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Paging Dr. Frischer - Varicose Veins
WRITTEN BY :   Dr. Alan Frischer

They’re twisted and enlarged, they’re purple and blue, and sometimes they swell and ache by the end of the day. Everybody knows someone with varicose veins. This makes sense; over half of American women and just under half of American men suffer from some sort of vein problem. Let’s explore together what varicose veins are and why they occur. The heart pumps blood through the body, which carries with it oxygen and nutrients. Arteries carry the blood from the heart toward the different body parts, and veins carry the spent blood back to the heart. Thus, arteries act as a high-pressure hose, but veins must rely on muscle contractions in order to pump the blood back to the heart. Varicose veins develop when the valves in the veins become faulty, and the walls become weakened. Normally these one-way valves act as flaps to keep blood flowing efficiently, usually against gravity. When the valves malfunction, however, they leak backward and blood pools. This causes pressure to build up, which weakens, enlarges, and twists the vein. Spider veins are caused in a similar manner, but are a milder problem. Although most varicose veins are found in the legs and feet, any vein can become varicose. The causes of varicose veins are many. Unfortunately, the biggest risk factors are out of your control: having a family history of the problem, aging, and being female. Hormonal changes also increase the risk, including entering puberty, taking birth control pills, pregnancy, and menopause. Pregnancy also leads to more varicose veins because the increased amount of blood flow causes veins to enlarge. The expanding uterus puts pressure on the veins in the pelvic cavity, which increases pressure on circulation in the lower extremities. Each additional pregnancy can lead to more and worse varicose veins. Obesity, prolonged standing, and leg injuries can all increase risks. Even excessive sun exposure can increase spider veins in those of us with fair complexions. The most common symptoms are legs that feel achy, tired, heavy, or numb; burning, throbbing, muscle cramping or swelling in the lower extremities; darkening of the skin; and an itching or irritated rash in the legs. Aside from being unsightly, what dangers do varicose veins present? While spider veins don’t pose a medical risk, varicose veins usually get bigger and can cause health problems. They can affect the general circulation of the body, causing pooling of blood in the lower extremities and poor blood return back to the heart. This in turn can increase the risk for blood clots, infection, skin sores, and ulcerations. A doctor’s evaluation will begin with a good history and physical. The discussion will include any injury to the legs, symptoms, history of blood clots, and the story of how the problem progressed. In order to make the diagnosis, the doctor will examine the legs and feet. Varicose veins are easy to see, especially when standing. The doctor will also note any tender areas, swelling, skin color changes, ulcers, and other signs of skin breakdown. An ultrasound test may be indicated to see if the valves are functioning normally, or to check for blood clots. The most common treatments for varicose veins are support hose, leg elevation, and weight loss. These non-invasive therapies may be sufficient. However, whether for medical or for cosmetic reasons, many people pursue more invasive options. The methods described below are effective but, as with all surgeries, may also be expensive, painful, and have side effects such as bleeding and infection. • Sclerotherapy can be very effective and is the most common invasive treatment for both spider and larger varicose veins. A solution is injected into a vein, causing its walls to swell, stick together, and seal shut. This stops the flow of blood and turns the vein into scar tissue. In a few weeks, the vein fades. Since the procedure does not involve anesthesia and can be done in the doctor’s office, many people start here. • Laser surgery is a newer technique for smaller spider veins. The vein is exposed to strong bursts of light, causing it to slowly fade and disappear. This treatment takes 15 to 20 minutes, and is done two to five times. • Endovenous techniques have replaced old surgical methods for some patients with severe varicose veins. It is also performed in the doctor’s office. A very small catheter is inserted into the vein, which emits a radiofrequency or laser energy that shrinks and seals the vein. • Finally, surgical ligation and stripping is the old technique of tying off and removing the bad vein. Blood flow shifts to the remaining veins. The surgery is done under anesthesia in an operating room. I encourage you to reduce your risk of developing new varicose and spider veins, and to make any symptoms you may feel milder and more manageable: • Wear sunscreen to protect your skin from spider vein formation. • Keep your weight as close to your healthy target as possible. • Maintain a low salt diet to decrease water retention in the legs. • Eat a high fiber diet to reduce the risk of constipation. Straining increases the risk of varicose veins. Cross your legs at the ankles, but not higher up. • Elevate your legs when resting as much as possible. • Avoid standing or sitting for significant amounts of time. When you stand, shift your weight from one leg to the other every few minutes. When you sit, stand up and move about frequently, or wiggle your feet to keep the muscles contracting. • Wear elastic support stockings if necessary, and avoid tight clothing that constricts around the waist, groin, or legs. • Exercise regularly to improve leg strength, circulation, and vein strength. Walking or running is excellent. • Consult with your doctor if you have questions or concerns regarding your varicose veins. As always, I wish you good health! Dr. Alan Frischer is former chief of staff and current chief of medicine at Downey Regional Medical Center. Write to him in care of this newspaper at 8301 E. Florence Ave., Suite 100, Downey, CA 90240.
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Published: March 27, 2009 – Volume 7 – Issue 49



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