Varicose Veins 101

Ah, varicose veins. Those bulging, bluish, ropey road maps on the legs. Where do they come from? And what, exactly, is the medical issue? And how do your veins work, anyway?

Bummer case of varicose veins!

Let's start at the beginning, shall we? The average human body contains approximately 6 quarts of blood that get circulated with every beat of the heart through all the arteries and veins and capillaries of the entire body and back to the heart about every 2 minutes. That's a gallon and a half of fluid that has to travel through miles of vessels every 120 seconds! Amazing. Arteries carry the oxygen rich blood to every cell in the body, where your cells pick up oxygen and nutrients and put back carbon dioxide and waste into the blood.

Veins move the de-oxygenated blood from your feet back up through your legs to your heart where the blood will get circulated through the lungs, drop off carbon dioxide, pick up more oxygen, and get pumped out again to your body.

The circulatory system of , well, Mister Clean evidently

Veins are squishy tubes that have a series of valves in them. The valves open to allow blood to move upward towards the heart, then snap tightly shut to keep gravity from pulling the blood back down into your legs and feet. You can think of it kind of like an elevator that should only go up. Move up one floor, stop; move up one more floor, stop; all the way to the heart. ( "3rd floor, ankle!; 4th floor, tibia and fibula!; 5th floor, ladies haberdashery!") Blood traveling up from your legs has to be pumped along by the muscles in your legs, and the valves in your veins are the only thing keeping gravity from pulling the blood back down to your feet.

It's tough job, fighting gravity every day, but somebody's got to do it

Varicose Veins occur because of Venous Insufficiency Disease, which is a fancy way to say that the valves in your veins are not doing their job. When the valves don't shut tightly, gravity pulls the blood downward which causes pressure to build up in the vein, sometimes causing it to visibly bulge up out of the skin. This falling downward of the blood is called "reflux". The more the blood gets pulled down, the more the pressure damages the already failing valves. Building pressure may also cause the vein to stretch out, so eventually the valves may not even meet inside the vein, leading to more reflux, and the whole thing is a vicious circle. Feh!

Ooo, I hate it when a good valve goes bad!

Varicose veins and Venous Insufficiency are hereditary. If your parents or grandparents had them, there is a very good chance that you will develop them too. In my case, thanks, Grandma Anna. : ( Women are more likely to develop it than men, but honestly, I've seen plenty of men with large veins and bad reflux. In fact, many men wait so long to see the doctor that by the time they get to me for an ultrasound exam their disease is usually fairly advanced.

What's not under this kilt? Varicose veins

Reflux disease isn't just an old person's problem either. Would you believe that I have seen children as young as 9 who were complaining of painful legs who had some reflux? I have had patients as young as 19 and 20 years old decide to have their bad veins closed with the EVLT laser procedure because their symptoms were so bad!

It might surprise you to learn that Venous Insufficiency disease is not always visible to the naked eye. You can have bad valves in your veins and venous reflux and not have any visible signs at all. I've seen people with beautiful looking legs that had severe reflux disease. The only way to be 100% sure is by having an ultrasound examination of your veins that includes a doppler test to see if the blood is being allowed to fall back towards your feet.

See Jack. See Jack scan. Scan Jack, scan!

Exercise won't save you from Venous Valve problems either. My patients have included runners, aerobics instructors, yoga instructors, competitive bicyclists, lifeguards, and postal carriers. Exercise is vital for your calf muscle pump action and your over all health & well being too, so venous valve issues aside, do it anyway won't you?

There are some common symptoms of venous disease that should clue you in even if you don't see any bulging veins: heavy feeling legs, tired legs, painful legs, itching legs, burning skin, frequent night cramps, daily swelling of the ankles or calves, restless legs, the appearance of purple "spider veins". If you have one or more of these symptoms on a regular basis, get thee to a vein doctor for an exam!

Swollen ankles due to venous reflux disease? Not in this case

Have you ever seen older folks with bluish ankles? That's due to reflux disease that leads to blood pooling beneath thinning/aging skin. When that pressure gets bad enough and goes on for a long time, an older person may develop ulcers on their feet or ankles that won't heal, or the skin on their lower calf may become red and hard and leathery. It pays to treat your reflux before it gets to that point.

Don't let this happen to you

The old school of thought was that varicose veins were a cosmetic issue and you should just wear compression stockings and make the best of it. Or, God forbid, have a vein stripping and get all cut up and have a long recovery and a lifetime of scars! Now though, the medical establishment and medical insurance companies realize that Venous Insufficiency is a real medical problem and it can be serious. It has an impact on a person's health and the quality of their life.

Because Venous Insufficiency and Varicose Veins only get worse as time goes on, we will see more and more cases as our population ages. Thank goodness there are some good treatments out there now to help people deal with their venous disease.