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You’re So Vein: When to See the Doc

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We weren’t all born with long, lean gams. And try as we might, our legs (like our faces) will also show the signs of aging. But, spotting the difference between cosmetic changes and the tell tale signs of vein disease just might be more important that you thought.

According to Dr. Perry R. Bubis, renowned vascular surgeon and author of Wish I Knew That: All You Need to Know About Veins Before You See Your Doctor, “ … more than 80 percent of women will develop vein disease at some time in their lives.” There is no clear medical cause for vein disease, but heredity, gender (yep, of course women are four times more likely than men to develop spider or varicose veins), pregnancy, and lifestyle seem to be contributing factors.

Itsy Bitsy Spider (Veins)
Many women past a certain age have tiny little visible veins on their legs. And while unsightly, these “spider veins” are simply broken blood vessels. Purple in color, they are usually twisted and clustered and show because they are near the surface of the skin.

Standing for long periods can cause your blood to pool in your leg veins, causing them to enlarge. And of course, we can blame age once again because as we get older, our skin gets thinner so these lovely little tendrils become more apparent. And, smoking, excess weight, and pregnancies can add to their severity.

The real cause of spider veins is not known, but they are more prominent in obese individuals, females, individuals who are on their feet for prolonged periods, minor trauma, pregnancy, and perhaps use of contraceptives. There may be a familial component to these veins (thanks, mom). In general, any condition that will increase pressure in the veins, can lead to spider veins.

There are two common treatments for spider veins. Sclerotherapy involves injecting a liquid agent through a tiny needle directly into the spider veins, causing them to contract and collapse. This procedure is best suited for medium to large spider veins because it relies upon fitting a tiny needle into a tiny vein. The procedure is performed in the office by a doctor or nurse and is relatively painless. Depending on the number of spider veins, the procedure may require five minutes to one hour. Afterward, you will wear ace bandages or compression hose for three to ten days as recommended by your doctor.

Spider veins can also be treated with lasers, during which a laser is applied to the skin over your spider veins. Laser energy causes your spider veins to coagulate and shrink. Laser therapy is most effective for small and medium size spider veins. Large spider veins respond poorly and are best treated with sclerotherapy. You are likely to experience mild discomfort similar to having a small rubber band snapping against skin. Treatments usually do not require sedatives, pain medications, or injections of local anesthetic.

Varicose Veins—Very Close Veins Is More Like It
Those ugly, bulging, blue, or purplish veins—well, those are varicose. And surprise, surprise, aging is a factor again. The valves in our veins weaken over time, which may cause veins to collect blood and dilate and pop up to show their ugly little faces.

For the most part, varicose veins don’t cause discomfort. But an unlucky few experience achiness or heavy feeling in their legs and even burning, throbbing, muscle cramping and swelling in the lower legs. Some patients report a sensation of itching around the veins in the legs.

“Primary vein problems (varicosities in the superficial veins) are the most common and often follow a family genetic tendency. Secondary vein disease (those in the deep veins) can result from many types of injuries to the legs, and, once corrected, it never reoccurs unless the leg is re-injured,” says Dr. Bubis

If you’re starting to notice varicose veins, by no means do you need to rush out to have them treated; if they are painful, talk to a vascular surgeon about your options, which includes ligation (tying the veins off with a suture) together with vein stripping, in which blood vessels are removed through small incisions. Dr. Bubis points out that some patients can have extensive spider and small vein disease as a result of vein stripping and as an alternative, it may be possible to use sclerotherapy together with compression and elevation.

When to Worry
There can be some serious issues related to the varicose vein disease. For instance, if you have varicose veins along with skin ulcers near your ankle, this could be a symptom of a severe form of vascular disease and require immediate attention. And, varicose veins can be associated with deep vein thrombosis, in which a blood clot develops that can break off and travel to the lungs. Phlebitis—an acute inflammation of veins—if untreated, can lead to clot formation, which in turn can result in a potentially fatal pulmonary embolism. So, if you’ve got ’em, keep varicose veins on your list of things to show your doctor at your next regular visit.

And, now, why we love Dr. Bubis: he’s put together a list of eight tips to help prevent these unsightly guys:

1. Keep excessive body fat down since it can increase the venous pressure in your legs—a good idea for reasons other than just veins, too.

2. Never stand motionless; always keep your leg muscles moving—flex away.

3. Don’t cross your knees for more than ten minutes at a time—hear that mom, I don’t have to be “ladylike” all the time.

4. Elevate your legs whenever possible. When on an airplane, get up every hour and walk around.

5. Sleep on your left side when pregnant, particularly after the fifth month.

6. Do not use anti-inflammatory drugs during sclerotherapy sessions.

7. Take Vitamin C to minimize bruising and promote rapid healing.

8. Prevent all types of injuries to your legs and skin—easier said than done for those of us clumsy-types.

“Prior to choosing your doctor, do your homework,” Dr. Bubis tells us. “It’s important to prepare a list of questions about the doctor’s background, experience, and expertise. And as with any medical diagnosis, consider getting a second opinion.”

Dr. Bubis’s book also has several chapters on selecting physicians, choosing the right treatment and even navigating the wonderful world of insurance. Be sure to consult your regular physician if you notice any changes in your legs, or before you undergo any procedures.

By Sharon Hall

The information in this article is not intended to treat, diagnose, or in any way be in lieu of medical treatment. It is meant for informational purposes only. You should always consult your doctor with any medical concerns.


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