Vein, vein, go away! Thirty years ago the appearance of a varicose vein meant the end of skirts and a life condemned to pants and compression stockings. Lucky for us, there a so many treatment options available that getting a varicose vein is nothing more than a nuisance. Here, vein expert Dr. Sanjoy Kundo of the Vein Institute of Toronto gives us advice on get rid of varicose veins for good.
Find the cause The only way you can truly know what's causing varicose veins to appear—and the best way to treat them—is by booking an ultrasound. Most varicose veins are a result of a faulty valve in the main draining vein of the leg. When the valve is faulty it causes the blood to backflow and overflow smaller, less "competent" veins, which then bloat with the unexpected pressure and become visible varicose veins. In 10 per cent of cases, though, the vein is an isolated, abnormal vein that is less serious and easier to treat.
1. Creams and pills If compression stockings are not the avenue for you, you could try an over-the-counter cream like Invisi-Vein by Venus Naturals (www.venusnaturals.com), whose ingredients include herbal circulation remedies like calendula extract (known for its anti-inflammatory capabilities) and vitamin E.
Another over-the-counter method that has been flooding the market lately is pills containing horse chestnut, such as Venarin (www.venarin.com) by Nutrica. Horse chestnut is a herbal extract whose properties, according to the Mayo Clinic, can significantly reduce pain and varicose vein size and may actually be as effective a treatment as compression stockings.
But do they work? Although these products are good sellers, Dr. Kundo dismisses creams and pills as treatment options, stating, "I've seen a lot of patients that have tried many different creams and pills, and nothing has yet to work. Once the varicose vein is there, there is an underlying problem that cannot be solved by these types of products."
2. Compression stockings The least invasive and first course of action for any type of varicose veins should be compression stockings. Though unflattering, compression stockings relieve pressure on varicose veins and aid in circulation. "Be aware," warns Kundu, "although compression stockings help patients physically feel better, it is not a cure. As soon as the stockings come off the veins will come back."
Page 1 of 2
3. Surgical stripping (ligation) For the past 30 years, surgical stripping has been the treatment option recommended by most doctors for the relief of varicose veins. To perform surgical stripping (also know as ligation), the doctor begins by making a number of small cuts from the groin to just below the knee, ties off (ligates) the abnormal vein and then removes the vein entirely. This procedure is done under general anaesthetic with a recovery time of four to six weeks and a 75 per cent success rate.
Surgical stripping is still a popular surgery today because it is the only varicose vein procedure covered by most provincial health plans, and is still the most widely used treatment option for varicose veins.
4. Endovenous Laser Ablation In the past 10 years a new varicose vein treatment, Endovenous Laser Ablation, has been turning heads in the dermatological community. This treatment is a minimally invasive procedure and is performed in the doctor's office with local anaesthetic. With the patient lying on his or her back, the doctor inserts a small hollow tube into the main draining vein of the leg and uses lasers to seal off the vein. With the vein sealed off, the blood is forced to flow through a secondary venous system, which relieves pressure on the bloated, abnormal varicose veins and allows them to shrink back to normal, invisible size. This procedure has a recovery time of about two weeks with a 90 per cent success rate.
Because of the high success rate and fast recovery time, Endovenous Laser Ablation is slowly becoming known as the most effective means for treatment of varicose veins. The average cost for an ablation is around $2,500 for one leg and $5,000 for both, which keeps this procedure from being the most widely used surgery.
5. Sclerotherapy Sclerotherapy is a technique whereby the patient is injected with a salt solution through a small needle into the dilated or abnormal vein. The solution irritates the lining of the vein and causes it, over time, to turn into scar tissue, which will eventually be reabsorbed into the body. This procedure should only be tried by patients who do not have a problem with the valve in main draining vein of their leg, or for patients who have had their main draining vein ligated or ablated; otherwise, there is a 50 per cent chance that the varicose vein will reappear.
Prevention Here are some simple tips to keep the veins away for good: • Don't cross your legs when sitting. • Exercise regularly to increase circulation and to allow blood to move freely through your legs. • Elevate your legs when resting as much as possible. • Avoid standing or sitting for long periods of time. • Avoid wearing tight clothes, especially at the waist.
Keeping a healthy lifestyle is important, of course, but quick fixes and flashy diets that you hear of online aren't the way to go. These trend diets, advertised to work wonders, can actually bring more hassle and danger than benefits to your health.
“People are willing to try and pay anything in the hopes of losing weight. There are many self-proclaimed ‘experts’ on the internet providing health advice that may not be safe or even science-based,” says Andrea D’Ambrosio, a registered dietitian and spokesperson for the Dietitians of Canada. “It’s crucial to be critical of information that we find on the internet to avoid being misled by false, unsubstantiated claims.”
D’Ambrosio says she reminds her clients that despite what personalities like Dr. Oz say, there’s no magical food or diet for weight loss.
Here are five popular diets to be wary of.
Juicing encourages dieters to juice their plant-based meals. It’s based on the idea that nutrients from foods such as fruits and vegetables can be absorbed quicker, and fresh juice gives our systems a rest from digesting fibre. While some claim this helps in weight loss and the removal of toxins, the truth is that the amount of sugar from the fruit you eat to maintain a feeling of fullness can equal more calories, which contributes to weight gain.
“Diets that remove entire food groups run the high risk of leading to nutritional deficiencies unless you make up the lost nutrients in other foods or supplements,” D’Ambrosio says.
2. Low-carb diet.
A low-carb diet requires the restriction of foods high in carbohydrates such as pasta, bread and certain fruits and vegetables. Although dieters don’t need to cut high-carb foods from their meals entirely, the suggested limit being advocated on social media, is 60 to 130 grams of carbohydrates per day. That’s less than three plain bagels.
3. No fat diet.
A fat-free diet sounds tempting, but is it really? When we think of fat, we often think of the bad kind that’s found in junk food, but we can also find it in nuts and seeds, fish and fruits like avocado. According to a publication by the Harvard Medical School, unsaturated fats (the good kind!) supply the body with energy and can even help prevent heart disease.
A positive note, D’Ambrosio says, is that these types of diets encourage people to eat less processed foods, which is healthier and helps weight management.
4. 5:2 diet.
For those familiar with diets, fasting is no stranger. The 5:2 diet is one of many regimens floating around the internet that has dieters eating normally (read: unrestrained) for five days and reducing food intake to 500 calories a day for the other two.
“Eating less than 500 to 600 calories a day on fasting days is very difficult for many people and challenging to sustain,” she says. “Many who attempt fasting or severe restriction also find a corresponding increase in cravings or binging after their day of restriction.”
5. Activated charcoal “diet”.
Touted by both health junkies and beauty enthusiasts on social media, charcoal can be consumed via tablets or used in cooking. Aficionados of activated charcoal claim it soaks up surface fat so that calories are not absorbed into the body, plus they say it removes unpleasant gases and toxins and reduces appetite.
The short-term effects may be tempting for those hoping to quickly shed a few pounds or to maintain a healthier lifestyle, but D’Ambrosio says there needs to be more research conducted for diets that boast impressive results. “If you want to lose weight fast, remember that you did not gain that quickly.” she says.
D’Ambrosio says working with a professional dietitian to ensure nutritional needs are met and healthy weight-loss strategies are implemented is a good plan for those who need a helping hand losing weight. “Forming a healthy relationship with food and a positive body image—regardless of weight—is also important during any weight-loss journey,” she says.
Tip from D’Ambrosio:
Food-tracking apps, such as eaTracker, give you a better idea of what (unhealthy) foods you’re eating and what swaps you can make to increase the nutrition and healthfulness of your diet.
Andrea D’Ambrosio is also the owner of Dietetic Directions a nutritional counselling and education company based in Kitchener, Waterloo.
Heart disease and stroke are one of the leading causes of death for Canadian women—and risk factors, symptoms and even treatment might vary by age. Here's what you need to know.
It was Dec. 13, 2014. I was getting ready to go out for dinner when suddenly everything went wrong. I lost coordination, almost like I was drunk. I went numb, as if the local anesthetic that dentists use had been applied to half of my body. My arm went limp, I could barely walk and, out of the blue, I got a raging migraine. At 31 years old, I was in the midst of a transient ischemic attack, often called a ministroke, but I had no idea.
It wasn't until the next day, when I was feeling only slightly better, that I realized something was really wrong. I didn't want to wait for an appointment with my family doctor, so I called Telehealth Ontario, the provincial service that connects callers to a registered nurse via telephone. In the very back of my mind, I wondered if I'd had a stroke—but I was too young, or so I thought. But when I described my symptoms, it became clear that I wasn't too young. In fact, the nurse who took my call was worried enough to send paramedics to my house. Soon, I was in the back of an ambulance, rushing through Toronto's busy streets on the way to the hospital.
The statistics Luckily, my stroke was mild, and, in July 2015, I underwent surgery to have a patent foramen ovale closure device inserted to close the hole in my heart. But, to this day, I'm still shocked at how little I knew about the risks associated with stroke and heart disease, or just how common they are. As I soon learned, about 1.6 million Canadians—557,000 of them women over the age of 24—report having cardiovascular disease. And, according to a study looking at factors and behaviours affecting cardiovascular health published in 2013 in the Canadian Medical Association Journal, fewer than one in 10 adult Canadians were in ideal cardiovascular health from 2003 to 2011, which means 90 percent of us are making choices that are increasing our risk for a cardiovascular event. In fact, heart disease and stroke is one of the leading causes of death for Canadian women, and most of us have at least one risk factor.
It's a club that I didn't particularly want to be a part of, but having joined, I began wondering what other women's experiences had been like.
Unlike me, when Victoria resident Carolyn Thomas started having a range of symptoms— crushing chest pain, nausea, weakness, sweating and a persistent ache down her left arm—on her 58th birthday, she immediately thought it could be a heart attack and went straight to the ER. But when she got there and told the doctor on duty about her symptoms, he said it was just acid reflux. "I remember exactly what he said," she recalls. " 'You're in the right demographic for acid reflux. Go home and call your family doctor for a prescription for antacids.' " Embarrassed and apologetic, she did just that. But her symptoms persisted for two more weeks. She eventually went back to the hospital, and this time, she was told she was suffering from what was actually one of the most serious types of heart attacks—a complete blockage of her left anterior descending artery, which is often referred to as the widow-maker.
Since then, she has recovered, but it's far from full—she had to retire early and continues to see a specialist at her regional pain clinic.
Irmine MacKenzie also went to the hospital immediately. It's been 35 years since the New Waterford, N.S., resident lost the use of her left arm and leg after suffering a stroke caused by carotid artery stenosis, narrowing of the arteries that carry blood from the heart to the brain. She was 61 years old and, having just finished eating breakfast with her husband, John, she headed to the kitchen to tackle the dishes. Suddenly, plates started dropping from her hands, shattering as they hit the floor.
After a six-week hospital stay and a three-month stint in a rehabilitation program in Halifax, she eventually learned to walk again. Her ability to manage quite well over the past three decades is clearly a testament to her grit— and maybe some kind words from a stranger. "I won't ever forget the ambulance driver who took me to the rehabilitation centre," she says. "He told me, 'We're taking you by stretcher now, but you'll be walking out of there with a cane.' " Sure enough, that's exactly what she did.
A better understanding It has now been two years since I suffered my transient ischemic attack, and I feel like I'm still learning about heart health. I now understand the importance of cardiac rehabilitation, for one thing. When I had my stroke, I didn't know this kind of program existed—my cardiologist didn't refer me to one, but having access to dedicated professionals in a safe, encouraging environment could have helped me navigate the health-care system and guided me toward healthier choices.
One thing I found myself, Carolyn and Irmine echoing is how, as women, we must advocate for ourselves in the health-care system, ensuring that our voices are heard and our health is looked after. We need to put ourselves first, without shame or guilt. As Dr. Paula Harvey, director of the cardiovascular research program at Women's College Hospital in Toronto, says, "It comes back to education and partnership with your health provider. Don't be afraid to ask questions and be informed."
Heart health by the decade Nearly two-thirds of all heart attacks and strokes occur in Canadians 65 or older, but younger Canadians are increasingly at risk. Here's what you need to know at every age.
In your 20s and 30s: Young people with heart-health issues are part of a growing minority. A study published in 2012 out of the University of Cincinnati College of Medicine found that, over a period of 12 years, strokes among people aged 20 to 54 made up an increasingly greater proportion of strokes across all age groups, growing from about 13 percent in 1993–94 to 19 percent in 2005.
Closer to home, the Heart and Stroke Foundation says several studies predict that the rate of strokes among younger adults will double in the next 15 years. The main reason? According to Dr. Tara Sedlak, a cardiologist at Vancouver General Hospital and clinical assistant professor at The University of British Columbia, it comes down to lifestyle—high stress levels, poor eating habits, lack of exercise and smoking. Research bears this out: The University of Cincinnati study suggested that a rise in lifestyle-related risk factors (such as diabetes, obesity and high cholesterol) may contribute to a higher incidence of stroke.
But there is a way to turn the tide: As with other age groups, simple changes such as exercising regularly, quitting smoking and eating healthily could see the rates of cardiovascular disease—and, more specifically, stroke—decrease, says Dr. Paula Harvey, director of the cardiovascular research program at Women's College Hospital in Toronto.
In your 40s and 50s: Cardiovascular disease is less common among younger women, in part because of their higher estrogen levels; the hormone offers some protection to the arteries. But as women approach menopause and their estrogen levels drop, the incidence of stroke and heart attack increases.
Unfortunately, broad knowledge of their increased risk may not protect perimenopausal women from misdiagnosis. According to research by the Canadian Medical Protective Association, which provides advice, legal assistance and risk-management education to 95,000 Canadian physicians, doctors are missing the signs of stroke in patients nearly 10 percent of the time, largely because symptoms are often nonspecific—patients often complained of headache, dizziness, nausea and vomiting.
And women, who have historically been less inclined to advocate for themselves, are particularly at risk. Research out of the University of Leeds in England showed that, between April 2004 and March 2013, 198,534 heart attack patients at National Health Service hospitals in England and Wales were initially misdiagnosed—and most of them were women. During that time, women suffering a heart attack were 50 percent more likely to be misdiagnosed compared to men.
It might be difficult to challenge doctors who tell you nothing's wrong, but Dr. Sedlak encourages women to listen to their bodies and to be firm with health-care providers about what they're experiencing. "If you feel there is a real problem, be persistent," she says.
In your 60s and beyond: Women over 65 have the most strokes of all age groups, but they still have fewer strokes than men the same age. However, a Danish study published in the Journal of the American Heart Association in 2015 found that, after 60, women tend to have more serious strokes than men—and they're more likely to survive, which can have serious repercussions on quality of life.
John Sawdon, the public education and special projects director of the Cardiac Health Foundation of Canada, explains that cardiac rehabilitation programs, which are free with a referral from your doctor, are the perfect next step for recovering cardiac patients of all ages, but they're particularly important for older Canadians, who tend to live more sedentary lives. These programs are supervised by a cardiologist and, after an assessment, are tailored by your cardiac rehab team, which usually includes nurses, physical therapists, kinesiologists and social workers. They can provide exercise training, education on heart-healthy living and stress counselling—all of which can contribute to the health and well-being of people who have heart problems. And they're effective, too: "Research has shown that those completing cardiac rehab live seven years longer than control groups," says Sawdon. It also "reduces incidence of another heart attack by 50 percent."
What's your risk? Ninety percent of adult Canadians have at least one risk factor for cardiovascular disease. But while factors such as obesity, hypertension, alcohol abuse, family history and ethnicity increase everyone's risk, regardless of gender, the following three are particularly relevant to women.
Smoking: While we all know that smoking is seriously unhealthy, it can be especially damaging to women's cardiovascular health. Smoking when taking the oral contraceptive pill can drastically increase the risk of heart attack and stroke. But quitting can cut your risk within a year.
Diabetes: According to the Canadian Diabetes Association, people with diabetes are at a very high risk of developing cardiovascular disease. In fact, "they may develop heart disease 10 to 15 years earlier than individuals without diabetes."
Mental illness and stress: "Women have a higher frequency of stress-induced heart disease, and women's hearts are affected by stress and depression more than men's," says Dr. David Fitchett, a cardiologist at St. Michael's Hospital in Toronto and associate professor of medicine at the University of Toronto.
Heart health dictionary
Atherosclerosis: When arteries narrow and harden due to plaque buildup.
Cardiomyopathhy: Diseases of the heart muscle, which cause it to become enlarged, thick or rigid.
Cardiovascular disease: A broad term for problems with the heart and blood vessels, often due to atherosclerosis. These conditions can lead to heart attack, angina or stroke.
Heart attack: Also known as a myocardial infarction, these attacks happen when the flow of blood to a section of the heart is blocked, preventing the muscle from getting oxygen.
High blood pressure: Also called hypertension, this is when the long-term force of blood against artery walls is elevated, requiring the heart to work harder, which may eventually lead to heart disease.
Microvascular angina: A disease of the small coronary artery blood vessels. Many angiograms do not view the small blood vessels, so this can be difficult to diagnose.
Spontaneous coronary artery dissection: A tear in the coronary artery wall. Physical or emotional stress appears to play a role. Most cases (around 70 percent) occur in women under 50—and a third of those are pregnant or postpartum women.
Stroke: When the blood supply to a portion of the brain is interrupted. This can happen when a blood vessel carrying oxygen and nutrients to the brain either bursts or is blocked.
Try this simple way to beat stress and help relieve symptoms of anxiety and depression.
If you're into yoga, there's a practice you might already be doing that's been shown to benefit people who suffer from mental illness.
A recent study from the University of Pennsylvania found yogic breathing, a practice known as Sudarshan Kriya, helped "alleviate severe depression in people who did not fully respond to antidepressant treatments," and lessened symptoms, such as stress, associated with the mental illness.
Karusia Wroblewski, who teaches yogic breathing in her yoga classes at Toronto's Yogaspace, says the technique has significantly improved the lives of both herself and her students. "They have more energy and their outlook on life improves," she says. "One student reported being able to cut back on anxiety medications. I just received a thank-you letter from a student who had suffered from deep depression, panic, anxiety attacks and insomnia."
Yogic breathing is more than just slowed inhalation and exhalation—it requires a conscious effort in recognizing and regulating our breathing patterns by adjusting the speed, rhythm and volume of each breath. According to Wroblewski, we often neglect the importance of breathing because it's a natural process. She says injuries, stress and even strong emotions can affect "healthy breathing."
Thankfully, for those who can't make it out to yoga class, you can practise yogic breathing at home. It's entirely safe for beginners. Wroblewski suggests finding an experienced instructor if you want to try intermediate or advanced techniques. Here's how to do it.
When: Try practising when you wake up in the morning, or at night right before you go to bed. It's not ideal to do this type of breathing on a full stomach.
Proper position: Start by lying on your back with a pillow under your knees and interlace your fingers, resting them on your abdomen. Close your eyes. Let the tension in your body melt away.
The basics: Inhale gently through your nose—imagine a balloon inside your body slowly inflating. Exhale through your mouth while the air escapes the balloon. Control your breathing; your breaths in and out should be smooth. While you're breathing, try not to dwell on your thoughts—just let them come and go, as if they were on a cloud floating by. Repeat the breaths three to four times, then close your mouth while continuing to breathe through your nose.
Fruit gets a bad rap when it comes to weight loss. Here's why avocado, dragon fruit, coconut, kiwi and even banana—yes, banana—are all diet foods.
Fruit can be a real pleasure when you're cutting back on calories—it's wholesome, nutritious and provides a sweet hit of pleasure. A few surprising fruits even come with weight loss benefits.
Dieters tend to steer clear of bananas because they're considered a high carbohydrate fruit. But almost-ripe bananas contain resistant starch. "This starch is not digested the same way as most starches," explains Amanda Li, registered dietitian at Toronto's Wellness Simplified. "It passes through the intestine unchanged as an insoluble fibre so you absorb less sugar from it." Insoluble fibre also helps control hunger pangs. Tip: Snack on green bananas that are just starting to turn yellow. Eat with cereal or yogurt to mask the hint of bitterness.
There are two reasons why dieters should add fresh—not dried, packaged—coconut meat to their fruit salad and fruit smoothies. "There's the satisfaction factor," says Li. Coconut meat's high in healthy fat, which helps slow down digestion of the sugars in the other fruits, keeping you feeling fuller longer, she explains. Plus, it contains medium-chain triglycerides, a type of dietary fat that's processed by the body for a quick source of energy rather than stored as fat. Tip: Don't want to crack one yourself? Look for freshly frozen coconut meat in health food stores. Some grocery stores also prepare fresh coconut meat.
Yes, avocado is technically a fruit, and Li says it's a terrific diet food because it contains high percentages of both healthy fat and fibre (seven grams, in fact, in one fruit). "The fat and fibre work together to keep you feeling full longer," she adds. Bonus—avocado's fat is chiefly monounsaturated, which offers protective heart benefits. Tip: Guacamole's an incredibly satisfying snack. Dig into Edamame Guacamole with toasted whole wheat pita chips.
"I love dragon fruit. Not only is it pretty looking, it's got good volumetrics," says Li. She's refering to the diet principle created by Dr. Barbara Rolls that substitutes deprivation for lots of healthy foods you can feel full on. Dragon fruit fits the bill, according to Li, because one whole fruit contains just 60 calories and only eight grams of sugar. "That's terrific compared to other fruits, she adds, pointing out that one apple is 80 to 100 calories. Tip: Cut the dragon fruit in half and scoop the pulp—seeds, too—straight out of the shell with a spoon. "It's refreshing, like cucumber, only sweeter," adds Li.
Kiwi is a handy diet food because it's portable. "You can throw a couple in your purse and go," says Li. And because you can eat the skin along with the flesh, you're getting five grams of fibre per fruit, says Li. Kiwi is also loaded with vitamin C and contains a natural enzyme that helps the body digest protein. Tip: Kiwi is a great diet snack on its own, but also delicious on salads and in meat marinades.