Unfortunately, as we all age, our risk of having problems with peripheral arterial disease (PAD) increases. Typical symptoms of PAD occur with walking. In most cases it begins with pain or cramping in the calf muscles and it usually occurs when walking. The distance that you walk before it happens can vary between people but it is predictable in the individual. If someone has PAD and they get pain after walking 3 blocks, then they can count on it happening as they reach the end of the third block. That distance will increase slightly if they are walking downhill and decrease if they are walking uphill.
The reason is supply and demand in the muscle of the calf. The supply is generally provided by the blood vessel. With PAD these is some degree of obstruction to the supply chain. When you are resting the demand in the muscle is at its baseline. early stages of PAD there is enough flow to meet the demands at rest. When you start to walk and use the muscles the blood vessels in the muscles open up to feed the area oxygen. because of the supply chain obstruction, the supply cannot keep up with the demand. When we are talking about muscle activity and oxygen delivery the end result is anaerobic metabolism. This occurs when the muscle is working beyond its oxygen level and the by product is lactic acid. This acid built up results in pain, burning, cramps. The treatment for this pain is to stop walking for a few minutes and the acid will wash out. Once the pain is gone I recommend you continue walking right into your doctors office to get this checked out!
Friday, July 1, 2011
Friday, May 20, 2011
What can be done about my ugly veins?
When you look in the mirror and see what looks like a bruise on you leg and it turns out to be a clump of purple veins it can be distressing to anybody. These things seem to pop up overnight. Also as we age it seems normal for your legs to feel tired at the end of the day, heck I'm 46 years old and tired legs are normal at my age. The truth is it isn't normal for you legs to be tired and the purple veins are not exactly normal either. The condition is called venous reflux. Because we walk upright and we live on earth with its gravity we are all at risk for venous reflux. It is estimated that 50-55% of women and 40-45% of men will have some evidence of venous reflux.
Venous reflux is technically the condition where blood falls back toward your feet when you are standing or sitting for long periods of time. This is caused by valves that are not working properly in the superficial veins of your legs. This condition increases the pressure in the superficial veins of your legs and that pressure causes them to widen and lengthen. It also allows for water to seep out of the veins into the tissue and cause swelling. Because water is heavy it doesn't take a lot of water to increase the weight of the leg and if it increases by one pound and you take 1000 steps, you will be feeling it later.
When you go to the doctor to get this checked out it isn't usually the most pressing of issues and it is either glossed over or not discussed at all. There are other issues that are more important and if the swelling and pain are bad enough, the smart doctors may recommend compression stockings. For mild venous reflux with minimal symptoms, wearing compression stockings while working or traveling will manage the symptoms well. In more moderate to severe cases the stocking are only the first step. Getting evaluated by a qualified specialist in total vein care is my recommendation for anybody who's symptoms cannot be controlled by compression stockings.
Finally, in regards to the first scenario, if you have a simple purple vein in your leg and pain and swelling at the end of the day. Don't self diagnose yourself. That little purple vein isn't causing your leg to swell. The swelling and your purple friend my be caused by superficial venous reflux and need to be evaluated by somebody who can take care of the underlying cause. Don't spend your hard earned cash on Medi-Spa sclerotherapy for the vein because it won't fix the problem.
http://coastalvascularcenter.com
Venous reflux is technically the condition where blood falls back toward your feet when you are standing or sitting for long periods of time. This is caused by valves that are not working properly in the superficial veins of your legs. This condition increases the pressure in the superficial veins of your legs and that pressure causes them to widen and lengthen. It also allows for water to seep out of the veins into the tissue and cause swelling. Because water is heavy it doesn't take a lot of water to increase the weight of the leg and if it increases by one pound and you take 1000 steps, you will be feeling it later.
When you go to the doctor to get this checked out it isn't usually the most pressing of issues and it is either glossed over or not discussed at all. There are other issues that are more important and if the swelling and pain are bad enough, the smart doctors may recommend compression stockings. For mild venous reflux with minimal symptoms, wearing compression stockings while working or traveling will manage the symptoms well. In more moderate to severe cases the stocking are only the first step. Getting evaluated by a qualified specialist in total vein care is my recommendation for anybody who's symptoms cannot be controlled by compression stockings.
Finally, in regards to the first scenario, if you have a simple purple vein in your leg and pain and swelling at the end of the day. Don't self diagnose yourself. That little purple vein isn't causing your leg to swell. The swelling and your purple friend my be caused by superficial venous reflux and need to be evaluated by somebody who can take care of the underlying cause. Don't spend your hard earned cash on Medi-Spa sclerotherapy for the vein because it won't fix the problem.
http://coastalvascularcenter.com
Sunday, May 8, 2011
Horse Chestnut for treatment of venous insufficiency
There are many herbal remedies that people swear by including ginkgo biloba for memory and ginseng for more energy. I have used both of these but never got any smarter or more energetic. There are not many herbal supplements that I would recommend with one exception. The one exception would be Horse Chestnut for chronic venous insufficiency or varicose veins. I have reviewed some of the literature on this supplement and I am reasonably convinced that this is useful for some people. Other medications and food don't seem to have the evidence to back them up. Kiwi fruit was once reported to me to prevent varicose veins. I found this interesting so I researched it on the Internet. Although Kiwi fruit is very high in vitamin C and eating 3 Kiwi is equivalent to taking an aspirin a day there was no evidence that it could have any impact on varicose veins.
Horse Chestnut is the exception. The Internet is full of valuable information about this herb. There is evidence that it is likely effective for the treatment of chronic venous insufficiency (CLI) which again is the fancy name for varicose veins. The raw nut is toxic and eating it is strongly discouraged. The commercial preparations are reasonably safe as long as you don't have an allergy to it or possibly latex. The active ingredient is believed to increase the tone of the blood vessels as well as decrease the capillary permeability which decreases swelling, thus decreasing the heaviness you feel in your legs. This supplement may also make you blood thinner so if you are on blood thinners such as aspirin or coumadin you should ask you doctor before starting horse chestnut supplementation.
If you do start taking this supplement, take it for no more that 3 months before seeing your doctor. If you do not get any improvement in 3 months it most likely wont work for you and something else may be wrong.
Leg swelling in general can be caused by many different disease processes. Get you legs checked out by a qualified vascular surgeon and find out if you have chronic venous insufficiency before you start any herbal remedies.
If you need a vascular surgeon to evaluate your varicose veins you can find us at http://coastalvascularcenter.com
Sunday, April 24, 2011
Avoiding Having Grandma's legs
Sitting around the table at the family reunion can be alarming when everybody is wearing skirts and showing off their 30 years of venous reflux. When looking at Grandmas and aunt Mary's legs you may be seeing into the future. There are steps you can take now to avoid that future scenario.
The condition that causes the purple lines on the older ladies legs is called venous reflux. In this condition, blood is allowed to fall back down the superficial veins toward the feet due to the effect of gravity and incompetent valves in the veins. Since blood has a similar density as water it can be heavy.
The greater saphenous vein travels along the inside of the leg from the groin to the ankle. There are no valves in the veins from the groin to the heart so when the valves in the leg go bad there is a column of blood from the heart to the ankle in advanced cases. This can cause pressures in the veins almost as high as the arterial blood pressure. The first thing to happen is usually the pressure in these veins causes the smaller elements of blood, namely water, to be pushed out into the tissue causing swelling. This type of swelling progresses throughout the day and usually resolves after waking up in the morning.
Besides swelling, other wonderful things happen to your beautiful legs. Veins under pressure will reliably do two things; lengthen and widen. These two actions will create the purple wiggly worms - similar to Aunt Mary's legs. The veins have fixed branch points and as the veins and they are fixed at the ends the vein will curl like Christmas Candy. The purple and red spider veins are showing the widening under pressure. The human eye cannot detect normal vein in the skin because they are too thin. As a segment of these fine veins become pressurized they increase in width and the small wedge of the venous network become a spider vein.
All this extra pressure on the veins can cause fatigue, heaviness, swelling, itching, leg cramps, excessive bleeding from a burst varicose vein, skin discoloration and ulceration.
Women are more at risk for venous reflux overall. The risk factors for venous reflux are pregnancy, obesity, prolonged standing or sitting, heavy lifting, family history and bad luck.
The best treatment for venous reflux is to prevent it. In some cases if it is a family tradition that all women in the family must have veins by the time they are 60 years old, then the goal is to put it off until you are 70.
Depending on you lifestyle there are some key things you can do now to decrease your future varicose vein burden.
Compression stockings are the first line of defense. Compression stockings are a great thing for women and men who work standing up most of the time. Postal workers, waitresses, nurses, flight attendants, teachers, and anybody else would benefit from compression stockings. When I am treating patients I recommend 20-30mmHg of compression. If you don't have big veins in you legs yet, a stocking with 10-20 mmHg of compression would be adequate. In my practice I recommend my patients wear them to work and take them off when they get home. Most of the patients who follow this plan report their legs feel better when the go out on the town after work.
Compression Stockings do not cure venous reflux. They do provide control of the consequences of venous reflux and slow the progression of varicose veins
Avoiding Hot baths will decrease the incidence of varicose veins. The heat in the bath leads to vasodilation. The vasodilation will increase the pressure through the vein and can lead to valvular dysfunction.
Dont cross you legs, cross you ankles. The saphenous vein runs on the inside of your thigh and you compress it when you cross your legs. Plus you mother said it was't ladylike!
Other preventive factors include exercise regularly and elevate you legs after exercising for 5 to 10 minutes, Avoid tight fitting clothing, and maintain a healthy weight.
Horse chestnut extract is a herbal supplement found in various vein preparations. Essentially the herb allows the stretched out veins to regain some recoil so they can reduce in size. Some question if this works but the Food and Drug Administration gave this herb the highest recommendation it gives out. This preparation showed some evidence of benefit and need to be further evaluated. I prescribe this for my patients
I treat this condition every day .. These are the nuts and bolts about preventing venous reflux and avoiding the complications
The condition that causes the purple lines on the older ladies legs is called venous reflux. In this condition, blood is allowed to fall back down the superficial veins toward the feet due to the effect of gravity and incompetent valves in the veins. Since blood has a similar density as water it can be heavy.
The greater saphenous vein travels along the inside of the leg from the groin to the ankle. There are no valves in the veins from the groin to the heart so when the valves in the leg go bad there is a column of blood from the heart to the ankle in advanced cases. This can cause pressures in the veins almost as high as the arterial blood pressure. The first thing to happen is usually the pressure in these veins causes the smaller elements of blood, namely water, to be pushed out into the tissue causing swelling. This type of swelling progresses throughout the day and usually resolves after waking up in the morning.
Besides swelling, other wonderful things happen to your beautiful legs. Veins under pressure will reliably do two things; lengthen and widen. These two actions will create the purple wiggly worms - similar to Aunt Mary's legs. The veins have fixed branch points and as the veins and they are fixed at the ends the vein will curl like Christmas Candy. The purple and red spider veins are showing the widening under pressure. The human eye cannot detect normal vein in the skin because they are too thin. As a segment of these fine veins become pressurized they increase in width and the small wedge of the venous network become a spider vein.
All this extra pressure on the veins can cause fatigue, heaviness, swelling, itching, leg cramps, excessive bleeding from a burst varicose vein, skin discoloration and ulceration.
Women are more at risk for venous reflux overall. The risk factors for venous reflux are pregnancy, obesity, prolonged standing or sitting, heavy lifting, family history and bad luck.
The best treatment for venous reflux is to prevent it. In some cases if it is a family tradition that all women in the family must have veins by the time they are 60 years old, then the goal is to put it off until you are 70.
Depending on you lifestyle there are some key things you can do now to decrease your future varicose vein burden.
Compression stockings are the first line of defense. Compression stockings are a great thing for women and men who work standing up most of the time. Postal workers, waitresses, nurses, flight attendants, teachers, and anybody else would benefit from compression stockings. When I am treating patients I recommend 20-30mmHg of compression. If you don't have big veins in you legs yet, a stocking with 10-20 mmHg of compression would be adequate. In my practice I recommend my patients wear them to work and take them off when they get home. Most of the patients who follow this plan report their legs feel better when the go out on the town after work.
Compression Stockings do not cure venous reflux. They do provide control of the consequences of venous reflux and slow the progression of varicose veins
Avoiding Hot baths will decrease the incidence of varicose veins. The heat in the bath leads to vasodilation. The vasodilation will increase the pressure through the vein and can lead to valvular dysfunction.
Dont cross you legs, cross you ankles. The saphenous vein runs on the inside of your thigh and you compress it when you cross your legs. Plus you mother said it was't ladylike!
Other preventive factors include exercise regularly and elevate you legs after exercising for 5 to 10 minutes, Avoid tight fitting clothing, and maintain a healthy weight.
Horse chestnut extract is a herbal supplement found in various vein preparations. Essentially the herb allows the stretched out veins to regain some recoil so they can reduce in size. Some question if this works but the Food and Drug Administration gave this herb the highest recommendation it gives out. This preparation showed some evidence of benefit and need to be further evaluated. I prescribe this for my patients
I treat this condition every day .. These are the nuts and bolts about preventing venous reflux and avoiding the complications
Saturday, April 23, 2011
Coastal Vascular Tips for Healthy Legs
Hello to anybody who finds this interesting. I am a vascular surgeon and there seems to be quite a bit of confusion about the blood vessels. I am going to start this blog with some background and hopefully in the weeks to come I can impart a bit knowledge to all of you.
In my practice I treat all sorts of vascular problems. The one that fuels the most questions would have to be venous reflux disease. Many have not heard of that term but it is the same thing as varicose veins. On a weekly basis I will discuss vein problems and let you know what can be done about each problem. I can give you information but this blog is in no way supposed to replace you family physician.
Check back soon for my first official information exchange
In my practice I treat all sorts of vascular problems. The one that fuels the most questions would have to be venous reflux disease. Many have not heard of that term but it is the same thing as varicose veins. On a weekly basis I will discuss vein problems and let you know what can be done about each problem. I can give you information but this blog is in no way supposed to replace you family physician.
Check back soon for my first official information exchange
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