Your Health: Venous Insufficiency

After a 3-month battle with Cellulitis, it was decided that the edema in my leg had been causing a majority of the problems, simply because my leg was so swollen that the antibiotics in my system were not reaching the infected tissues. This led to a series of tests, in an attempt to rule out a variety of different health conditions - Ultrasounds performed on both of my legs showed no sign of deep vein thrombosis (blood clots), blood work on my kidneys showed they were working fine, and a CT scan performed on my liver showed no abnormalities.

Nervous that the swelling in my legs may be a sign of heart failure, my doctor then sent me in for more ultrasounds on my legs and heart, as well as an EKG reading and a stress test. All came back as normal, leaving him terribly puzzled. Of course, this is nothing new - When the swelling first appeared in my legs, the doctors ran all sorts of tests on me, running up medical bills until I simply couldn't afford any more. This was 16 years ago and I have lived with the pain and swelling ever since.

But good news! After all of the tests and consulting with other doctors, my doctor believes we are now on the right track. The cause of my problems is venous insufficiency.

What is Venous Insufficiency?

Venous insufficiency, otherwise known as venous reflux, is a condition that effects roughly 2-5% of the U.S. population and is caused by problems in one or more of the deep veins in the leg. Normally, these veins have valves in them, which help to keep the blood moving back up your body, aiding in circulation. In some people, however, these valves are either missing or have been damaged to such a degree that they are no longer functioning correctly. The blood moves freely down into the leg but, if a person has venous insufficiency, it collects there and doesn't pump back up. When the person is sitting or standing, the blood continues to collect and results in swelling of the foot, ankle and in the lower leg. Left untreated, venous insufficiency is not only uncomfortable, painful and compromises mobility - it's also very dangerous.

If you're not careful, venous insufficiency can lead to many other painful and dangerous conditions such as deep vein thrombosis, stasis dermatitis and painful ulcerations of the affected areas. These conditions can lead to an increased risk of scar tissue, bone infections, or Cellulitis and the blood clots have a potential for causing a pulmonary embolism. In other words, venous insufficiency is nothing to toy with.

The Symptoms of Venous Insufficiency

Symptoms of venous insufficiency vary, depending on the degree in which you have it. In my case, I experienced edema (swelling) of my lower legs and a general heavy and stiff sensation in my lower leg and ankle during the first stages. Other people who have this condition may experience an itching or tingling sensation, like the pins-and-needles feeling you get when your foot falls asleep. Quite often, this discomfort intensifies if the person is standing or sitting for a prolonged period of time, and will decrease when they sleep, particularly if the legs are raised (I find that the discomfort eases, along with the swelling, when I sleep with a wedge pillow under my legs).

Other symptoms of venous insufficiency may include redness in the legs and ankles, changes in skin coloring around the ankles (usually to a mottled color or a brown shade), a hardening or thickening of the skin of the ankles and legs (this is a condition known as lipodermatosclerosis) and, in more severe cases, ulcers may form on the legs and ankles. The appearance of superficial varicose veins are also a common symptom of venous insufficiency.

If you find you are experiencing these symptoms, it's very important that you visit your doctor as soon as possible. Putting it off or ignoring the discomfort can lead to intensification of the condition and the possibility of other conditions complicating it further. Fortunately, with proper diagnosis, there are many treatments available to help with venous insufficiency.

Are You at Risk?

There are several different risk factors that could lead to venous insufficiency:

Genes: You may inherit venous insufficiency from your ancestors. Some family lines have faulty or missing valves in their veins, passing it down through the generations much like how they pass on blond hair or blue eyes.

Age: While venous insufficiency can occur at any age, it's most commonly seen in people over the age of 40, most likely due to a breakdown of the valves or general decrease in mobility as we age.

Gender: Venous insufficiency is a condition that's most common in women, though it can still occur in men (and men who smoke have an increased risk).

Height: It takes a lot of work to get that blood pumping properly around the body. Perhaps it has something to do with gravity, but the blood flows down much easier than it flows back up. Because of this, tall people may be able to reach the top shelves, but they also have a higher risk of developing venous insufficiency.

Weight: Yet another reason to eat right and stay fit - People who are overweight more susceptible for developing this condition. Also tied in with the weight factor, it can also affect women who are pregnant.

Work and Recreation: That sounds tricky, doesn't it? It's true - what you do, at work and at play, can lead to venous insufficiency. For instance, jobs that require long hours of prolonged standing can lead to this condition, but so can a very sedentary lifestyle. If you spend a lot of time sitting (whether that's working at a desk or feeding your World of Warcraft addiction), you're putting yourself at serious risk of developing venous insufficiency.

Diagnosing Venous Insufficiency

When a doctor is evaluating a patient for possible venous insufficiency, they usually start with the patient's existing complaint and their medical history. This includes looking over their general medical information, history of past surgeries and any history of vascular problems they might have had. They will usually ask questions regarding the sensations a person is experiencing in their legs - If you have experienced tingling, heaviness, cramping or fatigue in your legs, it's very important to mention this to your doctor.

Additionally, your doctor will perform a physical examination when attempting to make a diagnosis of venous insufficiency. This may include an examination of your legs, noting the size and diameter of the ankles, as well as paying attention to scars from ulcers or past venous surgeries. The doctor will also check your skin closely, looking for color and texture changes, as well as checking the edema on your leg. Be forewarned, if your leg is particularly sore in one area, it's important to point it out to the doctor. Not only will it draw his attention to potential problems, such as the possibility of deep vein thrombosis, but it will also lessen the chance that he will choose that area to poke and squeeze (I learned this the hard way, after discovering how much doctors enjoy pressing on legs and ankles that have pitting edema. I truly have my suspicions that it's something "fun" to do repeatedly, as my doctors often delight in doing so).

Once the physical examination is completed, the next step is to move on and have an ultrasound done on the affected area. This is usually done by a phlebologist, or vein specialist. Using Doppler imaging, they will then examine the veins, determining which direction the blood is flowing in and measuring to see if the valve is functioning normally. If you have a faulty valve in your vein, it will take longer to close and will allow the blood to reflux back in the reverse direction.

Treating Venous Insufficiency

There are many different methods for treating venous insufficiency, but the most common treatments include the wearing of compression stockings or having laser treatment to close the faulty valve and seal it shut. Of course, as with many medical conditions, the best form of treatment is preventing it from ever happening in the first place. Be sure to exercise regularly, not only to prevent weight gain, but also because exercising can help to move the blood back up your leg as your calf muscle tightens and relaxes. Avoid long periods of sitting or standing and be sure to eat right, as well as visiting your doctor for regular check-ups.

Sources:

Personal experience

http://www.nlm.nih.gov/medlineplus/ency/article/000203.htm - Further information on venous insufficiency

http://www.ehow.com/how_4586783_diagnose-venous-insufficiency.html - The diagnosis process