Restless Leg Syndrome & Vein Health

Joseph Magnant, MD, FACS, RPVI

Restless Leg Syndrome (RLS) or Willis-Eckbom Disease is a neurological disorder in which the person who suffers from it has a constant urge to move their legs. RLS most strongly affects people during times of inactivity, and can make it extremely difficult for a person to relax, rest, or sleep. While RLS can appear in a person at any age, it is considered both a progressive disease and a spectrum disease. RLS symptoms can either become worse over time or better, depending on the patient, and the severity of symptoms also varies strongly from patient to patient.

What is RLS?

In order for patients to be officially diagnosed with restless legs syndrome, they must meet the criteria described in the four bullets:

• Patients have a strong urge to move their legs, which they may not be able to resist.

• RLS symptoms start or become worse when a patient is resting.

• RLS symptoms get better when patients move their legs. Relief persists as long as the motor activity continues.

• RLS symptoms are worse in the evening, especially when lying down.

Many cases have shown that RLS occurs as a result of and is associated with venous reflux disease or venous insufficiency.

Venous contribution

Veins are blood vessels that are specially designed to pump blood back toward the heart, against the force of gravity. Inside the veins are a series of one-way valves that open and close with the rhythm of muscle contractions. Healthy valves close tightly, keeping blood moving upward toward the heart. With vein disease or venous insufficiency, the valves do not close properly, causing symptoms.

Venous insufficiency has many signs and symptoms and they go beyond the visible varicose veins. They include swollen, achy and heavy legs, skin discoloration and ulceration. Vein disease can be a contributing factor in the development of RLS.

With venous insufficiency, the valves of the deep and/or superficial veins of the lower extremities are either stuck or scarred in the open position or, more often, are floppy and continue to open, or prolapse, beyond the closed position. This results in reflux, or backward blood flow in the veins, which produces increased hydrostatic pressure in the downstream venous system.

Typically, the normal pressure in healthy veins, veins in which the valves are closing properly, is approximately ten millimeters of mercury at the level of the ankle when a patient is standing. If the valves are leaking from the groin all the way down to the ankle, by the end of the day the pressure could be as high as fifty or sixty millimeters of mercury. All of that extra pressure causes fluid to leak out of the veins into the skin, fat and muscle, causing pain and swelling.

It is thought that the return of this fluid, which contains water and protein, from the muscles back into the lymph vessels at night, when the legs are elevated, can trigger a cellular electrolyte imbalance and the symptoms of RLS. Thus, RLS symptoms often go hand-in-hand with venous insufficiency. However, not everyone with RLS has venous insufficiency, and not everyone with venous insufficiency has RLS.

We recommend that, before patients start taking prescription medication for restless legs syndrome, they request a consult by a qualified vein specialist. He or she will likely perform ultrasound evaluation to identify whether there is significant underlying venous insufficiency that might be causing or contributing to their problem.

There is no downside to getting an ultrasound; there is no radiation involved, no needles, no pain and it is a physiologic test that reveals which veins are leaking and how much they are leaking. Venous ultrasound for insufficiency is conservative and noninvasive, and it accurately identifies which patients are most likely to benefit from treatment.

Clearly, other causes of RLS exist, however, 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.

One such treatment for varicose veins is endovenous ablation therapy, a procedure that uses heat in either lasers or radio frequencies to seal off and close affected veins. Many patients report immediate relief in their symptoms, and, because the procedure is minimally invasive and relatively painless, most patients are able to resume their normal activities almost immediately and experience no interruption in their work or home life as a result.

If you are experiencing RLS, seeing a physician who specializes in vein disorders could be the most important step you take towards alleviating your discomfort. Before you consider medical therapy or medication for RLS, consider a venous insufficiency evaluation.

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Behind Bulging Varicose Veins!

Joseph G. Magnant, MD, FACS, RPVI

Martha had a really hard time sleeping through the night because her legs felt so achy and heavy. During the day, Martha’s legs and ankles would swell and ache. She also had unsightly varicose veins. Martha was fed up with her legs bothering her so finally she came to see me in our Fort Myers office. She was surprised when I told her that her leg swelling, achiness and varicose veins could be related to the leaking veins in her legs.

Martha had a venous insufficiency ultrasound performed on both of her legs in vascular testing lab. After reviewing her test results, I was able to identify from the ultrasound her underlying disease process. The swelling in Martha’s ankles and feet, the aching in her legs and her unsightly varicose veins were all related to her leaking blood vessels. This disease is called venous insufficiency. Continue reading

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How to Find the Right Specialist

Joseph G. Magnant, MD, FACS, RVPI

Today, it is important for patients to take an active role in researching their medical care. Fortunately, the internet is a great resource that provides patients with information to research health care providers along with the current available treatment options.

Despite all the information regarding advanced medical treatments being readily available to patients through the wide variety of media including print, television and the internet patients can find themselves lost in the maze of provider and treatment options.

The recommendations from a primary care physician are very useful when choosing the right specialist. Primary care physicians have a broad exposure to patient problems and are a great source for specialist referrals. The primary care physician should be included in all patient correspondence and be informed about their patients’ test results and future treatment plans through ongoing communication from the specialist physician.

A good starting point when researching specialty providers is the practice’s website. The depth of content and the completeness of each physician’s training record are important aspects to review. From a practice website, patients should gather and determine what percentage of the practice is dedicated to the physician’s area of specialty training and whether that area is applicable to the patient’s specific health issues.

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What will you RESOLVE to do in 2016?

Joseph G. Magnant, MD, FACS, RPVI

As each New Year dawns, many of us spend the weeks or months preceding the turning of the calendar contemplating potential New Year resolutions. I have RESOLVED to renew and further my commitment to the education of the general public and physician community regarding the wide variety of presentations of correctable superficial venous insufficiency.

It is estimated that 35-40 million adults Americans suffer from significant venous insufficiency who present with symptoms such as painful varicose veins, swollen legs, skin discoloration, restless leg syndrome, nocturnal leg cramps and frequent nighttime urination. Until the year 2000, the only treatments for venous insufficiency were compression hose or stripping. Endovenous closure, which was introduced in 2000, has significantly changed the landscape for patients with vein. Since introduced, endovenous closure (the minimally invasive and effective procedure of sealing the leaky veins within the legs with a small catheter) has been used successfully to treat hundreds of thousands of patients, relieving their disabling symptoms prior to developing venous ulcers or bleeding.

Since the superficial venous system (rather that the deep system) is responsible for the majority of patients’ problems with advanced signs and symptoms of venous insufficiency, it seems only appropriate to offer patients thorough venous evaluation and definitive therapy earlier in the course of the disease process rather than making them suffer complications such as bleeding, ulceration and cellulitis. I would like to highlight an interesting patient that made a resolution to make their leg problems a priority.

C.D. is a 58 year old female who presented through a podiatrist (the 8th physician she had seen for her legs) for evaluation of venous insufficiency. She has been told by a number of physicians that she had “fat and swollen legs” but that since she did not have any visible bulging varicose veins, Venous Insufficiency was not a consideration. Clinically, her legs were swollen, red, tender and extremely tight to the point that she could not perform activities of daily living. She RESOLVED to search further for a curable cause and her podiatrist referred her for a venous evaluation. Her ultrasound subsequently confirmed severe superficial venous insufficiency. Other symptoms included severe leg cramps and nighttime urination. The endovenous closure was performed on both legs, 2 weeks apart and she returned for her post-op follow-up, smiling from ear to ear, with ankle bones she could actually see. The swelling had resolved and she remarked that she was wearing tennis shoes for the first time in nine months.

So… in 2016, will you RESOLVE to address the important issue of the health of your legs? RESOLVE to live without swollen, achy, tight, red legs. Make the RESOLUTION to live a life free from painful leg cramps, nocturnal urination and restless legs. We have extended the opportunity for patients and the general public to RESOLVE their leg complaints. Vein Specialists offers a personal virtual vein consultation on our websites weknowveins.com and eveinscreening.com. Take the first step from the privacy and convenience of your home.

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Orthopedic Pain and it’s relation to Venous Insufficiency

Fran, an active medical office manager for her husband’s OB-GYN practice, decided to retire near the Gulf waters in Cape Coral. Happy in her Florida home, Fran immediately became involved in her community. She found herself on the go all the time.

As she stayed busy with all of her activities, her knee began to swell and ache. It was getting progressively worse until it began interfering with some of the things she enjoyed doing.

“I was having terrific pain in my right knee, the right side of the right knee,” she describes. “I also had a pronounced lump in the back of the knee, and I was very uncomfortable. The pain was excruciating. I couldn’t even drive a car for any distance because I would have to keep stopping to get out and walk. I couldn’t climb up a flight of stairs. I couldn’t exercise. It really stopped all activities for me..”

The pain finally wore her down so she made an appointment with an orthopedic surgeon to investigate what she naturally assumed was an orthopedic problem. She also saw her podiatrist who was concerned that part of her problem might have been related to her venous disease.  She was referred to Vein Specialists for further venous assessment. Fran was shocked by what Dr. Magnant’s evaluation uncovered.

Continue reading

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Nighttime Urination? It could be your veins!

Find out how frequent nighttime urination can be related to venous insufficiency.

Frequent trips to the bathroom, especially at night, are often seen as a natural occurrence of either age or simply water consumption, and, because of this, are often ignored or seen as inconsequential.  Nighttime urination, however, can be the sign of a serious problem. Frequent nocturnal urination is a symptom of Venous Insufficiency.

Patients with venous insufficiency and high venous pressure will experience swelling in their legs due to water and protein (serum) leaking from their thin-walled veins into the surrounding tissue during periods of leg dependency such as sitting, standing, or walking. The serum that leaks out then returns to the venous circulation through the lymphatic system when the legs are even with or elevated above the level of the heart, typically when a person is lying down or sleeping. The hydrostatic pressure caused by a person’s height in a vertical position, the pressure that forces the fluid from the veins into the tissues in the first place, is not present when the body is in a horizontal position and tricks a person’s kidneys into thinking there is excess fluid in the arteries.

When serum mixes with the venous blood, a person’s kidneys then filter the excess water from the blood and store it in the bladder as urine. Once the bladder is full, sensory nerves alert the body to a need to urinate, and there is a heavy correlation between the amount of fluid accumulation in the legs and the number of times that a person has to urinate. While most people experience some form of edema in their legs or feet by the end of the day, having to urinate more than once during any given night could be the sign of a problem.

The onset of edema (swelling) in the legs due to venous insufficiency can be subtle and gradual, even taking years to develop noticeably, with frequent nighttime urination trips increasing over time. There are other behaviors that can cause excess fluids to be present in the veins and tissues, such as excessive salt intake and the use of certain types of stockings, but, if varicose veins are present, then it is probably safe to say that venous insufficiency is causing or at least contributing to a person’s nighttime urination trips.

If nighttime urination is disrupting your sleep and affecting your concentration throughout the day, then it may be time to seek treatment that could be related to venous insufficiency. Dr. Magnant of Vein Specialists in Fort Myers and Bonita Springs will be able to determine and diagnose the underlying cause of your nighttime urination, through minimally invasive treatment.

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