Scott Webb (Host): Varicose veins are common and often misunderstood, and my guest is here to explain varicose veins and tell us about some of the modern treatment options that can help patients. And my guest today is Dr. Frances Yu. She's a family medicine and wound care physician with Prisma Health.

This is Flourish, the podcast brought to you by PRISMA Health. I'm Scott Webb. Dr. Yu, it's nice to have you here today. We're going to get to the truth about varicose veins. Like, are our legs telling us something? Are our legs talking to us in the form of varicose veins? And I guess maybe in order to answer that, Doctor, like, what are varicose veins exactly?

Dr. Frances Yu: Varicose veins, patients come in, they're very concerned when they have these ropey like veins on their legs. And what are they? So, the text definition of varicose veins, they're enlarged, occasionally twisted-appearing, sometimes visible veins just under the surface of the skin seen in the legs.

But to really understand veins, we need to understand blood flow. So, it starts in the heart. The heart pumps oxygenated blood through the arteries to get to your organs and your extremities, like your fingers and toes. The oxygenated blood then needs to be brought back to the heart, and that is the job of the veins.

So, the veins have these little valves in them that kind of open and close and help to keep the blood flowing on track back towards the heart. It is having to flow against gravity, because unlike the arteries, it doesn't have the heart to help it pump.

So, one of the main reasons for why varicose veins occur has to do with the valves. When the valves weaken or fail, the blood can flow in the opposite direction down towards the feet, and that can kind of cause some pooling in the vein. This causes some increased pressure at leads to some vein stretching and hence, becoming varicose.

Now, one quick distinction I did want to make about varicose veins is that they're not the same as spider veins, which a lot of people come in to ask about as well. Spider veins are more of the like tiny damaged blood vessels that are visible just below the skin surface. They kind of resemble a bruise, almost like thin web branches of like red, blue, or purple lines. Some people may find them distressing or not like how they look. But spider veins are, for the most part, harmless and usually painless, although some patients do report itching and burning on the surface of their skin.

Host: Yeah. So, let's dive in here and try to get to the, you know, the causes of varicose veins. Is it behavior, lifestyle, diet, genetics? Like, how do we end up with varicose veins?

Dr. Frances Yu: All of those things, yes. So, it's a combination of factors and genetics definitely plays a big role. So, you know, if your parents or grandparents have varicose veins, chances of you getting varicose veins is higher. Sitting or standing for long periods, and that includes a lot of different careers. For example, like factory work, people working in food service, truck, or car drivers, office workers, healthcare, and so much more.

Other contributing factors would be things like pregnancy, aging, hormonal changes, obesity, anything that can kind of increase pressure in leg veins. Spider veins have the same precursors as those, but they can also occur in your face due to excessive sun exposure.

Host: Yeah. And you mentioned that spider veins may, you know, cause some pain for some patients. How about varicose veins? Do they hurt at all and do they maybe cause, I don't know, other symptoms maybe other than just seeing them and maybe them being a little unsightly for folks?

Dr. Frances Yu: Yeah, they definitely can cause symptoms. But this really varies widely. It depends person to person. Some people only notice the appearance of bulging veins. I mean, I even have some patients with really thick ropey, big veins in their legs, but they have no other symptoms. Their legs feel wonderful and they don't even notice the bulging veins till they look in the mirror.

But other people, they might experience aching, heaviness, throbbing, and swelling in the legs, especially after a long day on their feet. One important distinction is that, for the most part, varicose veins does not cause anything like numbness, burning, or sharp pain, or even cramping. Real vein pain is really described as heavy. Some patients describe it as they're walking through mud or water, and it's usually dull and it's throughout the entire leg, not just one area.

Host: Yeah. It makes me wonder then, you know, because there's such a range perhaps of some people notice them, some people don't. I mean, obviously they can't see them, but they may "feel them." So, are they a sign that there's something dangerous going on, or a potential, you know, sort of significant health problem? Like what are we supposed to do if we know we have them, right? If we self-diagnose, if you will, we're like, "Okay, I have varicose veins," like, is it a problem if left untreated?"

Dr. Frances Yu: Yeah. So for the most part, varicose veins really are not dangerous. And treatment is optional and kind of focused on improving pain and swelling. But I will talk about some rare exceptions to that. It's really best described as symptoms that range through a spectrum. So on one end of a spectrum, you have people with varicose veins that are really cosmetic. Someone can have them throughout their life and they don't really progress and they don't really lead to swelling even.

In the middle of that spectrum are patients who can experience some daily distress, such as the heaviness we talked about earlier, aching. And this can start to affect their daily life in chores, job duties. And then, at the very end of that spectrum, there are some more rare complications that can occur such as skin changes, inflammation, even ulcers. These more severe complications occur after many, many years for an extended period of persistent unaddressed leg swelling. So while they're not often an emergency, it shouldn't be ignored, especially if their symptoms are changing or progressing.

And one exception I do want to add to that is one of the only very more immediate risks with the varicose veins is that they may lead to an increased risk of something called a superficial venous thrombosis. And it's just a fancy word for, essentially a clot in your varicose vein. And this is because blood moves more slowly through those enlarged portions of the vein. And anything that moves more slowly can have the higher potential of forming clots. So, this might present as painful bulging along the course of the visible vein. It can also cause a skin overlay to turn red. And these clots are usually treated with anti-inflammatories and close followup with ultrasounds, and sometimes a course of blood thinners. But if you start to notice this and you have a lot of pain, it's definitely recommended that you seek immediate care, because a superficial clot can progress to something more severe, such as a deep venous clot or DVT as people know it as.

Host: Yeah. And so, it sounds like, you know, if you have varicose veins and you're concerned, you know, speak with your provider, perhaps be referred. And then, treatments certainly are available. So, let's talk about that. How do you treat varicose veins and can they ever be, you know, completely removed, if that's the right word?

Dr. Frances Yu: Yeah. So in the past, they used to do vein stripping. So, really, vascular surgeons would put someone to sleep. And it would be an extensive procedure where they're actually taking the vein out. But these days, we have some more minimally invasive procedures that we'll talk about.

But depending on the severity in someone's preference, treatment options really range. There's an option of choosing more lifestyle changes of maintenance like with compression stockings. And then, if you want something more invasive, like those minimally invasive procedures, things like laser radiofrequency is what we use nowadays. And also, this can be paired with injections called sclerotherapy. And these treatments usually are all done outpatient and the patient is usually awake. We make them comfortable And the goal of the procedure is really to close off and remove the unhealthy veins without actually removing them. So whenever we burn them with the laser or inject the substance, it's essentially killing off the vein. And over time, your body will scar down and resorb it. And in most cases, the visible effect is noticeable after several months. The legs can start to look better. And then, also people's symptoms can improve-- heaviness, aching.

Host: Feel better. Sure.

Dr. Frances Yu: Exactly. Yeah. And it's important too to keep in mind that this treatment is not permanent in any way. So, people can still make new varicose veins in the future. And if that happens, you know, there's more treatment. We usually offer more injections down the line if they start to bother them again.

Host: Yeah. And as you said, there's a genetic component to this. So if mom, dad, grandma, grandpa, you know, if folks in your family had them, even if you've had one treated, you may get them again, but at least you know, you don't have to do the old school vein stripping, which just sounds entirely like something I just never would want to do.

Dr. Frances Yu: Yeah. It's quite intense.

Host: Yeah. I am certain it is, and I love hearing about all the new treatment options, lasers, injections, all that good stuff. So when do you recommend that someone speaks up just at their annual physical, like, "Hey, I think I'm getting a varicose vein here. What should I do?" What's your best advice?

Dr. Frances Yu: Yeah, exactly. So, if you start to have any concerns about those symptoms that we talked about earlier, if you, you know, have some leg pain, some like fatigue, swelling-- swelling is a really important one because swelling could lead to some more issues with your skin in the future. So, definitely good to speak with your doctor about.

And they usually send us referrals through there to the vein center. Also, you know, if you develop any of those other symptoms such as the redness or tenderness suddenly in the vein area, we need to evaluate that as well. And for anybody who's interested in just cosmetic improvement of varicose or spider veins, vein centers help with that as well, although it'll probably be like an out-of-pocket cost.

Host: Right. Yeah. If there's no real health complications and it's just people find them to be unsightly or whatever, yeah. But a range there, speak with your provider, be referred, lots of treatment options. Is there anything we can do, besides the genetics part, right? We can't control that. We can't outrun our genetics. Is there anything we can do? Is it working out? Is it eating better, quit smoking, like, you know, the greatest hits? What can we do, you know, for ourselves?

Dr. Frances Yu: Thankfully, it's very simple. It's just like all those things that you said. So, anything that's going to be helpful overall for your lifestyle is probably going to be helpful for your veins and your circulation as well. So, definitely staying active. Like I mentioned earlier, the veins And the lymph system, you know, they're very passive systems. They're usually working against gravity all day. So, having that calf pump and those muscles working really helps to maintain good flow. Also, maintaining a healthy weight is important. Avoiding long periods of standing or sitting by taking frequent breaks to walk when you can, elevating your legs when it's possible. Sleeping in the bed at night. That's a surprising one because I have some patients who fall asleep in their recliner, and that can really lead to a lot of leg swelling. And also, wearing compression socks consistently, especially if you're on your feet all day. All of these things can help support healthy veins and slow progression.

And I wanted to talk a little bit more about compression socks actually. Because there's so much information out there and so many things to choose from in terms of compression socks that people can feel overwhelmed. So, make sure you're looking for good quality socks. There's different brands, sizes, strengths. But in general, a good quality sock is measured in size by the circumference of your calf and your ankle. So, the widest part of the calf and the smallest part of your ankle. Generally, I don't recommend compression that's size based on shoe size. A general good strength is 20 to 30. That's what we recommend to our patients, but 15 to 20 is also acceptable and it might be more comfortable for people to use day to day.

I always say some compression is better than no compression. Compression comes in types. Most commonly the knee-high socks are what people use, but they can even, even be thigh high. They can come in pantyhose, they can even come in leggings. So, I personally wear my compression socks every day to clinic. Some of the brands we recommend are Medi, JOBST, Sigvaris, and Juzo. These sometimes can be on more expensive side. But, you know, they can be a really worthy investment. It's a good rule of thumb to just wear compression as soon as you're getting up in the morning. This is usually when your legs are the smallest. And then, taking them off before bed so you don't need to wear it to sleep. And you can wear compression with things like exercising, running, going to the gym, hiking, all that as well can also help with recovery.

Host: That's awesome. Well, great advice from an expert today. Lots of great information. I love learning from the experts, which I've done. I'm sure listeners feel the same. So, thank you so much.

Dr. Frances Yu: Thank you, Scott.

Host: And for more information, go to prismahealth.org/news. For more information and other podcasts just like this one, head on over to prismahealth.org/flourish. This has been Flourish, a podcast brought to you by Prisma Health. I'm Scott Webb. Stay well.