She’s Got Legs… (ZZ Top)

Astute readers may recall that during a long-haul flight to the US in the spring, I developed severe pain in both shins and ankles that curtailed my physical activities for some weeks.
After about a month, I self-diagnosed the pain as having been caused by venous valve “blow-out” on the flight, resulting in varicose veins of the shins.

Before leaving London for Boston in June, I contacted the office of a vascular surgeon recommended to me by my NHS GP. She said that waiting for treatment on the NHS would take years, and that I should be evaluated right away since the pain was affecting my ability to be mobile. This particular specialist is so in demand that there was a 6-week waiting period. The doctor’s wonderful secretary booked me in for a consultation on a Monday, andfor a procedure on the Wednesday of that same week. If the surgeon found something that needed surgical attention, it would be able to be taken care of right away.

So, off I went to the hospital around the corner to consult with “Dr. G”, who unfortunately for me was a tad late for his previous appointment. I was ready to create a fuss, so it was a good thing I had brought my knitting to the waiting room as it helped to calm me. Once in his office, he took notes as I described the saga of my veins, and then he conducted an ultra-sound scan of the veins in my legs. The Doppler technology clearly showed reflux (the valves not closing all the way when they are supposed to, resulting in backflow into the superficial leg veins) in the greater Saphenous vein. In the leg with the greater pain, it was occurring just below the knee as well as higher up in the thigh near the groin. So that explains the intermittent fluttery sensations there! The other leg has “just” the faulty valve below the knee, but also something called a “Boyd’s perforator”, which is the vein bulging out looking for someplace for the backed up blood to flow.

It was interesting to learn that the painful shin veins were not the entire problem, and that the foundation for the symptoms was much higher up in a large vein, near the knee and groin, and it was especially interesting to see it all displayed in glorious color on the Doppler scan. I felt like I had a weather map of my circulatory system on display, and that instead of the movement of clouds towards and away from the scanner showing an impending thunderstorm or tornado, it was showing a backflow of blood going the wrong way in my veins. I clearly remembered being taught about the Doppler effect on sound waves in one of my high school science classes, with the sound of a train horn’s pitch rising as the source of the sound gets nearer to the listener, and the pitch sounding lower as the train moves away. The movement of the stars in space (reddish stars moving towards earth, with the light wavelength shortening, and stars appearing to be blue moving away from earth, their visible light wavelengths appearing to lengthen) and now, even blood flow, can be illustrated by a computer program that red and blue colors to blood moving through the circulatory system. Hooray for Herr Doppler (Austria, 1842) !

The treatment of choice for the vascular reflux is laser surgery, where a catheter containing a tiny laser is inserted in the greater saphenous vein from ankle to upper thigh, and the valves and vein tissue are ablated (I believe “zapped” is the technical term) under local anesthesia. The protruding vein portions are then removed surgically through tiny incisions “the size of a freckle”. Recovery time is a week or two, although Dr. G. said he had one patient back on the golf course within two days of the surgery.

I was glad to be already booked in to the surgery schedule by the highly efficient Veron Williams, so only had two nights and one day to worry about the actual surgery. Although I had already done my internet research homework and knew what to expect IF I had the diagnosis, and was fairly certain that I had diagnosed myself correctly, it was a relief to learn from the surgeon that he considered the procedure to be warranted in my individual case, and that it was a pretty routine procedure from his point of view.

I will describe my day of surgery and the week that followed it in a separate entry.