Why do our legs swell, ache, and often get red and sore? Many of you
have written to ask about leg problems. There are a number of conditions
of the lower legs that affect large people and I am going to focus on some
of the more common flesh and skin maladies in this edition's column.
Whether you are fat or thin, 40% of women suffer at some point from varicose
veins. The heart is a powerful pump that pushes oxygen-rich blood to the
tissues. However, once the oxygen is used up, the veins have to carry the
blood back to the heart and lungs on their own. In order to fight gravity,
to get blood from the feet, leg veins use a shrewd system of one-way valves,
just like an oldfashioned hand pump you may have seen on your grandmother's
farm. As we walk, our leg muscles intermittently bulge, squeezing the blood
in the veins upward. In between steps, when the muscles relax, we would
expect the blood to just fall back down, but the one-way valves close, preventing
People who stand for long periods, or live sedentary lifestyles, tend to
leave the blood in their leg veins bulging until the little valves get so
stretched that blood starts to leak backwards. The worn out, stretched veins
and valves eventually become permanent varicosities (from the Latin meaning
"swollen"). The term usually refers to visible engorged and twisted
veins. Because the blood stagnates in varicose veins due to gravity, little
fresh oxygen is around to feed the tissues. Skin and muscle may begin to
get sick. Sensations of heaviness, itching and soreness are the body's way
off trying to stimulate you to get moving and improve circulation.
Some are bothered by what they consider the ugly appearance off snake-like
blue veins on the legs. Others fear the potential development of blood clots
that might break off and go to the heart or brain. Blood clots, however,
are only a concern when the veins deep inside the leg are affected.
Varicose veins are more bothersome after long hours of standing when the
blood begins to pool. People who do heavy lifting, or are very large or
pregnant, or even those who are chronically constipated, are in essence
putting downward pressure on the veins. Straining during a bowel movement
for example (bending forward and grunting, etc.) tends to back up the blood
in the veins.
In very large folks a number of other factors make the legs even more swollen.
As we get older and our hearts work "overtime" to pump blood through
a larger body, they may begin to weaken. Blood then backs up and the fluid
creates swollen ankles and feet. You may have noticed a ring of indentation
where your socks or shoes fit, especially after a long hot day. If the swelling
is such that you can leave a doughy thumbprint in your skin, it may mean
a case of a mild heart problem. This swelling, combined with naturally larger
legs needed to support a heavier frame, leads to stretching of the skin.
If you notice that the skin of your shins is shiny and itchy, or especially
if it is red or warm, an infection might be brewing. Bacteria love to proliferate
in stretched and swollen tissues. If left untreated the skin may even acquire
sores or ulcers, especially if you are a diabetic.
Sounds devastating? Well it doesn't have to be. For most varicose veins,
conservative, non-surgical treatment includes adding fiber to your diet
if constipation is a problem. Don't strain when you have a bowel movement,
let nature take it slow and easy. Cool water baths shrink throbbing vessels.
Support hose or special stockings help squeeze the blood upward and prevent
painful swelling of ankles and feet. These should be fitted to you properly,
and should never be worn to bed at night (no kinky remarks please).
If you must stand for long periods, walk around from time to time to stimulate
blood movement and elevate the legs whenever possible. Try to actually lie
back and put legs up on a pillow, rather than just sitting with your legs
bent, which only kinks the vessels and prevents flow-back to the heart.
Avoid tight high-heeled shoes (you disco throwback you!)... go for comfort,
you'll walk more, boogie down, and improve circulation.
If tiny "spider-like" veins bother you, these can often be injected
with a solution that permanently collapses vessels although this is more
of a cosmetic procedure. Don't ever try this yourself; bleeding varicose
veins can be difficult to stop. Larger veins are often pulled out carefully,
like roots off a plant from the ground, in an operation called "vein
stripping." New or normal veins take over pumping blood back to heart.
Many doctors prefer a slightly more conservative stripping of just a part
of the veins under local freezing.
If the skin on your legs gets "beefy" red, is warm to the touch,
or forms little ulcers, get medical attention. Antibiotics and special antiseptic
creams can stop the infection known as cellulitis if it is caught early.
If you follow all this advice, you'll be fine and able to dance the night
away with me... I'll be waiting. ß