Saturday , June 23, 2018

Dumaguing: Do you have leg ulcers?

SURELY, our beloved Sun.Star Baguio is coming out Saturday, April 1 but the title is not an April fool's joke, nor are we pulling your leg. Understandably, some may not be able to connect the word "ulcer" with the extremities like the legs because we are more accustomed to the words' peptic ulcer' which is due to hyper acidic erosion of the lining of the stomach and duodenum.

Leg ulcers are the manifestations of chronic venous disease or longstanding diseases that affect the veins especially of the lower extremities. Risk factors are varied; it could be hereditary, females are more affected, common among elderlies, pregnancy is a factor and so does obesity and for some reasons, the taller the person, he/she is more prone to venous diseases. Then, of course, there are the occupational and lifestyle predisposing factors. Singly or in combination, these risk factors initiate changes in the valve and wall of the veins which lead to altered shear stress on its walls, resulting to venous hypertension. The damage to the inner lining-endothelium- leads to inflammation with resultant microcirculatory and tissue damage which, in due time there is chronic venous disease.

The CEAP classification of chronic venous diseases range from Czero to C6 being the worst with varying signs like telangiectasias- spider like reddish discoloration of the skin, varicose veins, edema, skin pigmentation, lipodermatosclerosis, eczema, skin ulcers with the patients complaining of heaviness, aching, pain, tightness and skin burning.

International guidelines include the American Venous Forum and the Society for Vascular Surgery suggest vasoactive drugs (diosmin, hesperidin, rutosides, sulodexide, micronized purified flavonoid fraction (MPFF) or aescin for patients with pain and swelling due to chronic venous diseases. The American College of Chest Physicians in 2008, said for patients with persistent venous ulcers, flavonoids in the form of MPFF given orally or sulodexide administered intramuscularly and then orally.

Sulodexide, in various experiments and clinical experiences with patients whose lesions include gangrene, deep necrotic leg ulcers, peripheral neuropathy with plantar abscess, has been found to restore endothelial function, decrease endothelial inflammation, reduce blood viscosity and prevent thrombus growth and to top it all, Sulodexide has fibrinolytic activity, which taken all together improved cardiovascular signs and symptoms like pain, increased venous tone with more vigorous energetic venous flow, decreased stasis thus less edema and swelling and had induced much faster ulcer healing. With improved microcirculatory architecture, there is reduced recurrence of thrombotic events.

Vessel Due F is one of the more popular brand names of Sulodexide. It comes in 250 LSU capsules and ampules in 600 LSU/2ml. There have been occasional reports of gastrointestinal side effects with the capsule like nausea, vomiting while those injected had some pain, hematoma at the site of injection. For the most part, these adverse events have been mild and tolerable.

ABI or ankle brachial index is a non-invasive, simple basic screening test to determine the patency of the venous system, with various grading of compressibility and presence of obstruction in both upper and more so, in the lower extremities. Sulodexide is indicated for both venous and arterial insufficiency brought about not only by chronic venous disease but also cerebrovascular arteriopathy, coronary artery disease, diabetic nephropathy and vasculopathy.

Do you have redness, itchiness tingling sensation alternating with numbness of the toes, feet and legs, discomfort , cramps and pain while or after walking? A non-healing lesion in your legs? Pay a visit to your family physician.