Healthy Legs at Any Age
George Burns, that wise philosopher, said it best: “You can’t help getting older, but you don’t have to get old.” There’s no denying biology, but when a patient enters his or her golden years, attitude and lifestyle become more relevant to good health than ever. Perhaps the biggest obstacle when caring for senior patients is ageism on behalf of the doctor and the patient. “What do you expect? I’m old,” is a commonly held attitude, but the acceptance of decreased functionality as normal is a detriment to healthy and successful aging.
Veins and Aging
Paying attention to vein health is one aspect of successful aging. Venous insufficiency occurs when healthy veins become damaged and allow the backward flow of blood into the lower extremities. This pooling of blood can lead to a feeling of heaviness, aching, and can cause skin changes, such as spider veins or a brown, woody appearance of the lower legs. Seniors’ veins respond differently to everyday stress compared to that of a younger person’s because vein walls are primarily made of collagen. As the body ages, a decrease in the production of collagen causes the veins to become more brittle and the valves more likely to fail, especially in the superficial veins. Thus, there is a higher incidence of varicose veins in the elderly population.
Additionally, the skin begins to lose its elasticity and doesn’t respond to stress the way it once did. Because skin is the “end organ” of vein disease, ulcers, and bleeding varicosities can occur as a result of damaged veins. Many seniors think varicose veins and leg ulcers are a normal part of aging, but what they may not know is that they need not suffer with symptoms. Even those who experience an aching or heaviness in their legs can receive treatment and relief. Treating the symptoms also arrests the progression of their disease.
One barrier to treatment is that, in the past, patients’ options were limited. “Vein stripping” was the go-to procedure for many years. Treatment of venous disease today, however, is vastly different. Breakthroughs in phlebology and new approaches to treatment involve less time and less pain, and they are overwhelmingly successful over the long term when performed by an experienced specialist. The risk-benefit ratio makes treatment an ideal option for seniors. A trained phlebologist (vein specialist) will locate and treat a vein problem at its source, leaving no skin openings other than that of a typical IV access site. Considering the patient’s overall health prior to treatment is essential. As with any senior patient, taking into account a patient’s comorbidities is one of the most important aspects of venous care.
Common Problems and Solutions
Deep vein thrombosis (DVT) is also quite common among older patients. DVT occurs when a blood clot forms in one of the large veins, usually one of the lower limbs, such as the thigh or calf leading to either partially or completely blocked venous return. The incidence of DVT is higher in older people because of Virchow’s triad: 1) endothelium damage, including trauma to any blood vessel due to surgery, or even bumping into something, 2) stasis, a decreased blood flow due to immobility, and 3) hypercoaguability, an abnormal tendency toward blood clotting, due to heredity, acquired medical condition or even concurrent medications.
Seniors may be less active because of other medical conditions, such as arthritis or a respiratory issue that makes them less likely to walk or exercise. Walking causes the rhythmic contraction of calf muscles and, like a pump, forces all the blood into the deep veins and helps promote blood flow to the heart. Patients may not realize that walking just 30 minutes a day, even in three-minute increments, can improve vein (and overall) health.
Compression therapy is common in venous care, especially for seniors, but misapprehensions about compression stockings can sometimes be an obstacle. It’s important to make the distinction between graduated compression stockings and T.E.D. hose. Senior patients may have tried compression stockings years ago, before newer designs and donning devices were available. They may not know that there are now compression stockings on the market that are much more tolerable. There are even groups that send people to a patient’s home to assist with putting stockings on.
Although seniors have a 50% greater chance of suffering from vein disease, they have the same success with modern treatment options as anyone else. Modern techniques, such as endovenous ablation or ultrasound-guided sclerotherapy, are the most effective solutions for the majority of vein problems. They are minimally invasive, highly successful, and are not reserved for the young.
Dr. Cindy Asbjornsen is the founder of the Vein Healthcare Center in South Portland, Maine. Certified by the American Board of Venous and Lymphatic Medicine, she cares for all levels of venous disease, including spider veins, varicose veins and venous ulcers. She is the only vein specialist in Maine to be named a Fellow by the American College of Phlebology. You can contact Dr. Asbjornsen at 207-221-7799 or: [email protected].
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