Veins, lymphatics, swollen ankles, phlebitis and venous thrombosis

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The job of veins

The blood returns to the heart via the veins. Human beings were never designed to stand up and this has resulted in many problems because there is no proper pump to return blood to the heart. The body relies on the muscles of body, particularly the legs being in action. When these contract the veins are squashed and blood is squeezed out of them. The veins have valves in them at regular intervals and these make sure that when the veins are squeezed, the blood is moved in the right direction - i.e. back towards the heart.

If the valves in the veins fail, then blood pools in the veins. Largely speaking this occurs in the legs resulting in varicose veins. No-one really knows why the valves fail, but the problem often runs in families so there is probably some genetic weakness.

Another problem of standing upright is that there is increased blood pressure in the legs with consequent risk of thrombosis Pulmonary embolus.

The job of lymphatics

A small amount of blood (lymph) leaks out of blood vessels and returns to the circulation via the lymphatics. This is a network of tiny vessels which drain from the whole body via lymph nodes to the thoracic duct and eventually back into the main vein of the body - the superior vena cava. Lymphatic evolved to deal with tissue damage. In this event one finds large chunks of molecules such as cell membrane, DNA, etc from the damaged tissue. These chunks are too big to get across capillary walls into the blood stream but lymphatics have large holes into which these chunks can be engulphed so the immune system can deal with them in the lymph nodes. This is why we see lymph nodes swelling in response to infection not just to kill infection but also deal with the tissue damage that accompanies that.

Some of the chiunks spill over into the blood stream and this can be measured in a test Cell free DNA - this is a measure of tissue damage.

Ankle swelling

Ankles can be swollen because of increased pressure in the veins or lymphatics. You can tell the difference between the two because blockage of the veins causes pitting oedema (i.e. if you press the skin with your thumb for a few seconds it leaves a clear imprint) whereas lymphoedema does not. Lymphoedema often runs in families and is very difficult to treat effectively.

Pitting oedema due to increased pressure in the veins is treated by working out what causes the increase pressure in the veins! Pressure can be increased because of:

  • Hypothyroidism
  • Low cardiac output state
  • Failure of the muscle pump - for example sitting in an aeroplane for 12 hours, unable to walk and unable to put your feet up.
  • Allergy to Foods, Inhalants & Chemicals - signs and symptoms of - food allergy and chemical sensitivity often causes fluid retention which may manifest as puffy ankles.
  • Blockage of the veins. See Pulmonary embolus - blood clot to the lung - causes. If this occurs as a result of a thrombosis in the deep veins this is a serious matter requiring hospital admission for anticoagulation. Typically the lower leg is hot, painful and swollen with pitting oedema. Stretching the calf muscle causes pain. The blockage of the vein is not serious - the problem arises if the clot becomes dislodged and travels in the blood stream to the lungs where it gets stuck to cause a pulmonary embolus.

Oedema is rarely caused by low levels of protein in the blood as seen in malnutrition or liver disease. Obviously this is a serious matter.

Phlebitis

Phlebitis (sometimes called thrombophlebitis) simply means inflammation of the veins. It is caused when blood clots in the superficial veins of the legs. Why it does this I have no idea - I suspect that the wall of the vein gets sticky (perhaps as a result of allergy) and that triggers a clot. Certainly Dr Bill Rea in America has described a group of patients who react to chemicals with phlebitis.

Phlebitis feels like a hard worm in the vein - it is usually painful and often inflamed. It is not dangerous at all because the clot is stuck there and cannot move. It is a bore because it is painful. Doctors often treat with antibiotics but there is no logic to this because there is no infection. Aspirin like drugs are often given to reduce inflammation, but it gets better on its own with time.

The best way to tackle many problems of veins is to lie on your back with your legs in the air. The trouble is this is neither practical not dignified!

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