Dear doctor

The veins in Spain

Q: I'm going on holiday next month and can't face exposing my thighs, which are riddled with ugly broken blood vessels. What can I do?

A: You could join the rest of us and expose your less-than-perfect body with confidence, if not exultant pride. Or you could get them zapped by a dye laser, which does a lovely job. You don't get a lifetime guarantee that your thighs will remain perfect, because as we get older our skin thins and the thread veins are likely to recur and proliferate. These thread veins are small broken capillaries and laser treatment can vaporise them so they shrivel up to almost nothing. It stings a bit, and the price may hurt more. It will cost about £100 for a test dose then £300 per area treated, such as a thigh.

Laser treatment of thread veins isn't done on the NHS, and the cosmetic laser clinics are an unregulated hotchpotch, ranging from the excellent to the dire. Some are staffed by cosmetic surgeons, most by GPs earning a bit on the side - though they're not necessarily any the worse for that. To choose a bona fide one, speak to previous clients, ask your GP, and check out the credentials of the doctors (training, experience, reputation).

Can I have the un-snip?

Q: I had a vasectomy 20 years ago after my wife and I had completed our family. We subsequently divorced and I have now, at the age of 47, fallen in love with a great woman who is in her 30s and has never had children. We would dearly like to try for a baby, but I have been told that having had a vasectomy so long ago, my chances of a successful reversal operation are next to nothing. Is there anything I can do?

A: Vasectomy reversal is almost always successful, and so long as there is no other reason why your sperm count has fallen - for example surgery, drugs or infections - you stand a good chance of fathering another child. You will need to be referred to a urologist, who will explain the pros and cons to you and put you on a waiting list to have the delicate surgery needed to rejoin the severed ends of your vas deferens. You wake up with a painful and swollen scrotum - like a vasectomy only more so - and feel delicate for a few days afterwards. The proof of the pudding is in the semen samples you will then be asked to produce to check that your sperm are back in action.

Before you embark on the surgery, make sure you've covered all the aspects with your partner. Make sure she has a full check-up - for example a blood test to check immunity to rubella, a smear test and a blood pressure check, as well as a discussion with her GP about any pre-existing conditions or medication that may need attention before pregnancy - and that she starts taking folic acid when you get the all-clear after the operation.

Urine trouble

Q: I am in my 70s and in good health. I have to wake up twice a night to pass urine, which bothers me as I then find it hard to get back to sleep. I also disturb my wife with my comings and goings as she is a light sleeper. Have you any advice?

A: It is a rare 70-year-old man who doesn't get up to urinate in the middle of the night. Mostly, the need arises because of an enlarged prostate - the gland that sits at the base of the bladder and enlarges naturally as you get older. A large prostate can obstruct the exit to the bladder, making the stream slow to start, causing a trickle rather than a torrent and dribbling on disconsolately. It also makes you want to urinate frequently during the day, with an unpleasantly strong urge to go as soon as your bladder feels full. But waking up at night and finding it hard to settle back to sleep can also be due to pain, catnaps during the day, depression or drugs such as sleeping pills that disrupt normal sleep.

It may help to cut out caffeine, which keeps you awake and produces lots of urine, to restrict your fluid intake after 6pm, and to attend to any other problems, such as depression. Drug treatment with a group known as alpha-blockers - such as doxazosin or indoramin - can help, and these are particularly useful if you also have high blood pressure, because they reduce it. The flipside of this is that your blood pressure can drop too low, especially if you stand up quickly, making you feel dizzy and sick. Another group of drugs, including finasteride, lowers the male hormone testosterone so the prostate shrinks, but that takes up to six months. Surgery to cut away the prostate works best of all, but can make you impotent and incontinent if you're unlucky.

You will have an examination (a finger inserted into your back passage), ultrasound scan (a probe inserted up your back passage) and blood test to measure your prostate and check for prostate cancer.

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