Red wine glass and glass of beer

A Healthy Relationship with Alcohol

I recently spoke to a group of Mini Med students about alcohol withdrawal, but what really got their attention were the guidelines for “healthy” drinking.

According to a National Surveys on Drug Use & Health release, an estimated 7.6% (18.2 million) of people over age 12 met the criteria for alcohol dependence. Data from the national Epidemiologic Catchment Area (ECA) study suggests the number is even greater, with a lifetime prevalence of alcohol dependence as high as 14.7%. There is both a human & financial cost to this dependency. Estimates of financial impact from loss of productivity due to alcohol-related illness, premature deaths and alcohol-related crimes are greater than $134 million each year.

About 3 in 10 adults drink at levels that elevate their risk for physical, mental health and social problems in the United States. Of these heavy drinkers, about 1 in 4 currently has alcohol abuse or dependence. All heavy drinkers have a greater risk of hypertension, gastrointestinal bleeding, sleep disorders, major depression, hemorrhagic stroke, cirrhosis of the liver and several cancers.

We encourage physicians to ask their patients more about their alcohol intake (and please be honest with them!). In a recent study of primary care practices, for example, patients with alcohol dependence received the recommended quality of care, including assessment and referral to treatment, only about 10 percent of the time. Clinical trials have shown that doctor-patient discussions can promote significant, lasting reductions in drinking for at-risk drinkers who aren’t alcohol dependent.

So what is healthy drinking?

  • For healthy men ages 21-65: no more than 4 drinks in a day & no more than 14 drinks in a week
  • For healthy women ages 21-65: no more than 3 drinks in a day and no more than 7 drinks in a week
  • For healthy adults older than 65: no more than 1 drink in a day and no more than 7 drinks in a week
  • Recommend lower limits or abstinence as medically indicated; for example, for patients who take medications that interact with alcohol; have a health condition exacerbated by alcohol
  • Abstain completely if you are under 21 or pregnant

I got a lot of questions about why the recommendations change when someone is older than 65. The quick answer is that when you age, you don’t metabolize alcohol as well so the effects of alcohol are felt more quickly.  This puts older adults at higher risks for falls and car crashes.

As important as the above guidelines is how you define one drink—a recent study showed that we pour more wine depending on the size of the glass.

Examples of one drink include:

  • Beer: 12 fluid ounces (355 milliliters)
  • Wine: 5 fluid ounces (148 milliliters)
  • Distilled spirits (80 proof): 1.5 fluid ounces (44 milliliters)

Just as you would take note of your blood pressure or BMI, being aware of your alcohol habits is critical to your overall health.

 

Match Day 2014108

What is Match Day?

It’s hard to think of an event more dramatic than Match Day at LSU Health Shreveport. It’s a day that fourth year medical students have been working toward and thinking of at least since they began medical school.

First, the basics: After four years of medical school, students receive their MDs but still have to further their training in residency programs (like pediatrics or orthopedic surgery) before they can practice. Some students enter medical school knowing what specialty they want to pursue (many do change their minds), while others have no clue. By the end of their third year though, students are generally decided and are working on their residency applications. Students apply to programs through a centralized system (ERAS). They receive interview invitations from some programs and go on as many as they can or see fit (and yes, interview expenses comes of out the medical students’ pockets with a few exceptions). Students then create a rank list from the places they interviewed. Programs do the same, and NRMP runs the match. Then the waiting to find out the results at Match Day begins.

How the day works at LSU Health Shreveport: It is chaos. The normally vast and airy BRI Atrium fills up by 10:45 am. If you want a prime viewing spot, you can’t be shy about pushing your way through a crowd. If you look up, you’ll see faculty members, residents and younger medical students lining the balconies on the BRI’s upper levels. Medical school leadership make a few opening remarks about 5 minutes until 11 am—very much aware that students’ attention spans are short and that they are the only thing standing in between students’ results. Right at 11 am, one of the deans will draw an envelope from a brown paper bag and announce the first student to approach the microphone. He or she quickly tears open that envelope, announces the results and then pulls out the next name from the bag. Students say that not knowing when your name will be called adds to the anxiety levels. The whole process takes about an hour and 15 minutes.

match day 21

Here are some fun facts about the day:

  • Lloyd Shapley and Alvin Roth won a Nobel Prize in economics for their theoretical and practical work in matching theory. Shapley and his colleague, David Gale, developed the “stable marriage” algorithm in which men and women rank each other as potential mates and a series of offer rounds produces a best match. The Gale-Shapley algorithm is the basis of the matching algorithm used by the NRMP. Roth worked with NRMP to adapt it.
  • There’s compensation for being last to know your results. As each student walks away from the microphone, he or she puts $10 in a pot. This continues until one student is left. He or she gets about $1,000 for having to wait the longest!
  • Students already know they have matched—just not where. During Match Week, students receive an email that Monday (March 16) telling them that they have matched. So the ceremony is a fun and happy occasion with no chance of someone opening a blank envelope.
  • Announcing results in front of the group is optional. There is a lot of tension and stress leading up to this day; however, since it’s a tradition, most if not all students choose to take part. If someone opts to receive their results in private, they will have to wait until noon CST to find out.
  • Not all schools do it like this. Many have students open their envelopes all at the same time.
  • For the first time, the event will be live streamed. If you can’t make it in person, go to our YouTube page at youtube.com/LSUHSCShreveport on March 20 at 10:55 am. Look for the live event to pop up on the center of the page.
  • Share your photos. If you will be at the event, use the hashtag #LSUShvMatch. NRMP is also promoting #iMatched and #Match2015.
  • More about the algorithm. Rank lists are due 23 days before Match Day. How long though does it take a computer to run the algorithm? 17 seconds, according to this blogger/medical student.
  • Match Day for LSU Health Departments. Our residency programs have 125 spots in the Match.

Good luck students!!

 

Caroline and Kelli

Why I Give Blood

As a college kid, blood donation was something that I was always aware of, but not something I really gave much attention to.  My dad was always a blood donor.  He donated every few months, and he was proud that he had donated the equivalent of the total blood for two people.  I donated blood when I was in school, but it wasn’t something that I actively participated in.

Then, everything changed when I was pregnant with my first child, Caroline.  I was diagnosed with placenta previa in my first trimester of pregnancy.  Basically, my placenta was attached directly over my cervix, which is dangerous for both the mother and child.  Because of the placenta previa, I was referred to Dr. Lynn Groome at LSU Health Shreveport, who is a maternal-fetal medicine specialist.  I didn’t really understand the implications of placenta previa, but I thought it was neat that I received so many ultrasounds.  Little did I know, placenta previa can cause growth restriction in fetuses because the placenta, when it is in the wrong location, does not supply the baby with enough blood to grow at a normal pace.  It also carries a great bleeding risk.  Any change in my cervix could cause me to have uncontrollable bleeding.

In my 26th week of pregnancy, Caroline had fallen to the bottom 3 percentile in weight for her size.  I was having growth scans performed every 2 weeks, and my baby had not grown in 2 weeks.  I was admitted that day to LSU Health Shreveport’s Maternal-Fetal ICU.  Placenta previa prevented her from growing.  It also caused other problems for me, including severe pre-eclampsia and HELLP Syndrome, which resulted in my liver and kidneys shutting down.  My body was rejecting my pregnancy, and my doctors told me that they were trying to prolong my pregnancy as long as possible.  I’ll never forget the way they explained it to me.  The doctors told me that they would let me get down just to the point where they couldn’t get me back before they would deliver my baby.

That time came almost exactly 48 hours after I was admitted to the hospital.  My placenta actually started separating from my uterus, which is called placenta abruption.  In the middle of the night on Monday after I was admitted, I felt a rush of warm liquid.  I thought perhaps my water broke.  It was blood from the placenta abruption.  I was on strict bed rest.  I couldn’t move in the bed because my baby had to be connected to the fetal monitor at all times, so I only saw the sheets as the nurse was changing the bed.  I was horrified!  Blood was everywhere! My placenta abrupted again that night, and twice on Tuesday.  I had lost so much blood that I had to have transfusions on Tuesday and Wednesday.

By Wednesday, the placenta separation was so severe that it was causing Caroline to go into fetal distress.  Her heart rate plummeted.  My doctors decided to deliver her on Wednesday, April 20, 2011.  She was 14 weeks premature and weighed only 1lb, 6oz.  She was 12.5 inches long.  She, essentially, was the size of a 20oz soda bottle.

Little Caroline spent 84 days in the NICU at LSU Health Shreveport.  At first, the doctors were not optimistic.  We were told that she would not live 72 hours. She made it through, and ultimately she was discharged from the NICU on July 11, 2011.  Along the way, she had 29 blood transfusions.  Each time she had blood drawn for lab tests, she would need a transfusion afterward.

My doctors told me that no matter who I chose as my OBGYN, ultimately I would have been admitted to LSU Health because of the high risk associated with my pregnancy.  Thankfully, as a Level 1 Trauma Center and academic research hospital, LSU had the capabilities to take care of rare cases like mine.  LSU Health also had a Level 1 NICU, which can take care of babies born as sick and small as Caroline.  I am very thankful for the doctors and staff at LSU Health Shreveport, both for saving my life and my daughter’s life.

I am also thankful to everyone who donated blood for Caroline and me.  So many people heard about our story and donated blood for her.  Since I was so sick, I could not donate blood to her, which was heart-wrenching as a mother.  It is entirely because of the kindness of strangers that I have my daughter today.  This is why I am such a champion of blood donation.

 

Hand spoon spank

A Permanent Time-out on Spanking

Developing brains are exquisitely sensitive. New data shows even more that early childhood experiences greatly impact adult health. Disciplining is a part of helping kids develop, but as pediatricians, we should help make it clear to parents that there is no room for spanking or physical punishment.

In 1999, a survey revealed that 94% of toddlers had been physically disciplined in the past year. Although a lot of progress has been made since then, this statistic demonstrates how widespread the practice is among parents.  A global initiative in 2014 sought to end corporal punishment of all kinds. Spanking is what most people think of with corporal punishment, but the UN Committee on the Rights of the Child defines it as “any punishment in which physical force is used and intended to cause some degree of pain or discomfort, however light.”

Why are pediatricians so adamant? Spanking has been shown to lead to an increased risk of mood disorders, alcohol and drug abuse and other mental illnesses in adults.   It teaches kids that violence is the way to settle issues. It may not help with its immediate purpose either. Children will be unlikely to remember the reason behind the spanking—only the method and related pain and emotions.

So, spanking is out. Luckily there are other options in between physical punishment and letting your kids run amok. After all, discipline is the second most important gift parents can provide to their children (behind giving love), but it is also the hardest.

Here are a few techniques that may work for you:

  • Give warnings
  • De-brief with your child after incidents
  • Time-outs (let them know you’re nearby)
  • Counting to three
  • Instructing your child to redo something the right way
  • Planning: talking through something that you know may set your child off
  • Taking away toys (mixed research)
  • Canceling or postponing plans (use sparingly, if at all)
  • Ignoring behavior
  • Leaving the scene

Here are others disciplining options that are proven NOT to work:

  • Outbursts/loud yelling
  • Soap in the mouth
  • Withholding/giving food (you don’t want to start a complicated relationship with food)
  • Early bedtime (same as above, healthy sleep habits are hard enough to create)
Caroline Hagan, MS 1Debra McGaha, Occupational Health nurse

What You Need to Know About the Flu

Influenza activity has been increasing in Louisiana and across the country. Local activity has markedly increased this past week. LSU Health Shreveport faculty members have found through the University Health Diagnostic Virology Laboratory that 16% of respiratory specimens submitted this past week from patients were positive for influenza. As is being seen in the rest of the country, the majority have been influenza A H3N2.

If you have not received the influenza vaccine and are eligible, you should be immunized as soon as possible. It takes about one to two weeks following vaccine administration to gain immunity.

For many, the flu is mainly inconvenient and uncomfortable, but it should be taken seriously—thousands of Americans die from it each year and hundreds of thousands are hospitalized.

One of the biggest myths out there is that the flu shot can give you the flu. It is impossible. A small group of people may experience mild side effects that they mistake for the flu. Or, some people will have already been infected with the flu or a similar virus and symptoms will coincide with getting the vaccine.

The flu shot is not completely effective but it’s the best tool we have to prevent it. Washing your hands often and thoroughly is also recommended, as is good cough hygiene (sneezing or coughing into a tissue or your upper arm elbow–not your hand).

If an adult or child develops flu-like symptoms the person’s doctor should be contacted. Based on the age of the person, how severe the symptoms are, and whether the person has a medical condition which increases the chance that they will suffer complications due to influenza, the person’s physician will decide whether treatment with an antiviral medication is needed. The medication works best when given within 2 days of when symptoms begin. In addition, people with influenza should drink plenty of fluids and rest.

People at high risk for complications of influenza include: children younger than 2 years old, adults 65 years and older, pregnant women, persons with chronic medical conditions of the lungs (including asthma), heart, liver or kidneys; persons with hematological disorders (including sickle cell disease), persons with metabolic disorders (including diabetes), persons with neurologic conditions, muscular problems or spinal cord injury; persons with immunosuppression, American Indians/Alaska Natives, persons who are morbidly obese and residents of nursing homes and other chronic care facilities.

The Centers for Disease Control & Prevention has more information on the flu and flu vaccine.

Scale with tape measure bow

Treating Obesity

You don’t have to be a medical expert to know that obesity is a huge problem in Louisiana and across the country. Carrying extra weight has many health implications. In counseling patients and teaching others how to broach the subject, I’ve discovered that it’s hard sometimes to discern weight loss facts from fiction.

Here are some common ones—see if you can call tell the difference.

1. Walking one mile per day and maintaining your current diet will net a 50 lb weight loss over 5 years.

FICTION- You will only lose about 10 lbs.

Popular apps like Lose It and MyFitnessPal use the 3500kcal rule to estimate caloric expenditure.  The amount of calories varies by the individual and the intensity of the activity.

2. Shakes and other meal replacements promote greater weight loss.

FACT- But for them to be effective, they have to replace two meals a day.   There is good evidence in the literature to support this.  Meal replacement options vary from protein shakes like Ideal Protein to prepackaged options like Medifast.  In the end, they all limit caloric intake.

3. Setting realistic weight loss goals is important because otherwise patients will become frustrated and lose less weight.

FICTION- Setting ambitious weight loss goals has been discouraged by some in the past with the thinking that more attainable goals will yield better results.  There are no studies to support this.  Any weight loss goal should be encouraged, both big or small.

4. Slow gradual weight loss is associated with better long term outcomes.

FICTION- Any weight loss is going to be good.   The rate of weight loss does not affect the overall efficacy of the program.  The minimum weight loss in an obese person that is limiting calories by 500-1000 per day from normal eating patterns should be 1-2 pounds per week.

5. Sexual activity burns 100-300 calories per round.

FICTION – The average bout of sexual intercourse is only 6 minutes according to the New England Journal of Medicine.  That type of physical activity burns about 21 calories in a 154 pound man.  Sitting on the couch for the same 6 minutes would have burned about 7 calories, or only a 14 calorie difference.

6. Physical activity and exercise promote weight loss maintenance.

FACT – Exercise has been proven to help with weight loss maintenance and can even be relied on to lose weight without dieting.  However, the doses of exercise needed to lose weight without changing eating patterns is substantial and often unattainable for most people.

7. Breastfeeding your child is a protective factor for the baby’s future development of obesity.

FICTION – Breastfeeding has a lot of benefits, but this isn’t one of them. There’s no data to show that a breastfeed baby is less likely to be obese.

8. Diet readiness (a patient’s motivation) is important in predicting success when the patient starts a weight loss program.

FICTION: Degree of motivation is not linked to success; the fact that the patient has showed up is what is important.

iStock_000015521410Small

Stopping the Revolving Door of COPD Readmissions

Chronic Obstructive Pulmonary Disease (COPD) is a growing health problem among both women and men. In fact, the World Health Organization predicts it may be the fifth leading cause of death in the world by 2020 and jump to third by 2030.

It may be hard for some to grasp what exactly COPD is—and for good reason. COPD is not one single disease but a general description of chronic airflow limitations. You may be familiar with “emphysema” or “chronic bronchitis.” Those terms are no longer used as a diagnosis and now fall under the COPD umbrella.

Smoking is what most people associate with COPD, but it can be caused by other factors too like childhood respiratory infections, dust & chemicals, genetics and air pollution.

Big changes to COPD maintenance went into effect earlier this month. Medicare will now hold physicians and hospitals accountable for the readmission of patients with COPD within 30 days post discharge. Doctors and hospitals now have another incentive to prevent readmissions.

Let’s look at how things stand now: 

  • 20-30% of COPD admissions are readmitted in 30 days
  • 76% of these are unnecessary
  • 40% receive less than ideal care
  • 50% receive inappropriate care
  • Some readmissions are not due to COPD
  • Will see more patients with COPD due to the Affordable Care Act
  • Many patients go home with incomplete recovery

We have an opportunity to look at what works and implement it.

Having a COPD team made up of physicians, home health, respiratory therapists, occupational therapists, physical therapists and nurses to discuss post-hospital care is crucial and proven effective. Ensuring that the patient understands the instructions on oxygen therapy or other at-home therapies will also lead to better outcomes. It goes without saying that smoking cessation should be a priority if the patient still lights up.

There should be telephone calls to patients a few days after hospital release to make sure they are doing well and to see if they have any questions. Within two weeks, patients should also come in for a follow- up appointment.

Treating COPD should no longer be an isolated relationship between a patient and a doctor. By synchronizing efforts among all health care professionals, patients will fare better causing hospital readmissions to decline.

 

 

SONY DSC

Babies, Sleep & Safety

It’s a taboo topic among parents of young kids; many people are doing it but not many people talk about it. I’m referring to co-sleeping, or having a child sleep in the bed with his or her parents. The baby’s safety, sleep for exhausted parents, comfort for babies and convenience for breastfeeding moms all come into play.

First, let’s take a look at how common co-sleeping is and why it is so popular despite its negative stigma.

It is thought that as many as 45% of families co-sleep. The prevalence is much higher among African-Americans (50 to 70%), as well as in Asian and Indian cultures.  Breastfeeding mothers are three times more likely to create a family bed (another expression used for co-sleeping).

Proponents say that it encourages breastfeeding, babies seem to sleep better, sleep cycles are more in synch and it has a calming effect on the infant. The effects may not just be immediate, according to some. A retrospective study showed that male college students who co-slept as children had higher self-esteem and reported less anxiety in general.

At the other end of the spectrum are the concerns regarding the danger of co-sleeping. It has even been compared in popular media to putting a knife in the bed with a baby.

The US Consumer Product Safety Commission, among many other groups, says do not place infants in adult beds. Period. And there is ample evidence to back up their stance, starting with concern for risk of suffocation and strangulation and increase in the chance for SIDs (sudden infant death syndrome).

Between 1990 and 1997, there were 515 deaths linked to sleep in adult beds, most in babies under three months of age. Parental smoking, drug and alcohol use and obesity increase the risk of death.

So, parents face a conundrum:  During the daytime, you are supposed to provide support, security and encouragement while accommodating the individual needs of children, but at night, you should put children in dark rooms alone and let them “cry it out?” All are just trying to navigate a way for everyone to get some sleep—safely.

A compromise for exhausted parents may be to keep your baby in the same room but in a bassinet or crib for up to the first year of his or her life. In fact, “room sharing” without bed sharing can decrease the rate of SIDS by 50% and does make breastfeeding more convenient in those early months (also combatting SIDS).

For more information from the American Academy of Pediatrics on babies and safe sleeping, visit their website.

 

Mother and son reading

A Prescription to Read

The American Academy of Pediatrics (AAP) has come out strong in support of reading to kids, calling early literacy promotion an “essential component of primary care pediatric practice.”

In a June 2014 policy statement, the AAP recommends that all pediatricians advise families that reading aloud and talking about pictures and words with their young children has many benefits—increased language and vocabulary; reading readiness skills; enhanced brain development; and positive parent-child relationships.  This means that parents should be talking and reading to their infants and toddlers even before children can talk.

As an educator with a background in reading, I have preached the importance of a language rich environment for infants and young children for years.  I worked for 14 years with the Louisiana Department of Education providing instructional assistance to classroom teachers of young children with delays.  More recently, I developed and supervised the Early Head Start program for high risk, low income children, birth to three, and their families in Caddo Parish.

When I supervised the Early Head Start program, two concepts provided a foundation for our program:

1)      “It’s all about relationships.”  We sought to promote the strong emotional bond between parent and child; to ensure positive relationships between the teachers and young students in our program; and to develop partnerships in the community in order to help our children and families succeed.

2)      “Parents are the first and most important teachers of their children.”  Our Early Head Start team provided quality center-based, year-round programming for our students, but we knew that the families were the key to the continued and future successes of Early Head Start students.

The AAP statement also stresses the relationship between child and parent, of the need to teach parents how best to support their children’s learning; and the policy encourages community partnerships—all directed toward promotion of shared reading experiences in the early childhood years.

Evidence Behind the Problem

The position of the AAP, and of early childhood programs for at-risk children, is based on evidence-based research from the field of early education.  Betty Hart and Todd R. Risley’s research in the 1990’s found that children, between birth and age four, from low income homes hear much less talk (a restricted number and type of words) compared with children from middle income and higher literacy homes.  The language the lower income children hear is too often directive language (“No,” “Stop that,” “Hush).”   The low-income child also experiences fewer storybook routines.

Thus, the researchers calculated that by age four, children of poverty may have been exposed to 13 Million fewer words than children from working class families and 30 Million fewer words than children from language-rich, higher income homes.  More recently, the 2011-2012 National Survey of Children’s Health found that only 60% of American children from birth to 5 years of age whose families make 400% of poverty level were read to daily, suggesting that many middle income young children also lack a language rich, print rich environment. Today many parents feel pressed for time and have come to rely on electronic media to entertain their children.

What Parents, Pediatricians Can Do

Pediatricians are in a unique position to promote the value of early literacy to parents and to demonstrate appropriate methods of shared storybook reading.  Techniques to enhance the reading experience with young children can be modeled for families in the pediatric health setting.  Adults may start out reading or singing nursery rhymes or simple songs to infants.  As the baby gets older, the adult points to pictures in simple books and names objects for babies.  Older infants will eventually point to pictures when asked and attempt to imitate the parent.  The child will start to enjoy hearing the parent read a short predictable book or talk about the pictures in a familiar book.

However, young children may lose interest fairly quickly.  Pediatric staff should emphasize to parents that this is normal and should be accepted by the parents.  Reading with Mom, Dad, Grandma or Grandpa should first and foremost be a pleasurable experience, creating a warm bond of trust and comfort between child and adult.

The Five R’s

This AAP early literacy policy statement echoes an earlier AAP technical report on “School Readiness” in the promotion of the 5 R’s of early education:

  • Reading together is encouraged as a daily fun family activity
  • Rhyming, playing, talking, singing and cuddling together throughout the day promotes language development, as well as strong social-emotional bonds.
  • Routines are important to young children–meals and bedtimes–because it makes their lives more predictable and it is easier for children to comprehend and know what is expected of them.  This is why many children with problem behaviors rarely exhibit extreme behavioral issues in good early childhood classrooms.  Once the child is enrolled in a structured, nurturing, and developmentally appropriate learning environment, he adjusts to and often welcomes the daily consistency.  Moreover, experienced caregivers recognize that a certain amount of boundary testing is age appropriate and is a child’s way of asserting independence.
  • Rewards for successes are important—recognition for the child’s making honest efforts toward common, age-appropriate goals like helping or kindness to others.  Children love praise from the important adults in their lives.  Praise should be specific, an acknowledgement that the child’s efforts are recognized.  “You put your toys in on the shelf.  Thank you for helping to keep your room clean and safe.  I don’t want anyone to trip and fall over a toy.”  “You let your sister ride your tricycle.  That was a kind thing to do.”
  • Relationships that are constant, consistent, positive, and purposeful lay the foundation for healthy early brain development and learning.

Resources

Pediatric offices are urged to identify economic ways to provide developmentally, culturally and linguistically appropriate books at well child visits for high-risk, low-income children.  Displaying colorful posters, provision of simple written materials and sharing information about library programs and services is also helpful in getting the word out to parents.

The AAP recommends that pediatric providers partner with other child advocates to develop and support policies and programs that promote the goals described in the early literacy policy statement.

The Reach Out and Read program at LSUHSC, started in 1998, promotes early literacy by making books a routine part of pediatric primary care.  Between 6,000 and 7,000 low-income children receive a book at each well-child visit from 6 months to 5 years of age.  A volunteer reads to children once a month in the well-child waiting room.

Another source of free books for young children is Dolly Parton’s Imagination Library, currently available to families in select zip codes (71103, 71109, 71106, 71064, 71111) in Shreveport and Bossier thanks to sponsorship by United Way of Northwest Louisiana.  Parents sign up on-line for their children to receive free books monthly from birth to age five.

The AAP provides a literacy toolkit for pediatric providers, educators and parents.

Woman walking trail

A Leg Up on Varicose Veins

Summer is prime time for breaking out shorts, skirts, dresses and bathing suits. It can also be a time when those with varicose veins most wonder where they came from and how to prevent or minimize their appearance.

Where do varicose veins come from?

Veins carry oxygen-depleted blood from the body back to the heart. One-way valves within normal veins help combat gravity’s effect on blood flow – blood pooling in your feet – and maintain one-way flow back to the heart. Your calf muscles also help return blood to the heart by squeezing the leg veins as you walk.

When venous valves are damaged, blood pools in your legs. This excess pooling of blood then causes increased pressure leading to even more valve damage. It quickly turns into a vicious cycle of vein damage. As vein disease worsens, damage to vein valves can lead to skin and tissue changes (thickening and discoloration) and in the most severe cases ulcers.

Are my veins varicose veins?

Vein disease is very common, but not all people with visible veins have varicose veins.  True varicose veins are larger and bulge out when standing.   Other types of visible vein disease include smaller reticular veins which are blue-ish purple and typically do not bulge out as much as true varicose veins.  Even smaller are telangiectasias or spider veins. These are bright red or purple and are very near the surface of the skin.  They are less than 1 mm in diameter and do not bulge out of the skin.

A common misconception is that people with varicose veins are only bothered by their appearance.  In some cases, they can actually be painful and bothersome. Symptoms may include dull aching pain, heaviness, swelling, restless legs at night, and itching or burning.

Reticular veins and spider veins typically do not cause symptoms unless they are associated with other vein disease and are considered to be cosmetic problems.

Who gets varicose veins?

Varicose veins are very common, but there are factors that increase your chances to develop them. Some are almost universal: increasing age, family history, smoking, and sedentary lifestyle. Other risk factors are more specific to venous disease: previous blood clots, history of injury, pregnancy, and wearing high heels (which prevents the calf muscles from squeezing the leg veins normally during walking).

What can I do to prevent varicose veins?

  • Leg Elevation:
    • Elevate your legs when sitting or lying down.  The ideal position to prevent pooling of blood in the lower legs is to elevate the legs higher than the heart.
  • Compression stockings:
    • Most people think of their great-grandma’s stockings when they think about compression stockings, but now many companies offer an array of styles and colors to match your lifestyle and needs.
    • Compression stockings are not the same as TED hose.  True compression stockings should have the amount of compression printed on the package as a gradient of pressure.  (e.g. 15-20mmHg, 20-30mmHg, etc.)  If you are wearing compression stockings to prevent development of varicose veins, knee high stockings at the lowest amount of pressure are probably sufficient.
    • A surgical supply store should be able to measure your legs to make sure you get the right size stockings.  If you get swelling in your legs, be sure to be measured for your compression stockings at the beginning of the day BEFORE your legs are swollen.

What if I already have varicose veins?  What treatments are available?

Treatment of vein disease will depend on type, severity, and cause. Many patients can be managed by wearing properly fitting compression stockings.  Some patients may require surgical removal of the offending vein. However, advancement in technology has allowed some patients to take advantage of minimally invasive treatments which require fewer, smaller or no incisions.

Radiofrequency and laser ablation are used in the larger varicose veins and deliver focused energy through a special catheter inserted into the abnormal vein. These treatments cause the vein to warm and collapse.

For smaller veins, sclerotherapy is another treatment option. A medication is injected into the vein and causes irritation to the vein. Compression therapy then allows the vein to scar closed and decreases the unsightly appearance.

Very small veins like telangiectasias, may allow for laser treatment. The high powered focused light heats and damages the spider vein. Though laser seems like an easy enough solution, there are considerations and limitations involved with laser treatment – skin pigmentation, size and depth of the vein, etc. Not everyone will be a candidate and there are potential complication as with any procedure.

Talk to your doctor if your veins bother you – physically or cosmetically. They will be able to give you the best information as to what will work best for YOU and your veins.

For more information on venous disorders visit the American Venous Forum’s Handbook on Venous Disorders.