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The Truth About Varicose Veins: What Your Legs Are Telling You · Flourish- A Prisma Health Podcast

• 0:00
  Scott Webb (Host): Varicose veins are common and often misunderstood, and my
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  guest is here to explain varicose veins and tell us about some of the modern
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  treatment options that can help patients.
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  And my guest today is Dr.
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  Frances Yu.
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  She's a family medicine and wound care physician with Prisma Health.
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  This is Flourish, the podcast brought to you by PRISMA Health.
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  I'm Scott Webb.
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  Dr.
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  Yu, it's nice to have you here today.
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  We're going to get to the truth about varicose veins.
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  Like, are our legs telling us something?
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  Are our legs talking to us in the form of varicose veins?
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  And I guess maybe in order to answer that, Doctor, like, what
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  are varicose veins exactly?
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  Dr. Frances Yu:
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  Varicose veins, patients come in, they're very concerned when they have
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  these ropey like veins on their legs.
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  And what are they?
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  So, the text definition of varicose veins, they're enlarged, occasionally
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  twisted-appearing, sometimes visible veins just under the surface
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  of the skin seen in the legs.
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  But to really understand veins, we need to understand blood flow.
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  So, it starts in the heart.
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  The heart pumps oxygenated blood through the arteries to get to
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  your organs and your extremities, like your fingers and toes.
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  The oxygenated blood then needs to be brought back to the heart,
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  and that is the job of the veins.
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  So, the veins have these little valves in them that kind of open and close
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  and help to keep the blood flowing on track back towards the heart.
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  It is having to flow against gravity, because unlike the arteries, it
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  doesn't have the heart to help it pump.
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  So, one of the main reasons for why varicose veins occur
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  has to do with the valves.
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  When the valves weaken or fail, the blood can flow in the opposite direction
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  down towards the feet, and that can kind of cause some pooling in the vein.
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  This causes some increased pressure at leads to some vein stretching
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  and hence, becoming varicose.
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  Now, one quick distinction I did want to make about varicose veins is that they're
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  not the same as spider veins, which a lot of people come in to ask about as well.
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  Spider veins are more of the like tiny damaged blood vessels that are
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  visible just below the skin surface.
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  They kind of resemble a bruise, almost like thin web branches of
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  like red, blue, or purple lines.
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  Some people may find them distressing or not like how they look.
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  But spider veins are, for the most part, harmless and usually painless, although
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  some patients do report itching and burning on the surface of their skin.
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  Host: Yeah.
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  So, let's dive in here and try to get to the, you know,
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  the causes of varicose veins.
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  Is it behavior, lifestyle, diet, genetics?
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  Like, how do we end up with varicose veins?
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  Dr. Frances Yu:
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  All of those things, yes.
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  So, it's a combination of factors and genetics definitely plays a big role.
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  So, you know, if your parents or grandparents have varicose veins, chances
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  of you getting varicose veins is higher.
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  Sitting or standing for long periods, and that includes a lot of different careers.
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  For example, like factory work, people working in food service,
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  truck, or car drivers, office workers, healthcare, and so much more.
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  Other contributing factors would be things like pregnancy, aging, hormonal
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  changes, obesity, anything that can kind of increase pressure in leg veins.
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  Spider veins have the same precursors as those, but they can also occur in
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  your face due to excessive sun exposure.
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  Host: Yeah.
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  And you mentioned that spider veins may, you know, cause
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  some pain for some patients.
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  How about varicose veins?
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  Do they hurt at all and do they maybe cause, I don't know, other symptoms maybe
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  other than just seeing them and maybe them being a little unsightly for folks?
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  Dr. Frances Yu:
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  Yeah, they definitely can cause symptoms.
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  But this really varies widely.
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  It depends person to person.
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  Some people only notice the appearance of bulging veins.
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  I mean, I even have some patients with really thick ropey, big veins in their
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  legs, but they have no other symptoms.
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  Their legs feel wonderful and they don't even notice the bulging
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  veins till they look in the mirror.
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  But other people, they might experience aching, heaviness, throbbing, and
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  swelling in the legs, especially after a long day on their feet.
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  One important distinction is that, for the most part, varicose veins does not
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  cause anything like numbness, burning, or sharp pain, or even cramping.
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  Real vein pain is really described as heavy.
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  Some patients describe it as they're walking through mud or water, and
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  it's usually dull and it's throughout the entire leg, not just one area.
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  Host: Yeah.
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  It makes me wonder then, you know, because there's such a range perhaps of some
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  people notice them, some people don't.
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  I mean, obviously they can't see them, but they may "feel them."
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  So, are they a sign that there's something dangerous going on, or a potential, you
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  know, sort of significant health problem?
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  Like what are we supposed to do if we know we have them, right?
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  If we self-diagnose, if you will, we're like, "Okay, I have varicose veins,"
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  like, is it a problem if left untreated?"
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  Dr. Frances Yu:
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  Yeah.
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  So for the most part, varicose veins really are not dangerous.
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  And treatment is optional and kind of focused on improving pain and swelling.
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  But I will talk about some rare exceptions to that.
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  It's really best described as symptoms that range through a spectrum.
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  So on one end of a spectrum, you have people with varicose
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  veins that are really cosmetic.
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  Someone can have them throughout their life and they don't really progress and
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  they don't really lead to swelling even.
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  In the middle of that spectrum are patients who can experience some
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  daily distress, such as the heaviness we talked about earlier, aching.
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  And this can start to affect their daily life in chores, job duties.
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  And then, at the very end of that spectrum, there are some more rare
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  complications that can occur such as skin changes, inflammation, even ulcers.
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  These more severe complications occur after many, many years for
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  an extended period of persistent unaddressed leg swelling.
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  So while they're not often an emergency, it shouldn't be ignored,
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  especially if their symptoms are changing or progressing.
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  And one exception I do want to add to that is one of the only very more immediate
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  risks with the varicose veins is that they may lead to an increased risk of something
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  called a superficial venous thrombosis.
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  And it's just a fancy word for, essentially a clot in your varicose vein.
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  And this is because blood moves more slowly through those
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  enlarged portions of the vein.
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  And anything that moves more slowly can have the higher
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  potential of forming clots.
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  So, this might present as painful bulging along the course of the visible vein.
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  It can also cause a skin overlay to turn red.
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  And these clots are usually treated with anti-inflammatories and close
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  followup with ultrasounds, and sometimes a course of blood thinners.
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  But if you start to notice this and you have a lot of pain, it's definitely
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  recommended that you seek immediate care, because a superficial clot can progress
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  to something more severe, such as a deep venous clot or DVT as people know it as.
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  Host: Yeah.
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  And so, it sounds like, you know, if you have varicose veins and you're
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  concerned, you know, speak with your provider, perhaps be referred.
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  And then, treatments certainly are available.
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  So, let's talk about that.
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  How do you treat varicose veins and can they ever be, you know, completely
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  removed, if that's the right word?
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  Dr. Frances Yu:
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  Yeah.
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  So in the past, they used to do vein stripping.
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  So, really, vascular surgeons would put someone to sleep.
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  And it would be an extensive procedure where they're
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  actually taking the vein out.
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  But these days, we have some more minimally invasive
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  procedures that we'll talk about.
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  But depending on the severity in someone's preference,
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  treatment options really range.
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  There's an option of choosing more lifestyle changes of maintenance
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  like with compression stockings.
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  And then, if you want something more invasive, like those minimally
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  invasive procedures, things like laser radiofrequency is what we use nowadays.
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  And also, this can be paired with injections called sclerotherapy.
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  And these treatments usually are all done outpatient and
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  the patient is usually awake.
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  We make them comfortable And the goal of the procedure is really to
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  close off and remove the unhealthy veins without actually removing them.
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  So whenever we burn them with the laser or inject the substance, it's
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  essentially killing off the vein.
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  And over time, your body will scar down and resorb it.
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  And in most cases, the visible effect is noticeable after several months.
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  The legs can start to look better.
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  And then, also people's symptoms can improve-- heaviness, aching.
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  Host: Feel better.
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  Sure.
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  Dr. Frances Yu:
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  Exactly.
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  Yeah.
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  And it's important too to keep in mind that this treatment
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  is not permanent in any way.
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  So, people can still make new varicose veins in the future.
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  And if that happens, you know, there's more treatment.
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  We usually offer more injections down the line if they start to bother them again.
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  Host: Yeah.
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  And as you said, there's a genetic component to this.
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  So if mom, dad, grandma, grandpa, you know, if folks in your family had them,
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  even if you've had one treated, you may get them again, but at least you know,
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  you don't have to do the old school vein stripping, which just sounds entirely like
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  something I just never would want to do.
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  Dr. Frances Yu:
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  Yeah.
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  It's quite intense.
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  Host: Yeah.
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  I am certain it is, and I love hearing about all the new treatment options,
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  lasers, injections, all that good stuff.
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  So when do you recommend that someone speaks up just at their
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  annual physical, like, "Hey, I think I'm getting a varicose vein here.
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  What should I do?"
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  What's your best advice?
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  Dr. Frances Yu:
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  Yeah, exactly.
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  So, if you start to have any concerns about those symptoms that we talked about
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  earlier, if you, you know, have some leg pain, some like fatigue, swelling--
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  swelling is a really important one because swelling could lead to some more
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  issues with your skin in the future.
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  So, definitely good to speak with your doctor about.
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  And they usually send us referrals through there to the vein center.
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  Also, you know, if you develop any of those other symptoms such as the redness
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  or tenderness suddenly in the vein area, we need to evaluate that as well.
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  And for anybody who's interested in just cosmetic improvement of varicose
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  or spider veins, vein centers help with that as well, although it'll
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  probably be like an out-of-pocket cost.
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  Host: Right.
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  Yeah.
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  If there's no real health complications and it's just people find them to
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  be unsightly or whatever, yeah.
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  But a range there, speak with your provider, be referred,
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  lots of treatment options.
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  Is there anything we can do, besides the genetics part, right?
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  We can't control that.
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  We can't outrun our genetics.
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  Is there anything we can do?
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  Is it working out?
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  Is it eating better, quit smoking, like, you know, the greatest hits?
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  What can we do, you know, for ourselves?
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  Dr. Frances Yu:
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  Thankfully, it's very simple.
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  It's just like all those things that you said.
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  So, anything that's going to be helpful overall for your lifestyle is
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  probably going to be helpful for your veins and your circulation as well.
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  So, definitely staying active.
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  Like I mentioned earlier, the veins And the lymph system, you
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  know, they're very passive systems.
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  They're usually working against gravity all day.
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  So, having that calf pump and those muscles working really
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  helps to maintain good flow.
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  Also, maintaining a healthy weight is important.
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  Avoiding long periods of standing or sitting by taking frequent breaks
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  to walk when you can, elevating your legs when it's possible.
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  Sleeping in the bed at night.
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  That's a surprising one because I have some patients who fall asleep
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  in their recliner, and that can really lead to a lot of leg swelling.
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  And also, wearing compression socks consistently, especially
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  if you're on your feet all day.
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  All of these things can help support healthy veins and slow progression.
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  And I wanted to talk a little bit more about compression socks actually.
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  Because there's so much information out there and so many things to choose
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  from in terms of compression socks that people can feel overwhelmed.
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  So, make sure you're looking for good quality socks.
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  There's different brands, sizes, strengths.
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  But in general, a good quality sock is measured in size by the circumference
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  of your calf and your ankle.
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  So, the widest part of the calf and the smallest part of your ankle.
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  Generally, I don't recommend compression that's size based on shoe size.
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  A general good strength is 20 to 30.
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  That's what we recommend to our patients, but 15 to 20 is also
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  acceptable and it might be more comfortable for people to use day to day.
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  I always say some compression is better than no compression.
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  Compression comes in types.
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  Most commonly the knee-high socks are what people use, but they
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  can even, even be thigh high.
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  They can come in pantyhose, they can even come in leggings.
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  So, I personally wear my compression socks every day to clinic.
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  Some of the brands we recommend are Medi, JOBST, Sigvaris, and Juzo.
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  These sometimes can be on more expensive side.
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  But, you know, they can be a really worthy investment.
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  It's a good rule of thumb to just wear compression as soon as
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  you're getting up in the morning.
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  This is usually when your legs are the smallest.
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  And then, taking them off before bed so you don't need to wear it to sleep.
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  And you can wear compression with things like exercising, running,
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  going to the gym, hiking, all that as well can also help with recovery.
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  Host: That's awesome.
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  Well, great advice from an expert today.
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  Lots of great information.
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  I love learning from the experts, which I've done.
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  I'm sure listeners feel the same.
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  So, thank you so much.
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  Dr. Frances Yu:
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  Thank you, Scott.
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  Host: For more information and other podcasts just like this one, head on
• 12:21
  over to prismahealth.org/flourish.
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  This has been Flourish, a podcast brought to you by Prisma Health.
• 12:26
  I'm Scott Webb.
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  Stay well.