VARICOSE VEINS

SAIMA IBRAHIM
(feedback@pgeconomist.com)

July 19 - 25, 2010

Varicose veins commonly refer to the veins on the leg. These veins can appear anywhere in the body but most often affect legs and feet. When inflamed, they become tender to the touch and can hinder circulation to the point of causing swollen ankles, itchy skin, and aching in the affected limb. Varicose veins are often painful, especially when standing or walking. They often itch, and scratching them can cause ulcers. Serious complications are rare.

Varicose veins are a relatively common condition, and for many people they are a family trail. Women are twice as likely as men to develop them; nearly 10 percent of all adult men and 20 percent of adult women are affected by them to some degree.

Varicose veins are distinguished from reticular veins (blue veins) and telangiectasias (spider veins), which also involve valvular insufficiency. Many patients who suffer with varicose veins seek out the assistance of physicians who specialise in vein care. These physicians are called Phlebologists.

SIGN & SYMPTOMS

* Prominent dark blue blood vessels, especially in the legs and feet.

* Aching, tender, heavy, or sore legs; often accompanied by swelling in the ankles or feet after standing for any length of time.

* Bulging, ropelike bluish veins indicate superficial varicose veins.

* Aching and heaviness in a limb, sometimes with swelling, but without any prominent or visible blue vein, may signal a deep varicose vein.

* Discolored, peeling skin; skin ulcers; and constant rather than intermittent pain are signs of severe varicose veins.

* A brownish-blue shiny skin discoloration near the affected veins.

* Cramps may develop especially when making a sudden move as standing up.

* Minor injuries to the area may bleed more than normal and/or take a long time to heal.

* In some people, the skin above the ankle may shrink because the fat underneath the skin becomes hard.

* Restless legs syndrome appears to be a common overlapping clinical syndrome in patients with varicose veins and other chronic venous insufficiency.

* Whitened, irregular scar-like patches can appear at the ankles.

CAUSES

Circulate blood from the lungs to all parts of the body, arteries have thick layers of muscle or elastic tissue. To push blood back to the heart, the veins rely mainly on surrounding muscles and a network of one-way valves. As blood flows through a vein, the cuplike valves alternately open to allow blood through, and then close to prevent backflow. Veins have leaflet valves to prevent blood from flowing backwards (retrograde). Leg muscles pump the veins to return blood to the heart, against the effects of gravity.

Varicosity results from a chronic increase in blood pressure, which dilates the vein. Because superficial veins of legs which have less muscular support than deep veins and are subject to high pressure when standing. They are more likely to become varicose. When veins become varicose, the vein walls are pushed apart and the leaflets of the valves no longer seal properly and the valves do not work, making it difficult for the muscles to push the blood uphill. Instead of flowing from one valve to the next, this allows blood to flow backwards and the blood begins to pool in the vein, increasing venous pressure and the likelihood of congestion while causing the vein to bulge and twist.

Any condition that puts excessive pressure on the legs or abdomen can lead to varicosity. Hormonal fluctuations during pregnancy and menopause may be responsible for the high proportion of varicosities among women. Dietary deficiencies or the loss of skin elasticity due to aging are contributory factors. Prolonged standing or sitting, constipation, constrictive clothing, lack of exercise, obesity, or repeated heavy lifting can interfere with normal circulation to increase the likelihood that varicose veins will develop and can worsen existing varicosities. In chronic cases, the distended veins may be accompanied by aching pain or itching, and if the stretched skin breaks down, open sores may form.

Call Your Doctor If:

* Your varicose veins become painful.

* Swelling becomes incapacitating, or if the skin over your varicose veins becomes flaky, ulcerous, discolored, or prone to bleeding. You may want to have the veins removed to avoid further discomfort and prevent potentially more serious circulatory problems.

* You have red varicose veins. This may be a sign of phlebitis, a serious circulatory condition.

* You cut a varicose vein, control the resulting burst of blood and have the vein treated to prevent complications.

* You have varicose veins around your ankles that rupture and start to bleed.

TREATMENT

A mild case of varicose veins does not usually require a doctor's care. You can find relief from the discomfort of varicose veins with basic at-home treatment and various alternative remedies.

CONVENTIONAL TREATMENTS

* Superficial varicose veins normally do not require medical attention. To relieve the discomfort, doctor may recommend elastic support stockings. Support stockings help your leg muscles push blood upward by concentrating pressure near the ankles. Put them on before you get out of bed in the morning. Raise your legs in the air and pull the stockings on evenly; they should not feel tight in the calf or groin. You should wear them all day.

* To alleviate occasional swelling and pain, an over-the-counter anti-inflammatory drug such as aspirin is usually prescribed. If you notice skin around a varicose vein becoming ulcerous or discolored, or if you have continuing pain with no obvious outward signs, contact a doctor at once about the possibility of deep varicose veins.

* Varicose veins can be eliminated by one of several methods. Spider veins can be removed through laser treatment. A mild case of superficial varicose veins can be treated by sclerotherapy a chemical known as a sclerosing agent that is injected into the vein to collapse its walls so it can no longer transport blood. More severe cases may merit surgical removal, or stripping. Unfortunately, no treatment can prevent new veins from becoming varicose. Before pursuing a particular treatment, discuss all options with a dermatologist or vascular surgeon.

Active medical intervention in varicose veins can be divided into surgical and non-surgical treatments. Some doctors favor traditional open surgery while others prefer the newer methods. Newer methods for treating varicose veins such as Endovenous Thermal Ablation (endovenous laser treatment or radiofrequency ablation), and foam sclerotherapy are not as well studied, especially in the longer term.

SURGICAL TREATMENTS

The traditional surgical treatment has been vein stripping to remove the affected veins. Newer, less invasive treatments, such as ultrasound-guided foam sclerotherapy, radiofrequency ablation and endovenous laser treatment, are slowly replacing traditional surgical treatments. Most of the blood in the legs is returned by the deep veins, the superficial veins, which return only about 10 per cent of the total blood of the legs, can usually be removed or ablated without serious harm

VEIN STRIPPING

Stripping consists of removal of all or part the saphenous vein main trunk. The complications include deep vein thrombosis (5.3 percent), pulmonary embolism (0.06 percent), and wound complications including infection (2.2 percent). For traditional surgery, reported recurrence rates, which have been tracked for 10 years, ranging from 5-60 percent. In addition, since stripping removes the saphenous main trunks, they are no longer available for venous bypass in the future (coronary and/or leg artery vital disease

SCLEROTHERAPY

A commonly performed non-surgical treatment for varicose and "spider" leg veins is sclerotherapy in which medicine is injected into the veins to make them shrink. The medicines that are commonly used as sclerosants are polidocanol (POL) and sodium tetradecyl sulphate (STS). These detergent liquids can be mixed with air, CO2 or O2 to create foams. Sclerotherapy has been used in the treatment of varicose veins for over 150 years. Sclerotherapy is often used for telangiectasias (spider veins) and varicose veins that persist or recur after vein stripping. Complications of sclerotherapy are rare but can include blood clots and ulceration. Anaphylactic reactions are "extraordinarily rare but can be life-threatening," and doctors should have resuscitation equipment ready. There has been one reported case of stroke after ultrasound guided sclerotherapy when an unusually large dose of sclerosant foam was injected.

NATURAL REMEDIES

To cope with varicose veins, try a two-pronged strategy of natural remedies to ease the discomfort and preventive maintenance to keep your body fit and strong.

AROMATHERAPY

Blend 12 drops each of cypress and geranium essential oils in four ounces of a carrier oil such as almond, soy or sunflower. Gently apply the mixture to the legs by stroking upward, in the direction of the heart. Don't massage directly on the veins. Instead, massage the surrounding area and gently stroke the oil over the veins. Oils of cypress and chamomile may soothe swelling and inflammation and help relieve pain.

DIET AND SUPPLEMENTS

A high-fiber diet helps prevent straining of your stool, which can build up pressure and aggravate varicose veins. It is recommended that you consume at least 30 grams of fiber a day. To accomplish this, build your meals around whole grains, legumes, fruits, and vegetables, adding these foods to your diet as often as possible. Eat plenty of blackberries and cherries. They are rich in compounds that may prevent varicose veins or lessen the discomfort they cause.

PREFERRED FOODS

Whole foods diet with emphasis on the following foods: fresh fruits including berries and cherries, and citrus fruit making sure to nibble on the inside of the rinds, whole grains especially buckwheat and millet, garlic, onions, ginger, and cayenne pepper. Eat plenty of fish and cut down on red meat as much as possible. Moderately restrict fats and refined carbohydrates in diet.

FOODS TO AVOID

Sugar, salt, alcohol, fried foods, processed and refined foods, animal protein, cheeses, and ice cream.

HERBAL THERAPIES

Witch hazel - Application of a witch hazel ointment three or more times is necessary for two or more weeks before results can be expected. (Witch hazel may cause minor skin irritation when applied topically; this herb is not recommended for internal use.)

Horse chestnut can be used both internally and externally. (Horse chestnut should be avoided by anyone with liver or kidney disease. Its internal use is also contraindicated during pregnancy and lactation. Topically associated with rare cases of allergic skin reactions)

Bilberries - Support normal formation of connective tissue and strengthen capillaries in the body, and in this way help prevent varicose veins.

Gotu Kola - Strengthens blood vessels and improves peripheral circulation.

Ginkgo (Ginkgo Biloba) - Strengthens blood vessels and improves peripheral circulation.

Hawthorn - Strengthens blood vessels and improve peripheral circulation.

To disperse buildup of a protein that makes skin near varicose veins hard and lumpy, try eating more cayenne, garlic, onion, ginger, and pineapple, which contains bromelain, an enzyme that promotes breakup of fibrin.

HERBAL TEA

Hawthorn berries 3 parts

Yarrow 2 parts

Horse chestnut 3 parts

Ginger 1 part

Prickly ash bark 2 parts

Use two teaspoonfuls of the mixture. Infuse for fifteen minutes. Drink three times daily.

External applications of Camomile, Comfrey, Oatstraw, White Oak Bark, or Witch Hazel are believed especially beneficial.

Aloe Vera gel can be used to soothe itchy or irritated varicosities.

HOMEOPATHY

* Hamamelis: Tincture or lotion may be applied locally at night. Hamamelis 3X every three hours when veins are affected.

* Pulsatilla: 3X is recommended every eight hours after child delivery.

* Mercurius sol: if accompanied by infection, pus, and foul-smelling discharge.

* Lachesis: Blue color in area mainly on left side.

* Ferrum metallicum: if your legs look pale but redden easily and walking slowly relieves the weak, achy feeling.

* Arnica 30c

* Aconite napellus 6c

HYDROTHERAPY

It is beneficial to alternate between hot and cold baths. This is believed to stimulate circulation in the legs. It is easy to do this. You need two buckets or plastic wastebaskets tall enough to submerge the legs up to the knees. Fill one container with enough comfortably hot water to cover the lower legs and the other container with the same amount of cold water. Add two tablespoons of epsom salts per quart of water or you can add an aromatherapy oil to the water. Soak your feet and legs in the hot water for about three minutes, then immerse them in the cold water for about 30 seconds. Repeat three times, finishing with the cold soak. Perform this treatment once a day for at least one month to see results. If you have diabetes, use warm (not hot) water. Sponging or spraying legs with cold water can relieve aches and pain from superficial varicose veins.

JUICE THERAPY

Fresh fruit juices can be very helpful for those with varicose veins. Dark-colored berries such as cherries, blackberries and blueberries contain anthocyanins and proanthocyanidins, pigments that tone and strengthen the walls of the veins. Pineapples are rich in the enzyme bromelain, which helps prevent blood clots, an uncommon but serious complication of varicose veins. Juicing provides these nutrients in much higher concentrations then you can get by just eating the fruits. Drink eight ounces of fresh berry or pineapple juice, alone or diluted with another fruit juice, once or twice a day for maximum benefit. One or two glasses daily of fresh fruit or vegetable juices- especially any combination of apple, beet, carrot, celery, citrus, parsley, or pineapple-and dietary supplements may be helpful in preventing and treating varicosities.

EXERCISE

Maintaining your overall fitness, both nutritionally and physically, is most essential to preventing varicose veins from developing. Any program of regular exercise stimulates circulation, improves muscle tone, and helps prevent varicosities. However, high-impact aerobics, jogging, strenuous cycling, or any intense activity may increase blood pressure in the legs and accentuate varicose veins. Walking and swimming are considered excellent therapy, as are gentle leg-muscle stretches and utilising a rocking chair while watching television.

Lying flat on the floor and resting the legs on a chair seat or straight up against a wall for two minutes drains blood from swollen veins. Elevating the feet higher than the hips with a recliner or ottoman, and raising the foot of the bed a few inches, helps blood flow back to the heart from the legs. Start your morning with a brisk walk or finish your day with a swim or bike ride.

You can help control varicose veins with a program of specially designed exercises, under the direction of a trained exercise therapist who is knowledgeable about the condition's particular needs.

YOGA

Yoga's stretching and relaxation techniques can be particularly beneficial for varicose veins. Certain positions, such as the Plow, Corpse, and Half Shoulder Stand, promote circulation and the drainage of blood from the legs. The deep-breathing exercises in yoga may further alleviate discomfort by getting more oxygen into the bloodstream.

A special breathing exercise can help ease pain from varicose veins. Start by lying on your back on the floor, arms at your sides, with your feet resting above you on a chair. Breathe deeply through your nose using the belly breath. Gravity helps pull blood from your legs. The deep breathing creates a pull in your chest cavity that also draws blood from the legs. Fresh blood then enters your legs, easing the pain. Do this exercise once a day for about ten minutes.

MASSAGE

Regular massage can significantly alleviate discomfort associated with varicose veins. A trained massage therapist starts at the feet and massages your legs up to the hips and along the lymphatic system, to mobilize congested body tissues.

If you do the massage yourself, remember to never massage directly on varicose veins. A general leg massage can help reduce swelling in the veins. Sit up comfortably on a sofa or bed, with your legs raised slightly on a pillow. Now work up the entire leg from the ankle to the upper thigh. (Remember not to touch the varicose veins.) Do this daily for about five minutes on each leg.

FOLK REMEDIES

Apply a cloth saturated with apple cider vinegar on the varicose veins for 30 minutes twice a day. Follow this with a drink of two teaspoons of the vinegar in a glass of water.

Prepare a salve by stirring two cups of chopped calendula flowers, leaves, and stems into an equal amount of melted lard. Let the mixture stand for 24 hours. Reheat and strain. Coat this over your varicose veins and let it stand overnight.

Eat a few fresh marigold petals every day. This treatment is believed to shrink varicosities and nourish the veins.

Prepare a poultice of bruised cabbage leaves, rotten apples, chopped brown onions, or a half-and-half blend of cod liver oil and raw honey. Apply this overnight. This is believed to heal varicose sores.

To one pint of warm water, add three tablespoons of sugar and two tablespoons of apple cider vinegar. Take two ounces of this mixture every day.

Rub your legs with full- strength vinegar. Mix 2-tablespoons of vinegar with honey and drink it.

COMMON SENSE RECOMMENDATIONS

* Exercise regularly. Staying fit is the best way to keep your leg muscles toned, your blood flowing, and your weight under control.

* Eat foods low in fat, sugar, and salt. Drink plenty of water. Take supplements of vitamins C and E.

* If your job requires you to be on your feet constantly, stretch and exercise your legs as often as possible to increase circulation and reduce pressure buildup.

* If you smoke, quit. Smoking may contribute to elevated blood pressure, which in turn can aggravate varicosity.

* If you're pregnant, sleep on your left side rather than on your back. This minimises pressure from the uterus on the veins in your pelvic area. It also improves blood flow to the fetus.

* To ease painful swelling and inflammation, rest frequently, wear support stockings, and take one or two aspirin or ibuprofen tablets daily until the condition clears.

* If you like to sit with your legs crossed, cross them at the ankles rather than the knees for better circulation.

* Take occasional breaks and put your feet up. Periods of rest with your feet a few inches above your heart level let gravity work in your favor, helping pooled blood drain from your legs.

* Avoid high heels in favor of flat shoes.

* Wear loose clothing. Tight garments can restrict venous blood flow to leave blood pooled in the legs. Particularly harmful are girdles or pantyhose, garters, calf-hugging boots, or waist-cinching belts.

* Take an aspirin every day. This will thin the blood and prevent blood from clotting. (Consult your doctor if you are taking any heart medication or other medication for blood clotting.)