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Varicose Veins & Spontaneous Bleeding

August 12, 2015 ACP Blog

By Dr. Paul Shields

In his podcast, Dr. Kistner talks about a patient with spontaneous bleeding of varicose veins and the treatment relative to this. I think any physician who has been treating varicose veins and venous insufficiency will eventually have a patient visit their office in a panic because of bleeding from their varicose vein. Listening to the program reminded me of a patient from early in my career.

I had been practicing medicine for several years and was in the office one day when my receptionist came running to the back with a frightened look on her face. She was so worked up, I had to try and decipher what she wanted from me- just like in the old Lassie movies- because she was unable to make any sensible comments. After I realized Timmy was not stuck in a well or mine shaft, I came to the waiting room where I found a pleasant woman in her mid-50s, standing in a puddle of blood with a diaper wrapped around her lower leg. She looked familiar to me but I could not specifically recall how I knew her.

As I began to evaluate the situation, I soon learned she had been with her cousin in the office several months earlier while her cousin received treatment for her varicose veins. She was inquisitive and asked more questions than the actual patient and that was how I recognized her. Obviously she had a vested interest in learning more about venous disease, as she was dealing with it herself.

As for visiting my office that day, she explained that she had been at a local discount store shopping when she turned a corner to go down an aisle and innocently brushed against a metal shelf. The next thing she knew, a store employee was running after her with a roll of paper towels. As she turned to see what was happening, she recalled seeing a “river” of blood on the floor behind her. The store employees ultimately wrapped several paper towels and a diaper around the area of the bleeding and she was advised to go to the emergency room.

My next question focused on why she had come to my office instead of the emergency room. She explained that she did not have any health insurance and was worried she could not afford to go to the emergency room. More bothersome, she had to be at work later that afternoon and knew she could not afford to miss work. She said her cousin had been very happy with the treatment she had received and she hoped I would be able to help her.

After getting her to the procedure room, the “dressing” was removed and two tourniquets were applied. The bleeding varicose vein was treated with a single suture and a more appropriate dressing was applied. In talking with the patient, I came to realize while she had known about her varicose veins for “30 years,” she had never seen a doctor for an evaluation of her varicose veins. She ultimately returned to our office for a diagnostic ultrasound examination and thorough history and physical examination. During this process we were able to determine the underlying source of her varicose veins and worked with her to coordinate care that now allows her to work full days as a hair stylist with far less leg discomfort and no more bloody shopping trips.