You probably think this blog is about you. Don’t you? Don’t you? And you would be absolutely right. Okay I’m sure I’m not the first vein doctor to use Carly’s perfectly written breakup song about Warren Beatty for purposes of encouraging patients to get their varicose veins treated. If you are old enough (like I am) to remember vividly when this song was released (1972) then you are also in the age group of the population with the highest incidence of venous disease of the legs. These are problems that can affect both young and older people, but we know the incidence definitely increases with age.
I spend lots of time educating patients about what the symptoms of lower extremity venous disease are and how important it is to seek treatment for varicose and spider veins. I grew up listening to Paul Harvey on the radio. “The rest of the story” was always something different and deeper than what you were expecting. Venous disease in the legs usually progresses and gets worse, involving more and more areas of the leg in the path of whatever vein has gone bad. Early intervention is what I preach.
The rest of the story with venous disease is that there is such a wide variation in just how a patient will develop problems. Most patients will have typical symptoms of aching, fatigued feeling legs that feel heavy towards the end of the day, usually with a bulging vein here or there. Swelling that seems to go away overnight, only to return in the calves and ankles by quitting time is pretty typical. Changes in the appearance of the skin over time are a big tip off. This usually includes darkening, or an increase in pigmentation in the lower legs, a reddish itching rash on the skin of the lower calves and ankles, thickening or hardening of the skin in these areas, and the most advanced skin change is the appearance of a non-healing skin ulceration, a venous ulcer. There are patients who will only have bulging veins or a covering of spider veins and no symptoms at all. Wide variation.
Right lower calf venous ulceration before and after treatment.
The trick is heading all of this off at the pass. Getting treatment for venous disease is more important than ever. Bulging veins at the skin are at risk for lots of bad things. Superficial blood clots can form in these surface veins that can progress to deep vein thrombosis (DVT). Bulging veins just under the skin are often in vulnerable areas of the legs that are at risk for rupture and significant bleeding with even minor injuries. Even more concerning is the tendency of these veins for spontaneous rupture due to the high pressures that develop from underlying veins that are allowing reverse blood flow into them.
The good news for most people is that treatment is not anything like it used to be. There is an entire generation of people that still believe that “vein stripping” is still the only treatment. This was invariably a very painful procedure that had a very long recovery period with serious risks. Today, highly effective treatments are performed in an office-based setting in my clinic, extremely well tolerated under local anesthesia and mild sedation. There is minimal down time with patients able to return to work on the second day and pain is easily managed typically with over the counter medications.
Don’t wait a minute longer. Don’t daydream about getting something done. Don’t be naive like Carly. She had some dreams but apparently, they were clouds in her coffee. Gulp that coffee down, grab your phone and give us a call at Precision Vein Therapeutics 205-710-3800 for an evaluation. Two years after she released “You’re so Vein” she released my favorite song of all time, “I Haven’t Got Time for the Vein.” You don’t either.
Michael R. Barlow MD, RPhS
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