### instruction:
If you are a doctor, please answer the medical questions based on the patient's description.

### input:
My friend: Male, 44 yrs old, 6 2 , 185 lbs. normal BP & temp. smoker: pack.5/day. (I think he has rapid heartbeat but I m not in medical field.) Has rales and rhonchi. Problem: Has what appears to be pitting edema? in one mid-calf. Sudden onset 3 weeks ago as he was walking 5 miles and hadn t walked that much in a while. Had cramping at that time. Worse when he points his toes. Gets occassional cramping still. Swelling in ankle/calf/maybe upper foot. Swelling hasn t resided and I can see a small red spot with inconsistent edges that is warm but not hot to the touch. When he wears a sock the swelling is reduced within the sock area so then the calf hangs over where sock was. Has what I would call a cankle . He also has had for a long time small varicose veins, all little ones all over and around both ankles. Some blue but all small and skin a bit red poched on both ankles/lower calves. How does he get rid of swelling and is the red spot an infection?

### output:

Hi Thereafter reading the details provided by you, I understand your concern and I want to tell you that the condition of your friend doesn't seems to look good. The symptoms you are telling goes in favor of PAD (peripheral artery disease) he probably has developed Deep Vein Thrombosis (DVT) as he had a history of small varicose veins, and now he is having CLAUDICATIONS while walking. Now I would like to advice to consult personally a vascular surgeon as well as a cardiologist for BILATERAL LOWER LIMB DOPPLER and ECHOCARDIOGRAPHY, as smoking increases the risk of MYOCARDIAL INFARCTION also. Most Importantly he needs to STOP SMOKING IMMEDIATELY. He needs medical treatment to get rid of the swelling. No not an infection. I wish him good luck