Question: I am a 50 year old and work as a receptionist. I have an ulcer and swelling of legs at my ankles for the last several years. I have to elevate my legs to reduce the pain and swelling. I do not know why my ankles have dark skin. It looks ugly and must wear long pants to cover my legs to hide the ankles. I have been missing going to the beach for some time for the same reason. I dread going to the hospital because I must meet a big deductible. I do not know what to do. — Dolly, of Forest
You seem to have varicose veins in your legs, and that can be helped.
Vein disease is a condition that can commonly affect the veins in the legs. It can cause leg pain, varicose veins, swollen legs or open sores. Varicose veins are swollen and twisted veins. Legs are the common places the varicose veins are seen.
Rarely, in men they may be seen around testicles and may cause male sterility. Still more rarely, varicose veins may be found inside the body, like in the stomach.
Vein disease happens when the veins in the legs do not work right. Normally, the veins in the legs carry blood from the legs back to the heart. The veins have valves inside them to help keep blood moving in only one direction, toward the heart. The valves open to let blood flow to the heart and close to keep it from flowing back down the leg. Vein disease can happen when the valves are damaged or do not work well. This causes blood to collect in the legs. Blood is especially likely to collect in the legs when a person sits or stands for a long time without walking.
It may be that as a receptionist you are sitting for long time while at work.
Vein disease can be caused by a blood clot; leg injury; and being pregnant, especially more than once, as it causes a change in hormone levels that can weaken vein walls and cause weight gain.
Vein disease can also run in families without any of the above causes.
Initially, varicose veins do not cause symptoms.
People with long-term vein disease have symptoms that include leg pain or the leg feeling tired or heavy at the end of the day.
It can present as swollen veins looking like a spider. “Spider veins” are small leg veins that are swollen. These spider veins are tiny and usually do not cause blood clots. The larger varicose veins are leg veins that are swollen and twisted.
It can also show as swelling in the lower legs or ankles. People can have swelling at the end of the day initially but later have swelling all the time.
Sometimes folks with varicose veins get darkening of skin of legs like you have. The skin can turn red or red brown. This is called “stasis dermatitis.” Skin color changes often happen first around the ankle. This happens because blood stagnates in the legs and does not move up.
Many people who have varicose veins for a long time develop open sores, also called “venous ulcers.” These are usually at the ankle and can be painful, ooze and get infected.
To diagnose varicose veins, your doctor will do a physical exam, including looking at your legs while you’re standing to check for swelling.
You also may need an ultrasound test to see if the valves in your veins are functioning normally or if there’s any evidence of a blood clot. In this noninvasive test, a technician runs a small hand-held device against your skin. The transducer transmits images of the veins in your legs to a monitor. It can tell if blood is flowing toward the heart or if there is blood clot in the vein blocking the flow of the blood.
Blood clots may travel to the lungs and cause a serious condition called pulmonary embolism. Folks with pulmonary embolisms may be admitted to the hospital for treatment.
To reduce swelling in your legs, you can:
• Walk around, and try not to sit or stand in one place for a long time.
• Raise your legs above the level of the heart 3 or 4 times a day, for 30 minutes each time.
• Do exercises to point your toes and feet down and up a few times each day. The muscle contraction of calf muscles may pump the blood toward the heart.
To treat dry or itchy skin, you can:
• Wash your legs each day with a gentle cleanser. Do not use regular soap, which can make skin drier.
• Use an unscented moisturizing cream or ointment while your skin is still damp. A petroleum-based cream or ointment works well. Ask your doctor before using any other type of cream or ointment, because some can cause a rash.
If your skin problems are severe, your doctor might suggest special ointment, medicine or bandages.
Doctors can use different treatments to treat symptoms and reduce swelling. These can include:
• Special socks, bandages, or devices:
• Compression stockings are special socks that fit tightly over the ankle and leg. If your doctor recommends that you wear them, they will tell you which type to wear and how to put them on.
• Compression bandages are layers of bandages that wrap around a person’s leg. They are used when there is a lot of swelling, skin changes or an open wound.
• A compression pump is a device that fits around the leg and squeezes the leg every few minutes. It is used for people who have problems controlling swelling in other ways.
• Special coverings that are put on an open sore to help it heal.
• People who cannot use compression stockings or bandages might be able to try medicines that help the veins work better. People with a skin infection might need antibiotics. People with itchy skin might need a prescription cream or ointment.
• A doctor can remove or destroy damaged veins so they can no longer fill with blood. Doctors have been stripping the varicose veins for a long time. Food and Drug Administration approved radiofrequency ablation in 1999 and laser ablation in 2002. September 2020 Issue of New England Journal Medicine published quality of life five years after treatment for varicose veins. It was better after laser ablation or surgery than after foam sclerotherapy.
Sorry you had to wait all these years for treatment. The large deductible issue might be able to be avoided because laser therapy can be done as outpatient with less expense and you may not have to go to the hospital. This may be less expensive.
Suman Kumar Mishr MD, Fellow of American College of Endocrinology, Cridersville