The Relationship between Nails and Health.

Health, Lifestyle

fingernails main

Human nails are present on the dorsal aspect of all the fingers and toes. A nail is formed by the living cells presents that are present in the ends of the fingers and toes. It’s structure is shown in Figure 1.

Nail structure

Fig 1: Structure of a nail

  • The nail body or plate: Visible part of the nail that remains attached to the nail bed which represents the skin below the nail. 
  • The cuticle (Eponychium): It is the tissue that forms the rim of the base of the nail and overlaps the nail body. 
  • The nail walls or folds: These are the skin folds that supports the nail from three sides.
  • The lunula: This forms the whitish half-moon part at the base of the nail.
  • The nail root: The nail root forms the matrix which is the underlying structure of the nail found under the cuticle.

Growth rate of the nails

The nails grow from its roots and is made of keratin protein that is also seen in skin and hair. The growing of nails occurs when new cells of the nail matrix are formed pushing the older part of the nail to grow outside the edge of the nail body.  

Due to its biological design, the growth rate of a nail is dependent on the age, gender and environmental conditions. The average growth rate of the nails is approximately 0.1 mm per day that is 1 centimeter in 100 days. 

Why look at the nails?

The main function of the nails is to protect the ends of the fingers and toes from injury. 

Shape, colour and texture can often change with an underlying skin disease or an infection (most often fungal). Although, changes in the nails may not be the first sign of a problem, it can often be accompanied with an underlying health condition which is known or unknown to an individual. Hence, a simple examination of the nails can provide a lot of information about the health and the underlying risk of many conditions.

What should be examined about the nails?

  • Changes in the shape of the nails by comparing with the other hand.
  • Discoloration 
  • Changes around the nail
  • Monitor nail growth

Health problems that are reflected in nails

Abnormal shape and structure of the nail:

Clubbing: This is caused by thickening of the nail plate at the base of the nail due to softening of the nail bed that causes the nail to curve inwards.

It can be found doing a test by keeping the index fingers of both the hands together as shown in Fig 2.

CLUBBING

Fig 2: Test for clubbing

Normally, there should be an angle between the upper skin flesh of the nail and the nail plate forming a diamond shape window. If this window is absent and the angle is lost, it creates the “Schamroth sign” that indicates clubbing.

Clubbing can occur in conditions like:

  • Inflammatory bowel disease – inflammatory conditions of the small intestine and the colon involving ulcers that are formed in the intestine.
  • Lung diseases: Lung cancer, chronic bronchitis, Chronic obstructive lung diseases – asthama.
  • Heart Diseases: Congenital heart disease, heart defects and abnormalities

Koilonychia: This explains wasting of tissue under the nail plate causing the nails to become spoon-shaped as shown in Fig 3.

koilonychia spoon shaped

Fig 3: Spoon shaped nail

 This shape is seen in conditions like:

  • Iron deficiency anaemia – low red blood cells or haemoglobin
  • Diabetes
  • Raynaud’s disease- constriction of blood vessels of fingers and toes due to cold or stress.
  • nail-patella syndrome – genetic disorder affecting the nails and the knee caps.

Ripples on nails: This involves pitting of the nails as shown in Fig 4.

nail pits

Fig 4: Rippled Nail

This can occur as an early sign of,

  • Psoriasis (skin infection with scaly patchy skin problems)
  • Arthritis (painful inflammation of the joints).

Beau’s line: Presence of transverse lines or a line on the nail plate as shown in Fig 5,

Beau's lines

Fig 5: Beau’s Line

It can indicate,

  • Severe infection
  • Heart problem
  • Hypotension (Low blood pressure)
  • shock
  • Hypocalcemia (low calcium in the blood)

Cracked thin and brittle nails: This type of nail is shown in Fig 6.

split nail

Fig 6: Cracked nail

Cracked nails:

  • Thyroid problems
  • Metabolic bone disease like osteopenia (loss of bone mass invovingminerals and bone tissue)
  • Malnutrition

Bitten nails or Gnawed nails: Habitual biting of nails or picking causes damage to the nail plate, nail walls and the skin around the nail. 

Gnawed nails

Fig 7: Gnawed nails

Bitten nails:

  • Chronic anxiety problems
  • Obsessive-compulsive disorder

Nail abnormalities related to Colour

Dark lined nail: Blackish dark discolouration seen beneath the nail as shown in Fig 8.

discoloured nail

Fig 8: Nail with dark lines

 This type of discoloration can be seen among,

  • Dark skinned people with pigmentation problems
  • Melanoma (skin cancer)

Blue coloured nails:

Bluish discoloration of the nails also called as cyanosis is shown in Fig 9, can indicate a problem with the oxygen-carrying capacity in the blood relating to respiratory problems.

Cyanosis

Fig 9: Bluish nails

Conditions related to bluish nails:

  • Lung problems- emphysema (a lung condition that damages the air sacs in the lungs causing breathing difficulty)
  • Heart problems

Yellow coloured nails: Yellowish nails (refer fig 10) can also appear thin and cracked in severe cases.

yellow nails

Fig 10: Yellow discolored nail

Yellowish nails:

  • Fungal infections
  • Severe thyroid disease
  • Lung disease
  • Diabetes 
  • Psoriasis

Whitish nails: White nails with a discolored dark rim as shown in fig 11.

white nails

Fig 11: White nails

  • Liver diseases
  • Hepatitis

Nail Beading: Beads formed on the nails look as if it is like melted wax dripping down a candle ( Refer Figure 11). 

nail beading

Fig 12: Nail Beading

Conditions related to beaded nails:

  • Diabetes mellitus
  • Thyroid disorders
  • Vitamin B deficiency

What can you do if you find changes in your nails?

  • If you see any differences in your nail shape, colour or develop changes in your nails, it could be simply because of any deficiency and not necessarily related to an underlying health condition.
  • It is best to consult with a professional in order to get your finger and toe nails examined. You may be asked to undergo a blood test and/or other tests to correctly determine the cause of your health problem.
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The 5 Types of Hepatitis

Common conditions, Health, Lifestyle

Hepatitis liver

The liver is a vital organ located in the upper right part of your belly under the ribs.

Functions of the liver:

  • Making bile, a yellowish-green liquid that helps with digestion
  • Producing proteins and blood-clotting factors that the body needs
  • Regulating glucose (sugar) in the blood and stores extra sugar
  • Working with the stomach and intestines to digest food
  • Storing vitamins and minerals
  • Removing toxic (poisonous) substances from the blood

“Hepatitis” means inflammation of the liver. Hepatitis is also the name of a family of viral infections that affect the liver.

There are 5 types:

  • Hepatitis A
  • Hepatitis B
  • Hepatitis C
  • Hepatitis D
  • Hepatitis E

The most common types of hepatitis disease are Hepatitis A, B and C. 

Causes of infection and types –

Hepatitis A: This is caused by consuming food or drinking water that is contaminated with faecal matter (human waste). As compared to other infections of hepatitis, hepatitis A usually improves without treatment.

Hepatitis B: It can be transmitted through sexual contact with an infected partner, through infected blood transfusions and dirty needles. Hepatitis B may scar the liver (cirrhosis) and lead to liver cancer.

Hepatitis C: This is the most common form of viral hepatitis. The exact cause is unknown, but it can happen through blood transfusion of infected blood and blood products, contaminated injections and through injection drug use.

Hepatitis D: Hepatitis D occurs in people with hepatitis B, increasing the severity of symptoms associated with hepatitis B.

Hepatitis E: Similar to hepatitis A, hepatitis E happens among people in countries with unhygienic living conditions where contaminated water and food consumption often leads to a spread of infection.

Which hepatitis is dangerous?

  • Types B and C have been reported more among people leading to a chronic (long-term) illness of liver disease. It is the most common cause of liver cirrhosis (liver tissue scarring) and cancer.
  • In addition, there are vaccines to prevent Hepatitis A and B. However, there is no known vaccine for Hepatitis C.

Period of illness with different types of hepatitis

Acute Hepatitis viral infection: This is a short-term illness that occurs within the first 6 months after someone is exposed to the hepatitis virus. Hepatitis A and E may not cause chronic hepatitis but for some with compromised immunity and delayed treatment, it may lead to chronic infection.

Chronic Hepatitis virus infection: Hepatitis viruses B and C can progress from acute to chronic episodes of illness after about 6months. It is long-term as the virus remains in a person’s body and continues to affect liver cells for years to an extent that there can be a complete liver failure.  

Pathophysiology of Hepatitis infection

Acute infection: The course of the virus is not completely understood but once it enters into the body, it multiplies and the infection persists due to weak immune responses which fails to control the viral spread of infection. Symptoms will appear and continue.

Chronic infection is established with the progression of infection. Liver lesions appear due to the immune responses and inflammation of the liver cells. It also triggers fibrogenesis in which the cells of the liver become hard, thickened and fibrous. This leads to scarring of the liver tissue known as cirrhosis. People with cirrhosis are then at high risk of developing end stage liver disease (ESLD) with hepatocellular carcinoma (cancer of the liver cells). 

Chronic hepatitis

Fig 1: Stages of liver infection with Hepatitis C virus(HCV)

Signs and Symptoms with all types of hepatitis

  • Fever due to infection.
  • Fatigue due to loss of appetite, nausea, and vomiting. Also, lead to long-term weight loss.
  • Abdominal pain due to build-up of fluid in the stomach due to inflammation. This occurs when the damaged liver doesn’t produce enough albumin, a substance that regulates the amount of fluid in cells. This may also lead to Pale colored stools, darker urine.
  • Joint pain: Pain and stiffness are early signs of inflammation caused by the body’s autoimmune response to the hepatitis virus.
  • Jaundice: Bilirubin present in the hemoglobin of the red blood cells can build up and cause your skin and the whites of your eyes to turn yellow. 
  • Brain problems: A build-up of toxins in the brain can cause personality changes. Advanced symptoms include abnormal shaking, agitation, disorientation, and slurred speech.
  • Diabetes: Liver is unable to store excess glucose and too much sugar is present in the bloodstream which may lead to insulin resistance or type 2 diabetes.

Who may be at risk of getting Hepatitis?

  • Infants born to infected mothers can get hepatitis B
  • Travelers to regions with high risk of Hepatitis infection most commonly reported in Asia, Africa, South America and the Caribbean.
  • Sexual contact with infected persons that cause viral transmission through body fluids.   
  • Household members, healthcare professionals and caregivers of infected persons through an accidental transmission.
  • Recipients of blood transfusions who may have accidentally received an infected blood.
  • Long-term hemodialysis patients through an accidental infected needle use or blood transmission.

Diagnosis of hepatitis

Blood tests for the antibodies can be helpful in diagnosing both acute and chronic hepatitis. Physical examination of the symptoms along with diagnostic studies such as ultrasound scan of the liver or a liver biopsy is also done to determine the severity of liver damage.

Prevention and Treatment of Hepatitis

Immunization :

  • Hepatitis A immunization of children (1-18 years of age) consists of 2-3 doses of the vaccine. Adults need a booster dose every 6-12 months following the initial dose of vaccine. The vaccine is thought to be effective for 15–20 years or more.
  • Hepatitis B vaccines provide protection against hepatitis B for 15 years and possibly much longer. All newborns and individuals up to 18 years of age and adult should be vaccinated. Three injections over a 6 to 12-month period are provided for full protection.

Safety Measures to Prevent Hepatitis

  • Hygiene: Wash your hands after going to the bathroom and before cooking or eating.
  • Protective sex: This may lower the risk of transmission. It’s always wise to know the history of your sexual partners, especially if they have an infection, you may run the risk of contracting the disease.
  • Drinking clean water: Avoid tap water when traveling to certain countries or regions.
  • Careful handling of drug needles and use of disposable drug needles only.
  • Avoid sharing personal items such as toothbrushes, razors and nail clippers.

Once diagnosed with hepatitis, the treatment will depend on the type and stage of infection. Most adults recover completely from acute hepatitis A and B within six months period. Mild relapses may occur over time during the recovery of the disease. 

Early detection and treatment show excellent recovery from both hepatitis B and C. Further research development continues to provide a vaccine for hepatitis C.

 

Obesity – Adult vs Children

Common conditions, Food, Health, Lifestyle

Obesity

Obesity is the presence of excessive adipose tissue (fat) mass affecting the health status of any individual to an extent that it may lead to the risk of other serious health conditions. It is one of the most common global health problem replacing the more traditional public health issues.

Obesity in adults vs children

In order to classify an adult as obese, the body mass index (BMI) can be calculated that best classifies an individual according to his height and weight. 

BMI: It is the weight of the individuals body divided by the square of the body height ( expressed as kg/m2). The standard classification of an individual is given in table 1.

BMI good one

Note-BMI is not the best indicator for health as your excessive weight can also be due to healthy bulging muscles rather than fat storage. It does not give information on the fat storage distribution in the body especially in the waist region and cannot be used as a predictor for lifestyle changes and benefits.

Obesity in children  

In infants and children within 5 years of age, the obesity is determined according to the World Health Organization (WHO) “Child growth standards” and the WHO reference values for 5-19 years (body mass index-for-age).

WHO classification (birth to age 5)

  • Obese: Body mass index (BMI) > 3 standard deviations* above the WHO growth standard median*. 
  • Overweight: BMI > 2 standard deviations* above the WHO growth standard median*.

WHO classification (ages 5 to 19)

  • Obese: Body mass index (BMI) > 2 standard deviations* above the WHO growth standard median* (equivalent to BMI 30 kg/m2 at 19 years).
  • Overweight: BMI > 1 standard deviation* above the WHO growth standard median* (equivalent to BMI 25 kg/m2 at 19 years). 
*Growth Standard median: This is the standard of weight given for boys and girls by WHO according to the weight-for-length and weight-for-height of the children at a particular age.
*Standard Deviation: The weight difference of a child when compared to the mean (average) weight of the children belonging in the same age group.

Other classification for childhood obesity

  • Child is overweight: if BMI at or above the 85th percentile* and lower than the 95th percentile for children of the same age and sex.
  • Child is Obese: if BMI is at or above the 95th percentile* for children of the same age and sex.
*Percentile: It is a term used in statistics to give a value of a percentage of a child’s weight compared to the weights of the children of the same age group. For example, a test score that is greater than or equal to 75% of the scores of people who took the test is said to be at the 75th percentile rank.

Measuring Body fat in Adults

Waist Circumference: This method measures excessive fat around the waist and can be used as an additional measure in people who are obese or pre-obese according to the BMI.

For men, a waist circumference no more than 94cm and for women no more than 80cm is considered a safe range. Beyond which, one can develop obesity-related health problems.

Factors that lead to obesity

Genetic factors: The risk of obesity can be more if one or both parents are obese. This relationship of genes and obesity due to the environment and eating habits.

Age: With age, there can be a decrease in the metabolism of the body and loss of muscle mass. If physical inactivity ensues, coupled with bad eating habits, this can easily increase their ability to store fat in the body. Sometimes hormonal changescan also play a role leading to obesity. 

Gender differences: Women tend to gain weight during pregnancy due to hormonal changes.  Hormonal changes including estrogen, progesterone hormones can lead to weight gain. Imbalances in these hormones can also trigger insulin resistance, which in turn, leads to fat storage. In Men, imbalances in testosterone hormone can lead to weight gain. In general, it is observed that women are more at risk of weight gain compared to men also due to lifestyle differences.

Lifestyle:

  • Physical activity: With improvements in modern technology and conveniences, there is an increasing lack of physical activity. 
  • Food habits: Consuming foods with excessive fat, sugar and calorific foods. Increased snacking and overeating can lead to excessive fat storage.
  • Stress and lack of sleep: Both stress and lack of sleep can slow the body’s metabolism. Eating late at night can cause indigestion and leads to fat storage. 
  • Socio-Economic Status: Lack of resources, lack of access to healthy foods, unable to afford healthy foods or improper cooking habits, eating out too often can all lead to obesity.  
  • Side effects of medications: Certain pain medication, corticosteroids, antidepressants, thyroid medications taken by people with thyroid problems and other medicines can slow down metabolism and lead to fat storage. 
  • Known Medical Problem: Arthritis in the lower limb causing pain on weight bearing can reduce physical activity that leads to increasing fat storage.

Diseases such as stroke, kidney disease, Prader-Willi syndrome, Cushing’s syndrome and many others can prevent the person from engaging into physical activities due to pain or muscle/joint problems etc.  

Consequences of Obesity

obesity problems

Metabolic problems: 

The major metabolic risk factors resulting from obesity are

  • An increase in the total cholesterol concentrations especially triacylglycerol concentrations, and high-density lipoprotein (HDL) concentrations.
  • High blood pressure
  • Diabetes: Insulin resistance and glucose intolerance.

All this may lead to Metabolic syndrome that describes a group of risk factors that can increase the risk of developing a heart condition. 

Diabetes: Obesity can lead to deficiencies in sex-specific steroid hormones (estrogen, progestin etc) that causes insulin resistance and a decrease in glucose metabolism. 

Coronary Heart Disease (CHD): Metabolic syndrome and diabetes can lead to atherosclerosis and blocking of the major arteries of the heart leading to a heart condition.

Osteoarthritis: Osteoarthritis (OA) is an inflammatory condition that can be caused by obesity. Excessive weight gain can lead to wear-and-tear of the cartilage and bone leading to inflammatory joints. Other reasons underlying the relationship between obesity and osteoarthritis can be metabolic changes associated with increased fat storage. 

Pulmonary disease: Excessive weight gain in the upper body can increases breathlessness that will lead to CO2 retained in the body and a mismatch in the ventilation and blood flow that further worsens the respiratory system.

Hypertension: The exact cause is unknown, however, due to weight gain there is an increase in resistance to blood flow to and from the extremities. Increases in body mass index (BMI) can put an individual at a higher risk of developing hypertension. 

Gallbladder disease: Obesity is associated with increased secretion of cholesterol in the gallbladder that increases the risk of gallstones particularly cholesterol gallstones.

Hormonal disturbances: Increased obesity in women leads to increased male hormone (testosterone) production leading to hormonal imbalances. Upper body obesity is associated with an increase in testosterone that may be a major cause of problems related to menstruation. Obese men can also get hormonal problems that lead to erectile dysfunction. Childhood obesity can cause early puberty and hormonal problems later in adulthood.

Some forms of cancer:  There is an increased risk of growth of cancer cells in various body tissue among obese people. 

Fatty liver: Nonalcoholic fatty liver disease, a condition in which fat storage is excessive in the liver that can cause inflammation of the liver tissue and scarring(Cirrhosis).

Various psychological problems: There has been increased links of obesity with depression and mood problems possibly due to underlying hormonal problems or other conditions.

Prevention and Treatment 

  • Realistic healthy weight loss goal

Comprehensive lifestyle changes: 

  • Dietary changes: Avoid calorific or sugary foods. Developing meal plans to track what you consume. Seeking advice from a specialist to know what nutrients you are lacking or how to go about the changes. 
  • Increasing physical activity
  • Exercise: 3-4 times per week for 30 minutes each. 
  • Group support: Joining a weight loss group can help psychologically and improve motivational level toward achieving your goals.
  • Relaxation and stress management

Adherence to a weight loss program is important to bring about changes and to prevent health problems due to obesity. For further detailed assessment and treatment, it is best to consult an expert for individualized weight loss programs.

The Controversy about Monosodium Glutamate (MSG).

Common conditions, Food, Health, Lifestyle

CRS

In the food industry, great interest has been garnered over the use of a particular ingredient which has caused great controversy overtime. That ingredient is Monosodium Glutamate (MSG). It’s often used as a flavour enhancer. Although additives can improve the taste of many foods, it does carry a threat of causing allergies, food intolerance and even certain conditions among some individuals. 

What exactly is MSG?

MSG is a crystallised water-soluble kind of sodium salt made up of the amino acid “glutamate”.

Glutamate is present in nature both in its free form and usually bound to peptides and proteins. The free form is used as additive and is responsible for the flavour enhancing properties. The bound form does not have any effect on taste and is considered an excitatory neurotransmitter (the ones that keep you alert and awake) as they mediate many signals in the brain and is involved in normal brain function such as cognition, memory and learning. 

Commercially, MSG is made by fermenting molasses, sugarcane, corn sugar or starch. MSG can also be obtained from natural protein-rich foods such as seaweeds. 

How does MSG work?

There are glutamate receptors present in many parts of our body like the brain, tongue and other peripheral tissues.  The MSG used in food stimulates the glutamate receptors of the tongue to give a “meat-like” or “umami” taste to foods. 

MSG – Chinese Restaurant Syndrome (CRS)

MSG consumption has been linked to the term “chinese restaurant syndrome” since 1968. This syndrome is caused due to body’s intolerance to MSG. Although the use of MSG in chinese food is well known, other cuisines, processed foods and many fast foods also contain it. 

It is still considered as a common type of food intolerance that may possibly affect many individuals.  

Who can be more susceptible to MSG Symptom complex?

  • People with Respiratory problems like Asthma.
  • People with known immunity problems with histamine that causes allergies to additives.
  • People with intestinal problems like Coeliac disease.
  • People with a sensitive stomach to additives.

Signs and Symptoms of CRS

The type of allergic reaction, severity and frequency of symptoms can vary from person to person. Sometimes multiple symptoms can occur at the same time.

  • Neurological system:  anxiety or panic attacks, blurred vision, depression, dizziness, excessive sweating, fatigue, hyperactivity, irritable, poor concentration, sleep disturbance, mild to severe headaches, migraines, tiredness and leg cramps, numbness of the upper body, head and neck.
  • Skin problems: eczema, hives (urticaria), tissue swelling, tongue/ throat swelling, atopic dermatitis, facial flushing and burning, and angioedema (quick swelling of tissue under the skin).
  • Gut related problems: bloating(gas trouble), burning mouth or tongue, constipation, diarrhoea, indigestion, mouth ulcers, nausea,  vomiting, abdominal pain, cramping and irritable bowel syndrome.
  •  Respiratory symptoms: wheeze, cough, blocked nose and sinuses, hay fever, sneezing, rhinitis (inflammation of mucosal membrane inside the nose), unstable asthma, and laryngeal oedema.

When should you seek medical care?

Mild symptoms usually subside without treatment, however if symptoms are severe such as excessive swelling of the throat and tongue, difficulty in breathing and raised heart rate. It is best to immediately seek medical care to prevent the complication of allergic shock which is also known as “Anaphylaxis”. It is a potentially life-threatening allergic reaction with excessively severe symptoms associated with the MSG intolerance.

Diagnosis of MSG intolerance?

  • Medical evaluation (clinical assessment) can determine if the symptoms are not due to some other identifiable cause or disease process.
  • Heart rate and ECG-Electrocardiogram may be recorded to check the normal heart rhythm.  
  • Respiratory status will be checked for bronchospasm (narrowing of the airways).
  • Skin prick tests (or RAST) are used as a standard way of detecting allergen-specific IgE (a type of antibody produced in the body).

Prevention and treatment of MSG intolerance

Drinking water: Water can help flush out any allergens from the body especially MSG. It can reduce the impact and delay the occurrence of the allergic reaction. 

Elimination Diet: You can be put on a diet that excludes natural salicylates, amines and glutamate, as well as additives such as preservatives, colourings and MSG. This is to see if your symptoms improve with time.

Medication: Medical care can involve the use of prescribed medications that can help reduce the symptoms of allergic reaction.

Although, a reasonable amounts of such foods can be eaten among mild symptomatic individuals. It is best to avoid it as much as possible to prevent further complications.   

Varicose and Spider Veins – What are they and How to avoid them.

anatomy, Common conditions, Exercise, Health

main pic veins

What are Varicose and Spider veins?

Varicose veins are abnormal, dilated blood vessels (veins) caused by a weakening in the vessel wall. They may appear as swollen, twisted clusters of blue or purple veins.

Varicose veins are sometimes surrounded by thin, red capillaries also known as spider veins.

(group of tiny blood vessels located close to the surface of the skin, also called telangiectasias) – Refer Fig 1.

varicose veins
Fig 1: Varicose vs Spider veins

Role of veins and formation of abnormal veins

Veins carry blood back to the heart and have one-way valves that prevent the blood from back-flowing. The calf muscles act as a pump by which the blood is pumped back from the legs towards the heart as shown in Fig 2.

Deep Leg Veins

Fig 2: Normal blood flow through Veins, Calf muscle pump

If those valves of the veins become weak from extended periods of increased pressure and swelling, the blood can back up and collect within the veins. This causes the vein walls to weaken and bulge with blood, causing the veins to appear swollen and twisted as shown in Fig 3.

deformed valves

Fig 3: Normal vs Abnormal blood flow

Who can get it and where does it happen?

Varicose veins and spider veins can occur both in men and women. However, women are known to be affected more than men due to their hormonal predisposition and changes during pregnancy that affect the veins. 

These abnormal veins can develop anywhere, but most often appear on the legs and in the pelvic area because as compared with other veins in the body. This is because, lower limb veins work harder to carry blood back to the heart with forces from the body weight and gravity acting at the same time. This pressure can be stronger than the one-way valves in the veins.

Most varicose veins are seen on the surface of the skin as the superficial veins get swollen with blood collected in it that get raised on the surface and at times above the surface of the skin.  

Signs and Symptoms

Some may not have any symptoms but may be concerned about the appearance of the veins. Symptoms usually worsen after prolonged standing or sitting as the blood pools or collects in the veins of the lower limbs. 

Print

Fig 4: Swelling, Skin changes and Ulcers due to varicose veins

If symptoms occur, they may include:

  • Tiredness, burning, throbbing, tingling or heaviness in the legs
  • Itching around the vein
  • Swollen legs (Refer Fig 4)
  • Muscle cramps, soreness or aching in the legs
  • Brown discoloration of the skin, especially around the ankles (Refer Fig 4)
  • Leg ulcers (Refer fig 4)
  • Rarely varicose veins can form a painful blood clot, referred to as superficial thrombophlebitis (inflammation of a vein).

Risk factors and causes of abnormal veins

Varicose veins are related to increased pressure in the leg veins or defective valves in the veins.

They can happen due to reasons:

  • Idiopathic: The exact cause of this problem is unknown.
  • Heredity: A family history of varicose veins can put a person at risk of developing abnormal veins.
  • Advancing age: With aging veins can lose elasticity causing them to stretch. The valves in your veins may become weak, allowing blood that should be moving toward your heart to back-flow.
  • Prolonged standing or sitting.
  • Being overweight puts extra pressure on your veins, which means damage to the valves, making them more prone to swell.
  • Pregnancy: Pregnancy increases the volume of blood in your body but decreases the flow of blood from your legs to your pelvis. This circulatory change is designed to support the growing foetus but it can produce an unfortunate side effect — enlarged veins in your legs.
  • Hormonal influences during pregnancy, postmenopausal hormonal replacement therapy and use of birth control pills can cause excessive swelling in the lower limbs that hampers blood flow through veins. 
  • Wearing tight clothes can put pressure on the veins which can cause abnormal blood flow.
  • Injury to the veins due to trauma or accidents.
  • Other health conditions that cause increased pressure in the abdomen including liver disease, fluid in the abdomen, previous groin surgery or heart failure.

How is Varicose and Spider veins diagnosed?

A physical examination of the body especially the legs while the person is standing is done. A Doppler ultrasound scan can also check the blood flow in the veins near the skin’s surface and the deep veins. 

When to seek medical care?

  • Walking or standing becomes painful.
  • Soreness develops on or near a varicose vein
  • Your feet or ankles swell up very frequently.

If immediate care is not taken, symptoms may worsen. Complications may develop if there is an underlying disease in the deep veins or in the perforating veins which connect the deep and superficial veins.

  • Chronic venous insufficiency: Untreated venous problems may progress to a chronic condition of abnormal blood flow through the veins.
  • Venous stasis ulcers that result when the enlarged vein does not provide enough drainage of fluid from the skin. As a result, an ulcer (open sore) may form.
  • Fungal and bacterial infections may occur as the result of skin problems caused by the fluid buildup (edema) in the leg. These infections also increase the risk of tissue infection (cellulitis).
  • Thrombophlebitis: Inflammation of the vein due to blood clot formation.
  • Venous hemorrhage: Bleeding through the veins due to micro-tears and ruptures.

How to prevent varicose veins and its complications?

Lifestyle modifications:

  • Losing weight if you are overweight
  • Exercising regularly (especially walking)
  • Avoiding prolonged periods of sitting or standing
  • Avoid wearing tight-fitting undergarments and clothing that constricts the waist, groin or legs.
  • Avoid crossing your legs while seated.
  • Elevating your legs while sitting and sleeping will help.
  • When you need to stand for long periods, take frequent breaks – sit down and elevate your feet.
  • Do ankle pump exercises as shown in Fig 5.

ankle pumps

If you still develop varicose or spider veins, it is best to seek medical attention to know more in details on exercises and lifestyle changes that can be personalized to your needs.  

Why is Deep Vein Thrombosis Dangerous?

Common conditions, Exercise, Health, Lifestyle

DVT What is thrombosis?

Thrombosis is a process by which there is clotting of the blood in a part of the circulatory system. This causes a partial or total obstruction thus preventing blood from flowing normally through the circulatory system. This clot is known as a thrombus. 

What is Deep Vein Thrombosis(DVT)? 

A blood clot (thrombus) in the deep venous system is known as DVT. These clots are formed in the deep veins which are a part of the circulatory system that helps bring deoxygenated blood back to the heart. These veins have one-way valves that function to transport blood from various parts of the body to the heart as shown in Fig 1.

veins of our body

Fig 1: Deep veins of the body

Which body part can be affected with DVT?

There is a greater risk of developing DVT in your lower limbs than upper body as the deep lower limb veins work harder to carry blood back to the heart with forces from the body weight and gravity acting on them at the same time. In addition, if there are other factors that increases the pressure exerted on the valves in the deep lower limb veins, there are more chances of blood collecting within the veins thus making the lower limbs deep veins more susceptible to DVT.

Why is DVT dangerous?

There is a risk of a partial or complete detachment of this thrombus formed in the deep veins. This allows the thrombus to move with the blood flow and block other blood vessels. This process is called as venous thromboembolism.

pulmonary embolism

Fig 1: Thromboembolism

As shown in Fig 1, the thrombus blocks the blood vessel and cuts off the circulation to a particular body part or organ. This will lead to a lack of oxygen to the tissue (ischemia) and a loss of tissue function. The clot can also reach other blood vessels that supply the vital organs of the body, putting the body at a dangerous risk of stroke, lung, heart problems and post-thrombotic syndrome (PTS).

Post-thrombotic syndrome is a chronic(long-term) problem that occurs with DVT and involves chronic leg pain, swelling, redness, and ulcers (sores).

How does a thrombus form in the deep veins?

Blood clotting is the transformation of liquid blood into a semi-solid gel. The blood has a protein called fibrin. Fibrin is usually in its inactive state but when tissues or blood vessels are damaged, it becomes active. This process is called coagulation. The main reason of thrombus formation can be explained by the Virchow’s triad as shown in fig 2.

cause of thrombus

Fig 2: Main causes of thrombus formation

Conditions of prolonged bed rest or immobility which could be lifestyle-related or due to other reasons may cause stasis of blood within the veins that may lead to clot formation. Also, if there is an imbalance of the coagulation and anti-coagulation factors in the blood which may be caused by an injury or acute/chronic inflammation to the blood vessel walls may cause blood clot formation.

Who is at risk of developing DVT?

  • Anyone with vein trauma due to broken hip or leg fractures during accidents.
  • Long periods of air travel coupled with lack of movement in sitting position can cause excessive swelling in the legs and stagnation of blood flow leading to clot formation.
  • Bed bound individuals post-surgery, muscular paralysis from a spinal cord injury, pregnancy or having recently given birth, especially by C-section, causing swelling and lack of calf muscle strength that impair blood circulation in the legs.
  • People with inherited blood clotting disorder.
  • People who have cancer as tumors shed particles that contain procoagulant activity.
  • Smoking affects blood circulation and stiffens the blood vessel wall making a smoker at higher risk of DVT.
  • Side-effects with the use of hormone therapy, including that used for postmenopausal symptoms among women.
  • Individuals with varicose veins, which are swollen, twisted and painful may develop clots.
  • People with a history of heart attack, stroke or congestive heart failure have high levels of cholesterol in the blood that lead to inflammation and possibly clot formation.

Signs and Symptoms of DVT

  • Pain, swelling and tenderness in one of your legs (usually your calf)
  • Affected area can be very painful and heavy.
  • Warm skin in the area of the clot.
  • Redness of the skin, particularly at the back of your leg below the knee.

How is DVT diagnosed?

A physical examination may not be enough as there may be individuals with no possible signs of DVT. Diagnostic tests will be necessary to confirm the condition.

  • Doppler ultrasound scan:  A clot may be visible in the image. Sometimes a series of ultrasounds are done over several days to determine whether a blood clot is growing or to detect any formation or movement of a clot.
  • Blood test: An elevated level of a clot-dissolving substance called D dimer will be found in the blood.
  • Venography. A dye (contrast agent) is injected into a large vein in your foot or ankle. An X-ray procedure is then undertaken that creates an image of the veins in your legs and feet, to look for clots. 
  • CT or MRI scans. Both computerized tomography (CT) scan and magnetic resonance imaging (MRI) can provide visual images of your veins and may detect any clot formed. 

When to seek medical care?

  • If you get swelling, redness, and pain in your leg, it may indicate a blood clot and immediate medical attention should be given. Sometimes there may not be any signs or symptoms or these symptoms could be due to other inflammatory condition or infection, therefore, it is difficult to make the diagnosis without seeking medical advice.
  • If there is associated pain in the chest or breathlessness further concern exists that you may be at risk of a pulmonary embolus. This could be a potential danger hence if you are at risk its best to discuss with your doctor about taking medications for preventing clot formation.

How to prevent DVT?

  • Compression stockings for bed bound individuals.
  • Early ambulation Post-surgery – getting the individual out of bed walking to allow good circulation of blood. If not possible, use a continuous passive motion (CPM).
  • Low dose of anti-coagulants can also be prescribed by the doctor.
  • During long flights, it is recommended to move frequently and/or use compression stockings.
  • Ankle exercises can help pump the blood from the legs upwards to the heart.
  • Lifestyle modifications –  smoking cessation and increased exercise.

If in doubt or experiencing any of the symptoms, always seek medical advice immediately. When detected early, it’s much easier to deal with.