The Epidemic of Leg Swelling

Pitting edema can be seen in thin as well as heavy patients.  Support hose and exercise can help you

In the last few years, life style changes such as increases in rapid transit, work hours, and family involvement has brought about the demise of going for nice walks. This has been detrimental to our leg health. Physicians 10 years ago saw 1 of 10 patients with pitting edema. Today it is 8 out of 10 patients who otherwise seem to be healthy have pitting edema. This is in thin as well as heavy patients. Even though our understanding of the venous system has increased and our physician’s diagnostic tools have become better, the incidents of deep vein thrombosis has not lowered.

It is imperative that we promote a restoration of walking to our activities of daily living as a foundation of leg health and to reverse the epidemic of leg swelling. The calf muscle is a secondary pump to the heart to aid in returning the venous blood to the heart for re-oxygenation. The key to getting the most out of this secondary pump is to have a good walk (two miles a day) with unrestricted ankle range of motion at a moderate pace on a relatively flat surface.  This will allow for greatest “pump” from the calf muscle.

Increase walking activity to reduce the epidemic of leg swelling

Dr Dean Wasserman of the Vein Treatment Center of New Jersey believes a patient’s understanding and compliance with wearing compression stockings is key to the results obtained with Sclerotherapy which he performs. He also believes that while wearing compression stockings and walking will not cure venous insufficiency, moderate walks of 2 miles a day with good heel to toe action will enable his patients to “walk off” their edema within an average of 2 weeks.

If you cannot walk because of joint pain, please try riding a bicycle, which will eliminate the impact to your feet or joints. You will still receive the added calf pump action which assists in the blood flow plus you get the added benefit of seeing the neighborhood scenery by going thru the parks with bicycle paths and you will probably be able to meet other people doing the same thing.

The increase in leg swelling is subtle and menacing. Even though we hear much about incidents of edema), we are failing to actively participate in our own leg health by getting more exercise. No matter what we do for exercise, anything is better than being a couch potato and watching television.  Our sedate lifestyles have lead to many physical health problems and shorter healthy lives. Being overweight is one of the most dangerous things we can do to our bodies!  Obesity leads to heart problems, diabetes, and many other diseases.  So let’s wear our support hose and get out there and reverse the epidemic of leg swelling and by walking or bicycling!!

Relationship of Compression Hose on Venous Insufficiency and RLS

The most perplexing part of RLS is that when a patient lies down and tries to relax, the attempt triggers the sensations and the sensations prevent relaxation.Restless Legs Syndrome (RLS) is a group of disorders in which patients often experience great urges to move the legs to relieve uncomfortable or unpleasant sensation in the legs. The symptoms seem to be located deep in the legs usually between the knee and ankle. RLS can sometimes be unilateral and can also exhibit a wide range or severity ranging from occasionally to nightly. Movement of the legs only helps relieve the urge temporarily.

The most perplexing part of RLS is that when a patient lies down and tries to relax, the attempt triggers the sensations and the sensations prevent relaxation. Symptoms of RLS are worse in the evening when the patient is trying to watch television or relax and generally diminish late in the night. Many patients have trouble falling asleep and staying asleep. Patients are usually asymptomatic by morning. The reason for this is unknown. RLS can affect concentration, memory, stamina and impair job performance.

The worst cases of RLS are generally seen in middle age or older patientsBetween 5% and 15% of the American and European population are affected by RLS. Women are more likely to be affected by RLS. Age at onset can be as young as infancy or early childhood. Approximately 2% of children and adolescents have symptoms of RLS. Sleep disturbance is significantly more common in children and adolescents with RLS, as are “growing pains.” Incidence of RLS increases with age. Symptom severity increases in times of stress and as time goes by. The worst cases are generally seen in middle age or older patients. In certain cases, arm involvement can occur.

RLS is a group of disorders with similar symptoms. RLS is divided into Secondary RLS and Primary RLS (idiopathic because the cause remains unknown). Various medications or other treatments work in only a percentage of affected patients. There are around twenty recognized causes of Secondary RLS. RLS is often misdiagnosed, as many sleep and movement disorders share similar characteristics. Once the diagnosis of RLS is confirmed, possible secondary causes should be considered and corrected before the diagnosis of Primary (idiopathic) RLS is entertained. Only by treating underlying secondary causes can RLS patients achieve long-term symptom relief, thus avoiding chronic drug therapy geared at daily symptom control. Unfortunately, Primary and Secondary forms of RLS cannot be differentiated based on their clinical characteristics. Only after eliminating all causes of secondary RLS can Primary RLS be established.

The best remedy for RLS is to treat the underlying condition. The proper treatment of the underlying condition is obviously quite different for each of them. Treating the underlying condition is impossible in Primary RLS, but usually practical in cases of Secondary RLS. Despite this fact, most RLS patients never attempt to determine the underlying cause of their condition. Instead of seeking long-term correction of the underlying source of their symptoms, they simply focus on nightly symptom control in order to “just get some sleep.”

RLS Risk Factors

* Family history present in 50-70% of patients with RLS
* Prevalence increases with age (More prevalent in women than men)
* Smokers
* People that exercise less than 3 hours per month
* Diabetics are 4 times as likely to have RLS

To combat RLS get plenty of exercise, eat a balanced diet and stay active during evening hours.Researchers have noted that some patients with RLS have varicose veins. They hypothesize metabolites left in the legs due to the venous congestion may be a cause of RLS and concluded that: “It is possible that the condition is due to a functional vascular disorder.” In 1995 Dr. A.H. Kanter published his groundbreaking study reinforced the evidence that RLS can be caused by varicose veins when he found Sclerotherapy to be 98% effective in the initial relief of RLS symptoms. Dr. Kanter concluded that all patients with varicose veins and RLS should be considered for phlebological evaluation and possible treatment before being consigned to chronic drug therapy. Dr. Kanter stated: “Primary RLS is generally felt to be a condition in which an abnormal nervous system is reacting inappropriately to relatively normal legs. In RLS patients with venous disease, it appears that RLS is due to a relatively normal nervous system reacting appropriately to abnormal legs.”

The Phlebology article by Dr Clint Hayes, MD (one of our Texas Phlebologists and Researcher) described the results of a randomized, unblinded, parallel two-group, pre-post-test study funded by the American College of Phlebology, in which Endovenous Laser Ablation was performed of refluxing superficial axial veins using laser and ultrasound guided Sclerotherapy of associated varicosities. This study showed that operative correction of superficial venous insufficiency (SVI) in patients with SVI and RLS yielding to an average 80% improvement in RLS symptoms. We concluded that operative correction of SVI alleviates RLS symptoms in patients with SVI and moderate to very severe RLS, and recommended that SVI should be ruled-out in all RLS patients before drug therapy is initiated or continued.

It is becoming more apparent that, in an unknown percentage of RLS cases, the symptoms are secondary to underlying venous disease. Many of these patients have subtle physical findings not likely to be discovered with a cursory physical examination. RLS patients should therefore be properly evaluated for venous insufficiency by a vascular ultrasound technician familiar with the nuances superficial venous reflux (not simply the standard DVT evaluation). Any RLS patient found to have arborizing telangiectasias, varicose veins, or venous insufficiency should be referred to an experienced Phlebologist for appropriate evaluation and treatment.

It is important to note Dr. Hayes has suffered from RLS all his life. In his article in Vein magazine, Spring 2010, it is noted that he has no associated venous disease, but states that “RLS may some how be linked to edema because when I wear graded compression stockings in the operating room, I sleep just fine that night. If I don’t wear my stockings while I operate, I note pretibial edema when I get home, and kick all night long.” He also states “This is another study that needs to be done to determine the impact of compression hose on venous insufficiency and RLS”

The American Venous Forum (AVF) and companies such as BSN Medical (Jobst), Mediven, Sigvaris and Juzo are actively sponsoring many research programs such as how compression stockings affect vein disease and vein health. A particular field for future study is the impact compression stockings have on Restless Leg Syndrome!

What can you do? Please keep your Physician aware of the impact compression stockings have on your life style and how they have impacted you health.

The Certified Fitters at Support Hose Plus will be glad to assist you and your fiends in the ins and outs of compression stockings. As you know, carries all the major brands of support hose, so irregardless of the size or height of the person we will be able to fit most in the correct stockings.

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