VARICOSE VEINS

• Do you legs start aching in the afternoon?
• Do you always wear long pants, even at the beach?
• Do you share at your legs and wonder “Where is Route 66?”

Welcome to the world of varicose veins, that twisting topography of swollen, congested blood vessels that twist and hump like interstate highways on a road map. Caused by structural weaknesses inside, varicose veins are proof that gravity only goes one way down.

An Uphill Battle
Basically a varicose vein is a blood vessel that doesn’t quite have the oomph to push its cargo––blood––back into circulation. Here’s what happens. When blood exits your heart through the arteries, it shots right along, assisted both by gravity and by heart’s pumping action. The return trip through the veins, however, is more arduous. Not only do you veins exert less pressure, but also much of the journey, particularly from the feet and legs, is uphill.

To help the blood move upward, your veins are lined with tiny one-way valves. The valves open to let blood through, then snap shut as it passes. This system allows the blood to move in stages, its weight supported by valves. Sometimes, however, the valves fail. (Or in some cases, they’re congenitally absent). When this happens, the rising column of blood comes crashing down. “Instead of carrying blood away from the skin and muscles and to the heart, the vein now is carrying blood in a reverse flow,” explains Mitchel P. Goldman, M.D., an assistant clinical professor of dermatology at the University of California, San Diego, and the author of a textbook on treatment of varicose veins. Since the blood has trouble going upward, it tends to pool at the bottom of the vein. When this happens, the vein becomes varicose––distended, in other words.

Varicose veins are extremely common, affecting one in five adults, Dr. Goldman says. Women are five times more vulnerable than men, and the veins often crop up during and after pregnancy. Varicose veins rarely are a serious problem, although the impaired circulation, if left untreated, can cause ulcers to develop on the lower legs. But they can make the legs achy and tired. They also can make them look bad. Even with surgery, there isn’t a cure for varicose veins, Dr. Goldman says. But with a few simple tricks, you can relieve some of the ache––and, in some cases, help prevent them from forming.

Keep The Blood Moving

Your heart is a real powerhouse, pumping approximately 1 ½ gallons of blood every minute. But varicose veins don’t get enough of that action. For your blood to keep moving, it needs some extra help. For example:

Walk your dogs. Unlike arteries, veins depend on your muscles to move blood along. Every time you stand up, take a walk or flex your toes, the muscles in your legs squeeze the veins, actually squirting the blood upward. The more you move your legs, the more pressure you exert on your veins––and the less blood you have just sitting there. Every now and then, shift your weight from foot to foot. Wiggle your toes. Move your feet, heel to toe, to get a really good stretch.

Flatten those heels. “When you wear high heels, you do not activate your calf muscles properly, which allows blood to collect in the veins,” Dr. Goldman says. Flat heels can give your muscles (and your veins) the help they need. Of course, flats are bit more comfortable, too.

Prop them up. Since your blood, like Isaac Newton’s apple, has a powerful tendency to go downhill, it naturally gravitates to your legs––and your varicose veins. You can reverse the flow simply by raising your legs above the level of your heart. During the day, put your feet up now and then to let the blood drain out.

Keep your weight down. This can help in two ways. First, when you’re overweight, you have more blood, and this puts additional strain on your veins. Second, learner people have more muscle, and muscle, remember, helps move the blood along. In other words, too much cushion means not enough pushin’.

Fill up on fiber. “If you’re straining to have a bowel movement, you’re going to put a lot pressure on the pelvic veins, which impedes the blood flow back to your heart,” Dr. Goldman says. Try to eat several helpings of fruits, vegetables and whole grains a day. This will help the stools pass more easily and will take some of the pressure off your veins.

Stay out of hot water. In fact, you should avoid all high temperatures, whether from saunas, hot tubs or sunbaked beaches. Heat dilates your veins, which in turn lowers the pressure that pushes the blood uphill, DR. Goldman says.

Loosen up. Those tight-fitting pants, girdles and panty hose that flatter your figure can flatten the veins between your heart and your legs, Dr. Goldman says. Do your bloodstream a favor and stick to looser, more comfortable clothes.

Wrap them up. While tight clothes can make your varicose veins worse, graduated compression stockings, whish apply prescribed amounts of pressure, can help prevent them. For stockings to work, however, they should be fitted to your legs by a doctor, Dr. Goldman says.

In fact, most people with varicose veins don’t need medical treatment, he adds. But when your legs are hurting, or you’re so self-conscious that you refuse to wear shorts in July, then it might be time to consider more serious measures.

Going for The Cure

If the idea of surgery scares you stiff, think how Galen’s patients must have felt. Galen a Greek physician who practiced medicine some 1,800 years ago, suggested that varicose veins be removed––with hooks! Today’s techniques are more sophisticated, thak goodness, and surgery––with a scalpel or, in many cases, with injections––often is the best for varicose veins, Dr. Goldman says.

When you have surgery, the problem veins simply are removed. “The legs have thousands and thousands of veins, and most of them are connected to each other,” Dr. Goldman explains. “By eliminating the useless veins, you’re going to improve the circulation to the others.” Once removed, varicose veins don’t come back. However, other veins may eventually become varicose, he adds.

With surgery, of course, there always are risks––from bleeding, infection and other complications. There’s also the risk of scarring, which in some cases can be as unsightly as the veins are. To avoid these risks, many doctors now are removing varicose veins with a procedure called sclerotherapy, or injection injects an irritating solution into the vein, which then collapses and eventually disappears.

With smaller veins, one injection may be enough; larger veins may require two, three or even four injections, Dr. Goldman says. After each treatment, the legs are wrapped with graduated compression stockings to prevent the collapsed veins from opening up again. Should a vein reopen, another injection will close it again.

Most varicose veins are “100 percent” curable, Dr Goldman says. “Particularly for smaller veins, I can’t see the treatments getting much better than they are now.”