Dear Readers:

J.N.H. is a 52 years old high school teacher who lives and teaches in Kingston. She says she wears thick, heavy stockings regularly to conceal ugly varicose veins over both of her calves. The veins first developed during her last of three pregnancies, twelve years ago and weren't too bad then, but they seem, more recently, to be worsening. Sometimes the veins are tender. J.N.H. has worn support stockings as suggested by a physician some years ago, but she finds these uncomfortable and wears them infrequently. J.N.H. has heard that the varicose veins can be treated surgically and asks Lifeline about treatment options.

Varicose veins are swollen twisted veins often seen on the calf and the inside of the legs. They occur more commonly in women. The swollen, prominent veins occur as a result of failure of the one way valves which they contain which, along with contraction of the muscles surrounding the veins, help to move venous blood in one direction, back up to the heart. When one or more of the valves in the vein fail to work, the blood settles, pools and even flows backwards. The veins receiving this blackflow of blood dilate and stretch which further prevents even more venous valves from working properly. The affected vein becomes swollen, prominent and eventually bulge and twist.

When present, varicose veins are often associated with ankles and feet and a sensation of heaviness in the lower legs. When extensive, the affected veins can become sore and tender to touch. Due to the poor circulation the skin in the affected area may itch and become dark. The varicose veins are worsened with long standing and any swelling present will worsen as the day progresses.

Certain factors can contribute to the development of varicose veins. These include:

Obesity

Pregnancy

Chronic constipation

Regular lifting of heavy weights

Long standing or sitting

Lack of exercise

Hormonal changes

Some women find that their varicose veins act up during their menses (periods) and are tender and swollen at this time.

Varicose veins can cause problems within the area where they occur. Bleeding under the skin with black and blue stains, blood clots in the veins causing thrombo-phlebitis and the breakdown of tissues due to poor blood circulation resulting in ulcers to the area are frequently seen complications. Occasionally a blow to the skin over a varicose vein may result in profuse bleeding.

When the varicose veins are mild or not causing many symptoms wearing support stockings is usually advised. These stockings come in different sizes as well as differing tensile strengths to give varying degrees of support and are available as below the knee socks, above the knee and as panty hose. It is not "one size fit all" and therefore it is possible that JN.H's support stockings are too tight for her. She should ask a physician to measure her calf and thigh and prescribe support stockings based on these measurements and the severity of the varicose veins.

Varicose veins can be more definitively treated by either injection sclerotherapy or surgical stripping of the varicose veins.

With sclerotherapy, a sclerosing chemical is injected into the distended varicose veins which causes the walls of the veins to fuse together so that they no longer carry blood. Collateral circulation develops between other nearby veins to carry the blood. Sclerotherapy is an out-patient procedure and does not require hospital admission.

It is performed over two to three visits. With surgical stripping the vein is clamped and cut both in the thigh and the ankle. A fine wire is attached at the upper end and the vein is then pulled out of the leg (stripped) and the leg bandaged. Both methods work well but the procedure do not prevent the development of other varicose veins later on, so the individual will have to be careful to avoid the situations which caused the original varicose veins.

Write to:

Lifeline

PO Box 1731

Kingston 8