Conservative Therapy

 

Short of curative minor vein procedures performed by the providers of Vein Specialists of Alaska routinely, these are the recommended things to lessen the clinical severity of the pain/swelling associated with venous insufficiency/varicose veins of the legs:

Maintain a normal body weight and normal body mass index (BMI).

To calculate your BMI, click here. A BMI of 25 or less is ideal. A BMI over 25 (overweight), especially over 30 (obese), is extremely stressful to many organ systems of the body, including the venous system.

Stay active.

Veins love for their owner to be active with muscles contracting. Walk for exercise daily (also heart and brain healthy). If you predominantly stand or sit at work, try to take quick breaks to move around during your work day, or at minimum, activate your calf muscle pump. If you predominantly sit, you can do this by moving your feet away/towards you repeatedly several times each hour. If you predominantly stand, you accomplish this by standing on your tiptoes repeatedly several times each hour.

Avoid high-heels.

Women should not wear high heels with only rare exception. Walking in high heels negates the ability for the calf muscle to contract while walking. This calf muscle pump is very important to constantly help squeeze the lower extremity venous blood and propel it upwards towards the heart. Women can get away with low heeled footwear on a regular basis and still contract the calf muscle pump during walking.

Avoid regular bath tub and hot tub exposure.

Excessive heat, especially prolonged moist heat to the legs makes vein wall dilate and if the underlying veins are diseased already, this just causes more back flow of venous blood and perpetuates the venous volume overload problem. Showering is preferred.

Analgesics

Pharmaceuticals

OTC and prescription strength medications in the anti-inflammatory class are preferred since they help temporarily reverse the inflammation in the vein walls that is caused by the underlying venous insufficiency problem.  Over-the-counter (OTC) use of ibuprofen (Motrin) or naproxen (Aleve), or their prescription strength counterparts are most commonly used.   A newer class of anti-inflammatory prescription medications is also available, particularly when the older standbys are not tolerated or do not work.  This newer class are termed Cox-2 Inhibitors, and there are 2 commonly prescribed:  meloxicam (Mobic) and celecoxib (Celebrex).  Although many people take these medications daily, VSA cautions against this because daily dosing can lead to either significant stomach irritation (to the point of bleeding) and/or kidney filtration impairment (this problem can become advanced with little warning).

If the anti-inflammatory medications are not tolerated, some people with vein problems find acetaminophen (Tylenol) helpful. The caution with acetaminophen is to avoid excessive or too regular dosing, since irreversible liver impairment or liver failure can result.

Natural OTC Agents

Horse Chestnut is a natural plant-based medicine.  There are other natural medicines touted to help vein sufferers, but based on medical published papers, this is the only one VSA feels has enough scientific evidence to mention.  Multiple patients who are evaluated by VSA report that it is helpful to alleviate some of the discomfort caused by their vein disease.  Generally over time, the benefit wears off, but it is not unusual for a patient to relay 2-3 years of meaningful relief before the benefit subsides. It is generally well-tolerated.

With any natural medicine, such as Horse Chestnut, VSA encourages you to shop at a reputable natural health food/supplement store and insist on pharmaceutical grade. “Pharmaceutical Grade” insures through independent testing that the product actually contains the ingredient(s) in the amount the label states, and is free of potential harmful impurities.

Compression Hose

Compliance with compression therapy of at least 20-30mm Hg is recommended for vein sufferers since there is medical data to suggest improvement in symptoms (pain/swelling) with daily hose compliance.  Data is lacking in the realm of whether strict compliance with the compression hose actually retard progression of the underlying venous insufficiency problem.  This is where the “jury is still out.”

Regardless, many health insurers mandate a trial of conservative therapy (including compression hose) to be tried and failed before more definitive measures, such as the modern non-hospital vein procedures employed by VSA, will be authorized or performed.

Upside of hose:

  • If properly fit, the hose may indeed induce meaningful improvement in the pain and/or swelling of the vein sufferer and allow them to continue on without need for invasive procedures.
  • Avoids the risk, albeit small, of modern out-of-hospital based vein procedures.

Downside of hose:

  • If improperly fit, are miserable.  For unusual or difficult body types, custom fit hose are an option, but with delay of measuring, then ordering, and much higher cost.
  • Some patients, especially those afflicted with arthritis of the hands or wrists, have trouble putting on the hose (“donning”) and/or taking off the hose (“doffing”). Fortunately for such patients, there are “donning devices” sold that aide with at least donning the hose. Doffing may still require a good prayer and glass of your favorite alcoholic beverage in advance.
  • If the hose are to do any good for pain and/or swelling of venous insufficiency/varicose veins, must be thick enough to invoke proper compression. The downside of “thick” is “hot”.  If you work in air conditioning, or are not exposed to hot summers, then this fact may be a moot point. For some, this is a major complaint. For those that exercise regularly, the hose also can be a major nuisance.
  • Cost. Even though many insurers require a trial, with very few exceptions will the same insurers cover the cost of the compression hose.  This can be further frustrating if the patient requires custom-fit hose that are several times higher on the cost scale, costing $150 or more per pair.
© 2016 Vein Specialists of Alaska