You could be at risk of varicose veins-

early detection can save your life!

“Just because you can not see them, doesn't mean you don't have them.”

                                                                                         -Felipe Reitz

Facts of varicose veins

- there are two systems of veins in the legs: the important deep veins and the superficial veins under the skin. It is the superficial veins that become varicose

- approximately 20% of population have some pathological changes of the veins. They are most common in people aged 30 to 70.

- more than 25% of all men will develop varicose veins as they age

- women are more likely to suffer from varicose veins and up to 50 % may be affected

- almost all women get varicose veins during pregnancy

- varicose veins are a risk factors for deep vein thrombosis and may result from it

- hemorrhoids are actually varicose veins of the anus or rectum.Symptoms include rectal itching, pain and blood in the stool

General description

Varicose veins are abnormally enlarged, bluish and lumpy-looking veins, most commonly occur in the legs and develop because of a loss of elasticity in the walls of the veins. This is the result of malfunctioning valves inside the veins. Blood pulses through arteries, powered by the beating of the heart to provide nutrients and oxygen to the tissues. Veins return blood from the rest of the body to heart, so the blood can be recirculated. To return blood to the heart, the veins in legs must work against gravity. Muscle contractions in the lower legs act as pumps, while toned, elastic vein walls help blood return to the heart. Tiny one-way valves in the veins open as blood flows toward your heart then close to stop blood from flowing backward.
Like arteries, the veins are tube-shaped vessels in graduated size, but unlike the arteries, the veins have tiny valves on their inner walls to prevent the blood stream from flowing backward, toward the arteries. If valves do not work properly (congenitally incomplete valves), circulation is impaired. Poor circulation contributes to blood accumulation in the veins results stretching them, dilatation and tortuosity can occur.

Risk factors of varicose veins:

- aging causes wear and tear on the valves in your veins that causes the valves malfunction.
- sitting or standing in one position for prolonged periods of time
- habitually sitting with legs crossed
- lack of regular exercise
- excess weight, constipation, heart failure, liver disease, abdominal tumours
- heavy lifting
- pregnancy- increased blood volume and the weight of the growing foetus put pressure on leg,  veins and a surge in the hormone progesterone makes vessel walls more elastic
- genetics - family history of varicose veins
- deficiency of vitamin C, bioflavonoids and fiber
- obesity - being overweight puts added pressure on your veins.
- gender - hormonal changes during pregnancy, premenstruation or menopause may be a   factor. Female hormones tend to relax vein walls. Taking hormone replacement therapy or birth control pills may increase the risk of varicose veins
- geography – studies show that varicose veins are less common outside the countries of the
Western World

Symptoms of varicose veins

Varicose veins are dark purple or blue in color and may appear twisted and bulging — like cords. They commonly appear on the backs of the calves or on the inside of the legs. But, they can form anywhere on your legs, from your groin to your ankle.
Swelling, restlessness, leg sores, itching, muscle cramps and feeling of heaviness in the legs are characteristic of varicose veins. Symptoms may worse just before period or while taking birth-controls pills or hormone-replacement therapy, since hormonal changes cause blood-vessel walls to relax.
Varicose veins may be first noticed as oedema - an accumulation of fluid in the legs may occurs where there is incomplete circulation of the blood.
Types of varicose veins include:
Venous lakes: These are pools of blood in the veins, often found on the face and neck Reticular veins: These flat, blue veins under the skin often appear behind the knee. Telangiectases: These are fine clusters of blood vessels similar to spider veins, reddish in color and often found on the face or upper body.
Complications

Most cases of varicose veins do not cause a serious problem, but in cases, if varicose veins are not treated properly more serious complications may occur, including:

Phlebitis- the venous wall becomes inflamed and progressively deteriorates Occasionally, veins deep within the legs become enlarged. In such cases, the affected leg may swell considerably. Any sudden leg swelling that may or may not be accompanied by pain and redness warrants urgent medical attention, as it may indicate:

A blood clot — a condition known medically as thrombophlebitis.

Eczema of the leg - which may, in turn, lead to ulcers. First sign of trouble is often mild eczema and itchiness of the skin – usually just above the ankle. This can be just a small patch, or a larger area and can become very severe, with inflamed, red, scaly skin all around the lower leg.

Varicose ulceration- painful ulcers may form on the skin near varicose veins, particularly near the ankles. Ulcers are the result of long-term "water logging" of these tissues, caused by increased pressure of blood within affected veins. Brownish pigmentation usually precedes the development of an ulcer. Ulcers require urgent medical attention.

Bleeding varicose veins  - hemorrhage from a ruptured vein or

Pulmonary embolism- occur in pulmonary arteries, most frequently caused by detached fragments of  venous thrombus (blood clot) form a leg or pelvic vein that travels into pulmonary artery to the lung and lodges there. This cause severe breathing difficulties and can even cause death.

Deep vein thrombosis or venous thrombosis occurs when a blood clot forms in a deep veins of the legs. If the blood clot is small, it can be dissolved by the body. On the other hand , it can grow and block the blood flow through vein, which is a potentially fatal condition

Diagnostic methods

- simple visual examination in disease of the veins of the lower extremities
- special functional tests
- venography: radiographic (X-ray) demonstration of a vein after the injection of contrast medium into the foot vein
- ultrasound or Doppler ultrasound in the case of venous thrombosis – the probe can detect the direction of blood flow which is audible. It indicates where the veins have come from and 
helps in the planning of any operation
- medical infrared thermography as an unique method of examination

Medical Infrared thermography as a diagnostic tool

This method (also called computerized thermographic image CTI) is absolutely safe for patient and has excellent diagnostic informativeness. There are no limitations to use infrared thermography as a method of primary diagnostic (screening procedure) and as a method to follow-up control after treatment.
At the early stage of varicose disease, where there are no visual clinical signs of venous insufficiency, on thermograph image slight hyperthermia above the affected veins is detected.
The reason of increasing temperature above the superficial vein is the retrograde blood flow from the deep vein, where temperature is higher.
It is important to emphasize that the first thermographic symptoms of the venous disorder appears a long time before the first visual detection of the veins enlarging. That is the reason why infrared thermography may be applied as a method of early, pre-clinical diagnostic of varicose vein disease.

Treatment methods for varicose veins

Many people who develop varicose veins find that they require no medical treatment at all. However, if large amounts of fluid accumulate in the legs giving rise to pain and discomfort, you should contact your health adviser/ practitioner/physician with a view to receiving treatment. For mild cases of varicose veins, your doctor will probably advise you to rest frequently with your legs raised and he may also advise you to wear lightweight elastic compression stockings for a specified period of time. These will help to ease the discomfort but will not make the varicose veins disappear.
Self-help measures — such as exercising, losing weight, not wearing tight clothes, elevating your legs and avoiding long periods of standing or sitting — can ease pain and prevent varicose veins from getting worse. Varicose veins that develop during pregnancy generally improve without medical treatment within three months after delivery.
Some people may require surgical intervention. Fortunately, treatment usually doesn't mean a hospital stay or a long, uncomfortable recovery. Less invasive techniques generally allow varicose veins to be dealt with on an outpatient basis.

Non-surgical:

Sclerotherapy- this method involve the injection of a sclerosing solution (saline or detergent –like solution) into each vessel that irritate the vessel’s surface membrane. The process closes the veins, forcing blood to reroute to healthier veins. In a few weeks, treated varicose veins should fade. It is effective in treating small veins. Sclerotherapy doesn't require anaesthesia and can be done in your doctor's office (practised in Ireland)
Laser therapy - using a laser procedure is more commonly to close off smaller varicose veins and spider veins, especially on the upper body and the face. Laser surgery works by sending strong bursts of light onto the vein, which makes the vein slowly fade and disappear. No incisions or needles are used.

Massage therapy – can aid in stimulating the legs by massage the area around veins (not massage veins directly).

Microwave treatment - innovative approaches to treating varicose veins include using microwaves, delivered by a fine tube inserted into the veins. This causes the affected veins to collapse and shrink. It is available at some hospitals for smaller veins but is not routine treatment.

Surgical: 

Removal of varicose veins may be recommended if the veins are causing a considerable amount of discomfort. It requires only local anaesthetic in an outpatient procedure.

Catheter-assisted procedures – doctor inserts a thin tube (catheter) into an enlarged vein and heats the tip of the catheter. As the catheter is pulled out, the heat destroys the vein by causing it to collapse and seal shut. This procedure is usually done for larger varicose veins. Other catheter-assisted methods use a blade to destroy varicose veins or radio waves to close them. Vein ligation and stripping - 'tying-off' (ligation) of the damaged portion of vein and the stripping or removal of that section This procedure is usually performed under general anaesthesia and requires admission to hospital. (practised in Ireland).

Ambulatory phlebectomy-  removing smaller varicose veins through a series of tiny skin punctures. Local anaesthesia is used in this outpatient procedure. Scarring is generally minimal.

Endoscopic vein surgery -  surgeon uses a thin video camera inserted in your leg to visualize and close veins. Only small incisions are needed. This operation is performed only in an advanced case involving leg ulcers.

Valve repair – a synthetic material is used to restore valve.

Removing varicose veins is generally a safe surgical procedure. However, in order to give informed consent, anyone deciding whether or not to have this procedure needs to be aware of the possible side-effects and the risk of complications. Side-effects are the unwanted but usually mild and temporary effects of a successful procedure. For this operation, they are likely to include:

•  soreness, which can be controlled with painkillers,
•  bruising, which should ease within a couple of weeks, 
•  a small amount of bleeding from the wounds,
•  small scars from the incisions.

Complications are unexpected problems that can occur during or after the operation. Most people are not affected, but the main possible complications of any surgery are excessive bleeding, infection or an unexpected reaction to the anaesthetic. Complications may require further treatment such as returning to theatre to stop bleeding, or antibiotics to deal with an infection.

Nutritional supplements for varicose veins

- Coenzyme Q10 – improves tissue oxygenation, increase circulation and enhances immunity
- Coenzyme A – works with coenzyme Q10 to support the immune system’s detoxification of many dangerous substances
- Dimethylglycine – improves oxygen utilisation on the tissue
- Essential fatty acids - reduces pain and helps to keep blood vessels soft and pliable
- Glutathion - protect the heart, veins and arteries from oxidant damage
- Pycnogenol - stimulate blood circulation, boost immunity, neutral
- Grape seed extract - free radicals, strengthen connective tissue
- Vitamin C- aids circulation by reducing blood clotting tendencies
- Bioflavonoid complex - to promote healing and prevent bruising
- Rutin - a potent noncitrus bioflavonoid that helps maintain the strength of blood vessels
- Vitamin E - improves circulation and aids in preventing heavy feeling in the legs (d-alpha tocopherol form recommended)

Herbs for varicose veins

- Aloe vera gel is a cooling and soothing topical treatment for varicose veins
- Bilberry supports the health of connective tissue, including that of the veins
- Bromelain can reduce risk of clot formation in the blood vessels
- Butchers broom, ginko biloba, gotu kola and hawthorn berries improve circulation in the legs
- Cayenne helps to relieve pain and inflammation and also expands blood vessels, reducing stress on the capillarities. It is available in  capsules and cream forms.
- Dandelion alleviates tissue swelling by reducing water retention
- Horse chestnut makes a good treatment for the discomfort of varicose veins
- Herbs used in traditional Chinese medicine: magnolia flower (Magnolia liliflora), scutellaria (Scutellaria baicalensis also known as Baikal skullcap), trichosanth (Trichosanthes kirilowii) and wild angelica (Angelica dahurica)
- Bathing legs (or other affected area) in white oak bark herb tea three times a day helps to stimulate blood flow. Simmer (but not boil) a strong tea and use this tea to make compresses. Apply to affected areas.

Recommendations

- Eat a diet low in fat and refined carbohydrates and includes fish, fresh fruits and vegetable.

- Eat as many blackberries and cherries as you can. These may help prevent varicose veins, or ease the symptoms if you already have them.

- Include garlic, ginger, onions and pineapple in diet.

- Make sure, that your diet contains plenty of fiber to prevent constipation.

- Avoid animal protein, processed and refined food, sugar, ice cream, fried foods, cheese, peanuts, junk foods, tobacco, alcohol and salt.

- Maintain a healthy weight and get regular exercise: walking, swimming, cycling to promote good circulation.

- Wear loose clothing that does not restrict blood flow. It is good idea to wear supportive elastic stocking – these help to support the varicose veins and prevent swelling.

- Elevate your legs above heart level for twenty minutes at least once a day to alleviate symptoms.

- Avoid long periods of standing or sitting. Take rest periods several times during the day to elevate legs.

- Avoid crossing your legs, doing heavy lifting and putting any unnecessary pressure on your legs.

- If you sit at a desk all day at work, make sure to get up and walk around periodically. Try to rest feet on an object that is elevated from the floor when seated.

- If you stand for long period, shift your weight between feet, stand on your toes or take short walk.

- Elevate your feet while sitting down.

- After bathing apply castor oil directly over the problem veins and massage the oil into legs from the feet up

.
- To help improve circulation and ease pain, stand into cold water and simulate walking.

References
1. P. A. Balch, J.F Balch: Prescription for Nutritional Healing (Third Edition), Penguin Putnam Inc, 2000
2. P. Kumar, M. Clark: Clinical Medicine (Fifth Edition), W.B.SAUNDERS, 2002
3. STEDMAN’S Medical Dictionary (28th Edition), Lippincott Williams &  Wilkins, 2006
4. A. Ovechkin: Medical Infrared Thermography, 2005
5. Wimaier, Raff, Strang: Vander’s human physiology, The mechanism of body function
   (10th Edition), McGraw-Hill, 2006
6. Forbes, Jackson: Color Atlas and Text of Clinical Medicine, Mosby – Wolfe, 1998
7. W.D.McArdle, F.I.Katch, V.L.Katch: Exercise Physiology, (fifth edition), Lippincott 
    Williams &  Wilkins 2001
8. Anatomy & Pathology, (4th Edition), Lippincott Williams &  Wilkins, 2005