Pull up your stockings and show the red card to chronic vein problems in your legs
Q I AM 74 and have played sport virtually all my life. Up until March I was refereeing up to eight football matches per week but currently I can’t do that. I had two operations for varicose veins more than 30 years ago and a bilateral pulmonary embolus in 2016.
My skin on my left ankle is now a bit purple, dry and flaky and the change in colour is more noticeable when I am up and about.
I am advised it could be either venous stasis dermatitis or chronic venous insufficiency and told to wear pressure stockings. Surely there is some other treatment I could have? What about laser?
A THE purple skin you describe does sound like venous stasis dermatitis, which most commonly occurs in the lower legs. This happens when there is a problem with the flow of blood in the veins, reducing the flow back up the legs, which in turn leads to pooling of blood in the lower veins, usually around the ankles.
In time, some of this blood slowly leaks out into the skin, which not only causes discolouration but also inflammation. Leaking is more likely when you are standing up.The most common causes are long-standing varicose veins or a previous deep vein thrombosis (DVT).
You have previously had varicose veins but after treatment, which in the past usually meant removing the affected vein, blood usually flows without a problem in another vein deeper inside the leg.
When you have a DVT, a blood clot forms inside one of these deep veins and can cause permanent damage to both the vein wall and the valves inside, which prevent back flow down the leg with gravity.
Unfortunately you have the double whammy of both conditions, making you very susceptible to venous stasis. The aim of treatment is to improve blood flow in the veins in the legs to stop further leakage of blood.
If you still have large varicose veins then dealing with these can help and one possible treatment is endovenous laser ablation. This involves inserting a catheter containing a tiny laser into the vein and then delivering short bursts of energy that heat up the vein and seal it closed. If the problem is due to previous damage to veins then treatment is usually with below-knee compression stockings, which push the blood upwards. They can be uncomfortable and difficult to get on and off. They come in three different grades of pressure and though class three are the most effective, I suggest you start with class one and get used to those first. They are available on prescription from your GP.
You should also keep the skin around your ankle well moisturised and if it is itchy and inflamed then applying a steroid cream (again, available from your GP) may help.
Exercise can boost venous blood flow so even though you can’t do your usual duties on the pitch, try and do as much walking or jogging as you can and when you sit down, raise your legs above your hips so gravity can help the blood from your legs return to your heart.
Q FOLLOWING blood tests at my local surgery I was told my potassium level was high and I had to go back for more tests until it went back to normal.
I had been concerned that lockdown would prevent me getting out in the sun as much as I would like. Could taking vitamin D tablets have affected my potassium count?
I take a daily aspirin, plus bisoprolol and pravastatin for angina.
A MEDICATIONS are a common cause of raised potassium level, especially those known as ACE inhibitors (which have names ending in “pril”, such as ramipril) and ARBs (which have names ending in “artan”, such as losartan). Long term use of bisoprolol can also be to blame.
Vitamin D would not affect potassium levels so please don’t stop taking a supplement if you aren’t getting much sunlight. It is important for strong bones and teeth and low levels can also cause tiredness. There
is also some evidence that people with low vitamin D levels are at increased risk of a poor outcome from Covid-19 infection.
The main source of vitamin D is not from food but rather it is generated in the skin when it is exposed to sunlight. Vitamin D deficiency is very common in the UK and everyone is advised to take a daily 10 microgram supplement.
This is especially important in older people who are not going outside, such as those who have been shielding themselves at home. If possible try to get outside every day, exposing your arms, without sunblock, for 15 minutes daily. But be careful, especially in the middle of the day, that you then cover up to avoid getting burnt.
Q FOR the last five years I have felt perpetual tiredness. I was given iron tablets but they have had no effect. Most nights I wake up three times.
Recently I tried taking 25ml of various types of liqueur before going to bed. My sleep has been unbroken for four nights now, my energy is back to normal and I can work all day without feeling exhausted.
Is this amount of regular alcohol potentially unhealthy for me? I have high blood pressure and asthma.
A THE alcohol in liqueurs can vary between 20 and 40 per cent and 25ml of a strong one, such as Drambuie, contains one unit of alcohol while a weaker one, such as Baileys, contains half a unit. So on that basis your nightly tipples are adding up to a maximum of seven units a week, which is within recommended guidelines, though these also state that you should have at least two days a week alcohol-free.
You also haven’t mentioned if you are drinking anything else at other times of the day, which will of course increase your daily unit count.
However though your nightcap appears to be helping you, it isn’t a good long-term solution to your broken sleep and, in fact, if you continue with it you may find you start waking up again as this often happens if you drink alcohol before bed.
Some medications can cause night-time waking, including beta blockers, which can be used to treat high blood pressure, while anxiety and depression can also be to blame. In older people, needing to get up to pee in the night is quite common and in those who snore, sleep apnoea (pauses in your breathing) can also wake you up.
It sounds as if unbroken sleep has helped with your tiredness levels but I would suggest you see your doctor in case you need further tests to check for other possible causes, such as an underactive thyroid or diabetes, as well as to discuss other strategies to improve your sleeping.
● If you have a health question for Dr Leonard, email her in confidence at yourhealth@express.co.uk. Dr Leonard regrets she cannot enter into personal correspondence or reply to everyone.