Blood Lines

By staff March 1, 2005

Sarasota manufacturer Rick Wheeler has always been physically fit, even swimming competitively in his youth. He attributes his strength to good genes, but genetics were against him when it came to his vascular system.

As they had in his mother and sister before him, the veins running through Wheeler's thighs throbbed with pain, itched and burned constantly. His wife, Susan, fared no better. Each of her three pregnancies left behind a new, prominent vein, prompting Rick to joke, "It's almost as if every vein got its own name."

At 41 and 43 years old, Rick and Susan Wheeler are typical varicose vein patients. Although much of the advertising for vein treatments targets young women sprucing up for swimsuit season, vein problems usually afflict those between the ages of 30 and 70, causing a lot more pain than the psychological trauma of looking bad in a bikini.

As they worsen over time, varicose veins can swell the feet and calves, creating the itching or burning sensations that plagued Rick Wheeler. Some victims develop deep vein thrombosis (blood clots), and others suffer painful skin ulcers around the ankle, making the pursuit of relief far more than a simple case of vanity.

The American Society of Plastic Surgeons estimates that at least half of all women are affected by varicose veins, and that 41 percent of them will have some type by the time they reach the age of 50. (Men are also affected, though they're less likely to seek treatment because their legs are covered by hair.)

Varicose veins strike pregnant women because of diminished circulatory flow from the legs to the pelvis. They're caused in others by malfunctions in the valves that veins use to pump blood throughout the body. Hormonal fluctuations, synthetic hormone therapy and oral contraceptives can all cause the condition. Also, as we age, our veins lose their elasticity, causing blood to pool in their stretched remnants.

Thankfully, removing them does little harm; as Dr. Joseph Pecoraro of Bradenton's Cosmetic Vein Clinic of Florida notes, "They're unhealthy veins, anyway." Pecoraro explains that blood will always reroute to nearby healthy veins. "Most of the veins we remove, if they were healthy, would be the veins we'd take to do bypass surgery," he adds.

In fact, modern medicine has given us an arsenal to combat the two types of veins that bedevil us. The first, spider veins, are known by their tree-branch appearance and jagged lines that often result from sun exposure. True varicose veins are darker in color and can protrude like twisted cords. They lie deeper below the skin than spider veins and are most common in the legs, but can appear elsewhere.

"In the past, people had been told this is something they have to live with," says Dr. John Dunne, of Erasers Body Enhancement Centers, Inc. "That's just not true." But traditional methods for removing deep varicose veins involved surgically "stripping" them from beneath the skin, as was done to Rick Wheeler's mother 20 years ago and his sister in 1996. Side effects could include anything from infection to inflammation, swelling and redness. The procedure also caused occasional permanent scarring, damage to surrounding nerve tissue, numbness, burning sensations and blood clots. "Stripping is only rarely done now because it requires hospitalization," says Dunne. Not only is it painful, but with stripping, varicose veins have a 30-percent rate of recurrence.

Today, Dunne and many doctors prefer "closure" techniques that use radio frequency to send energy into the vein via a small catheter or tube, causing the vein wall to shrink and seal. This type of treatment usually requires only a single incision and little down time for patients. One hour-long session is generally sufficient, but severe cases may require up to five visits.

Closure procedures have a 94 to 98-percent success rate, and lasers are making the process even more attractive. Endovenous laser therapy, or EVLT, "does the same thing that [closure] does, only it does it with a laser in a matter of minutes," says Pecoraro.

"This is just amazing," raves Wheeler, who, along with his wife, underwent EVLT last summer. He admits that after his session he felt as if he'd been punched in the legs a few times, but, "It wasn't unbearable. I didn't even need a Tylenol."

Lasers and intense pulse lights (IPLs) have been used for years to treat small spider veins along the nose and face, but until recently, they've proved ineffective for deep leg veins. Dunne says a recently approved FDA model produces results that are equivalent to radio frequency closure, with the same lack of side effects, only faster. And unlike older lasers, this one is just as effective on darker-skinned people, including those of Asian, African-American or Middle Eastern descent.

"I've been waiting for this laser to come along," says Dunne. He says the new laser takes only seven minutes to treat the area from the ankle to the groin, compared to 25 minutes with radio frequency closure. The procedure requires no needles or incisions, and the only side effects are slight redness or swelling that abates after a few days.

For spider and varicose veins that lie closer to the skin's surface, doctors prefer sclerotherapy, a technique in which doctors inject a solution into veins that causes them to collapse. Sclerotherapy has been used in Europe for more than 50 years, but has only become popular in the U.S. in the last decade. It's usually performed on an outpatient basis, and it requires no anesthesia, but can entail anywhere from five to 40 injections per session (Pecoraro compares the sensation to a mosquito bite). The procedure generally lasts less than an hour and requires between three and five visits.

Doctors advise pregnant women to avoid sclerotherapy, since pregnancy-induced varicose veins sometimes disappear within three months of giving birth. If they don't, doctors still prefer to wait until after breastfeeding ends, to avoid any possible transfer of the sclerosing agent.

Rare complications include formation of blood clots in the treated veins, inflammation, and allergic reactions to the sclerosing agent. Sclerotherapy can cause bruising that lasts as long as a month. A more common side effect is the emergence of brown patches along the skin that may take several months to fade. Occasionally, sclerotherapy can result in the eruption of even more, finer blood vessels around the initial treatment area, requiring additional injections.

Doctors emphasize that none of these treatments will prevent future occurrence of varicose veins; but Pecoraro notes that insurance will cover EVLT if your veins are causing a serious medical condition (like skin ulcers or blood clots). If your case is ruled strictly cosmetic, you'll spend about $2,000 for the procedure. Sclerotherapy costs an average of $300 to $400 per treatment.

Before you begin any procedure, though, Dunne suggests trying compression stockings. They increase blood circulation by squeezing the leg muscles and are available at most drugstores and pharmacies or through your doctor. Current styles are much more attractive than those produced 10 or even five years ago. "Some people just require control of symptoms," says Dunne. If medical treatment is still necessary, Dunne proceeds with a combination of sclerotherapy and laser closure methods.

It's a far cry from the surgical solutions that kept Wheeler's mother and sister bed-ridden for weeks, and Wheeler insists, "This is a significant advance. I have a hard time envisioning a better way to treat this condition."


. Limit sun exposure to prevent spider veins on the face.

. Concentrate on leg exercises to improve circulation and vein strength.

. Keep your legs uncrossed when sitting to avoid constricting blood vessels.

. At rest, keep legs elevated above the heart.

. If your job requires long periods of standing, shift your weight every few minutes. If you're at a desk all day, get up and move around every half hour or so.

. Doctors believe women's high heels put too much pressure on leg veins. You'll benefit more from low-heeled shoes that work the calf muscles.



If the very thought of needles or lasers to treat your varicose veins makes you shudder, these complementary and alternative therapies may be just what the doctor ordered.

Researchers at the University of Maryland Medicine recommend a diet rich in complex carbohydrates derived from whole grains and dark, leafy greens. Supplement that diet with vitamin C (in doses from 500 to 1,000 mg) three times a day, vitamin E (from 200 to 600 IU per day), and 15 to 30 mg of zinc. Just remember that high doses of vitamin C can dry the skin, and some people's digestive systems do not tolerate high concentrations of zinc.

Massage may be effective because it improves the poor circulation that's often blamed for varicose veins. Applying witch hazel may work for the same reason, and there's evidence that herbs like horse chestnut, gota kola and bilberry can help as well.

While scientists at the Mayo Clinic do not discount the possibility that herbs may relieve the symptoms caused by varicose veins, they doubt they will eliminate them entirely. They also warn that herbal supplements are not regulated by the Food and Drug Administration for potency or efficacy, so be aware that you risk potential drug interactions. Buy only from reputable dealers, and consult your doctor before taking any herbal supplements if you are already taking any medication.

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