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Varicose Veins - What You Need to Know

What are varicose veins?

The circulatory system is made up of the heart, veins, and arteries. Arteries carry oxygen-rich blood from the heart to nourish your tissues, while veins have one-way valves which channel oxygen-depleted blood back toward the heart. If these valves are damaged, the blood pools in the leg veins and leads to feelings of fatigue, heaviness, aching, burning, itching, cramping, restlessness, swelling and even eczema and leg ulcers.

What causes varicose veins?

Heredity causes most varicose veins. If one of your parents has varicose veins, your risk of having them is about 70%. Other predisposing factors include obesity, leg injury, multiple pregnancies and standing occupations, such as nurses, teachers, and barbers.

Are varicose veins a threat to my health or are they just cosmetic?

Varicose veins indicate that the pressure in the veins of the legs is too high (a condition called venous hypertension). Longstanding venous hypertension can result in damage to the deep leg veins and to the overlying skin. Impairment to the deep veins can lead to blood clots and sometimes to sudden death from pulmonary embolism. Blood clots are especially frequent if you are confined on a long plane or car trip. Injury to the skin will result in stasis dermatitis, pigment changes, thickened skin and possibly, leg ulcers with scarring. In addition, venous hypertension can cause pain, fatigue and swelling of the legs. The presence of increasing numbers of spider veins may also suggest venous hypertension.

Can these veins develop in one leg and not the other? Most patients develop varicose veins in both legs. However, the severity of the varicosities will differ. Some may require treatment, while others may only require compression stocking therapy.

Are all varicose veins visible from the outside?

No. Varicose veins may be deep enough that they are not visible. A duplex ultrasound evaluation of your legs is the best way to detect all varicose veins. This is a painless, noninvasive test using sound waves to detect the size of veins and direction of blood flow.

What are the options for varicose vein treatment?

A new procedure called endovenous laser ablation, or EVLA, has been available to treat varicose veins for about seven years. EVLA involves a nonsurgical laser procedure in which the laser fiber is inserted into the damaged vein and it is switched on, permanently sealing the vein shut. The blood that normally flowed through that vein is redirected into normal veins which carry it back to the heart. EVLA is performed under local anesthesia while you are awake and is very comfortable. Most people return to work the next day. EVLA is a safe and effective procedure that is replacing the older technique of surgical vein stripping. Another way to treat varicose veins is called foam sclerotherapy. For this treatment, no anesthesia is required and a small butterfly needle is used to deliver an FDA-approved sclerosant chemical to the veins. They immediately shrink and are cleared by the body's metabolism over several weeks to months. This procedure is relatively painless and is very safe. Vein stripping surgery is not performed very often nowadays since these newer procedures are so safe and effective.

Do these treatments cure varicose veins? After all diseased veins are treated, most people have a remission of symptoms, leg swelling improves and the skin begins to heal, including leg ulcers. Many patients do not have problems again for years. Due to many factors including heredity, however, some people are predisposed to future problems. Since there is no way to prevent other veins from becoming damaged, varicose veins may be an ongoing challenge for some patients.

Will my varicose vein treatment be very painful?

The degree of pain that a patient experiences during vein treatments varies from patient to patient. The survey we conducted indicated that most patients thought the procedure to be pain-free, while a few reported experiencing a moderate degree of pain. The amount of pain is dependent on several variables, such as age, sex, weight, and pain tolerance level.

Are there any side effects of the treatments?

As with any invasive procedure, risks of vein treatments include allergic reaction to one of the medications, bleeding, postoperative pain, infection, blood clots or nerve injury. If any of these side effects occur, they are usually temporary if promptly treated.

How long after laser treatments will I be able to return to my normal routine?

Most patients return to their normal routine the next day, however, you should not resume aerobics, heavy exercise routines, running, sports or travel for at least a month after your laser treatment. It is very important to walk at least thirty minutes each day after the procedure to prevent blood clots from forming in the veins. Walking on a treadmill is fine. Extended plane or car travel should be postponed for a month after the procedure.



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Blood Pressure and Its Implications on Exercise

Definition of Blood Pressure.

Blood Pressure (BP) is the pressure exerted on blood vessel walls by circulating blood.

What is the difference between Systolic and Diastolic blood pressure?

Systolic blood pressure is the pressure within the arteries when the heart contracts increasing blood flow through the arteries and therefore in turn the pressure. Diastolic pressure is when the heart is at a relaxed state so there is a decreased pressure through the arteries.

The two main determinants of blood pressure are Cardiac Output and Peripheral Resistance.

Cardiac output can be defined as the amount of blood pushed out of the heart in one minute, so the higher the amount the higher the blood pressure. It can be affected by two main determinants which are the stroke volume and heart rate. Generally as the heart rate increases, so does blood pressure, as the increased heart rate will mean more blood will be pushed through the arteries therefore increasing pressure. Stoke volume is normally increased by the body when its put under stress. As this increases it means the amount of blood being pumped out of the heart each beat is increased, and therefore squeezing more through the arteries and increasing blood pressure.

Peripheral resistance is the resistance the blood vessels put on the blood flow throughout the body it can increase and decrease due to vasoconstriction and vasodilatation, depending the stresses that the body is under.

High Blood Pressure (Hypertensive)

Recognised levels of hypertension (high blood pressure) are a systolic level above 160 mm HG or a diastolic of 100 mm HG or more. There are major risks associated with prolonged high blood pressure and these are coronary heart disease, stroke and heart failure. Recognised levels of hypotension (low blood pressure) are systolic readings of 100 mm HG or below or a diastolic reading of 60 or below, there are no real harmful effects of low blood pressure, apart from symptoms of dizziness, loss of consciousness and blurring vision.

Factors that affect a persons Blood Pressure

There are two different types of factors effecting both systolic and diastolic blood pressure these are acute and chronic factors. The acute factors that affect blood pressure (BP) are environmental stressors are placed on the body such as aerobic exercise and heavy weight training which will cause the body to increase the blood flow to cope with the demand of oxygen. Stress and Anxiety increase BP due to the chemicals released that will cause the heart to beat faster and work harder. Things like food, caffeine, and smoking all increase blood flow firstly due to digestion, caffeine increases alertness of the body which causes an increase in cardiac output and smoking inhibits the amount of oxygen we take in which means the heart has to work harder to push the oxygen that does get in the lungs around the body. Also in the long term it causes an increase of cholesterol causes a narrowing of the vessels and therefore increases in blood pressure.

Chronic factors, or more long term factors, that increase blood pressure increase both systolic and diastolic blood pressure. Once again stress and smoking are two factors and causes are as explained above. Nutrition can have a major effect on how the heart operates poor diet can lead to increased cholesterol and the clogging of the arteries etc, which means that pressure through the arteries will be increased due to the smaller circumference of the vessels that need to get through, this can also be applied to the obese person. Finally sedentary lifestyle will mean that the heart will be weak and the vessels will become more inflexible and a hardening of the arteries walls therefore they will not be able to vasodilate as much and therefore increase BP.

Common categories of hypertensive drugs.

What are there main effects and there possible implications for exercise?

The common categories of anti-hypertensive's are Beta Blockers, calcium channel Blockers, Antiotensin Converting Enzyme Inhibitors and Diuretics.

Beta Blockers - These drugs decrease the heart rate and in turn the cardiac output and increase coronary perfusion. It also decreases stroke volume which in turn again reduces cardiac output. They affect the training by making everything a lot harder and therefore it will seem like there is a decreased effort however there isn't it's a decreased workload but still the same amount of effort put in, overall they will slow the person down when training.

Calcium Channel Blockers - These drugs decrease myocardial contractility and block calcium dependent contractions to the smooth muscles in the arteries and in turn this increases vasodilatation. This can cause resting tachycardia (increased heart rate) which needs to be carefully monitored when exercising, also blood pooling can occur if exercised is suddenly stopped therefore it is important to have a long warm down at the end of a session.

Angiotensin Converting Enzyme Inhibitors - These block the angiotenmsin converting enzyme, which stops angiotensin I being converted to angiotensin II which is a powerful vasoconstrictor and this therefore blocks vasoconstriction. In exercise this can lead to dehydration so you must watch fluid intake throughout exercise regime, also as stated above sudden stopping of exercising again can cause blood pooling therefore a long cool down is recommended.

Diuretics - These reduce venous return as they increase secretion from the kidneys of water and sodium ions. Doing this can result in electrolyte imbalances causing a greater loss in potassium and magnesium. This may induce muscles weakness and possible cramps and cardiac dysrhythmias, therefore regular blood test at the doctors should be had to monitor potassium levels in the blood.

Exercise Consideration for people with High Blood Pressure.

Warm up and cool down for about 5-10 minutes to aid in vasodilatation of the vessels in the warm-up preparing the body for exercise and the warm up is essential to help to prevent the onset of post workout hypotension.

Aerobic exercise should initially start at a moderate level of about 60% gradually increasing over a period of 4-6 weeks to 70-75% effort. Effort should be judged using an RPE scale (Rate of Perceived Exertion). Exercise routine should last up to an hour and it is recommended also to do a few 10 minutes spurts of continuous exercise outside of the gymnasium routine.

Resistance work should be low in weight and high in reps about 15-20 per set and exercises should not go until concentric failure, avoid heavy weight above the head, and do not train in positions where the feet are above the head. Make sure there is a spotter there to help and choose more isolation exercises rather than compound movements.

The safest and most effective way to train is with a personal trainer, qualified in dealing with high blood pressure clientele. This will make sure that hypertension suffers will train at there optimum level whilst being exposed to a wide range of training styles, making progression much quicker, more effective and safe.



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