiency, which is when a vein is not performing adequately at returning blood back to the heart. With venous insufficiency, there often is obvious swelling of the veins (including varicose veins). Its symptoms include leg pain or a feeling of heaviness, swelling and skin changes or ulcers.

Initial treatment of venous insufficiency is periodic leg elevation, exercise and compression stockings, but some people won’t see results with this regimen and will need additional treatment.

One increasingly common treatment is ablation (destruction) of leg veins. This can be done surgically, but new treatments include injection of medications that damage the veins enough that they close.

Heat treatments accomplish the same goal. The heat can be applied from the outside (usually by laser) for superficial veins or internally, by an intravenous catheter that uses radio waves to heat the vein. Ablating the damaged veins forces blood to flow through other, undamaged vessels, with success rates of greater than 70 per cent at 10 years.

Dear Dr. Roach: I am a 73-year-old male in reasonably good health. I recently had the TURP procedure to address issues associated with benign prostatic hyperplasia.

Before the procedure, I was taking the generic equivalents of Proscar and Flomax. I have been unable to get a definitive recommendation on continuing these drugs. It seems to me that the reasons for taking Proscar — i.e., preventing enlargement of the prostate — still remain relevant. And I certainly would not want to go through another TURP. Also, the Flomax supposedly helps with relaxation of the urinary tract, which still might be necessary, as my flow is not particularly voluminous, despite the surgery.

Anon. The transurethral resection of the prostate procedure is the most effective treatment of severe prostate symptoms in men who do not respond to medications. Some men have dramatic improvement and no longer need the medications.

However, many men continue to have some symptoms even after surgery, and they continue to see benefit from medicines such as finasteride (Proscar), which block prostate growth, or tamsulosin (Flomax), which relax smooth muscle in the prostate.

However, sometimes urinary symptoms are due to bladder problems, not the prostate at all. If that’s the case, different kinds of medicines can be prescribed.

Dr. Roach writes: Many people have written about sleep apnea, and I wanted to bring up some of the treatments I didn’t discuss in my previous column.

Some people wrote about their surgeries, including surgery to move the jaw forward and those that remove soft tissue from around the airway.

There are other surgical procedures to treat obstructive sleep apnea. However, the choice of surgery, and even whether surgery is an option, depends on an individual’s anatomy. I lack space and expertise for a comprehensive review of these situations.

I also heard from people with an oral appliance, which may be a reasonable choice in people with mild or moderate obstructive sleep apnea.