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Month: April 2019

What causes my varicose veins?

Are you hesitant and unhappy about not being able to wear shorts, because bearing those calves with unsightly and swollen veins in the legs causes you embarrassment?  Alternatively, do you suffer from swelling, discomfort, and fatigue, after spending much time on your feet? If you do, you are suffering from varicose veins.  I will try to explain, in layman terms, what causes varicose veins, who is predisposed to getting varicose veins, how you can prevent varicose veins and how to get them cured.

There are two sets of blood vessels providing circulation in your legs.  The arteries bring the blood from the heart to the legs and provide nourishment to the legs.  The veins take away the blood from your legs back to the heart. So how do veins take blood out of your legs and back to your heart against gravity? When you the calf muscles contract and that squeezes the veins in your leg and pumps the blood out of your leg back to your heart. When you stand, gravity pulls the blood your leg. To prevent blood from stagnating in your legs, in normal veins you have a series of one-way valves directing blood, up towards your heart, away from your legs. Every time you take a step, the valve opens, the blood exits the leg, and then when gravity wants to pull the blood back in the leg, the valve snaps shut. For various reasons these valves stop working, and that allows gravity to continuously pull the blood back into the leg. This causes pressure on all the superficial veins, which causes them to dilate over time and grow larger. This pooling of non-circulating blood in the legs causes increased venous pressure, which then results in swelling and bulging of veins in the legs, called the varicose veins.  Varicose veins cause the symptoms of aching, heaviness, swelling, throbbing, itching, restless legs and nocturnal cramps. If left untreated for a long time, these bulging veins compromise the integrity of the skin, resulting in skin discoloration, skin thickening, non-healing leg wounds and ulcers in the legs.



Varicose veins occur when the valves in the leg veins no longer function, causing blood to pool in the legs.

Am I at risk of developing varicose veins?

Women are more likely to develop varicose veins. The prevalence of varicose veins is higher in women (55%) compared to men (45%). Likely reason is hormonal changes during puberty, pregnancy, and menopause, or from the use of birth control pills.

Your chances of developing varicose veins get higher with advancing age .. It is estimated that 50% of the US population over 50 years old has varicose veins.

The family history of varicose veins increases your chances of developing varicose veins.

Positive family history is found in 50 % of cases of varicose veins. If both parents have varicose veins, your chances to develop the disease approximately 90%.


Women who are overweight (BMI 25-29.9) have a 50% increased risk of developing varicose veins compared to women who are not overweight. Women with a BMI greater than 30 are three times as likely to develop varicose veins. Standing occupation such as teachers, flight attendants, barbers, hair stylists, etc., increase the risk of developing varicose veins

how can I prevent varicose veins?

 If you have predisposing factors, you can not completely prevent the development of varicose veins, but you can certainly delay its progress and reduce symptoms by following common sense advice outlined below-

Wear support elastic gradient compression stockings daily during waking hours. Remove stockings when you go to bed. Compression stockings should be measured and fitted to your leg size.

Avoid sitting or standing for an extended period of time. Try to keep moving to keep your calf muscles active. Walking strengthens calf muscles.

Raise your legs above the level of your heart for at least 30 minutes when possible during breaks from work.

Exercise your calf muscles, when sitting, by raising your heels up and down. You can do that sitting on your desk and working.

When you are sitting, do not cross your legs or dangle them over the edge of a chair

Exercise regularly to maintain proper muscle tone and good circulation.

Maintain a healthy weight. If you are overweight, try to lose some weight.

If nocturnal cramps and restless legs bother you, raise your feet when you sleep by propping them on a pillow

how can I get rid of varicose veins?

Frankly speaking, the varicose vein is a progressive condition. You can deal with the symptoms and slow its progression, but you cannot get rid of them without definitive treatment.  The evaluation for the varicose veins is non-invasive and straightforward. The treatments are minimally invasive. You are awake and alert during the procedures. No downtime is required. You can return to work the next day. The procedures require no cutting or general anesthesia

Most procedures are covered by insurance with minimal to no out of pocket cost to you. Our billing department works with you to get prior authorization and insurance approval.

You can call 410-761-8007 and make an appointment for a consultation or a FREE SCREENING evaluation. We will evaluate your legs, free of charge, and make necessary recommendations for the treatment.


We are all aware of the ill effects of smoking.  The hazards of long-term smoking including the development of COPD, lung cancer and heart attack and stroke is well-known.  Quitting smoking is not easy. Nicotine is extremely addictive. There are multiple strategies that have been tried for smoking cessation with some success.  Although the prevalence of tobacco smoking In recent years has declined steadily in the United States and has come down to 14%, the number of people using e-cigarettes is steadily rising. We should all be aware that electronic cigarettes have not been approved by the food and drug administration( FDA)  for smoking cessation.

There has been a report Of a new multicenter, randomized trial of thee- cigarettes, compared with nicotine replacement therapy for smoking cessation (1).  In this trial in addition to behavioral support, the participants also received either a three-month supply of the e-cigarettes or standard nicotine replacement products.  The study results are encouraging. After one year, the period of abstinence from smoking was higher in the e-cigarettes group( 18%) compared to the nicotine replacement group( 10 %).  At least in the short-term, these results are encouraging. Also in the short-term, the e-cigarettes were relatively well-tolerated without significant side effects. However, this does not negate the fact that we need long term trials to establish the safety of e-cigarettes.

It’s too early to arrive at any conclusion about the long-term benefits and safety of the e-cigarettes.  One troubling concern, however, has recently emerged. The use of the e-cigarettes amongst the youth is increasing and has been described by US Surgeon General almost to have reached the level of an  “epidemic”.

Recently flavored e-cigarettes have become more popular in the marketplace.  The flavoring is added to enhance the appeal to the first time users. There has been a concern raised about flavored e-cigarettes.  There is a discussion amongst some experts to urge the FDA to ban the use of flavored e-cigarettes.

What’s the bottom line?  

Following is a summary of the CDC guidelines. (2)

  • E-cigarettes have the potential to benefit adult smokers who are not pregnant if used as a complete substitute for regular cigarettes and other smoked tobacco products.
  • E-cigarettes are not safe for youth, young adults, pregnant women, or adults who do not currently use tobacco products.
  • While e-cigarettes have the potential to benefit some people and harm others, scientists still have a lot to learn about whether e-cigarettes are effective for quitting smoking.
  • If you’ve never smoked or used other tobacco products or e-cigarettes, don’t start.
  • Additional research can help understand long-term health effects.



  1. A randomized trial of E-Cigarettes versus nicotine replacement therapy: Peter Hajek, et al. N Engl J Med 2019;380:629-37.


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