Dear Doctors: My husband is 74 and has congestive heart failure. He has what look like burns on his left leg. There is a lot of swelling, and his leg is leaking blood and fluid. He sees a cardiologist and has been told he should see a vascular surgeon. Why a surgeon? How would that help?

Dear Reader: Congestive heart failure is a condition where the heart is no longer able to pump blood efficiently. It struggles to send enough oxygen and nutrients to the tissues of the body. This may be due to mechanical issues, such as malfunctions in the chambers or valves of the heart. It could also be that the muscle itself is weak. Either way, the result is a range of symptoms. These can include shortness of breath, weakness and fatigue, irregular heartbeat, wheezing, a persistent cough and swelling in the ankles, feet and legs.

The swelling that you described is a common effect of heart failure. Known as edema, it is part of a chain reaction that begins with the heart's decreased pumping strength. As blood lingers in the veins, pressure builds up. This, in turn, forces fluid into the surrounding tissues, a condition known as peripheral edema. This swelling stretches the skin and causes inflammation. It can make the skin fragile enough to break open and form the burnlike wounds you’ve observed.

This type of weeping wound indicates a critical problem below the surface of the skin. More specifically, it signals serious circulatory issues. That’s why your husband is being referred to a vascular surgeon. This specialty focuses on the veins and arteries that carry blood throughout the body. A vascular surgeon can determine the tests needed to pinpoint the cause of the extreme edema your husband is experiencing. These tests can map and measure blood flow, detect blockages, evaluate valve function and assess how well circulation is reaching the lower limbs.

Although the title of this specialty includes the word “surgeon,” it doesn’t necessarily mean a patient is being referred for a surgical procedure. Treatment options for this type of edema may include medication to reduce fluid buildup. Compression therapy can be used to improve circulation. There are also minimally invasive procedures designed to restore normal blood flow. Major surgery is considered only when there is severe blockage or when structural problems in the veins or arteries cannot be managed in any other way.

There is hope if your husband undergoes a thorough evaluation by a vascular surgeon and then follows up with appropriate treatment. Circulation in his legs and the edema and skin wounds can improve. He’ll likely work with additional specialists to manage his congestive heart failure. These may include a wound care specialist, a cardiologist to monitor heart function and adjust medications, a nutritionist or physical therapist to support appropriate lifestyle changes and a primary care physician to coordinate overall care. This may sound daunting, but congestive heart failure is a systemic condition that benefits from a team-based approach.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

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Dear Doctors: Any advice on controlling chiggers? When I work in the yard, they eat me alive unless I wear long pants. My wife does not garden and is rarely bitten. My son worked with me last weekend and said they don't bother him. Why not? When we took a walk later, I got bitten again.

Dear Reader: “Chiggers” is the name given to an early life stage of trombiculidae, a species of parasitic mite so small, they’re almost invisible to the naked eye. Classified as arachnids, they are closely related to spiders and ticks. Chiggers are found in warm, humid environments throughout the world. They thrive in dense, shaded vegetation where there is abundant moisture. Here in the United States, they are most common in the southeast, south central and Midwestern states.

As part of their life cycle, adult females lay eggs in moist, decomposing organic matter. The larvae that emerge from those eggs climb the surrounding vegetation and wait to attach to a passing host. These include birds, rodents, reptiles and, as many gardeners and outdoor enthusiasts in chigger country can attest, humans. Differences in body chemistry and even the texture or color of someone's clothing can play a role in whether they become a host. That may explain why your son seems not to be bothered by them.

It's when the larvae find a host that the trouble begins. The hard red welts and maddening itch of a chigger bite are the body's response to the chemicals the larval mites inject into the skin as they feed. The discomfort can last for two or more days. There are medications to ease the itching. Treatments can include calamine lotion, hydrocortisone creams, antihistamines or corticosteroids. The one bit of good news is that, unlike in some parts of Asia and the Pacific, chiggers in the U.S. do not carry or transmit diseases.

When it comes to preventing chigger bites, the most effective method is to create a physical barrier. Since they climb from below, long pants tucked into socks and closed shoes help reduce exposure. Long sleeves will help protect you from larvae you may brush against in tall grass or low-hanging leaves. It can also be helpful to treat shoes, socks and the cuffs of your pants with chemical deterrents, such as insect repellents that contain DEET or picaridin.

Even then, the battle against chiggers isn't over. After spending time outdoors, it's a good idea to shower promptly to wash away any larvae before they attach. Chiggers are vulnerable to heat, so you can also tumble clothes and footwear in a hot dryer to make sure none survive the trip into your home.

Unfortunately, it’s not possible to rid an outdoor area of chiggers. Guidance from the Centers for Disease Control and Prevention recommends that you protect yourself by making your yard less inviting. You can do this by clearing away leaf litter, keeping the grass trimmed and pulling weeds. Combine these steps with vigilant personal protection and a first-aid kit stocked with anti-itch medications, and you can reduce the risk of itchy misery during chigger season.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctors: Why is there so much different advice about walking? I just read that doing 15 minutes a day can help you live longer. I've also heard that a few minutes after a meal is important, long walks help your brain and just a few short walks a day are good as long as you walk really fast.

Dear Reader: You've asked a great and reasonable question. With so many studies looking into the health benefits of walking, it's no surprise that the variety of findings might lead to confusion. The truth is -- and we're not trying to be cute here -- they are all correct. Walking is a great form of exercise. It's free, doesn't require special equipment and can be done virtually anywhere at any time. What these walking studies show is that the practice yields some type of health benefit when done at any pace, for any duration at any frequency.

Our bodies were built for walking. The biomechanics of how our muscles, bones and connective tissues move contribute more than just locomotion. With each step, the compression and release of the skeletal muscle helps move lymph throughout the body. The gentle shifts of weight that take place with each step keep connective tissues supple and lubricated. The simple act of maintaining good posture engages the core muscles. Add in how walking supports the heart and lungs, can lift mood and has been found to have a protective effect on cognition and it’s easy to see why it is often referred to as the perfect exercise.

When it comes to the different advice that has emerged from decades of research into walking, it isn’t actually contradictory. Each study simply highlights a different piece of what is a much larger puzzle. A walk after eating engages the large muscles of the legs, which leads to improved post-meal blood sugar control. Walking just a few times a day at a swift pace helps heart health and circulation. Studies have found that even a few minutes of walking several times a day leads to improved health. And now, a new study has linked the practice of walking 15 minutes or more each day to improved longevity.

The study, conducted by researchers in Australia, looked at health data from more than 33,500 adults in their 60s. Those who walked for 10 to 15 continuous minutes each day lowered their risk of heart disease and early death. As with all observational studies, the results can only suggest a link between walking and improved longevity; they can’t prove the connection. Still, with so many studies pointing to the health benefits of walking, the conclusions become hard to ignore.

When it comes to your own life, choose the type of walking that best fits your circumstances. Maybe it’s a post-meal stroll, a short brisk walk, a long weekend hike or a rotating mix of all three. The kind of exercise you genuinely enjoy is the one you’ll keep doing -- and that’s the one that will make the biggest difference.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)