Aching Legs or Sweaty Feet?

Long periods of standing in the one position in certain occupations such has hairdressing, nursing or machinery work can often lead to discomfort in the legs and feet. Symptoms such as a vague aching sensation, itchy legs or burning and sweating feet can be due to poor clearance of venous blood out of the legs. 

People affected with venous disease that causes venous incompetence are particularly prone to these symptoms if they are standing for prolonged periods and not walking around. Walking helps clear the blood out of the lower limbs because contraction of the calf muscles compresses the deep veins and this is the mechanism by which venous blood gets pumped up and out of the legs. It’s known as the “Calf muscle pump”.

If you are experiencing uncomfortable symptoms such as just described and your work involves extended periods of standing on your feet without the opportunity of moving about too much, you might be suffering from venous incompetence and poor clearance of venous blood out of your legs due to venous disease. This can often occur without the presence of visible varicose veins.

A duplex venous ultrasound of the saphenous veins and deep veins in your legs is the appropriate investigation for this problem.

Hidden Varicose Veins?

Many people suffering from varicose veins know that they have them because blue ropey veins can be seen bulging through the skin on their legs. Others may report a discomfort or feeling of heaviness which alerted them to the fact that they could have venous disease.

Obesity can mask the symptoms of the failing valves because the swollen veins are often hidden.  Aching in the leg might be attributed by patients to the extra weight they are carrying rather than hidden varicose veins.

Many of my patients carrying excess weight are only alerted to the fact that they might have varicose veins once skin damage starts to occur. Varicose veins left untreated can lead to leg ulceration. 

With overweight patients it can also be more of a challenge to assess and treat the problem because the veins can be deeper within the leg making it harder to map and properly access and identify the diseased veins.

This article was published in Brisbane Style Magazine November 2013 - Dr Nick Kemp is regular contributer on the Ask The Experts Panel.  

Aspirin for DVTs?

Many people believe that taking an Aspirin before going on a long haul flight will reduce the risk of DVTs - This is False. 

Blood clots arise due to thrombisus anywhere in the arterial or venous circulation. Heart attacks and strokes occur due to blood clots in the arterial circulation, where as DVTs occur in the venous circulation.

Blood clots are composed of two components: a protien called Fibrin and particles called Platelets. Platelets aggregate together like a mess and Fibrin acts like glue to hold it all together to form a clot. 

Aspirin interferes with Platelet aggregation by irreversibly inhibiting Thromboxane A2, which makes it useful in preventing arterial clots. However Aspirin does NOT interfere with Platelet aggregation mediated by Thrombin (in the venous system) explaining why it is not effective in preventing DVTs. 

DVT risk on flights can be reduced by wearing compression stockings and walking up and down the aisle for 10 minutes every hour. 

Article written by Dr Kemp and featured in the Experts - Brisbane Style Magazine October Edition. 

The World Of Vein Care

The 2013 World Meeting of the International Union of Phlebology convenes next week in Boston. A highlight in every phlebologist's calendar, this event draws physicians, nurses and healthcare professionals with an interest in venous disease. 

Although Dr Kemp will not be attending this years event, he will be following the discussions and debates closely online. Speakers from around the world will be taking to the podium to share their knowledge of best practice and new medical findings relating to sclerotherapy, endovenous laser ablation, ultrasound and much more.  

Dr Kurosh Parsi from the Sydney Skin and Vein Clinic (President of the Australasian College of Phlebology and Vice President of UIP) is attending and will be talking about the rapidly growing field of phlebology in Australia. Exciting stuff!

www.uip2013.org

Ultrasound Guided Foam Sclerotherapy (UGFS)

It may surprise you to learn that the use of injections to cure varicose veins dates back more than 100 years. In 1942 a physician named Orbach introduced the idea of turning a sclerosant solution into froth before injection into varicose veins. He found that this increased the efficacy of treatment by five times. Fifty years later another physician named Cabrera (1995) went a step further by converting a sclerosant solution into foam (smaller bubbles than froth). This method was soon recognized to be a highly effective way of treating varicose veins.

At about the same time Ultrasound began to be introduced as a method of guiding the injection of sclerosants directly into the source of varicose veins hidden beneath the skin. A positive characteristic of sclerosant in the form of a foam (unlike solution) is that it is readily seen on ultrasound so that its progress through the varicose veins can be tracked. This allows the doctor to follow the movement of the sclerosant and target treatment more precisely.

Why is foam sclerosant better than liquid sclerosant?

Sclerosants can only work by coming into direct contact with the internal vein wall. Here the sclerosant acts like a chemical peel removing the internal lining and exposing the collagen underneath so that the vein walls then stick together sealing off the varicose veins. Sclerosants in liquid form quickly become inactivated by proteins in the blood. Foam instead has the advantage of acting like a plug pushing the blood away and internally lathering the vein wall.

This aspect of foam not only means more effective treatment but also allows much lower doses of sclerosant to be used or conversely a given dose can treat much larger segments of varicose veins. This also means that there are less treatment sessions required that would be needed to treat the area using liquid Sclerotherapy.

Over the last decade Ultrasound Guided Foam Sclerotherapy (UGFS) in combination with Endothermal Ablation has led to a revolution in the treatment of varicose veins such that conventional surgical stripping of varicose veins is becoming obsolete.

As seen in Brisbane Style Magazine September edition -  Dr Nick Kemp is a regular contributer to the "Ask The Experts" page and also features in this month's Toowong section.