On July 17, 2021, Seniors Today hosted yet another interesting Health Live with Dr. Paresh Pai on Varicose Veins and Vascular Care in Senior Citizens.
Dr Paresh Pai is a Senior Consultant Vascular and Endovascular Surgeon at the Breach Candy, PD Hinduja, Lilavati and Raheja Hospitals in Mumbai. He is equipped with more than two decades of experience in the management of cerebrovascular disease, distal small vessel reconstruction in atherosclerotic and diabetic limbs, venous thromboembolic disease and endoluminal treatment of aortic aneurysms.
Dr Pai is a former Treasurer and Secretary of the Vascular Society of India. He is a past Consultant Vascular Surgeonat the Westmead Hospital in Sydney, Australia.
Your legs have calf pumps and ankle pumps. They also have valves. It is with the help of these valves and pumps that the blood from your lower limbs is pumped back to the heart (venous return). The valves avoid downward movement of the blood back to the lower extremities due to the effect of gravity. It is when the valves stop functioning well that you develop varicose veins. It’s like two-way traffic in a one-way street. As a result of which the pressure in the veins builds up. Since the veins are thin walled, they start ballooning out and these ballooned out veins are called varicose veins.
Varicose vein is the price we are paying from changing from a 4-legged gait to a 2-legged gait. This has caused an increase in the hydrostatic pressure in the legs due to standing. The more you stand, the more is the pressure. Therefore people who have occupations that require them to stand for longer durations of time, have higher pressure in their venous systems and thus are at a higher risk of developing varicose veins.
Risk factors for developing varicose veins include:
Hereditary – If you are genetically predisposed your chance of getting varicose veins is higher.
Obesity – The fat does not give support to the veins. And the veins tend to start getting bigger/ distended because of the lack of support.
Standing for long periods of time.
Age. If a patient develops varicose veins by the age of 50-60, we say that it is age related. They can either decrease with time if the individual reduces the amount of time they spend standing or they may continue to persist and increase if they continue to stand and work.
Pregnancy is another cause for varicose veins. This is because the weight of the baby and the hormonal changes during the pregnancy tend to relax the tissues including the veins and the valves hence leading to development of varicose veins.
Blood clots – It is a very important but not as common cause as the others. When you develop varicose veins as a result of blood clots, the blood clots tend to destroy the valves and when the clot dissolves they eat away the valves and they lead to secondary varicose veins; it is seen post blood clots and is called post thrombotic syndrome.
Professions that are prone to development of varicose veins- policemen, flight attendants, nurses, school teachers, shopkeepers
Pain in the calf which feels like heaviness. It comes towards the end of the day. Some people may also have nocturnal cramps either in the calf muscles or in the thigh. This is seen in 97% of the patients who have chronic venous insufficiency.
Swelling- this is seen in 90% of the cases that develop varicose veins.
Dark pigmentation of the legs- seen in 11% of the patients with chronic venous insufficiency. It starts with red in colour and gradually darkens and if it continues it can cause scarring of the soft tissue and the leg starts to look like a champagne bottle and is called an “inverted champagne bottle”.
Venous or varicose ulcer- it typically develops in the area just above the ankle but it can be anywhere. Due to the varicose veins, you tend to get a lot of itching and you scratch and a small wound gradually becomes a big wound. This is because the fluid that keeps coming out is extremely toxic/ acidic. The ulcers are typically superficial and can be resolved if treated on time.
How to prevent varicose veins-
Control the risk factors, this includes:
Cutting down on your smoking
Reducing your weight
Reducing the amount of hours you spend standing
Controlling the risk factors is important, because even if you treat the varicose veins but do not control the risk factors there is a tendency for new veins to become bad because the cause continues.
Avoid standing or sitting for very long periods. Move around frequently and take rest. When you rest, see to it that your feet are elevated or a little higher than the level of the heart, about 15 cm or 6 inches above the heart.
Elevate the foot end of your bed, in such a way that there is a slope of 4-6 inches from the foot to the head end. In this case you have a slope and it does not put load on your back or your knees.
Graduated compression stockings are special stockings that the pressure is more as you go down and the pressure is lower as you go up.
The measurement of the stockings is very important. Make sure you measure the size required when there is no swelling on your legs.
You should wear your compression stockings first thing in the morning.
The stockings will not make the veins go back to normal but it will prevent further progression and also provide support to the veins that have already gone bad.
Tippy toes is a good exercise for varicose veins. Move your feet back and forth on the floor. Deep breathing exercises are also important.
Varicose veins are treated by different methods
Conservative method. This is a temporary line of treatment because as long as you are following the treatment, you are fine. As soon as you stop, you’re back to where you started.
Injection sclerotherapy, in which we inject a sclerosing agent which is used to damage the veins, shrivel them up and they shrink and die.
Endo-venous surgery or radio frequency is when you do this from within/ inside the vein.
Open surgery can also be done where you make a cut and disconnect the vein that has gone bad.
We can also use either one or more of the above methods in combination to treat varicose veins.
5 reasons when Dr Paresh says they go ahead with the treatment-
- Cosmetic reasons
- People who apply for jobs or are deemed medically unfit undergo the treatment on a elective basis
- Increasing in size gradually and steadily
If you have an unprovoked DVT it is suggested that you take blood thinners for at least 5 years.
If it is a provoked deep vein thrombosis you need to see the cause for the DVT, if it is a transient risk factor, you can take it for 6-8 months and then stop. But if the real factor is persistent, you need to take the medication lifelong.
The small tiny visible veins on your feet go by 3 names- spider veins, venous telangiectasia or superficial varicose veins. Depending upon the size, they are treated.
Dr Paresh informs us that we can get ourselves Class-II compression stockings from a company that goes by the name of LabMedica that imports these stockings. Their contact details are as follows- 28085040. You can give them a call anytime between 10:00 am and 4:00 pm
You can reach out to Dr Paresh Pai at his clinic in Gamdevi. He is available at the clinic everyday from Monday to Friday between 10:00 am to 2:00 pm.
The clinic numbers are 23804400 or 23804499 or you can drop a message on WhatsApp at 9869426541
He currently only visits the Hinduja Hospital for the OPD which starts at 8 o’clock every Friday