Lisa, a 45 year old athletic nurse, was suffering with throbbing pain and fatigue in her legs.
“I just kept wondering why my legs were killing me. Wearing heels every day and constantly getting in and out of my car, I thought perhaps I needed to be wearing flats, that maybe there wasn’t anything else really wrong.”
She had researched restless leg syndrome (RLS) on the internet and seemed to have all the symptoms. According to the RLS Foundation, in order for patients to be officially diagnosed with RLS, they must meet the criteria described as follows:
1. An irresistible urge to move one’s legs especially in bed at night.
2. Relief with walking or exercising the calf muscles,
3. Improvement of symptoms by the morning
4. Worsening of symptoms during the third trimester of pregnancy and improvement within 6-8 weeks post delivery if applicable.
Her primary care physician said that perhaps she did have restless leg syndrome. Since she had visible varicose veins Lisa decided to see Dr. Magnant, a board-certified vascular surgeon who specializes in vein disease evaluation and treatment.
“We need to stop thinking about this disease as varicose veins,” emphasizes Dr. Magnant. “Of all the patients I see in my office, about 50 percent have varicose veins, and the remainder have symptoms (what you feel) or signs (what you can see externally) of venous insufficiency other than varicose veins. These signs and symptoms may include swollen and achy legs, restless legs, night time leg symptoms of cramps or frequent urination, or skin discoloration, vein bleeding and ulceration. More than 95 percent of the patients seen in my practice have treatable superficial venous insufficiency.
“There are many manifestations of venous insufficiency. Some of our patients experience restless legs. Other patients may have ankles so swollen that the calf and ankle appear to have merged as one; my patients have described them as cankles. Some patients experience extreme frequency of urination at night, while others have swollen, achy legs or bulging varicose veins.
“I recommend that before patients start taking prescription medication for RLS, they request a consult by a qualified vein specialist who will likely perform an ultrasound evaluation to identify whether there is significant underlying venous insufficiency. There is no downside to getting an ultrasound; there is no radiation involved, no needles, no pain, and it is a physiologic test which reveals which veins are leaking and how much they are leaking. Venous ultrasound for insufficiency is conservative, noninvasive, and it accurately identifies which patients are most likely to benefit from treatment. If there is significant venous insufficiency identified by ultrasound the next step is a trial of compression hose therapy. If the patient experiences significant relief or improvement of their symptoms, they may want to consider correction of their venous insufficiency as the next step as the majority of patients in this category will greatly benefit in terms of RLS cure or relief as a result of their venous treatment.”
Although there are other factors affecting RLS, we encourage patients to consider venous insufficiency as a contributing factor and to request a venous insufficiency evaluation by an experienced vein specialist prior to undergoing a “million-dollar” workup for other diagnoses or initiating medical therapy for RLS.
Dr. Joseph Magnant is a Vascular Surgeon and Vein Expert with Vein Specialists. 1510 Royal Palm Square Blvd #101 Ft. Myers, FL 33919. 3359 Woods Edge Cir #102 Bonita Springs, FL 34134. www.weknowveins.com. 239-694-8346