MEN'S HEALTH MATTERS:The majority of venous leg ulcers can be successfully managed in the community
Q I am a 65-year-old man and have enjoyed good health until I developed a break in the skin of my right leg just above the inside of my ankle joint. My public health nurse tells me it is an ulcer and has been dressing it for a while but it shows no sign of healing. I have had it for over a year and wonder what to do with it now.
AFirst of all you should see your GP who will check to see if the circulation in your leg is normal and will then decide on the most appropriate treatment.
The majority of leg ulcers are related to problems with veins and not the arteries. If your doctor can feel pulses in your foot, the "circulation" is generally satisfactory and the likelihood is that the ulcer is related to problems with your veins.
Commonly, people will have an area of brownish discoloration in the stocking area of the leg for some years which is due to long-standing problems with the veins and that area which is "scarred" has broken down.
The majority of venous leg ulcers can be successfully managed in the community. In general, an appropriate dressing will clean up the surface of the ulcer.
A compression bandage placed over this dressing serves to counteract the problems with the veins and allows the ulcer to heal over time. The reason for the compression bandage is that the valves in your veins are not functioning properly which gives rise to an increased pressure within the veins. The bandage that you require firmly compresses the leg and normalises the flow of blood in the veins and reduces the pressure within the veins.
In some instances, blood tests and scans of your leg may be indicated, but your general practitioner will advise you about this. These tests will be performed in hospitals having a specialised vascular surgical unit.
The results of these tests will allow treatment to be tailored to your particular situation.
A small proportion of patients who have ulcers require surgery. Your vascular surgeon will advise you. Treatment is aimed at getting the ulcer to heal and then treating the underlying problem with the varicose veins.
In the long run, regardless of whether you have surgery it is likely that you will need to wear medical grade stockings for life.
Q I am 64 years old and am to have a biopsy of my prostate gland because the prostate blood test (PSA) is slightly abnormal.
What does this procedure entail?
AIf a transrectal ultrasound (Trus) and biopsy has been recommended, the reason is that you may have an abnormality within the prostate gland.
Transrectal ultrasound of the prostate allows the doctor to see deep into the prostate, perhaps revealing abnormal areas that are difficult to find by digital rectal examination.
Transrectal ultrasound can also tell us whether the seminal vesicles are normal, the size of the prostate, and in some cases can suggest if any other abnormalities are present.
No special preparation is required prior to your biopsy and you do not need to be fasting. Initially you will be given antibiotics to help prevent infection because the procedure is done through the back passage. You will then be asked to lie on your side.
The ultrasound instrument is placed into the back passage in a similar fashion to the doctor examining the prostate with a finger. You will then be given a local anaesthetic and a fine biopsy needle is guided with
the help of the ultrasound probe and multiple biopsies are taken.
The entire procedure takes less than 15 minutes and may be a little uncomfortable but is not usually painful.
You will be kept fully informed throughout the procedure.
In general, this is a very safe procedure and most people have no trouble.
Occasionally after a biopsy some bleeding will occur. There may be blood in the urine, mixed with the sperm or blood on the bowel motions. If this occurs, it usually settles after a day or two and increased fluid intake helps.
You may also experience some mild transient difficulty passing urine.
This weekly column is edited by Thomas Lynch, consultant urological surgeon, St. James's Hospital, Dublin with a contribution from Mr Prakash Madhavan, consultant vascular surgeon, St James's Hospital, Dublin