The best way to use compression stockings for leg support
DEAR DR. ROACH — I suffer from varicose veins in my lower left leg, into the ankle and top of the foot. My question is whether it is good for my veins if I wear compression socks (knee or ankle) over the bad area, or if I should be wearing the higher thigh or full compression hose alone?
Being as hot as it is in Richmond, Va., in the summer, I tend to wear none at all, but am worried about long-term consequences of this.
I am 56 and a little overweight; I am on my feet a lot. Would I be better off getting vein surgery, or would I still have to wear the support hose even after surgery? Is the success rate good for the surgery?
My main goal is to prevent problems later on. However, I often have discomfort in my veins now, especially when I am on my feet a lot. I am less worried about cosmetic results. — S.B.
ANSWER — Compression stockings should be high enough to compress all of the affected area. In your case, I suspect below-theknee would be fine. If you have any doubts, your physician or nurse can tell you what height (and strength, since some provide more compression than others) to get. Some surgical-supply stores will do custom fitting. In addition to the stockings, periodic leg elevation (lifting the legs above the heart for 30 minutes, three times daily) and regular exercise are helpful.
Medications are not especially helpful for swelling of the feet and varicose veins. I often see diuretics used, but they are not effective for the long term. Some evidence supports the use of horse chestnut extract, but my experience with my own patients was that it was only modestly beneficial (if at all).
For people with symptoms despite these conservative measures, it is reasonable to consider surgery, which improves both symptoms and appearance. There are many kinds of procedures, including the classic “vein stripping” — injection of medication to close the veins — heat or laser therapy and others. The best one depends on the individual’s circumstances, so therapy must be individualized by a vascular surgeon. The success rates vary by type of procedure, but somewhere around 80 percent of people who have a surgical procedure done are very happy with the results.
For people who choose surgery, stockings are recommended to be worn for a period of time after surgery (a few days to a few weeks), but most people do not need them long term.
DR. ROACH WRITES — I recently wrote a column on statins and their effect on blood sugar. My opinion was that despite a small increase in blood sugar, the net effect of statins remains very beneficial for people with, or at higher risk for, heart disease. I stated that I didn’t know of any statins that do not elevate blood glucose. It turns out, there is one.
Dr. John Patrick Stein, a family medicine doctor in St. Louis, Mo., wrote to tell me that a newer statin, pitavastatin (Livalo), does not have the side effect of raising blood sugar. This may be an option in people who are either diabetic with marginal control or pre-diabetic. I appreciate Dr. Stein writing in.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to: ToYourGoodHealth@med. cornell.edu. Health newsletters may be ordered from www.rbmamall.com.