Ask the doctor - blood and circulation

Read expert medical advice with doctors' questions and answers from Prima, SHE and Good Housekeeping

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Help for varicose veins
Can any alternative remedies help varicose veins? I'm not overweight and am otherwise fit and well, but my ankles swell so much that I have to wear trousers to hide them.

The supplements I usually suggest are red vine leaf extract, and
pycnogenol (from the bark of the French maritime pine), which can be
taken individually or together. These supplements have a benefi cial action on the connective tissue surrounding blood vessels to strengthen their walls and reduce leakage of fluid. This helps improve symptoms associated with varicose veins such as swelling, and may reduce discomfort. Take regular exercise, such as walking, and avoid standing still for long periods. When sitting, have your feet up on a stool or
footrest. Support stockings or tights will help minimise discomfort or pain. Wear Class I elastic support tights or stockings for mild problems, Class II knee-length compression stockings for moderate varicose veins, and Class III graduated compression stockings
for severe cases.

Dr Sarah Brewer, Prima (Sept 09) 

 

Why can't I get treatment for my varicose veins?

I've suffered from varicose veins for years and, before I had children, my GP told me I could have them treated once I'd completed my family. Now, even though my legs ache terribly as well as looking horrid, he tells me that treatment for varicose veins is considered ‘cosmetic' and isn't available on the NHS. Why is that?

Nearly one in three people get varicose veins during their lifetime and although the veins never look pretty, they don't often cause serious complications. They do, however, cause symptoms like aching, heaviness and swelling. Occasionally they can lead in the long term to eczema and leg ulcers, but it's impossible to tell which patients will go on to develop these. For this reason, cash-strapped Primary Care Trusts in some parts of the country have decided that they won't save many serious complications by treating varicose veins and therefore they are ‘allowed' to refuse to treat them on the NHS. However, if your quality of life is being signifi cantly affected, it's certainly worth pressing your case with your GP again.

Dr Sarah Jarvis, Good Housekeeping (Sept 09) 

 

Can I pass on hepatitis C onto my husband?

I had a routine blood test because I was feeling tired, and I'm horrified to discover that I've got hepatitis C. I feel so ashamed, and I can't even tell my husband as I'm terrified I might have passed it on to him, too.

Like you, about 200,000 people in the UK have a long-term hepatitis C infection, and many of them have no idea. You don't contract hepatitis C only from using drugs - you could have got it from a blood transfusion before 1991 (all blood and blood products in the UK are now screened, so there is no risk) or from dental or medical treatment in some developing countries. Many people never get any symptoms (which can include tiredness, muscle aches, nausea and pain over the top right side of your stomach) at all. Even if you do, your chances of developing serious liver damage are less than one in five. It's vital you tell your husband, however, because he needs to get tested, too - although there is about a 95% chance you won't have passed it on to him. Fortunately, treatment offers more than a 50% chance of a complete cure, and cutting out alcohol and eating a healthy diet can improve your long-term outlook.

Dr Sarah Jarvis, Good Housekeeping (July 09)

 

Do iron supplements have to constipate me?

I have anaemia. Which iron supplements are the least likely to cause constipation as a side effect?

You can boost your iron intake with iron-rich foods such as red meats, sardines and shellfish. The ‘haem' form of iron in red meat is up to ten times more easily absorbed than that in vegetables. Wheatgerm, wholemeal bread, egg yolk, green vegetables and dried fruit still provide useful amounts. But don't overboil vegetables as this decreases their available iron.

Sources of vitamin C (such as citrus and berry fruits, kiwi and green leafy vegetables) promote iron absorption but tea and coffee reduce it, so iron supplements are best taken with orange juice or water. Iron chelated (tightly bound) with amino acids, such as Solgar's Chelated Iron (£6.95 for 100 tablets), Solgar's Gentle Iron (£8.19 for 90 capsules) or Nutrigold's Iron (£9.95 for 60 capsules) are usually better tolerated and less constipating than ferrous sulphate. Other options include iron-rich spa water (Spatone Iron+, £6.49 for a 28-day supply) or iron-rich yeast supplements (such as Floradix Formula, £13.45 for 500ml). All products available from The Nutri Centre (0845 602 6744).

Dr Sarah Brewer, Prima (May 09)

 

Can I bring down my blood pressure?

 

Is there anything I can do to reduce my high blood pressure naturally? I am an otherwise healthy 42-year-old - and don't like taking drugs unnecessarily.

 

You can start by checking out your weight, with the ideal aim of a body mass index (BMI) of 20-25 - you'll find a BMI calculator at www.nhs.uk. If your weight is high, try to lose 1-3lb a week; and even if you can't achieve a BMI within the normal range, any sustained weight loss will help. It's also worth bearing in mind that exercise alone has been shown to bring down blood pressure. You should eat at least five portions of fruit and veg a day - beetroot is the best for reducing blood pressure. Also follow a low-salt, low-fat diet by not adding extra salt or fat to your cooking and avoiding ready-meals, where the salt and fat are often high. Alcohol is beneficial too, but have no more than two units a day, and preferably red wine. Stress can play a part, although it may be difficult to control. Look at the stress triggers in your life and take measures to help reduce them. You should avoid caffeinated drinks, such as coffee and tea, and instead try calming herbal teas or barley cups.

Dr Louise Selby, SHE (Apr 09)

 

 

How can I manage my Raynaud's disease?

 

I have been diagnosed with Raynaud's disease. What is it, and how can I help myself?

Raynaud's is a condition in which small arteries in the fingers and toes are oversensitive to cold. They react by constricting and cutting off blood flow to the digits, which makes them go white, feel numb and tingle. As a sluggish blood flow returns, the digits turn blue, then, when the circulation becomes normal, bright red. The condition can be intensely painful. Fingers are affected more than toes, and women more than men. Self-help includes keeping hands and feet warm, not smoking (this further constricts small arteries) and avoiding sudden or extreme changes in temperature. Eat more oily fish or take omega-3 fish oil supplements to reduce blood stickiness. Garlic tablets and ginkgo biloba extract can improve blood flow to the peripheries, while ginger is naturally warming. Magnesium is also advised for its beneficial effects on circulation. Contact the Raynaud's & Scleroderma Association on 01270 872776 or visit www.raynauds.org.uk.

Dr Sarah Brewer, Prima

 

Might I have hepatitis C?

I'm losing sleep worrying about hepatitis C, as I recently had a blood transfusion. Can you still catch it from this?

 

Hepatitis C is a virus that attacks the liver and is spread through contact with the blood of an infected person. Blood donations have been screened for hepatitis C since 1991, so the risk of catching it in this way is now low. The main ways are sharing drug-injecting equipment, having unprotected sex, sharing a razor or toothbrush with someone who has the virus, or having a tattoo or piercing with non-sterile equipment. If you think you may be at risk, see your GP, as early diagnosis and treatment can clear the virus and help prevent liver damage. For information, visit www.nhs.uk/hepc or call 0800 451451. 
Dr Sarah Brewer, Prima

 

My blood pressure is too high

I have borderline high blood pressure. I’m exercising and I’m not overweight. What are the alternatives to tablets?

A number of lifestyle approaches can lower a raised blood pressure and help reduce the need for drugs. Eat more fruit and veg, cut back on salt, and select wholegrain foods rather than processed ones. Fish, garlic, nuts, olive oil, dark chocolate and red wine (in moderation) are beneficial. On the supplement front, antioxidants, garlic, omega-3 fish oils, co-enzyme Q10, magnesium and calcium could all help. My book, Overcoming High Blood Pressure (Duncan Baird, £12.99), provides three nutritional and exercise plans to help lower blood pressure naturally. Information is also available at my website www.naturalhealthguru.co.uk.

Dr Sarah Brewer, Prima 

 

Do I really need injections?

I'm about to have my second hip replacement, and the surgeon says I need daily injections to thin my blood. I didn't have these last time - are they necessary?

Clots on the leg, or deep vein thromboses (or DVTs) can travel to the lung and cause a pulmonary embolus (PE), which can be fatal. DVT and PE are common problems in patients who are immobile - especially after major surgery on a lower limb. Increasingly, doctors are giving preventive treatment to thin the blood just before and just after surgery. This treatment was offered less often in the past because the medicines were more difficult to administer. A single daily injection for one to two weeks after your surgery can protect you against such clots - I would certainly recommend that you have them.
Dr Sarah Jarvis, Good Housekeeping

 

Low blood pressure

I’ve been taking tablets for high blood pressure for several years. My GP always used to check my blood pressure every three months, but now she’s told me I only need to be seen every six months. I’m worried – is it safe to go that long without a check?

I understand why you're concerned, as many people are used to having their blood pressure checked every three months, but new research shows that blood pressure is just as likely to stay well controlled if it is checked every six months. However, if your medication is altered or you need blood tests, it may need to be checked more often.
Dr Sarah Jarvis, Good Housekeeping
 

Medication for high blood pressure

I have high blood pressure and was prescribed Lisinopril, but I suffered side-effects. After changing to Atenolol, the symptoms disappeared, but I now get very tired.

High blood pressure is a common problem that affects all age groups. It's a condition doctors find hard to treat - not because we don't have medicines that will help, but because most have side-effects. High blood pressure itself doesn't cause any symptoms, but it hugely increases your risk of suffering a heart attack or stroke. If you've been feeling fine and are started on tablets that make you feel unwell, it's tempting to stop them but, of course, that puts you back at increased risk of heart attack. Rather than stopping, ask your GP about alternatives. Atenolol is from a group of medicines called beta-blockers, which can make you prone to tiredness and breathlessness. Lisinopril is from a group called ACE inhibitors, which cause a nasty dry cough in up to one in five people. Talk to your GP about an alternative called an ARB, which has similar benefits but remarkably few side-effects.
Dr Sarah Jarvis, Good Housekeeping
 

Low blood pressure

I had my blood pressure checked recently and was told that it was extremely low – 95 over 51. Should I be worried?

Your blood pressure is a little low - the bottom of the ‘normal' range is 90/60 (the top is about 140/90). But I can reassure you that if you have no symptoms and don't have a history of heart problems, then you really don't need to be concerned. There's certainly no need to adjust your diet or your lifestyle, in fact, low blood pressure can be a sign that your heart is particularly healthy. You're very unlikely to have a stroke if it stays that way. If you're getting symptoms, however, such as lightheadedness (especially when you stand up quickly), dizziness, blurred vision, fainting or poor concentration, see your GP. There are a few medical causes of low blood pressure, such as underactive thyroid, a hormone condition called Addison's disease, diabetes and low blood sugar. All these can be checked out with blood tests. Many tablets can also cause low blood pressure, so remember to tell your GP about any you're taking.
Dr Sarah Jarvis, Good Housekeeping
 

Why have I got thread veins?

What's the cause and how can I get rid of them?I'm in my thirties and broken thread veins have started appearing on my legs. What's the cause?

Thread veins are dilated blood vessels just beneath the skin surface. They can be linked with over-exposure to extremes in temperature, sun damage, and can also be hereditary. They sometimes disappear on their own if the cause is removed - for example, try wearing sun block and avoiding strong sunlight. Supplements containing bilberry extracts or Pycnogenol help to strengthen blood vessels. Thread veins can be treated by special electric currents, pulsed light therapy or laser treatments in private clinics.
Dr Sarah Brewer, Prima
 

Tips to lower blood pressure

Natural remedies can reduce your blood pressureI have raised blood pressure. Is there anything I can take to treat it naturally?

Black grapes contain antioxidants, such as resveratrol, plus minerals, such as potassium and magnesium, which have a beneficial effect on blood pressure. One study shows that drinking half a pint of red grape juice a day for two months helps reduce blood pressure by 7.2/6.2 mmHg. In people with hypertension, taking 30g to 40g olive oil a day can halve the need to start antihypertensive drugs over a six-month period. Dark chocolate has blood pressure-lowering action, too, and garlic tablets can also be effective.
Dr Sarah Brewer, Prima
 

Ease varicose veins

Lately I have noticed that the veins in my legs are becoming more visible and pronounced. My legs have also started to ache, and in hot weather my ankles swell up. I want to be able to wear shorts and skirts but my legs look really awful. I'm only 35. Could I have varicose veins already?

Yes, it's possible to develop varicose veins at 35. They affect 30 per cent of adults, but are more common if there's a family history of them or you're overweight or pregnant. The veins appear, bulging and twisted, just under the skin. This occurs when the vein wall weakens, causing it to dilate. When this happens, valves that prevent blood flowing back down your legs stop working properly and this then affects the circulation.

Varicose veins are unsightly but often nothing to worry about. However, your aching and swollen ankles are classic problems. In severe cases, the skin on the lower legs may even develop ulcers.
Losing any excess weight will help keep them at bay, and graduated compression support stockings will stop your ankles swelling and ease some of the aching – Elbeo has some for £4 (The Leg-Care Company ; 01288 359599). Raise your feet when sitting to help reduce the swelling, and apply cool witch-hazel solution (Boots Witch Hazel, £2.19, www.boots.com to soothe. 

Sclerotherapy – injecting chemicals into the veins – can be a good solution for smaller ones. Surgical options include stripping out larger veins and making small cuts to remove the smaller ones (avulsion). Radio-frequency ablation or laser ablation destroy veins with heat. Speak to your GP about options, or find out more at www.besttreatments.co.uk
Dr Louise Selby, SHE
 

High blood pressure

My father has very high blood pressure and his brother died of a heart attack last year at the age of 58. My blood pressure has been normal until now, but has recently risen. I am 38 and although I don't exercise regularly, I'm not overweight. With my family history, should I be worried?

A one-off, above-normal blood pressure reading does not mean that you have 'high blood pressure'. Your reading will change throughout the day and can increase when you are more stressed or have just been exercising. However, it is important to monitor things to make sure that you don't have a medical problem.

In the UK, about half of people over 65 and one in four middle-aged adults have high blood pressure. It's not something you should ignore, as it can increase the chances of cardiovascular disease (such as heart disease or stroke).
Because you have a family history of high blood pressure, you may be more at risk. Ask your GP to arrange three further blood pressure tests, when you are relaxed. If it is consistently high then you should discuss treatment. This can include lifestyle changes and medication. There are several drugs available and the one chosen will depend upon any existing medical problems, age and ethnicity. In the meantime, you can help yourself by taking regular exercise, quitting smoking, eating a low-fat, low-salt diet and maintaining your current weight. If possible, reduce your stress levels by taking up yoga or some form of relaxation technique. Studies have also shown that garlic may have beneficial effects in managing hypertension. You can use it regularly to flavour your food or, if you don't like the pungent smell, buy odour-free garlic capsules. You could try Holland & Barrett, Odourless Garlic capsules, 100 capsules, £4.99. For more information, contact the Blood Pressure Association, www.bpassoc.org.uk. High Blood Pressure Foundation, www.hbpf.org.uk. British Heart Foundation, 0845 070 8070 (calls charged at local rate) or www.bhf.org.uk
Dr Louise Selby, SHE

 

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The answers to specific problems may not apply to everyone. If you're worried, see your GP. For more information, visit www.netdoctor.co.uk