Socks, oedema & preventing varicose veins

During my medical rotations, I started writing short stories about patients and experiences where I thought prevention would have made a big difference. The stories were tucked away on my computer, and have now found their way out!

Many of the things I saw made me feel puzzled, some made me feel angry. This one made me want to invest in compression sock stock.

During my dermatology intership, I learned three things. One, dermatologists are extremely busy people. Two, they don’t just deal with the face, but three – they also deal with the legs. So much so that, to my surprise, I spent most of my dermatology internship staring at ankles and feet!

But it makes sense actually, since the skin of the legs is dependent on good blood circulation, and a lot of people have suboptimal blood circulation (especially at an older age), which results in the skin becoming damaged.

Good blood circulation helps good skin

Normally, arteries supply the whole body with blood from the heart, and veins carry the blood back from tissues to the heart. To do this properly all the way from the legs, veins need the support of leg muscles in pumping the blood back up.

When the legs move around (walking, running, exercising), the muscles are active, the veins get the support they need and the blood is circulated back to the heart. When the legs are inactive (sitting or standing for long periods of time), extra strain is put on the veins in the legs, which then have to deal with higher and higher load, and eventually, start to damage and dilate (like an eclair filled with too much cream).

When blood circulation suffers, the skin suffers too. Managing the consequences of varicose veins and oedema are daily grinds at the dermatology out-patient-clinic.

Patients, varicose veins and current treatment

Admitted and free-range patients with fluid retention and visible thick purple veins visit the dermatologist for some good advice. Any wounds on their legs repair more slowly, they run a higher risk of infection and their skin is cracked and dry.

The dermatologists’ advice is usually as follows: a fatty cream against dry skin, a zinc powder against infection, “keep your feet up!” for better circulation, and “wear compression socks!” to prevent excess fluid retention in the legs.

The patients nod and smile. I nod and smile too, but secretly I’m thinking – is this really the best we can do?

I wonder whether some of these people can even pay for compression socks, let alone bend forward and put them on. I think about how they’ll have to get home nurses to help them put on the socks, and how they will afterwards spend the whole day sitting in a chair next to the window (ironically not getting any movement in their legs at all).

Couldn’t there have been some way of preventing this all along?

Shouldn’t we wear compression socks from a young age?

Later that day I follow around a cute female dermatologist in her 30s. She tells me that she’s already been wearing compression socks for years because “The best thing you can really do about varicose veins,” she says, “is to prevent ever having them”. According to her, EVERYONE working in a bar or any other profession with lots of standing (police officers, surgeons, hairdressers) should preventively wear compression socks. Not the regular ones from shops, but serious custom-measured ones, because those are the only ones that really work.

“Oh, that’s pretty cool to know!”, I think to myself. I like knowing it, and it’s certainly useful advice for my pretty legs, but why is she not telling this to all her young patients? And why doesn’t every dermatology clinic have information folders about compression socks for prevention of varicose veins for people with a standing profession?

Why wait until people get older, get these problems, then have to organise home nurses to visit them once a day at their home while they huff and puff trying to push their big swollen leg into the tiny tight sock?

Prevention deserves a more prominent place in this, I think.

I let the irritation simmer in my thoughts while I stop at a department store on my way to my side-job (as a barista) to buy a pair of compression socks, the best quality I can find, in an ugly brown colour.

One day, I tell myself, I will write this down somewhere.

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All the images are from my private collection so please ask permission if you wish to use them.