Varicose veins are swollen veins in the legs

The affected area will be painful and turn red

The risk for varicose veins is related to older age

Immobility, pregnancy or obesity and overweight

Varicose veins can cause an itchy rash or dermatitis

Inflammation of the varicose veins called phlebitis

Discolored skin in the area around the varicose vein

Due to the leakage of a blood dye called hemosiderin

Blood clot can occur in the vein due to inactivity

Medicine such as the Pill may increase coagulability

It may be a sign of deep vein thrombosis

A venogram will confirm the diagnosis

Treatment is with compression stocking

With regular exercise and avoiding standing

Sclerosing of the varicose vein can be by injection

Surgical removal is done by stripping and vein ligation

-An original poem by Kenneth Kee

Varicose veins are quite common in Singapore women especially those who have to stand for long periods such as teachers, housewives, pregnant women and hawkers.

There are so many patients who have swollen large varicose veins in their legs, some not complaining, others with infected ulcers which are made worst by diabetes and poor blood circulation.

This patient is a 52 year old housewife who had 5 pregnancies each of which cause her varicose veins to be come worse.

She had varicose veins since 10 years ago.

Recently the veins become swollen and painful.

In spite of many treatments by other doctors both public and private, her varicose disorders did not improve.

After Chinese medicines cause ulcers in one varicose vein near the ankle of her varicose veins, her family brought her to see me.

To me the most important goal of treatment was to treat the ulcer before going on treat the varicose veins.

I had to do a complete debridement of her ulcers patiently cleaning it, applying antibiotic ointment and wrapping her whole leg from foot to knee with bandages to ensure proper flow of blood.

A compression stocking was used over the bandaging to ensure blood flow is good.

Fortunately she did not have any diabetes or any other illness which may affect the healing of her wound.

Hydrogen peroxide slightly diluted is one of the best cleaning solution for any wound because it provides oxygen and at the same time the bubbling oxygen will bring any debris to the surface.

I use it all the time for my patients.

She was told to return daily for cleaning and application of antibiotic ointment.

While at home she was to keep her affected foot raised while sitting at home or sleeping.

She was allowed to walk with her compression stocking.

Slowly the wound become smaller and smaller until it finally closed.

Once the ulcer closed I told her that I was going to treat the vein which leads to the ulcer first to ensure that there is no recurrence of the ulcer.

I used an insulin syringe to inject the sclerosing chemical (phenol in almond oil used in hemorrhoid injection) into the vein before the ulcer to kill off the blood vessel under local anesthetic.

The leg was bandaged with a compression stocking placed over her affected.

The patient was initially apprehensive but she accepted my decision.

After 1 week of treatment the vein was found to be flat and did not give any problems.

I then referred her to a microvascular surgeon to remove the remaining varicose veins.

She had no more problems with her varicose veins after surgery

TABLE OF CONTENT

Introduction

Chapter 1 Varicosity of Vein

Chapter 2 Causes

Chapter 3 Symptoms

Chapter 4 Diagnosis

Chapter 5 Treatment

Chapter 6 Prognosis

Chapter 7 Peripheral Vascular Disease

Chapter 8 Venous Ulcers

Epilogue