By Max Hammonds, MD (retired), MPH
“Hello, Mrs. Volt.” The receptionist smiled in recognition to Becky.
“I brought my mother today to see Dr. Poston.” Becky indicated her mother, Mrs. Ruth Werner, who was leaning on her walker.
The receptionist waved to Mrs. Werner. “Yes, we have her on the schedule. Please have a seat. The nurse will call you shortly.”
Fifteen minutes later, Becky was seated in Examination Room #3. Her mother was perched on the exam table, a gauze bandage wrap just above her left ankle.
Dr. Poston entered the room and washed his hands. “Good afternoon, Becky. Mrs. Werner, how good to see you again.” Sitting on his roll-around stool, he positioned himself in front of Mrs. Werner, unwrapping the bandage. Looking up at her, he said, “So, how is the small ulcer on your leg doing?”
Ruth thought a moment, then looked at her daughter. “It still itches, and my leg feels heavy all the time, actually both legs, like I have heavy weights around my ankles.”
Dr. Poston put on examination gloves and gently touched the skin around the pencil eraser-sized hole in the skin just above her ankle. “The swelling seems to have gone down. And the redness is gone. Beth, how often do you change the dressing?” He looked at Beth after he spoke.
“The wound care people said to change it only once every two or three days. It’s just to keep it covered, now that the infection has cleared up.”
Dr. Poston smiled at her. “Good for you. Doing just as they said. It does look better.” Then he looked up at Mrs. Werner. “And you, young lady, I see that you don’t have your compression stockings on. Do you wear them?”
Mrs. Werner looked at her daughter again – for an escape. “Well, sometimes. They’re so difficult to get on. And they are not very comfortable – or especially pretty.”
Dr. Poston looked at Beth, who rolled her eyes upward. Then he looked back to her mother and smiled. “True. They’re not the latest fashion. But they are necessary.” He rolled his stool back a bit and looked up at her. “Well, I got a good report from the ultrasound people. They say that your leg veins, especially the deep ones, are free of clots. So, the big danger is not there.
“But it doesn’t really mean that your veins are fine. We talked before about the valves in your veins. They work like little elevators. Every time you flex your leg muscles, the blood in your veins is pushed up to the next valve level. With every leg flexion, the blood moves up to the next level and the next level.” He pointed out each level on her leg as he spoke.
“But your valves are not working as they should. Your elevator is not working properly, and the blood is staying in your legs, not moving up. This makes your legs swell, makes them feel heavy – as you’ve noticed. When your legs swell, especially in the skin, it decreases the arterial blood flow to your skin. Your skin doesn’t get the oxygen and nutrients it needs – and your skin begins to break down.
He cocked his head. “Are you going to wear those fashionable pressure stockings?”
“Do I have to?” she asked in a small voice.
“No. But your legs will turn the color of a cocnut, and the other leg will get an ulcer – just like this one. And it won’t heal – just like this one. And if it gets infected or if it gets a clot . . .”
Ruth Werner began to tear up, making a small, dark pathway through the circle of rouge on her right cheek. Dr. Poston stood up and held her head on his chest for just a moment, then patted her on the shoulder.
He retrieved a tissue from the counter and offered it while holding eye contact with her. “We won’t talk about harder things just yet. But you need to be a good girl and do what’s best for you. You let me know if anyone says anything ugly about your beautiful stockings. And I’ll deal with them.”
He looked at Beth as he spoke. “And keep your legs up for half an hour at least 4 times a day – whenever you sit down to rest – but not over the sharp edge of chairs.”
Beth nodded her head. “She’s pretty good about that.”
Dr. Poston nodded, speaking as if to himself. “No diabetes. No high blood pressure,” then turned sharply. “You didn’t take up smoking, did you?”
Mrs. Werner laughed. “No, sir. I didn’t.”
“Okay. Keep walking.”
Beth nodded again.
“See you next month.”
