Enlarged veins or an engorged complex of smaller vessels.
Varicose veins are dilated tortuous veins occurring in about 15 per cent of adults – women more than men. They most commonly occur in the legs but may also occur in the anal canal (HAEMORRHOIDS) and in the oesophagus (due to liver disease).
Normally blood ?ows from the subcutaneous tissues to the super?cial veins which drain via perforating veins into the deep veins of the leg. This ?ow, back towards the heart, is aided by valves within the veins. When these valves fail, increased pressure is exerted on the blood vessels leading to dilatations known as varicose veins.
Treatment is needed to prevent complications such as ulceration and bleeding, or for
cosmetic purposes. Treatment alternatives include injection with sclerosing agents to obliterate the lumen of the veins (sclerotherapy), or surgery; in the elderly or un?t, an elastic stocking may su?ce. One operation is the Trendelenburg operation in which the saphenous vein is disconnected from the femoral vein and individual varicose veins are avulsed. (See also VASCULITIS.)
Thrombosis Thrombosis occurs when blood, which is normally a liquid, clots within the vein to form a semisolid thrombus (clot). This occurs through a combination of reduced blood ?ow and hypercoagulability (a reduced threshold for clotting). The most common site for this to occur is in the deep veins of the leg, where it is known as a deep-vein thrombosis (DVT).
Predisposing factors include immobility (leading to reduced blood ?ow), such as during long journeys (e.g. plane ?ights) where there is little opportunity to stretch one’s legs; surgery (leading to temporary post-operative immobility and hypercoagulability of blood); oestrogen administration (low-dose oestrogen oral contraceptives carry a very low relative risk); and several medical illnesses such as heart failure, stroke and malignancy.
Deep-vein thrombosis presents as a tender, warm, red swelling of the calf. Diagnosis may be con?rmed by venogram (an X-ray taken following injection of contrast medium into the foot veins) or by ultrasound scanning looking for ?ow within the veins.
Prevention is important. This is why patients are mobilised and/or given leg exercises very soon after an operation, even major surgery. People should avoid sitting for long periods, particularly if the edge of the seat is hard, thus impeding venous return from the legs. Car drivers should stop regularly on a long journey and walk around; airline travellers should, where possible, walk round the aisle(s) and also exercise and massage their leg muscles, as well as drinking ample non-alcoholic ?uids.
Diagnosis and treatment are important because there is a risk that the clotted blood within the vein becomes dislodged and travels up the venous system to become lodged in the pulmonary arteries. This is known as PULMONARY EMBOLISM.
Treatment is directed at thinning the blood with ANTICOAGULANTS, initially with heparin and subsequently with WARFARIN for a period of time while the clot resolves.
Blocked super?cial veins are described as super?cial thrombophlebitis, which produces in?ammation over the vein. It responds to antiin?ammatory analgesics. Occasionally heparin and ANTIBIOTICS are required to treat associated thrombosis and infection.... veins, diseases of
Causes: referred pain from a disordered abdominal organ, displacement of pelvis, lumbosacral spine, slipped disc and lumbar spondylosis. See: LUMBAR INTERVERTEBRAL DISC PROLAPSE.
Paget’s disease or lumbago not associated with sciatica (radiating pain down the back of the leg via the sciatic nerve).
Symptoms. Local tenderness, reduced range of movement, muscle spasm. Usually better by rest; worse by movement.
Differential diagnosis: exclude other pelvic disorders such as structural bony displacements, infection from other organs, carcinoma of the womb or prostate gland. Pain in the small of the back may indicate kidney disease or stone. See: KIDNEY DISEASE, GYNAECOLOGICAL PROBLEMS.
Frequent causes: varicosities of the womb and pelvis. These are identical to varicose veins elsewhere, venous circulation being congested. Pressure on a vein from the ovaries may manifest as lumbago – treatment is the same as for varicose veins.
Root cause of the pain should be traced where possible. As most cases of backache defy accurate diagnosis the following general treatments are recommended. For more specific treatments, reference should be made to the various subdivisions of rheumatic disorders. See: RHEUMATIC AND ARTHRITIC DISORDERS, ANKYLOSING SPONDYLITIS, etc.
Alternatives. Barberry (commended by Dr Finlay Ellingwood), Black Cohosh, Bogbean, Buchu, Burdock, Celery, Devil’s Claw, Horsetail, St John’s Wort (tenderness of spine to the touch), White Willow, Wild Yam (muscle spasm).
Celery tea. Barberry tea. See entries.
Decoction. Formula. White Willow 3; Wild Yam 2; Juniper half; Valerian half. Prepare: 3 heaped 5ml teaspoons to 1 pint (500ml) water; simmer gently 15-20 minutes. Dose: 1 wineglassful (100ml or 3fl oz) thrice daily.
Tablets/capsules. Black Cohosh, Celery, Devil’s Claw, Wild Yam, Ligvites.
Formula. Devil’s Claw 2; Black Cohosh 1; Valerian 1; Juniper half. Mix. Dose: Powders: 500mg (two 00 capsules or one-third teaspoon). Liquid extracts: 1 teaspoon. Tinctures: 2 teaspoons. Action is enhanced where dose is taken in cup Dandelion coffee, otherwise a little water.
Practitioner. Tincture Black Cohosh 4; Tincture Arnica 1. Mix. Dose: 10-20 drops, thrice daily. Black Cohosh and Arnica are two of the most positive synergists known to scientific herbalism. Both are specific for striped muscle tissue. Common disorders of the voluntary muscles quickly respond. (James A. Cannon MD, Pickens, SC, USA)
Practitioner: alternative. Tincture Gelsemium. 10 drops to 100ml water; dose, 1 teaspoon every 2 hours. Topical. Castor oil pack at night. Warm fomentations of Lobelia and Hops. Warm potato poultice. Cayenne salve. Camphorated, Jojoba or Evening Primrose oil. Lotion: equal parts tinctures: Lobelia, Ragwort and St John’s Wort; mix: 10-20 drops on cotton wool or suitable material and applied to affected area. Arnica lotion. Wintergreen.
Chiropractic technique. Ice and low back pain. Patient lies on his stomach with two pillows under abdomen, the low back in an arched position. Apply ice-bag or packet of peas from the freezer on top of lumbar area; pillow on top to hold ice firm. Patient not to lie or sit on ice-pack.
Diet. Oily fish.
Supplements. Daily. Vitamin B-complex, Vitamin C (500mg); Vitamin D 500iu; Vitamin E (400iu). Dolomite. Niacin.
Supportives. Bedrest in acute stage. Diathermy. Spinal support. Relaxation techniques to reduce muscle tension. ... lumbago
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