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Venous disorders and management

Sujal Torgal Patil

 

As we age many of us find jagged purple lines or swollen bluish cords spreading across our thighs and calves. What are these lines? These warped blood vessels occur in up to 60 per cent of adults. Chronic venous insufficiency in the form of varicose veins is a common complaint amongst teachers, drivers, tailors, security personnel, soldiers, rickshaw pullers, etc. Venous disorders are on a rise today owing to the drastic deterioration of dietary standards and poor lifestyle choices. The veins in the legs carry blood back to the heart. They have one-way valves that keep blood from flowing backwards. In cases of chronic venous insufficiency (CVI), the valves don’t work like they should and some of the blood may go back down into the legs. This causes blood to pool or collect in the veins. As blood pools within the vein, pressure builds and the vessel wall weakens. As a result, the vein tends to bulge and twist. Depending on the size of the blood vessel and extent of swelling, the result is a spider vein or varicose vein.

According to ayurveda, it is an imbalance in the functions of vata dosha which is primarily responsible for normal blood circulation. Secondly, the on-site disease element ie the venous system or siras (in Sanskrit) are said to be affected by an abnormal increase in vata dosha and also associated vitiation of the rakta dhatu (blood tissue) due to dietary and other factors. They lose their normal structure and elasticity and succumb easily to the stasis of blood. These pathological changes are usually associated with AMA or endotoxins which are formed in the body as a result of faulty digestion. Therefore, this needs to be rectified as a first step while treating venous disorders.

 

Causes

Dietary causes: Excessive intake of dry, cold, arid, hard, heavy foods, curds and fermented food products, junk or processed foods, caffeinated drinks or even excessive tea or coffee may lead to gradual varicosity of veins.

A blood clot in a deep vein in the leg (called deep vein thrombosis) can damage a valve or there could be a congenital absence of valves.

Lack of exercise can cause CVI too. So can sitting or standing for a long stretch of time which raises the pressure in the veins and may weaken the valves.

Women are more likely to get CVI. Chances also might be higher in individuals who smoke, are over 50 years of age, pregnant women or those who have been pregnant more than once, with a family history of CVI or a history of blood clots.

Some dietary deficiencies may cause a loss of elasticity in the veins. Standing for protracted periods, engaging in physical activity that puts more strain on the legs, wearing constrictive clothing and total lack of exercise can give rise to varicosity.

 

Symptoms

In the initial stages, symptoms could be minor twitching in the veins due to pooling of blood, dull ache or mild itching. Over a period of time there could be an increase in pain, heaviness or cramping in legs, itching and tingling in the affected area, pain that gets worse when standing and pain that gets better when legs are raised.

Skin changes in the legs include swelling of the legs, irritated or cracked skin if you scratch it, blackish discolouration the affected area, red or swollen, crusted, or weepy skin (stasis dermatitis), and varicose veins on the surface, thickening and hardening of the skin on the legs and ankles. In severe conditions there could be wounds or ulcers on the legs or ankles.

Modern science includes control measures like wearing compression stockings to improve blood flow in the legs. Certain drugs to manage skin conditions, pain or sore could be prescribed symptomatically. In advanced cases, invasive procedures like sclerotherapy, phlebectomy, a laser or radiofrequency procedure and varicose vein stripping are advised.

Ayurveda lays emphases on an individual’s dietary regimen and lifestyle as follows.

Diet: One’s diet should consist of light and warm meals every day. Avoid excessively dry or oily food. Include bitter vegetables like amaranth, fenugreek, bitter gourd, bottle gourd, ridge gourd, snake gourd and spinach in the diet. Always drink boiled water throughout the day even if it is filtered. Reduce tea or coffee and alcohol. Avoid non-vegetarian foods, bakery products, excessive sweet foods and refined flour products. It is important to not eat unless hungry. Reduce the intake of salt and sour items too as they vitiate the blood tissue.

Lifestyle: One’s lifestyle should not be too exhausting or too sedentary. Avoid standing, sitting or being in one position for a long time as it causes poor blood circulation. Avoid exerting any kind of pressure on the abdomen, especially while passing stools or pushing or pulling something manually. Avoid tight clothing and rule out other causes of abdominal pressure like portal hypertension, etc. Avoid controlling natural urges like urination, defecation, sneezing, etc. If your job demands standing for a long time, take breaks in between and rest, stretch your leg muscles often to increase circulation. While sleeping keep the legs elevated for some time every night. Wearing varicose socks or stockings helps to some extent in reducing the pooling of blood. If you’re pregnant, try to sleep on your left side rather than your back.

Exercise: Forms a very important part of management as it facilitates the upward movement of blood, and thus avoids stasis thereby reducing swelling and pain and tones the muscles. Daily walks, mild jogs, swimming or cycling will facilitate venous return. Yoga asanas include virasana, sarvangasana (shoulder stand should be practised for 10 minutes daily if possible), kapotsana, bhujangasana, shavasana, halasana and pawanmuktasana.

One particularly beneficial manoeuvre is to elevate the legs while lying on your back. This should be done four or more times daily for 20 minutes. Exercise the feet by pointing and flexing (forward and backwards).

 

Treatment

The prognosis with ayurvedic management is excellent. It includes ruling out the causative factors related to diet or lifestyle, improves the health of the venous system by strengthening the veins with medications to improve metabolism, removes endotoxins for blood purification to improve circulation, etc.

External therapies if required can be administered. For example like various medical packs, lymphatic drainage treatment (not directly on the vein), panchakarma procedures like blood-letting or leech therapy are only to be administered in cases which are specifically indicated. Surgical intervention is to be considered in severe cases provided one follows dietary and lifestyle guidelines to avoid relapse.

(Writer is chief medical officer at Traya Natural Health Centre and can be reached at wellnesstraya@gmail.com)

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