QUESTION: I am a 36-year-old female with no previous medical illnesses or serious chronic conditions. I am active and despite working a high-paced corporate job I manage to train about three times a week.
Recently, I’ve become self-conscious about my physical appearance. My legs have conspicuous veins that attract unfavourable attention. There seems to be an abundance of wrinkly, swollen blood vessels on my legs, especially behind the knees and calf areas.
Occasionally these vessels stand out and are sometimes so painful I can’t touch them. After really strenuous days, they throb intermittently when I lie down. I have tried various skin preparations and topical oils but to no avail.
Along with the pain, it looks bad and makes me feel undesirable. What can I do to get this fixed and is it risky? Is this kind of procedure covered by medical aid and how long does it take?
ANSWER: Varicose veins have been a topical issue for many decades and new therapies are constantly being tried to minimise surgical intervention. The problem affects one out of two people over the age of 50 and is more common in women than men. Haemorrhoids are a type of varicose vein, while spider veins are like varicose veins, but smaller.
Most patients ask me if there is a significant risk of developing complications if left untreated – the answer is yes. If there are recurrent episodes of thrombophlebitis (inflammation of the superficial venous system) the risk of developing deep venous thromboses increases. The inflammatory response adds to a process that makes blood sticky and possibly thicker – thus facilitating clot formation.
What are varicose veins ?
They are enlarged veins that are swollen and raised above the surface of the skin. They vary in colour from dark purple to blue, and often appear to be twisted and bulging.
How do they present?
As painful, swollen areas mostly on the lower leg, with brown discoloration at the level of the ankle (in severe cases) and skin ulcers in severe cases.
Where are they commonly found ?
At the backs of the calves or on the inside of the leg.
How and why do they occur ?
Defective valves in the veins that facilitate blood flow toward the heart lead to blood pooling and cause them to enlarge.
Tips to prevent complications
* Exercising.
* Losing weight.
* Elevating your legs when resting.
* Not crossing them when sitting.
* Wearing loose clothing.
* Avoiding long periods of standing.
* Acting on painful varicose veins.
* Wearing support stockings or socks.
Main causes
Three main causes are defective venous valves, pregnancy and thrombophlebitis. Most common complications are blood clots and venous ulcers.
Best treatment for thrombophlebitis?
Anti-inflammatories, heparin topical gel and a broad spectrum antibiotic.
How is diagnosis made ?
Clinical evaluation is of paramount importance while you are standing or sitting with your legs dangling. A duplex ultrasound exam assists in investigating blood flow in the veins and to rule out other problems such as a blood clot.
Treatment
Vein stripping is surgery to remove varicose veins usually only done in patients who are in a lot of pain or who have skin sores. Less invasive treatments are laser ablation, radiofrequency ablation and sclerotherapy are used with variable results.
Endovenous Thermal Ablation (endovenous laser treatment or radiofrequency ablation), and foam sclerotherapy are not as well studied.
When is surgery indicated?
* Leg pain.
* Skin sores due to poor blood flow.
* Appearance gets worse.
* Thickening and hardening of the skin in the legs and ankles.
Alternative natural remedies
The compound aescin, derived from horse chestnut, has been shown to be as effective as support stockings to strengthen the vein walls reducing the risk of further damage.
You might try a supplement called V-nal to aid blood flow.
Stiletto cost
Avoid wearing high-heeled shoes every day, they are not fashionable for your veins.
If you wear a heel that is more than 3.81cm high every day, your calf muscle will not effectively pump blood out of the leg.
Try this at home: walk in lower heels and then high heels, and feel how the calf contracts. The foot simply moves forward in high heels and you won’t feel your calf contracting as you walk.
High-heeled shoes make you use the muscles in your buttocks, rather than calf muscles, to walk.
Walking in high heels does not promote blood flow in the legs, while low-heeled or athletic shoes help strengthen calf muscles and improve circulation. – www.ehealthmd.com
* Dr Darren Green, a trusted figure in the field of media medicine, is a University of Stellenbosch graduate who adds innovative spark to health and wellness issues.
He features on 567CapeTalk, and is a regular guest on SABC3 and the Expresso show. Dr Green works as an emergency medical practitioner at a leading Cape Town hospital and completed four years of training as a registrar in the specialisation of neurology.
If you’ve got medical problems, contact the doctor at [email protected], 021 930 0655 or Twitter @drdarrengreen. Catch him in Cape Town on 567 CapeTalk, most Fridays at 1.30pm.
The advice in this column does not replace a consultation and clinical evaluation with a doctor.
Cape Argus