Varicose veins may look ugly but for a lucky majority who develop them, their appearance will be the only cause of concern. Distended and dilated, these veins appear just below the skin and can create a spider web pattern of blue and purple lines that make sufferers self- conscious. But for a small percentage, varicose veins can cause itching and pain, and even lead to wounds that make some form of treatment necessary.
The good news is that treatment – both surgical and non-surgical – has proven effective time and again, says Dr. Rezni Cassim, Vascular and Transplant Surgeon and lecturer at the Professorial Surgical Unit at the National Hospital.
As you read this, approximately five litres of blood is wending its way through your system. Travelling along an intricate system of veins and arteries, the blood circulates throughout your body. The arteries carry the blood from your heart out to your body, and the veins carry the blood from your body back to your heart. The blood travelling along your arteries is a rich red, an indicator that it is full of oxygen. The blood travelling back along your veins, on the other hand, is much darker because your body has extracted the oxygen in the blood. That’s why veins look purple or blue.
“Going down is easy, high arterial pressure and gravity sends the blood down,” says Dr. Cassim, speaking of the movement along the arteries. Going up, on the other hand, is a fight against gravity and is helped by a system of valves in the veins. “The venous system is designed in such a way that there is a one way flow, with valves stopping the blood from flowing back and defects in the valves are the cause of most problems. " Such defects can appear anywhere, from groin to just above ankle, and cause varicose veins. A malfunctioning valve can create a long column of blood, resulting in what is known as venous hypertension. The venous hypertension may cause varicose veins and its complications.
Dr. Cassim explains that the condition is most often familial, appearing in a member or members of the same family. Aside from the hereditary component, varicose veins can be aggravated by pregnancy. The body has dual systems of veins – one is deep seated and other superficial. If the deep veins are blocked, those just under the skin must cope with a greater load and can develop varicose veins.
An arteriovenous fistula can cause varicose veins in places like your arms. Arteriovenous fistuli represent abnormal connections or passageways between an artery and a vein. In a healthy system, blood flows from arteries, into capillaries and then into veins. An arteriovenous fistula however, can cause the blood to bypass the capillaries and flow directly from artery into vein.
They fall into two categories: congenital fistula which a person may be born with and acquired fistula which develop after birth and may have been caused by trauma/surgery. A big fistula can allow a large volume of blood, under high pressure to flood the vein. The latter, not having been designed to channel so much blood with high pressure, becomes distended. Apart from these there are other rare secondary causes for varicose veins.
Many of Dr. Cassim’s patients are young people. For younger patients, the appearance of the veins is often embarrassing. “The younger they are, the more concerned they tend to be,” says Dr. Cassim, adding that aside from such cosmetic concerns, 90% of his patients will not have any problem. But varicose veins can cause complications. You can have swelling of the legs, because of the pressure, itchiness of the leg, eczema, pain, pigmentation and ulcers (wounds). “When inadvertently traumatised the veins may bleed heavily, and patients should immediately apply pressure to prevent further blood loss,” says Dr. Cassim, emphasising that bleeding should stop in approximately 15 minutes.
“These complications present a reason to treat varicose veins,” he says, “the diagnosis itself is very simple.”
The ulcer is one of the most unpleasant complications, simply because it can take so long to heal. Dr. Cassim has seen patients who have struggled with one for 10 years. “We use a technique called strapping to treat it – it’s a special way of putting pressure on the ulcer to heal it – but that can also take 3 to 6 months to heal,” he says, adding, “All this can be prevented at an early stage.” If you have varicose veins with pigmentation, itching or skin changes, consider it your cue to seek medical advice.
Though varicose veins are simple enough to treat, what doctors are worried about is the possibility of an underlying secondary cause. “If there is a sudden onset of varicose veins, it is better to seek treatment,” cautions Dr. Cassim. However, if you’ve had varicose veins for several years and experienced none of these complications, and do not want treatment for cosmetic concerns, you can choose to leave them untreated.
For those who are interested in non-invasive treatment for complications, Dr. Cassim recommends the wearing of a graduated pressure stocking during the day. The stockings help to force the blood upwards. At night, keeping the legs elevated will encourage healthy circulation. These must become the habits of a lifetime if they are to be effective. Exercising, losing weight, and avoiding long periods of standing can also help. For those who are self- conscious, however, wearing a stocking might not seem like a viable solution.
Doctors seeking to treat varicose veins can choose to do a duplex scan to identify the malfunctioning valves in the vein. There are many invasive methods to treat varicose veins. Dr. Cassim describes the process as akin to getting a haircut – except the time scale differs radically. The varicose veins can recur in 60% of patients in 6 to 8 years. Of course, 40% will be recurrence free. Doctors often employ minimally invasive techniques such as sclerosant injection, foam therapy, or laser ablation to treat these veins.
Other patients, more interested in a long term solution, will opt to have the veins completely removed in an operation. It includes “vein stripping” and the surgery occurs under anaesthesia. Because so much of the blood flows through the deeper veins in the legs, the superficial veins can usually be removed or ablated without serious harm. In the end, it’s the patient who makes the choice, says Dr. Cassim, adding that each approach has its advantages and disadvantages.
Showing posts with label leg pain. Show all posts
Showing posts with label leg pain. Show all posts
Wednesday, December 8, 2010
Sunday, December 5, 2010
Foot Pain at Night
Q:
I have neuropathy in my feet. It can be extremely painful at night, and it keeps me awake most nights. Is there any way to reduce the pain, and will this ever subside?
— Debbie, Wichita, KS
A:
Neuropathy is a painful and distressing complication of diabetes. In some people, it disappears on its own over a period of about 12 months. In others, however, it persists. There are medicines your doctor can prescribe to relieve your symptoms.
The U.S. Food and Drug Administration has approved two drugs, duloxetine and pregabalin, to treat the foot pain from diabetic neuropathy. Duloxetin is an antidepressant, and pregabalin is used to treat seizure disorders. Both have some side effects. Duloxetin can cause nausea, sleepiness, dizziness, decreased appetite, hot flashes, and constipation. Pregabalin can cause sleepiness and confusion and can also lead to dependence.
You might consider other kinds of treatment too, both traditional and not. In one Australian study, the antioxidant alpha-lipoic acid was shown to reduce pain. And other medications — including some antiseizure medications, antidepressants, and opiates — have been used with some success. Some people have used acupuncture, topical creams containing capsaicin (a substance found naturally in hot peppers), and other alternative therapies. Of course, many of these treatments have not been well studied enough to determine their effectiveness.
I would advise you to consult with your doctor to decide which treatment works best for you. It's important to remember, of course, that none of these medicines cure the underlying cause of neuropathy. That's why it's important to focus on tight glucose management. The basic problem that leads to neuropathy is nerve and blood vessel damage caused by high blood glucose levels.
Learn more in the Everyday Health Type 2 Diabetes Center.
I have neuropathy in my feet. It can be extremely painful at night, and it keeps me awake most nights. Is there any way to reduce the pain, and will this ever subside?
— Debbie, Wichita, KS
A:
Neuropathy is a painful and distressing complication of diabetes. In some people, it disappears on its own over a period of about 12 months. In others, however, it persists. There are medicines your doctor can prescribe to relieve your symptoms.
The U.S. Food and Drug Administration has approved two drugs, duloxetine and pregabalin, to treat the foot pain from diabetic neuropathy. Duloxetin is an antidepressant, and pregabalin is used to treat seizure disorders. Both have some side effects. Duloxetin can cause nausea, sleepiness, dizziness, decreased appetite, hot flashes, and constipation. Pregabalin can cause sleepiness and confusion and can also lead to dependence.
You might consider other kinds of treatment too, both traditional and not. In one Australian study, the antioxidant alpha-lipoic acid was shown to reduce pain. And other medications — including some antiseizure medications, antidepressants, and opiates — have been used with some success. Some people have used acupuncture, topical creams containing capsaicin (a substance found naturally in hot peppers), and other alternative therapies. Of course, many of these treatments have not been well studied enough to determine their effectiveness.
I would advise you to consult with your doctor to decide which treatment works best for you. It's important to remember, of course, that none of these medicines cure the underlying cause of neuropathy. That's why it's important to focus on tight glucose management. The basic problem that leads to neuropathy is nerve and blood vessel damage caused by high blood glucose levels.
Learn more in the Everyday Health Type 2 Diabetes Center.
Sunday, September 26, 2010
Ease leg pain, improve appearance
When warm weather came, Angela Snodgrass shunned wearing shorts. Only capris. They covered up the unattractive veins in her legs.
As a physical therapist and mother of two young children, she's on her feet a lot. Since her first pregnancy seven years ago, she had itching, ankle swelling and dull, aching pains in her legs.
At work, she took breaks from standing by sitting on a stool. At home, she couldn't stand up after showering to finish getting ready for work due to pain in her calves.
"It just got progressively worse," said Snodgrass, 32, of Connersville, Ind.
"The varicose veins bothered one leg during my first pregnancy and then the other, too, during my second pregnancy. I also noticed more spider veins," she said, while getting injection treatments at the Decatur Vein Clinic in Greenwood.
Last month, she started to get relief at the clinic. As she nears the end of her treatments, which included endovenous laser procedures and injections, her pain and unsightly veins are almost gone.
Like Snodgrass, many women - and some men - are getting help from a number of minimally invasive procedures available to help aching, painful legs and enlarged veins that can appear twisted and bulging.
"All you have to do is spend a day at the pool and you see how many people it affects," said Dr. William Finkelmeier, a vascular surgeon with VeinSolutions. "It's really a significant problem."
About 50 percent to 55 percent of women and 40 percent to 45 percent of men in the U.S. suffer from some type of vein problem, the Office on Women's Health in the U.S. Department of Health and Human Services says. Young women also are affected, particularly because of pregnancy.
Vein-clinic doctors say public education about treatments is improving, and varicose vein research has advanced in the past 15 years.
This month, a new injectable liquid drug, Asclera, approved by the Food and Drug Administration in April, became available in the United States. It primarily can be used to treat tiny, spider veins or small varicose veins.
With deeper varicose veins, clinics normally first use laser or radiofrequency endovenous techniques. They involve putting a small tube into a vein, inserting a probe with a device at the tip that heats up the inside of the vein and closes it off.
The problem is that many people delay or don't seek treatment.
"Most of our folks have been dealing with symptoms - legs aching, throbbing, heaviness - for five to 10 years before coming in," said Dr. Jeffery Schoonover, regional medical director for Vein Clinics of America
BARB BERGGOETZ • THE INDIANAPOLIS STAR • JULY 6, 2010
As a physical therapist and mother of two young children, she's on her feet a lot. Since her first pregnancy seven years ago, she had itching, ankle swelling and dull, aching pains in her legs.
At work, she took breaks from standing by sitting on a stool. At home, she couldn't stand up after showering to finish getting ready for work due to pain in her calves.
"It just got progressively worse," said Snodgrass, 32, of Connersville, Ind.
"The varicose veins bothered one leg during my first pregnancy and then the other, too, during my second pregnancy. I also noticed more spider veins," she said, while getting injection treatments at the Decatur Vein Clinic in Greenwood.
Last month, she started to get relief at the clinic. As she nears the end of her treatments, which included endovenous laser procedures and injections, her pain and unsightly veins are almost gone.
Like Snodgrass, many women - and some men - are getting help from a number of minimally invasive procedures available to help aching, painful legs and enlarged veins that can appear twisted and bulging.
"All you have to do is spend a day at the pool and you see how many people it affects," said Dr. William Finkelmeier, a vascular surgeon with VeinSolutions. "It's really a significant problem."
About 50 percent to 55 percent of women and 40 percent to 45 percent of men in the U.S. suffer from some type of vein problem, the Office on Women's Health in the U.S. Department of Health and Human Services says. Young women also are affected, particularly because of pregnancy.
Vein-clinic doctors say public education about treatments is improving, and varicose vein research has advanced in the past 15 years.
This month, a new injectable liquid drug, Asclera, approved by the Food and Drug Administration in April, became available in the United States. It primarily can be used to treat tiny, spider veins or small varicose veins.
With deeper varicose veins, clinics normally first use laser or radiofrequency endovenous techniques. They involve putting a small tube into a vein, inserting a probe with a device at the tip that heats up the inside of the vein and closes it off.
The problem is that many people delay or don't seek treatment.
"Most of our folks have been dealing with symptoms - legs aching, throbbing, heaviness - for five to 10 years before coming in," said Dr. Jeffery Schoonover, regional medical director for Vein Clinics of America
BARB BERGGOETZ • THE INDIANAPOLIS STAR • JULY 6, 2010
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