Dear Doctor: I was recently diagnosed with chronic venous insufficiency in both legs. What is it, and why does it happen? What does it mean for my health?

Dear Reader: One of the tradeoffs of the evolution of upright posture in humans is that at some point, the various fluids that circulate throughout our bodies face an uphill climb. This is particularly true of our blood, which gets pumped from a location high up in the body. Not only does it need to reach all of our tissues, but it has to complete a timely round trip back to the heart.

A branching network of arteries carry oxygenated, nutrient-rich blood away from the pumping chambers of the heart and out to the tissues via the capillaries. A similar network of veins return oxygen-poor blood and waste products back to the heart.

When you have chronic venous insufficiency, or CVI, it means that the deeper veins in your legs aren’t working efficiently to return the blood to the heart. This happens when the walls of the veins become weakened, and when the tiny one-way valves within the veins no longer function properly. These valves are an ingenious solution to the gravity fighting against the blood moving up from your legs back to the heart.

Working in concert with our muscles and with the smooth and elastic vein walls, these valves use a pair of opposing flaps to prevent the rising blood from ebbing backward between heartbeats. With CVI, the blood fails to make a consistent upward climb and pools in the veins. Blood pressure within the veins rises, which can damage both the veins and the valves.

Risk factors for CVI include age, family history, prolonged inactivity, pregnancy, obesity and being quite tall. CVI may also occur in people who have experienced deep vein thrombosis, which is a blood clot in the deep veins of the leg. Symptoms include swelling in the lower leg and ankle -- particularly after prolonged standing -- as well as aching, throbbing or tiredness in the legs. Skin on the legs and feet may itch, flake or appear leathery, and new varicose veins may emerge. The condition becomes more common after age 50, and is seen more often in women than in men.

Chronic venous insufficiency is not life-threatening; if ignored, however, it can lead to serious complications. These include leg ulcers, pulmonary embolism, deep vein thrombosis and secondary lymphedema, which is swelling in the tissues due to damage to the lymphatic system.

Depending on the severity of your particular condition -- there are varying degrees of CVI -- your doctor will outline strategies for you to follow. These can include being advised to lose weight, wear compression stockings, exercise regularly, elevate the legs, avoid prolonged standing and maintain skin care. Some patients benefit from nonsurgical treatments that use injected solutions or laser therapy to collapse certain smaller vessels.

It’s important for your health that you follow your doctors’ recommendations and make managing CVI part of your daily routine.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctor: I am 67 years old, with arthritis in my hands and feet. My daughter recently had a fall, and X-rays showed signs of arthritis in her foot. She’s only 34. What are the most important things she can do to keep it from progressing, or at least slow it down?

Dear Reader: When we talk about arthritis, we’re referring to a range of conditions that result in pain, stiffness and swelling that affects the joints, most often in the hands, feet, hips and knees. Although rare, the inflammation from certain types of arthritis can affect other parts of the body, such as the kidneys, heart, eyes and lungs. Arthritis occurs in people of both sexes, and of all ages, races and body types. It is estimated that up to one-fourth of Americans are living with some type of arthritis, which makes it one of the leading causes of disability in the U.S.

The two most common types of arthritis are osteoarthritis and rheumatoid arthritis. The former is caused by wear and tear of the joints. The latter is an autoimmune disease in which the person’s own immune system attacks and damages the connective tissues. Both result in similar symptoms, which include stiffness in the morning and after inactivity, pain while walking, localized joint pain and swelling, tenderness or warmth within the joints.

There are several things your daughter can do to manage the progression of arthritis. (And these can benefit you, as well.) One is to maintain a healthy weight, which lessens the daily toll on the joints in the feet, hips and knees. A healthful diet, with an emphasis on lean proteins and a wide variety of fresh fruits and vegetables, is important. So is minimizing foods known to kick up inflammation, which includes refined starches, added sugars, red meat and saturated fats and trans-fats.

It may seem counterintuitive, but staying active lessens arthritis pain, keeps joints moving and increases range of motion. Go for joint-friendly exercises that are enjoyable enough to do regularly. These include low-impact options such as walking, cycling, tai chi, yoga, Pilates, swimming and water aerobics. Strength training, which helps to build up the muscles that support your joints, can also be very helpful. However, it’s best for this to be done under supervision, at least in the beginning.

As when adding any new exercise to your daily routine, it’s a good idea to first check in with your health care provider. Which leads us to a final bit of advice: If your budget and health insurance allow, we think it would be wise for your daughter to have at least one visit with a rheumatologist. They can assess her condition, provide her with a baseline from which to evaluate the progression of her arthritis and help educate her on what to expect in the future. If she’s experiencing pain, they can help her explore a range of options to deal with it. The more she knows about arthritis in general -- and her condition in particular -- the more active she can be in participating in her own care.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctor: I heard two teenagers in line at the drug store talking about the skin microbiome and how you shouldn’t use soap on your face because it wipes out the good bacteria. We hear a lot about the gut microbiome lately, but is the skin microbiome really even a thing?

Dear Reader: The word “microbiome” refers to any community of microorganisms that live together peaceably in a specific environment. To reflect the fact that they don’t cause illness, it’s said that they “colonize” an area rather than “infect” it.

In terms of the human microbiome, we’re talking about the vast array of microbes that live upon and within our bodies. These colonies are typically composed of bacteria, bacteriophages, fungi, protozoa and viruses. Depending on their location, they number into the millions, billions and, in the gut microbiome, trillions.

In addition to the gut, anatomical sites of distinct microbiomes in and on the human body include the nose, mouth, esophagus, lungs, genitals and even the hidden depths of the belly button. And, yes, the skin, which is often referred to as the largest organ in the body, is the site of a microbiome. Multiple ones, in fact. They differ depending on their specific locations, and are affected by the variety of environments they interact with, including oily, moist and dry.

For instance, the skin between your toes, which spends long stretches of time in the moist darkness created by socks, shoes and perspiration, hosts a different profile of microbes than does the skin on your scalp, behind your ears or on the backs of your hands.

The epidermis, which is the top layer of the skin, is a tough environment for microbes. It’s dry, acidic and low in nutrients, and great swaths of it are exposed to the elements. And, yet, millions of bacteria, viruses and fungi find a way to make it their home. Depending on their location, they survive on the available proteins, oils, salt or moisture. Research shows that, as with our gut, many of the microbe colonies on our skin play a role in fending off potential pathogens. They also play a role in wound healing, in maintaining skin’s overall health and in how we smell. All of which is good reason to take a look at our bathing and skin care routines.

Dermatologists have long suggested that harsh soaps, too much scrubbing and daily bathing with overly hot water can strip the epidermis not only of helpful oils, but also wreak havoc on beneficial microbe colonies. To protect your skin’s microbiome, think in terms of gentle, pH-balanced soaps, and gentler overall treatment. That means save the scrubbing with loofas and brushes and other rough materials for the truly grubby areas. Instead of a vigorous rubbing with a towel when you are finished bathing, gently dab and pat your skin dry. And, in case you were wondering, you definitely want to keep up the vigilant hand washing that helps keep us safer during the coronavirus pandemic.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)