Problems relating to veins, especially in the legs, can affect a group member’s productivity when the you-know-what hits the fan. Varicose veins, skin changes, and blood clots can severely impact the health and quality of life of loved ones in good times or bad.

Millions, especially over the age of 50, experience issues with veins. Normal veins have one-way valves that keep blood flowing in the right direction. Over time, weakened or damaged valves can cause blood to pool (called “stasis”) and even flow backwards. As a consequence, the veins grow larger and become distorted, resulting in the classic appearance of varicose veins.

Varicosities are most commonly seen in people who are:

• 50 years of age or older. The valves in your veins weaken as you age.
• Have a family history.
• Female. High levels of estrogen as seen during puberty, pregnancy, and while taking birth control pills increase your risk.
• Obese. Extra weight puts pressure on the veins and causes them to swell.
• Work in a profession that requires long periods of standing, lifting weights, or sitting with legs bent.

Although most cases are more cosmetic issues than anything else, inflammation in varicose veins due to poor circulation (known as “phlebitis”) can occur. Over time, the skin overlying these areas is damaged. Symptoms of stasis dermatitis with phlebitis include:

• Itchy, dry, and discolored skin, especially over varicose veins.
• Soreness over the affected area.
• Heaviness or achiness in the leg.
• Swelling, often on the inside of the ankle, improved after sleeping but worsening during the day.

Severe stasis dermatitis appears dark and hardened, with intensely itchy, scaly skin. The lower part of the calf may decrease in size, taking on the appearance of an upside-down bowling pin. Pain is common, and “leaky” skin breakdown may occur (see below). Tissue begins to degrade and form ulcers which are hard to eliminate.

Although surgical procedures to remove varicose veins may eliminate stasis dermatitis in normal times, the off-grid medic’s strategy must be, instead, to treat the symptoms and improve quality of life. The treatment involves using compression stockings or elastic wraps to provide support, moisturizers for dry skin, and elevation of the affected limb above the heart to decrease swelling. Pain meds can be used as needed. Open wound care, antibiotic creams, or raw honey may be needed if there are skin ulcers. The medic should encourage sufferers to accumulate these supplies in their storage.

Besides the skin manifestations of varicose veins, the medic might be confronted by one of these complications:

Thrombophlebitis: In superficial thrombophlebitis, a varicose vein on the surface of the skin becomes inflamed due to a blood clot. 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 with elastic support hose for 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 cause. Sometimes, the condition improves on its own.

As an aside, a blood clot in a hemorrhoid (discussed elsewhere in this book) is a type of superficial thrombophlebitis.

Deep vein thrombosis (DVT): In DVT, a blood clot 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 seen 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. Indeed, shortness of breath may be the only symptom noticed. This is referred to as 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, as each tree may have variable amounts of Salicin. Do not attempt this treatment on someone who is also on blood-thinning medications such as warfarin (Coumadin).

Besides wearing simple support hose, encourage patients with varicose vein issues to:

1. Exercise their legs to improve tone; this will provide support to the blood vessels.
2. Avoid standing for long periods of time.
3. Shift their weight from foot to foot often.
4. Take short walks if they sit all day.
5. Keep their weight down to avoid putting strain on their legs.
6. Elevate their legs above the level of the heart for a half hour daily and during sleep.
7. Avoid wearing high heels for long periods (probably not an issue in the aftermath of a disaster).
8. Eat a low-salt diet. Less salt consumption can help with the swelling seen with varicose veins.

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. Take 300 mg of horse chestnut seed extract (usually contains 50 mg of aescin) by mouth twice daily. For external use only, create a mixture of 4 parts witch hazel with 1 part tincture of horse chestnut and rub on affected varicosities. Be aware that this is dangerous for those with liver or kidney disease; horse chestnut can be fatal if eaten raw.

Joe Alton MD

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