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When to Treat Varicose Veins

June 15, 2015 ACP Blog

In his recent podcast, Dr. Kistner talks about how to know when it’s time to seek treatment for varicose veins and how difficult it can be for people to decide how long he or she should wait until they seek treatment. One of the key points he makes is how obesity can obscure the signs of varicose veins in people who are obese or overweight. Obesity is a very prevalent problem in the United States and there are many factors that contribute to this but I will not go into that, rather obesity usually goes hand in hand with sedentary lifestyle. Many people spend hours on end in chairs with their feet on the floor in dependent position, making it a challenge even without varicose veins for the blood in the veins to return to the heart.  In listening to the podcast, I remembered talking to a very jolly and very overweight patient named Delores.  Delores was referred to us for leg pain and swelling. She didn’t have any visible veins showing on her legs but her legs were certainly large. It was hard to tell from just glancing at her whether her legs were large from excess fat or they were large from swelling.

I asked her about her lifestyle and she said she didn’t walk much but that she didn’t eat that much either. She didn’t smoke and didn’t drink. She was in her mid-sixties and about five foot tall and about 50 pounds overweight for her frame. Delores said she loved to crochet, watch Jeopardy, her favorite show, and loved to cook. I asked her to describe her leg pain and she said they mostly hurt at the end of the day. She got short winded when she walked but had no leg pain when she walked. She said she didn’t wear support stockings because she couldn’t bend over to put them on. An ultrasound was performed of her veins and lo and behold, Delores had significantly large, varicose veins deep under all the fatty tissue in her legs. She also had signs of fluid buildup in her calf and ankle regions on ultrasound.

Our physician gave her the following recommendations to try for one month and to follow up with us to let us know how she was doing. She told Delores to put her feet up on a hassock when she crocheted and watched TV.  She advised her to park her car far back in the parking lots of the stores she frequented to force herself to walk farther each day than she would normally do and to walk for ten minutes 3 times a day. Lastly, she instructed Delores at mid-day, every day, to lay on the couch on her back and put her feet way up on the arm of the couch for 5 minutes. After a month, Delores came back and said she was indeed in less leg pain.  Our doctor then instructed Delores to walk for fifteen minutes 2 times per day, continue to park far from the front doors of her stores and to elevate her legs daily. Another month went by, and Delores was feeling a bit better.

By the end of one year, Delores could walk for thirty minutes, had lost ten pounds and was feeling significantly better. She wasn’t short winded when she walked anymore.  She could also put on support stockings each morning. I was really pleased how Delores progressed, even though it took a while, but her sedentary lifestyle was a significant factor to the pain she had in her legs that might not have been nearly so significant if she wasn’t obese.  Delores still has varicose veins but is managing the pain and the swelling with exercise, elevation and stockings. Her heart is probably even stronger now because of her exercise and her heart can beat more efficiently, and in turn, has better oxygen in her lungs and her legs don’t have to work as hard! Go Delores!