Years ago, when I was a very young inexperienced nurse on a cardiovascular surgery unit, I was completing an intake history on an older woman and asked her if she had any open wounds or sores. She pulled up her pant leg and showed me a pretty serious one. I asked her, “How long have you had that sore?” She replied, “Oh, since March…”—I started to mentally count the months of duration—“… of 1977.” Six years prior! I thought to myself how could anyone allow an open sore like that to continue for six years. I had seen my first venous stasis ulcer, though not my last.
I recently attended an in-service and tour of a new clinic in San Antonio that is dedicated to helping people with vein disease, namely varicose veins. Because it is a progressive disease with a slow onset, these veins often go undiagnosed. Many of us have seen family or clients with varicose veins, but I was unaware that deeper varicose veins buried under tissue often go undetected by many.
Symptoms of varicose veins can include heavy and painful legs, swelling of legs at the end of the day, burning sensation in lower legs and feelings of fatigue. There may also be darkening or discoloration of the skin and obvious bulging superficial veins or ulcers. Leg cramps at night could be related to varicose veins as well as restless leg syndrome. We heard a story of a lady who had not been able to sleep well in years due to painful, restless legs. She tried a variety of therapies without success. But after visiting the vein center, she slept through the night for the first time in years.
Encourage the people with diabetes you work with to use compression hose with gentle pressure, move their legs on a regular basis while sitting and elevate their legs to help with blood return.
Healthy veins have valves that open and close along the way to assist the blood in traveling back up from the legs to the heart. A doctor from the clinic explained that when valves in the vein fail or enlarge, it cannot hold the blood in place on its way back up so the blood pools in the lower legs—a condition referred to as venous reflux disease. The resulting increased pressure causes veins in the lower legs to enlarge and dilate, resulting in bulging and discoloration in the lower legs. If left untreated, ulcers, tissue death, permanent staining of the skin and infections may occur.
Venous reflux disease can worsen over time and develop into a more serious disease called chronic venous insufficiency without proper medical attention. Factors that contribute to venous reflux include age, gender, family history, heavy lifting, multiple pregnancies, obesity and prolonged standing. Venous reflux can be determined by ultrasound of the legs.
There is hope and help for those with venous reflux. Using an ultrasound, an interventional radiologist can position a small catheter in the diseased vein through a small incision. This small catheter delivers heat to the vein wall, causing it to shrink and thus sealing the vein closed. Once the diseased vein is closed, blood will reroute itself to other healthy veins for an improved trip back to the heart. The client is instructed to wear compression hose for a few weeks. They are encouraged to walk 10 minutes every hour and to refrain from extended standing or strenuous exercise. Most people can return to normal activities within a few days.
To prevent vein problems, encourage the people with diabetes you work with to use compression hose with gentle pressure, move their legs on a regular basis while sitting and elevate their legs to help with blood return. If they mention painful legs or have visible varicose veins, encourage them to seek help as treatment is available.
About the Author
Barbara Walz is an RN, BSN and has been a certified diabetes educator since 1986. Since 2000, Barbara has coordinated a multi-site diabetes study examining the macro-vascular effects of diabetes at the South Texas Veterans’ Healthcare System under the supervision of Dr. Ralph DeFronzo.