Chronic venous insufficiency: Types, symptoms, causes, and treatment

Venous insufficiency is fairly common. According to the Society for Vascular Surgery, it affects up to 40 percent of people in the United States.

It is also usually chronic. This condition causes leg and foot swelling, varicose veins, and aching legs.

In this article, we cover the causes and risk factors for venous insufficiency, as well as how to diagnose and treat it.

What is venous insufficiency?

The heart pumps oxygen-rich blood through the arteries to the rest of the body, while the veins bring deoxygenated blood back to the heart.

When a person has venous insufficiency, their veins have trouble moving deoxygenated blood from the arms and legs back to the heart. Faulty valves inside the veins usually cause venous insufficiency.

Veins have valves made up of two flaps, which prevent the backward flow of blood. These are called bicuspid valves. If the veins are damaged or become dilated, the valves may fail to close properly.

When the valves do not work properly, blood will flow back into the veins instead of forward to the heart. This causes blood to pool in the veins, often in the legs and feet.

This results in many of the symptoms associated with venous insufficiency, such as skin discoloration, swelling, and pain.

Symptoms

Some of the symptoms of venous insufficiency include:

  • heaviness, throbbing, or dull aching in the legs
  • swelling of the legs and ankles
  • cramping or itching in the legs
  • patches of darker, brownish skin
  • thicker or harder skin on the legs or ankles
  • open sores
  • blood clots
  • varicose veins

The following factors are more likely to cause venous insufficiency:

  • having a family history of the condition
  • having blood clots
  • having varicose veins
  • being pregnant
  • having obesity
  • smoking
  • having phlebitis, or swelling of superficial veins
  • sitting or standing for long periods of time

Treatments

The best treatment for chronic venous insufficiency will vary from person to person. Doctors must consider several factors before deciding on the best treatment course.

Some of these factors include the cause and symptoms of venous insufficiency and the age and health status of the person.

Treatments for chronic venous insufficiency include the following:

Medications

Healthcare provides may prescribe medications that improve blood flow through the vessels. Some medications that can help treat venous insufficiency include:

  • diuretics, which are medications that remove excess fluid from the body
  • pentoxifylline, which reduces inflammation and improves blood flow
  • blood thinners, or anticoagulants, which prevent blood clots

Home remedies

People can reduce the symptoms of venous insufficiency at home using the following methods:

  • Wearing compression stockings. These are special elastic stockings that apply pressure to the lower leg and foot. Compression stockings help reduce swelling and improve blood flow.
  • Elevating the legs above the heart. This helps pull blood from the legs toward the heart
  • Practicing good skin hygiene. People with venous insufficiency can develop skin problem, such as dermatitis, cellulitis, or atrophie blanche (white atrophy).

People with venous insufficiency can take care of their skin using the following methods:

  • keeping it moisturized so that it does not become dry or flaky
  • exfoliating regularly to remove dead skin cells
  • applying topical ointments as their healthcare provider instructs

A physical examination is the first step toward diagnosing venous insufficiency. A doctor will also review a person’s medical history and current health status before making a diagnosis.

Diagnostic procedures that help determine whether or not a person has venous insufficiency include:

  • Venogram. This examination uses X-ray technology to examine how blood flows through the veins. It requires injecting contrast material into a vein. Healthcare providers uses venograms to locate blood clots and evaluate varicose veins.
  • Duplex ultrasound. This noninvasive test examines the speed and direction of blood flow through the veins and arteries.

Additional medical tests for venous insufficiency can include:

  • CT scan
  • MRI scan
  • blood tests

Prevention

Many of the risk factors associated with venous insufficiency are related to a person’s lifestyle. People can reduce their risk of developing venous insufficiency by making small lifestyle adjustments, such as:

  • getting regular exercise
  • avoiding wearing high heels
  • avoiding standing or sitting for long periods of time
  • maintaining a healthy body weight

Summary

Venous insufficiency is common condition in which the blood does not flow smoothly through the veins and back to the heart. This is due to faulty valves in the veins.

Venous insufficiency is a common condition. It is not life-threatening, but it is usually chronic.

Symptoms of venous insufficiency include varicose veins, swelling, and heavy, aching legs.

Left untreated, venous insufficiency can lead to other health conditions, such as dermatitis, venous ulceration, and chronic venous hypertension.

Treatment of venous insufficiency varies depending on the severity of the symptoms, the individual’s medical history and current health status, and the cause of the condition.

Treatments for venous insufficiency focus on managing symptoms and preventing further complications. Those who have had venous insufficiency require ongoing care even after successful treatment, as the condition often reappears.

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Chemo-brain IS real: How cancer treatment causes mental fog

Chemo-brain IS real: Scientists discover how cancer treatments damage white matter to cause mental fog

  • More than half of cancer patients treated with chemo experience brain fog 
  • ‘Chemo-brain’ is a recognized phenomenon, but poorly understood
  • Stanford University researchers found that chemo affects three types of cells in the white matter 
  • They also discovered that a drug that may block and reverse these effects 

Scientists have finally begun to work out what exactly ‘chemo-brain’ is – and may have found a way to reverse the brain fog cancer treatment cause, a new study reveals. 

More than half of patients that receive chemotherapy report experiencing a cognitive fog for months and sometimes years after undergoing the intensive cancer treatment, but doctors haven’t really understood what causes this. 

A team of Stanford University scientists, however, have identified chemo’s effects on three different types of brain cells. 

They think that chemo causes a sort of arrested development for some brain cells and blocks the activity of cells that help ensure our brain cells are well-fed with nutrients because the drug triggers an overly-active immune response. 

In their experiments on mice, a drug to quell those immune cells helped to reverse chemo’s cognitive effects, giving the team hope that a treatment could be on the horizon.  

More than half of cancer patients who undergo chemotherapy experience ‘brain-fog.’ A new study reveals how the drug affects three types of brain cells – and a potential way to reverse it

The advent of chemotherapy was a revolution in the treatment of cancer.

Around the time of World War II, the US military’s tests of mustard gas led to the discovery that compound based on mustard gas could combat some cancers. 

Soon thereafter, the predecessor to the now commonly-used methotrexate was discovered. 

Tumors grow when a DNA mutation allows cells to divide and multiply out of control. But methotrexate’s predecessor blocked that DNA from replicating, so it blocked cancer growth, too. 

Chemo’s roots in poisons and warfare are telling. Any chemotherapy is toxic to us – it’s just most toxic to carcinogenic cells.   

And our body responds accordingly. chemo often makes patients nauseous, unable to eat, makes them achy and tired and makes their hair fall out. 


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Most worryingly to many cancer patients, chemo often comes with a decline in cognitive function that can last far longer than the treatments – or even the cancers, in some cases – themselves do. 

Chemo-brain was once dismissed as a wive’s tale. 

Even the world-renowned Mayo Clinic still calls the term ‘misleading’ and says that it is ‘unlikely that chemotherapy is the sole cause of concentration and memory problems in cancer survivors. 

We are at last beginning to understand what role it does play, however. 

The Stanford researchers focused on the neuron-supporting brain cells in the white matter. 

Three particular types seemed implicated in chem-brain: oligodendrocytes, astrocytes and microglia. 

Oligondendrocytes produce myelin, the coating that protects neurons. If these sheaths are damaged incomplete or missing, signals sent between brain cells are liable to interference. Like a radio, the signals might not come through clearly – or at all. 

Astrocytes lay important supporting roles for neurons, making sure that they are running smoothly and getting sufficient nutrition. 

And microglia are the brain’s own personal immune system. 

The researchers gave some mice with cancer chemotherapy, and left the others untreated.   

In the brains of those who had had chemotherapy, the myelin-producing cells never reached maturity, so they couldn’t produce sufficient myelin to protect the neurons. 

As a result, the mice moved more slowly, and had a harder time recalling elements of an environment that should  have been familiar to them. 

Even when they were injected with cells that would become oligondendrocytes from healthy mice, the cells got stuck in a state of arrested development in the chemo-treated mice’s brains, suggesting it was something about the toxicity of the brain environment that was interfering with this process. 

On the other hand, chemo seemed to supercharge the brain’s immune cells. The microglia were ‘persistently activated’ for at least six months after chemo was administered. 

They were on the defensive, behaving as if there was an infection or other pathogen to fight off, which likely meant prioritizing defensive action over other functions like nutrition. 

Indeed, the overactivity in the microglia interfered with the astrocytes, and the neurons struggled to get enough nutrition, which could be an additional cause of brain-fog. 

Remarkably, the Stanford researchers discovered that they could use a drug that attacked the microglia to restore the balance between them and the nutrient-feeding cells – reversing the cognitive effects of the chemo. 

‘The biology of this disease really underscores how important intercellular crosstalk is,’ lead study author and Stanford neurologist Dr Michelle Monje said. 

‘In addition to existing symptomatic therapies – which many patients don’t know about – we are now homing in on potential interventions to promote normalization of the disorders induced by cancer drugs. 

‘There’s real hope that we can intervene, induce regeneration and prevent damage in the brain.’     

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Adenomyosis causes pain, heavy periods and infertility but you’ve probably never heard of it

Adenomyosis is a condition of the uterus (womb), where the tissue that grows on the lining of the uterus (also known as the endometrium) is also present on the inside muscular wall of the uterus. Adenomyosis can cause symptoms such as heavy bleeding during your period, bleeding when you are not due for your period, period pain (dysmenorrhea), pain during or after sex (dyspareunia) and infertility.

Although women with adenomyosis often also have endometriosis, they are different conditions. With endometriosis, cells similar to those that line the uterus are found in other parts of the body such as the fallopian tubes, the ovaries or the tissue lining the pelvis (the peritoneum).

The area of the uterus affected by adenomyosis is known as the endometrial-myometrial junction, which is where the endometrium and the myometrium (the muscular part of the uterus) meet.

Disruption in the endometrial-myometrial junction is now considered an important contributor to reproductive problems such as recurrent implantation failure, a condition that can prevent women falling pregnant. Adenomyosis can either be quite spread out, known as generalised adenomyosis or localised in one place, also known as an adenomyoma.

Adenomyosis can have a number of causes though none have been definitively identified. There is an association between the presence of adenomyosis and the number of times a women has given birth: the more pregnancies, the more likely you are to have adenomyosis. Women with adenomyosis have also often had a trauma to the uterus such as surgery in the uterus, like during a caesarean section.

How common is adenomyosis?

Like endometriosis, we don’t know exactly how many women may be affected by the condition. What makes the impact of adenomyosis so tricky to determine is that it is quite commonly found during regular screening tests, even when women are not complaining of any symptoms, which means many women may have it and not know about it.

Because it’s often found in women with other conditions like endometriosis, it’s difficult to determine which condition caused the symptoms. We don’t currently know why some women with adenomyosis have symptoms and others don’t.

There are also a number of different criteria for diagnosing adenomyosis, which can differ in important factors. For instance, the number of sections of adenomyosis that need to be affected for a diagosis when looking at tissue samples under a microscope. This makes it a problem when we try to work out how common adenomyosis is.

There can also be differences of opinion among the experts who look at these tissue samples. Experts can look at the same slides and come to very different conclusions.

How is it diagnosed?

Unlike endometriosis, which can only be definitively diagnosed through a key-hole surgery, a diagnosis of adenomyosis can be done through both invasive and non-invasive methods. The most common invasive method is a uterine biopsy (tissue sampling). A biopsy of the uterus can also be performed to make the diagnosis by an abdominal key-hole surgical procedure (laparoscopy) but this remains limited to clinical trials.

Biopsies going through the vagina up to the uterus may have a role in the diagnosis of adenomyosis, but can potentially damage the uterus and therefore are avoided in women wishing to fall pregnant. The ultimate biopsy is a hysterectomy (the removal of the uterus). This is the most accurate method but is obviously a significant surgical procedure and will prevent women having children. A diagnosis of adenomyosis has been made in between 10-88% of hysterectomy specimens showing how common this condition is.

Non-invasive diagnosis can be made by different types of imaging. Ultrasound is commonly available and can be done either using the probe on the abdomen or, preferably, placing the probe in the vagina.

However, ultrasound isn’t always the best choice as it only detects adenomyosis about 50-87% of the time. Magnetic resonance imaging (MRI) is a better choice as there are a number of typical features seen during MRI. These vary throughout the cycle and in response to hormonal therapy but can reliably predict adenomyosis.

What are the treatments?

Management options for adenomyosis include hormonal therapy and surgery. These are mainly targeted at reducing symptoms such as pain. There isn’t much research into whether these increase the chance of getting pregnant.

Hormonal treatments focus on suppressing menstruation. This can be achieved by combined oestrogen and progesterone therapy (such as the combined oral contraceptive pill), progestogen-only treatment (such as a Mirena) or placing women into an “induced” menopause (through GnRH analogs).

Surgical treatment is most effective when the adenomyosis is localised to a smaller area and can be removed, and this type of surgery doesn’t prevent women falling pregnant in the future. If the adenomyosis is spread throughout a larger area then treatments include destroying the lining of the uterus (endometrial ablation) provided adenomyosis is not too deep, and hysterectomy, both of which will prevent further pregnancy.

Other treatment options are interventional radiology such as uterine artery embolisation, where the blood supply to the uterus is cut off and magnetic resonance-guided focused ultrasound where the adenomyosis is destroyed with ultrasound energy.

Does it affect fertility?

There is some evidence adenomyosis can reduce fertility, but this is still controversial. Clinical studies are limited by difficulties and differences in diagnosis and their study designs have problems.

Some MRI studies show changes consistent with infertility, but because patients presenting with infertility in their 30s and 40s are more likely to be diagnosed with adenomyosis, it’s difficult to say if adenomyosis is the cause of their fertility issues.

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