‘Waxing’ in vain with the curse of those painful varicose veins

A condition recognized by those creepy, gnarled, twisted green vessels on the posterior of the thighs and legs, the curse of Varicose Veins (VV), can be far more than mere cosmetic. Amongst the several problems that summer brings, pain and heaviness with discomfort in the legs at the end of the day, often accompanied by night cramps, may be the first signal of “Vein Pain”.Initially these symptoms are seen to wane off with rest and some exercise, but unattended, these patients could go on to sprout VVs. VVs can theoretically occur anywhere in the body. But the standing posture, gravity, intra-abdominal pressure increase like multiple pregnancies or obesity, ageing etc, which are common causes, lead to a loss of elasticity in the vessels and this is why they are usually seen in the lower limbs.
What one sees are the superficial veins in the legs (responsible for only 10% of the circulation) which get dilated, owing to incompetency of the valves.
The venous blood from the lower half of the body returns to the heart via the conduit of veins which are pumped by the calf muscles upwards. The reflux against gravity is normally ensured by small leaflets (valves). Incompetency of these valves results in the blood initially trickling back and then staying put in the vein which then creates out-pouchings and branches, which cast the spidery purple telangiectasia (bunches). Surprisingly chronic venous insufficiency affects 8 out of 10 adults. Persons who stand erect in one position without too much movements are likely to sprout VVs ( policemen, surgeons, shopkeepers, chefs, hairdressers, hostesses).
While for the majority, symptoms from VVs are mild, in the more severe cases the skin overlying the leash of ugly out-pouchings may become thin, develop venous eczema, ulcerate and even bleed on trivial traumas. The inadequate circulation causes swelling of the ankles, discoloration of the legs and thinning out of the subcutaneous fat and muscle (lipodermatosclerosis).
Note, VVs should not be confused with deep vein thrombosis which involves larger and deeper blood vessels and is a more serious condition..
How does one cope with them? From home remedies like cold showers and avoiding tight pelvic clothes and high heels, to elevation of the limbs when laying down and wearing stockings when erect, medicine has come a long way.
Traditional permanent remedies meant stripping the veins off but this has now been replaced by the less invasive ultrasound-guided foam sclerotherapy, endovenous laser and radio frequency ablation of the abnormal veins
However, the advent of newer oral drugs - phlebotonics (medication to improve vascular health), like flavinoids have met with success in relieving symptoms and halting the progress of VVs.
You may wear long skirts to ’skirt’ the issue but ‘Vein Pain’ can be irritating and bothersome, so within possible limits, alter lifestyle, so that the “Baaghi” in your legs stays subdued.
(Dr Hemant Thacker is a consultant physician & cardiometabolic specialist attached to south Mumbai hospitals. His email id is dochpt@gmail.com)