Varicose veins are dilated blood vessels, usually in the legs, which have lost tone in the valves that control blood flow.  This swelling of the vascular structures occurs in about 15% of the population, and becomes more common with age (50% over age 50).  Women are several times more likely to have this problem than men.

Varicosities are gravity dependent; they may be more common in people whose occupation requires constant standing. In a power-down setting, we will be spending more time on our feet by necessity.  Therefore, we must plan to prevent, if possible, and treat varicose veins before they become serious.

Varicose Veins and Spider Veins

Varicose veins are similar to but not the same as “spider veins”. Spider veins are tiny vessels called capillaries and exist everywhere in your body.  When they become varicose, they appear like little red or blue spider webs; you may find them on your legs, face, or just about anywhere. People with fair complexions seem to get more of them.

Classically, varicose veins are larger, blue, swollen, and stick out from the skin.  They tend to look twisted or contorted. Varicosities cause the circulation to become less efficient. This causes pain and fatigue in the legs, and could lead to an inflammation known as “phlebitis”.

You’re more likely to get varicose veins if you:

•  Are 50 years of age or older. The valves in your veins weaken as you age.
•  Have a family history.  If your mother had varicose veins, you are likely to get them as well.
•  Are a woman.  High levels of estrogen as seen during puberty, pregnancy, and while taking birth control pills increase your risk.
•  Are obese.  Extra weight puts pressure on the veins and causes them to dilate.
•  Work in a profession that requires long periods of standing, lifting weights or sitting with your legs bent.
•  Spend longs hours in the sun, especially if your complexion is fair. You may notice them first on your cheeks or nose.

Complications from Varicose Veins

Besides the discomfort and an unpleasing cosmetic appearance, varicose veins are usually not dangerous.  Occasionally, however, you might see one of these complications:

Thrombophlebitis: a varicose vein on the surface of the skin can become inflamed; this is due to a blood clot which formed due to the poor circulation in the area. Symptoms include:

• Painful swelling
• Warmth to the touch
• Redness (sometimes along the line of the vein).
• Tender, hard nodules
• Itching
• Fever

Basic treatment involves moist warm compresses and anti-inflammatory medicine for discomfort and fever. Elevation of the affected extremity may be useful. Elastic support hose is helpful while performing activities of daily living. Although most cases of thrombophlebitis are not due to infection, antibiotics are occasionally needed.  Cephalexin (Keflex) is known to have activity against Staphylococcus, the most common bacterial culprit. As an aside, hemorrhoids are a type of superficial thrombophlebitis; look for an article on the subject in the near future.

Deep vein thrombosis (DVT): A blood clot that forms in a DEEP vein. The patient will experience a “full” or “firm” feeling, usually in the calf area.  This will be accompanied by pain, heat, swelling, and redness as in superficial thrombophlebitis.

While many people may present with no symptoms at all, a DVT can be dangerous if the blood clot dislodges and makes it way to the lungs or other vital organs.  Indeed, shortness of breath may be the only symptom noticed.  In this circumstance, a blood clot may have already made it into the lung.  This is referred to a “pulmonary embolism” and is possibly life-threatening.  Other signs and symptoms may include breathlessness, chest pain, a fast heart rate, panting, and/or bloody phlegm.

In addition to compresses and pain relief, patients with deep vein thrombosis may require blood thinners; Salicin from the under bark of willows, poplars, and aspens is a natural alternative if the pharmaceuticals have run out. The amount given using this method will, however, always be uncertain. Each tree may have variable amounts of Salicin. Do not attempt this treatment on someone currently on medications such as Coumadin.

If your patient has varicose veins, have them stock up on compression stockings or support pantyhose while times are good.  These will be unavailable in a collapse setting and neither will curative treatments like surgery, lasers, or chemical injections. If the resources are there to eliminate this issue in normal times, consider doing so. Encourage your patients at risk to:

•  Exercise their legs to improve tone; this will provide support to the blood vessels.
•  Avoid standing for long periods of time. Shift their weight from foot to foot often and take a short walk if they sit all day.
•  Keep their weight down to avoid putting strain on their legs.
•  Elevate their legs above the level of the heart for a half hour daily, and perhaps during sleep.
•  Wear support stockings.
•  Avoid wearing high heels for long periods (I doubt you’ll be wearing high heels after a disaster).
•  Eat a low-salt diet. Less salt consumption can help with the swelling that you see with varicose veins.
•  Wear sunscreen; this will limit spider veins in people with fair complexions.

The herbal remedy most quoted to treat varicose veins is the horse chestnut (Aesculus hippocastanum. Horse chestnuts contain a substance called aescin, which appears to block enzymes that damage capillary walls. Make a tincture (grain alcohol-based mixture) with the herb and take 1 tablespoonful up to 3 times a day.

For external use only, rub a mixture of 4 parts witch hazel with 1 part tincture of horse chesnut and rub on affected varicosities.

Hopefully, you will never seen a deep vein thrombosis or pulmonary embolism in times of trouble.  However, you will see varicose veins; knowing how to deal with them will improve your group members’ comfort and functionality.

Dr. Bones