Q: Varicose veins run in my family, so when a few appeared on my legs I wasn't
exactly surprised. But then one of the veins started looking really swollen,
plus it turned red and hurt to touch. Now it's starting to burn, particularly
when I get out of bed in the morning. Is this serious?
Dr. Donnica: This is serious enough that you should see a doctor today.
You are describing a condition called phlebitis, which simply means inflammation
of a vein. While it sounds like you have superficial phlebitis--the involvement
of a vein near the surface--which is rarely serious, we worry about a related
condition called thrombophlebitis in which one or more blood clots causes pain
and may block blood flow.
In the worst-case scenario, deep vein thrombophlebitis (DVT) may involve a
dislodged blood clot that may travel and block blood flow to the lungs; this
potentially fatal condition is called a pulmonary embolus. It is possible for
people with superficial phlebitis to also get deep vein thrombophlebitis, so
a medical evaluation is necessary. Varicose veins are a risk factor for phlebitis
and thrombus formation. Other risk factors include: a sedentary lifestyle (not
getting enough exercise) or prolonged inactivity for any reason (including sitting
in a car or on a plane for many hours); obesity; smoking; medical conditions
that increase blood clotting; injury to the arms or legs; hormone replacement
therapy; birth control pills; and pregnancy.
Before going to the doctor, you may take aspirin or ibuprofen (unless you have
an allergy to these medications or are taking any medication with which aspirin
or ibuprofen is contraindicated) to lessen the pain and inflammation. A simple
physical exam alone cannot distinguish purely superficial thrombophlebitis from
phlebitis that has both superficial and deep vein components. Your doctor may
order a painless ultrasound test to identify whether any of your deeper veins
are involved. Your treatment plan will be based upon the specific diagnosis.
If you have superficial phlebitis, your doctor may recommend continuing to
take anti-inflammatory medications as well as prescription leg compression stockings
(knee or thigh high) to improve your blood flow and to help reduce your pain
and swelling. Elevating your leg and applying warm compresses may also help.
You may not need antibiotics unless you have signs of infection. If you have
deep vein thrombophlebitis (DVT), you will probably need to stay in the hospital
for a few days for diagnosis and treatment to ensure that no complications occur.
Treatment will include an anticoagulant (blood thinner) for 3 to 6 months.
Created: 6/25/2005  - Donnica Moore, M.D.