Veinous Problems and Leg Ulcers - Treatment and Management

ABOUT 500,000 PEOPLE IN THE UK ALONE HAVE RECURRENT LEG ULCERS!

Not only are ulcers uncomfortable and painful, but they also prevent you from leading a normal work or social life.

The Charity says, "How sad it is to find out that the majority of these leg ulcers could be cured. Not "healed" by dressings and bandages that only temporarily get rid of the ulcers for them to come back again. But cured for good."

It is vital that a specialised duplex ultrasound scan is carried out immediately.

Over the last 20 years, research has led to improved understanding of leg ulcers, what causes them and how to cure them. Using this research, it is now possible to permanently cure most leg ulcers, totally changing lives.

If patients with leg ulcers are properly investigated and treated, the majority should be permanently cured. 

The Leg Ulcer Charity is run by a Board of Trustees including Prof Mark Whiteley.

Prof Mark Whiteley is an internationally recognised specialist in venous disease and the founder of the Leg Ulcer Charity.

Following years of treating venous leg ulcers successfully in patients who had been told that they were incurable and would be in compression bandages for life, Prof Whiteley set up the leg ulcer charity knowing that over 50% of patients suffering from leg ulcers could be cured if investigated and treated using the latest understanding.

Prof Whiteley explains:

• The basic principle of curing a leg ulcer is simply to find out the underlying cause of the leg ulcer and to correct it. Providing it can be corrected, the body will heal itself.
• Without doubt exercise, physiotherapy, diet (particularly high protein, vitamin C and zinc) help the healing process
• Ulcer dressings do not heal ulcers unless they have some active growth factor or biological ingredient, but they can make the environment of the ulcer surface more friendly towards healing. However that is useless if the underlying problem hasn't been corrected.
• Compression bandages or compression stockings increase the pressure inside the lower leg that can reduce blood refluxing down "hidden varicose veins" and also reduce swelling of the lower legs. Once again this can help temporary healing but as soon as the compression is removed, the same process starts again and the ulcer recurs. If it is an arterial ulcer, the compression makes the ulcer worse and more painful. 

CURING VENOUS ULCERS DUE TO "HIDDEN VARICOSE VEINS" - THE COMMONEST CAUSE OF LEG ULCERS: 

• The majority of venous leg ulcers are due to "hidden varicose veins" (also called superficial venous reflux or chronic venous incompetence). These cannot be seen on the surface and so if a specialised duplex ultrasound scan has not been performed, doctors and nurses may be unaware that "hidden varicose veins" are present. 
• In these cases, the duplex ultrasound scan shows which of the veins have lost their valves and are allowing blood to fall the wrong way down the "hidden varicose veins". This backward flow of blood is called "venous reflux" and when it hits the veins at the bottom of the leg, the resulting inflammation causes the skin damage. Over the years, the inflammation and progressive skin damage causes swelling followed by red skin stains, sometimes with venous eczema, followed by brown stains and finally leg ulceration.
• Although steroid creams may make venous eczema feel better, and support stockings and dressings may temporarily reduce the reflux by pushing hard on the outside, none of these factors are a cure.
• Once the venous duplex ultrasound scan has identified which veins have lost their valves and are allowing venous reflux, venous specialists can close these "hidden varicose veins" under local anaesthetic using combinations of endovenous laser, radiofrequency ablation, foam sclerotherapy, phlebectomy and perforator vein closure (TRLOP). There are also new endovenous techniques.
• All of these techniques are pinhole procedures and none require a general anaesthetic or sedation. In skilled hands they rarely fail.
• Once the venous reflux has been stopped, ulcer healing usually follows within 3 to 6 months provided the patient is walking well and the ulcer isn't perpetuated by constant dressing. In the majority of people who have had treatment, nature's own dressing - the scab - is as effective if not more effective than any dressing.
• Compression might be needed if there is still swelling at the ankle or in the short term after foam sclerotherapy but the aim is to try and get the patient out of all compression. There are a proportion of patients who do get a complete cure but due to persistent swelling, often from lymphoedema, will need to wear graduated compression stockings whenever they are up and around. Usually these can be below knee and worn as socks.

CURING VENOUS LEG ULCERS DUE TO DEEP VEIN PROBLEMS ARE A MUCH LESS COMMON CONDITION:

• Patients who have either blocked deep veins, reflux in the deep veins or both present a more challenging situation.
• A large number - if not the majority - of patients who have been told that they have "damaged deep veins" or "blocked deep veins" actually have only "hidden varicose veins" and so are curable. 
• Do not accept that your ulcer is incurable due to you having deep vein problems unless you have had an expert duplex ultrasound scan that has proven beyond a shadow of a doubt that only your deep veins are causing the ulcer.
• If you have had a duplex ultrasound scan and probably another scan to confirm it such as an MRI or venogram, and your deep veins have been shown to be the problem, then there is a lot of research suggesting that you might still be curable.
• Blocked veins or narrowed veins can be assessed using a specialised investigation called IVUS (intra vascular ultrasound) and the blocked or narrowed veins can be opened up by inserting a expandable metal tube called a "stent". The results from this have been excellent. 

CURING ARTERIAL LEG ULCERS:

•  Arterial ulcers account for approximately one in 10 leg ulcers. The cure for these is to find where the arteries are blocked and to either open up the blockages using balloon angioplasty or arterial stents or even bypass grafts.
• Arterial leg ulcers are well catered for in the National Health Service and most vascular surgeons are specialist in arteries not veins. 

CURING OTHER LEG ULCERS: 

Leg ulcers due to other conditions are few and far between.

More information from the Leg Ulcer Charity here: legulcercharity.org

As noted above, exercise, physiotherapy, diet (particularly high protein, vitamin C and zinc) help the healing process.

 According to WebMD, amino acids, iodine and zinc are important - see  webmd.com/vitamins-supplements/condition-1347-Leg+ulcers

So the protocol is:

1. Consult with your medical professional
2. Have an expert duplex ultrasound scan and follow the relevant protocol once it's determined what type of ulcer you have
3. Find a qualified physiotherapist with relevant experience: the Chartered Institute of Physiotherapists website is a good place to find one
4. Consult with a qualified nutritionist experienced in natural nutrition: the Nutrition Resource directory can be helpful 
5. Improve your diet to be high protein, high in vegetables nuts and seeds, low in processed foods gluten and sugar, only moderate amounts of fruit, use bone broth to increase the collagen to improve your skin. Consider the benefits of vegan, vegetarian and/or paleo diets.
6. Take supplements to enhance your diet including amino acids zinc iodine and vitamin C. AminoPure are excellent new amino acid supplements containing full strength Young Tissue Extract from the pristine forests of Norway. 
7. Ensure the legs are raised for at least part of the day and night. A leg support cushion can be really helpful. Get a cushion cover for hygiene and comfort. There is a selection on Amazon, for example
8. Regularly move! It's proven that "sitting is more dangerous than smoking". Here's a TED talk going into more detail:  Although it's important not to sit for long periods, inevitably with leg ulcers you'll be sitting and lying down more than usual. Here are some exercises you can do while sitting down: grandparents.com/health-and-wellbeing/exercise-and-de-stress/chair-exercises
9. Reduce stress: it's a proven fact that stress produces excess cortisol which plays havoc with the body. Stress increases inflammation in the body. Inflammation underpins most disease and ill health. Removing the sources of stress helps a great deal. You can't get well if you are worried and anxious all the time. Science now proves that DNA actually changes due to stress - eg see this article about epigenetic inheritance https://www.theguardian.com/science/2015/aug/21/study-of-holocaust-survivors-finds-trauma-passed-on-to-childrens-genes. 
10. Living in the present through practising meditation and mindfulness allows us to learn to let go of problems and live in the now. Worrying can only take place when living in the past or the future - worrying about what has happened and might happen. Being present, it's impossible to worry. Here are ways to practice mindfulness and meditation:

1. • Breathing deeply - in for 7 seconds, out for 11 - can also help enormously
   • Cutting out sugar and processed foods
   • Eating more vegetables, nuts, seeds, good fats like coconut oil, olive oil and some fruits
   • Choosing organic whenever possible
   • Choosing Extra Virgin oils - olive, coconut, macadamia, hemp are all really good
   • Avoiding alcohol for some days of the week or longer, to give your liver a rest
   • Taking good quality supplements like AminoB12 which includes the important vitamins B12 in bioavailable form
   • Vitamins C, D, K2 and the mineral magnesium are also important
   • Stopping watching the news
   • Avoiding negative people
   • Spending time in nature
   • Grounding - having your bare feet against the earth so you can absorb the resonance of our planet - standing on grass or walking on the sand at the beach for example
   • Absorbing more negative ions from being in nature
   • Going to bed early and getting up early
   • Establishing routine
   • Decluttering
   • Seeing your health professional - your GP/medical Doctor, naturopath, nutritionist, chiropractor, osteopath...
   • Having a regular massage
   • Swimming 
   • Raising your heart rate regularly

Do try these approaches and we hope you feel better soon. Please note that we are not giving health advice - these are lifestyle tips which have helped many other people. If you are concerned about your health, always see your health professional.

As you can see, there are many and varied ways to take care of yourself and your loved ones, summed up by

- Conventional Medicine

- Lifestyle and self-care

- Complementary and alternative healthcare.

Together, these combine as Integrative Health.

Here at Get Your Boom! Back, we are strong supporters of Integrative Health.

There are many definitions of ‘Integrative’ health care, and all of them involve coordinating ‘conventional’ and ‘complementary’ approaches.

Integrative Health: