♪ ♪ THE DAY HAS BEEN LONG, YOU HAVE BEEN ON YOUR FEET AND NOW YOUR LEGS ARE A LITTLE SWOLLEN.

NO BIG DEAL.

MAYBE OR MAYBE NOT.

STAY WITH US AS WE TALK WITH VASCULAR SURGEON Dr. MANDA MALEY ABOUT VENOUS AND LYMPHATIC DISEASE NEXT ON "KENTUCKY HEALTH."

>> "KENTUCKY HEALTH" IS FUNDED IN PART BY A GRANT FROM THE FOUNDATION FOR A HEALTHY KENTUCKY.

THE CAUSES OF PERIPHERALLY DEEMA OR SWELLING ARE NUMEROUS AND CAN RANGE FROM INACTIVITY OR WEARING OF RESTRICTIVE CLOTHING TO LIFE THREATENING MEDICAL CONDITIONS LIKE CARD CARDIAC RENAL OR LIVER FAILURE.

MOST OFTEN THE PRIMARY CAUSES ARE FROM DISORDERS OF VEINOUS OR LYMPHATIC SYMPTOMS.

COMMON CAUSES ARE INFECTION, OBSTRUCTION SUCH AS FOLLOWING RADIATION TREATMENT FOR BREAST CANCER AND MALFUNCTION OF VALVES WITHIN THE WALLS OF THE VEINS CAUSING VEINOUS INSUFFICIENCY.

TO EXPLAIN HOW THEY FUNCTION AND WHAT HAPPENS WHEN THEY FAIL, WE HAVE AS OUR GUEST TODAY Dr. MANDA MALEY, VASCULAR SURGEON AND ASSISTANT FOREVER AT THE UNIVERSITY EVER KENTUCKY COLLEGE OF MEDICINE.

AFTER GRADUATION FROM EAST CAROLINA UNIVERSITY, SHE COMPLETED AN INTERNSHIP AT THE UNIVERSITY OF MARYLAND MEDICAL CENTER IN BALTIMORE AND THEN A COMBINED RESIDENCY AND FELLOWSHIP IN VASCULAR SURGERY AT THE EINSTEIN JEFFERSON HEALTHCARE NETWORK IN PHILADELPHIA.

THANKS FOR BEING WITH US TODAY.

>> THANK YOU FOR HAVING ME.

>> Dr. MALEY, WHAT DOES A VASCULAR SURGEON DO?

>> WE HANDLE ALL BLOOD VESSELS, VEINS, ARTERIES AND LYMPHATIC SYSTEM.

ANYTHING THAT IS PHYSICALLY INSIDE YOUR HEART OR SKULL.

SO IF SOMEONE HAS VARICOSE VEINS, THAT'S SOMETHING WE TREAT AND IF SOMEONE HAS BLOCKAGES IN THEIR ARTERIES TO BRING BRAIN THAT CAN CAUSE A STROKE OR IN THEIR LEGS OR ARMS, WHICH CAN CAUSE ISCHEMIA OR LACK OF BLOOD FLOW TO THOSE CAUSING THE LIMB TO DIE, ESSENTIALLY.

WE TREAT THOSE THINGS WITH ENDOVASCULAR PROCEDURES LIKE TINY WIRES AND CATHETERS, BALLOONS, A ROTO ROOTER OR OPEN BYPASS WHICH IS LIKE BEING A HUMAN PLUMBER.

WE TAKE EITHER YOUR OWN VEIN OR PROS THETSIC MEANING PLASTIC TUBING AND KIND OF BYPASS AROUND THOSE BLOCKAGES.

WE ALSO TREAT THINGS LIKE AN YOUR RECIDIVISMS UN ANEURYSM TO PREVENT IT FROM GETTING LARGER AND I GUESS THAT'S THE GIST OF IT.

>> THAT COVERS A WHOLE LOT OF THINGS.

>> WE DO A LOT.

>> WHICH I'M SURE WE'LL TALK ABOUT MORE.

SO WHEN WE TALK ABOUT THE VASCULAR SYSTEM, SO ARTERIES, VEINS, LYMPHATICS.

WHAT IS THE DIFFERENCE BETWEEN THESE THINGS?

>> ARTERIES ARE THE BLOOD VESSELS THAT CARRY BLOOD OUT TO YOUR ORGAN FROMS YOUR HEART AND THE VEINS BRING THE BLOOD FLOW BACK.

VEINS ARE MORE THIN WALLED.

AND THE BLOOD FLOW IS A LITTLE SLOWER THROUGH THOSE.

LYMPHATICS ARE A SEPARATE SYSTEM THAT TRAVELS WHITE BLOOD CELLS THROUGH YOUR SYSTEM TO KIND OF HELP YOU FIGHT INFECTION AND THINGS LIKE THAT.

SO IF YOU HAVE EVER HAD ANY KIND OF STREP THROAT OR ANYTHING AND YOU FELT THE BALLS OR ESSENTIALLY, WE CALL THEM BUCK SHOT UNDERNEATH YOUR CHIN OR ANYTHING, THOSE ARE SWOLLEN LYMPH NODES.

THAT MEANS YOU HAVE WHITE BLOOD CELLS ARE TRAVELING TO HELP WITH INFECTION.

>> SO WHAT ARE THE FUNCTIONS, SAY, YOU KNOW, DIFFERENCES BETWEEN THE LYMPHATIC AND THE VENOUS SYMPTOMS.

ANY DISTINGUISHING FEATURES BETWEEN THE TWO?

BECAUSE WE THINK ABOUT IN TERMS OF FLUID-- AT LEAST I USED TO THINK OF FLUID TRAVELING THROUGH THE LYMPHATICS GETTING BACK TO THE HEART.

I DON'T KNOW.

>> LIMP FLUID GETS BACK TO THE HEART EVENTUALLY THROUGH A DUCT BUT VEINS ARE JUST MOVING YOUR BLOOD FLOW KIND OF AFTER YOUR ARTERIES HAVE DISTRIBUTED IT THROUGHOUT YOUR ORGANS AND LIMBS BACK UP TO THE HEART.

L WR MPH FLUID AND ONE IS BLOOD.

>> BOTH ARE THROUGHOUT THE ENTIRE PART OF THE BODY.

>> YES.

>> A LOT OF TIMES, I ALLUDED TO IN OUR OPENING ABOUT EDEMA OR SWELLING.

WHAT IS THAT REALLY GOING ON WHEN SOMEONE HAS SWELLING IN THEIR EXTREMITIES?

>> IT'S A MEDICAL TERM MEANING THERE IS EXTRA FLUID IN THE TISSUES, SWELLING IS A MORE GENERIC TERM THAT DOESN'T NECESSARILY MEANY DEEM A.

FOR INSTANCE, YOU COULD HAVE SWELLING IN THE JOINT SPACE THAT IS NOT EDEMA NECESSARILY.

ANDY DEEMA IS A FANCY MEDICAL TERM FOR ENLARGEMENT IN THE TISSUE.

>> FOR EDEMA IT'S A CHARGE OF $100 AND SWELLING IS FREE CONSULT A LITTLE.

I ALLUDED TO ALSO, SOMEONE WHO MAY BE STANDING UP OR, FOR A WHILE, MAY HAVE SOME SWELLING IN THEIR LOWER EXTREMITIES.

IS THAT A BAD THING THAT MIGHT BE TAKING PLACE?

>> NOT NECESSARILY.

SO THERE IS MULTIPLE DIFFERENT CAUSES FOR WHY SOMEONE MIGHT HAVE SWELLING FOR INSTANCE IN THEIR LEGS IF THEY HAVE A JOB THEY'RE ON THEIR FEET A LOT.

ONE COULD BE VENOUS INSUFFICIENCY WHICH JUST MEANS THE VEINS ARE NOT WORKING WELL AGAINST GRAVITY TO GET THE BLOOD BACK UP TO THE CENTRAL PORTION OF YOUR BODY TO YOUR HEART.

THERE COULD BE POOLING DOWN IN THE LEGS THAT COULD CAUSE ITCHING, SWELLING, DISCOMFORT, LEG HEAVINESS.

THE OTHER IS LYMPHEDEMA WHICH HAS DIFFERENT CAUSES BUT CAUSE SIMILAR SYMPTOMS BECAUSE IT'S EXTRA FLUID IN THE TISSUE WHICH CAN BE UNCOMFORTABLE.

>> HOW DOES THIS FLUID GET INTO THE TISSUE?

IS IT LEAKING OUT OF THESE VESSELS?

OR WHAT IS GOING ON?

>> SO IT DEPENDS ON THE CAUSE.

SO WITH LYMPHEDEMA, IT'S INTERSTITIAL PRESSURE SO THE FLUID IS NOT GOING BACK UP BECAUSE THERE IS SOMETHING THAT'S WRONG WITH THE DUCTS, SO IT FILLS THE TISSUES BECAUSE IT NEEDS SOMEWHERE ELSE TO GO.

WITH VARICOSE VEINS OR EDEMA, IT'S USUALLY BECAUSE THE BLOOD IS GOING INTO TRIBUTARIES THROUGHOUT AND CAUSING TINY CAPILLARIES THAT WOULD NOT NORMALLY HAVE BLOOD FLOW INTO THEM OR POOLING INTO THEM THIS SWELL AND THE SAME THING CAN HAPPEN THERE IF THEY GET TOO SWOLLEN.

>> CAN YOU TELL BY LOOKING AT SOMEONE THAT THE SWELLING MAY BE BECAUSE THE VEINS ARE NOT WORKING AS WELL AS THEY SHOULD OR BECAUSE THE LYMPHATIC SYSTEM IS NOT WORKING?

>> USUALLY WITH PHYSICAL EXAM YOU CAN DESIRN THAT.

SOME PEOPLE WILL HAVE VARICOSE VEINS WHICH ARE SPIDER VEINS OR THE LITTLE VEINS THAT WE CAN SEE ON PEOPLE THAT ARE DISCOLORED.

THE OTHER ARE THE LARGE ENGORGEMENT OF THE ENDS OF THE LEGS YOU WOULDN'T NORMALLY SEE IN SOMEONE WHO DOESN'T HAVE VENOUS INSUFFICIENCY.

IT CAN BE UNILATERAL OR BILATERAL MEANING BOTH LEGS IN SOME CASES OR ARMS.

BUT IT'S A PHYSICAL EXAM.

>> YOU USED THE TERM A COUPLE OF TIMES ALREADY.

YOU SAID VARICOSE VEINS AND YOU TALKED ABOUT YOU CAN HAVE THESE SPIDER THINGS WHAT ARE VARICOSE VEINS.

>> THEY'RE JUST SMALL SUPER SUPERFICIAL VEINS THAT WOULD NOT HAVE BLOOD POOLING INTO THEM AND THEY BECOME ENLARGED BECAUSE GRAVITY IS PULLING THE BLOOD BACK DOWN.

THE VEINS THAT PUSH THE BLOOD BACK INTO YOUR CENTRAL SYSTEM AS YOU WALK OR MOVE YOUR MUSCLES, KIND OF PUSH THAT FLOOD FLOW BACK UP AND YOU HAVEBY VALVES INSIDE YOUR VEINS THAT CLOSE TO PREVENT GRAVITY FROM HAVING THE BLOOD POOL BACK DOWN AND IF THOSE VALVES ARE NOT WORKING WELL, THE BLOOD WILL POOL DOWN AND FILL SOME OF THE SMALLER VEINS AND MAKE THEM ENLARGED SO THEY'RE MORE VISIBLE.

THE SMALLER VEINS WHICH ARE CALLED SPIDER VEINS ARE USUALLY JUST UNSIGHTLY BUT NOT UNCOMFORTABLE FOR PEOPLE BUT THEY'RE THE VERY SMALL VISIBLE VEINS.

>> OTHER THAN THE ESTHETICS OF THESE THINGS, MAY OR MAY NOT BE APPEALING TO US, DO VARICOSE VEINS IN AND AMONGST THEMSELVES PRESENT A PARTICULAR MEDICAL PROBLEM?

>> IT'S VARICOSE VEINS IN THE LOWER EXTREMITIES THAT'S NOT USUALLY A PROBLEM.

THERE ARE OTHER REASONS YOU CAN HAVE SOMETHING WHICH ISY SCOFF JEEL OR MORE INTERNAL AND THAT'S USUALLY FROM LIVER PROBLEMS IF IT IS VARICOSE VEINS IN THE LEG, IT'S NOT USUALLY AN ISSUE UNLESS YOU ALLOW THEM TO PROGRESS TO CAUSE AN ULCER WHICH IS SKIN BREAKDOWN FROM THE SWELLING AND TENSION ON THE SKIN.

IF THAT HAPPENS, THOSE ULCERS CAN BECOME INFECTED AND THAT CAN BE AN ISSUE.

BUT THEY'RE NOT LIFE THREATENING.

>> A LOT OF US ARE CONCERNED ABOUT MAYBE IT CAN BREAK OFF AND TRAVEL TO THE LUNGS AND GET A PULMONARY EMBOLISM AND GO TO THE BRAIN, I GUESS.

THESE DO NOT CAUSE THOSE KINDS OF PROBLEMS?

>> NOT USUALLY, NO.

IF IT PROGRESSES FAR ENOUGH AND YOU ARE NOT ABLE TO USE COMPRESSION ENOUGH TO KIND OF TREAT IT IF THE SWELLING GETS BAD ENOUGH, YOU CAN HAVE SKIN BREAKDOWN THAT CAN CAUSE A WOUND AND BECOME INFECTED.

THAT'S THE BIGGEST RISK.

>> DO YOU SEE THEM EQUALLY FREQUENT IN BOTH MEN AND WOMEN, A JOB SPECIFIC THING.

>> MUCH MORE FREQUENT IN WOMEN AS MOST VASCULAR DISEASE.

AND PEOPLE WHO ARE SITTING A LOT INSTEAD OF A DIFFERENT NATURE.

BEING ON YOUR FEET, WAITRESSES, NURSES, THOSE KINDS OF PROFESSIONS ARE COMMON BECAUSE THEY'RE UP WALKING AROUND AND WITH GRAVITY PUSHING THE BLOOD BACK DOWN THEY'RE MORE LIKELY AND WOMEN WITH CHILD BIRTH BECAUSE THE BABY WILL PUT PRESSURE ON THE ILIAC VEINS WHICH ARE THE VEINS THAT GO INTO THE LEGS THAT CAN CAUSE SOME COMPRESSION WHICH WILL CAUSE INABILITY FOR THE BLOOD FLOW TO GO PAST IT.

>> IS THERE ANY REASON WHY ONE SHOULD TREAT THIS CONDITION?

IF YOU HAVE AN ULCER YOU WANT TO TREAT IT SO IT DOESN'T GET INFECTED OR IF IT BECOMES DISRUPTIVE TO YOUR DAILY LIFE.

IF THE SWELLING IS SO UNCOMFORTABLE THAT THE ITCHING, HEAVINESS, ACHINESS SO YOU CAN'T PERFORM YOUR DAILY ACTIVITIES COMFORTABLY, THAT'S A REASON TO TREAT IT.

>> THESE VEINS ON THE OW SIDE OF THE LEG, DO THEY COMMUNICATE WITH THE VEINS THAT ARE DEEPER INSIDE OF OUR LEGS, THE ONES WE DON'T NECESSARILY SEE OR ARE THEY TWO SEPARATE SYSTEMS?

>> THEY DO CONNECT.

AT EVERY POINT IN OUR BODY, THE SUPERFICIAL VEINS AT SOME POINT CONNECT WITH THE DEEP SYSTEM.

IF YOUR DEEP SYSTEM IS WORKING WELL, MEANING THE VALVES IN THE DEEP VEINS THAT WE DON'T NECESSARILY SEE ARE WORKING WELL, IF WE SHUT DOWN THE SUPERFICIAL VEIN THAT IS NOT WORKING WELL, IT DIRECTS TRAFFIC TO THE VEIN THAT IS WORKING WELL.

LIKE ON A HIGHWAY THROUGH TOWN, NEW CIRCLE ROAD FOR INSTANCE AND THERE IS A TRAFFIC BLOCK AND YOU DIRECT EVERYONE TO THE INTERSTATE AND EVERYONE CAN GET WHERE THEY'RE GOING QUICKLY, THAT'S ESSENTIALLY WHAT SHUTTING DOWN THE SUPERFICIAL VEIN IS.

>> SO WHEN YOU ARE TREATING SOMEBODY THAT HAS THESE REALLY LARGE VARICOSE VEINS WHAT ARE YOU TRYING TO DO?

>> USUALLY TRYING TO, IF IT'S A NAMED VEIN LIKE A GREAT OR INTERACCESSORY VEIN, I'LL USUALLY TRY TO SHUT THEM DOWN SO CAN I DIRECT BLOOD FLOW TO THE DEEP VEINS WORKING WELL SO THEY DON'T HAVE THE VARICOSE VEINS, THE SMALL ERR SPIDER VEINS AND THAT THE SWELLING AND THINGS WILL GO AWAY.

SO I'M DIRECTING THE BLOOD FLOW AWAY FROM THE VEIN THAT WAS NOT WORKING WELL TO THE ONE THAT IS WORKING WELL SO THE BLOOD FLOW CAN GO BACK UP INTO THEIR HEART.

>> IS THERE ANY SPECIAL TESTING THAT DO YOU TO MAKE SURE THE DEEP VEIN IS WORKING WELL.

ULTRASOUND OR SOMETHING LIKE THAT?

>> ULTRASOUND.

IT'S NOT RADIATION, IT'S NOT PAINFUL.

IT'S A VERY QUICK TEST JUST TO MAKE SURE THAT THE DEEP VEINS ARE WORKING WELL SO THAT IF WE SHUT DOWN THE SUPERFICIAL VEINS, IT'S SAFE.

>> TELL ME ABOUT USING THE COMPRESSION STOCKINGS.

>> IS THAT REALLY OF VALUE.

>> INCREDIBLY YES.

EVERYONE SHOULD WEAR COMPRESSION STOCKINGS IF THEY HAVE A JOB WHERE THEY'RE IN A CHAIR OR ON THEIR FEET QUITE A BIT.

IT HELPS IN WOMEN WHO HAVE A FAMILY HISTORY OF, YOU KNOW, VARICOSE VEINS OR SEVERAL PREGNANCIES OR A PROFESSION WHERE THEY'RE UP ON THEIR FEET.

SOME PEOPLE CAN RELIEVE ALL OF THEIR SYMPTOMS AND GET RID OF ANY SPIDER VEINS BY WEARING COMPRESSION CONSISTENTLY ALONE DURING THE DAY WHILE UP ON THEIR FEET.

>> WHAT ABOUT ELEVATION, SITTING BACK, KEEPING YOUR LEGS SLIGHTLY ELEVATED?

YEAH, SO IF YOU HAVE ELEVATION ABOVE THE LEVEL OF YOUR HEART, IF YOU ARE LYING IN BED OR ON THE COUCH, IF YOU CAN PROP THEM UP ON PILLOWS OR OTTOMAN ABOVE THE LEVEL OF I DON'T ARE HEART, THAT'S HELPFUL AS WELL BECAUSE IT'S FIGHTING AGAINST GRAVITY.

>> A GOOD THERAPEUTIC OPTION FOR SOMEONE WITH VARICOSE VEINS IS TO SIT BACK ON THE COUCH, HAVE A COLD BEER WATCHING FOOTBALL, IS THAT CORRECT?

>> OCCASIONALLY.

>> I WAS HOPING THAT WAS GOING TO BE A GREAT... [LAUGHTER] SO WHEN YOU HAVE THESE LITTLE VEINS, ARE YOU STILL DOING LITTLE INJECTIONS TO MAKE THEM GO AWAY?

>> YEAH, YOU CAN DO A THERAPY WHERE WE INJECT A MEDICATION THAT KIND OF IRRITATES THE VEIN AND CAUSES IT TO COLLAPSE ON ITSELF.

WE USE TINY NEEDLES THAT CAN BE DONE IN CLINIC WITH NO PAIN MEDICATION.

NOT PAINFUL AT ALL UNDERSTAND IT CAN SHUT THOSE DOWN.

THAT'S USUALLY COSMETIC REASONS.

>> WHAT ABOUT EVERYBODY IS USING A LASER FOR SOME REASON OR ANOTHER.

WHAT IS IN YOUR LASER TOOLKIT.

>> SHUTTING DOWN THE SUPERFICIAL VEINS YOU CAN LASER TO IRRITATE THE INSIDE OF THE VEIN TO CAUSE IT TO COLLAPSE.

I USE RADIO FREQUENCY OBLATION THAT IS A HEATING ELEMENT BUT THE LASER DOES THE SAME THING.

>> DO YOU HAVE TO PUT ANYTHING IN THE VEIN TO STRIP IT OUT?

>> I DON'T DO VEIN STRIPPING ANY LONGER BUT IT IS SOMETHING THAT IS TALKED ABOUT IN THE LITERATURE.

THE VEIN STRIPPING IS KIND OF LIKE PULLING THE VEIN OUT.

I USUALLY WILL JUST DO RADIO FREQUENCY OBLATION AND IF NOT THE NAMED VEIN WHERE YOU JUST MAKE TINY INCISIONS, LESS THAN HALF CENTIMETER AND JUST PULL OUT THOSE LITTLE VEINS AND THEY DON'T HAVE TO HAVE TOUCHERS SUCHERS AND PEOPLE CAN GO ABOUT THEIR ACTIVITY THE NEXT DAY.

>> BIG VARICOSE VEINS SOMEONE MAY HAVE, YOU MAY BUZZ THEM OR SOMETHING LIKE THAT ON THE OUTSIDE?

>> I USUALLY MAKE THE SMALL INCISIONS AND PULL THEM OUT AND THEN MAKE SURE THAT THE SUPERFICIAL VEINS ARE WORKING WELL SO THEY DON'T REOCCUR.

>> GOTCH GOTCHA.

LET'S GO TO THE LYMPHATIC SYSTEM NOW.

MOST OF US GET CONFUSED WHEN SOMEONE, AGAIN, WE SEE SWELLING, WE THINK IT'S A VEIN.

WHAT ARE SOME OF THE COMMON PROBLEMS?

YOU TALKED ABOUT RADIATION.

BUT WHAT ARE SOME OTHER ISSUES THAT MAY CAUSE A PERSON TO HAVE SWELLING BECAUSE OF LYMPHATIC DISEASE.

>> LYMPHEDEMA.

THE NUMBER ONE CAUSE IS A PARASITE, IT'S NOT COMMON IN THE UNITED STATES AT ALL.

SO IT'S FROM MOSQUITOES.

MORE COMMON IN OTHER COUNTRIES.

WE DON'T ACTUALLY HAVE A HUGE ISSUE WITH THAT HERE.

USUALLY IN THE UNITED STATES IT'S FROM SOME KIND OF TRAUMA, CANCER TREATMENTS, SO COMMONLY WITH BREAST CANCER, QUITE A FEW DECADES AGO THEY WOULD DO A RADICAL ACTION LEAR DISSECTION AXILARY TO MAKE SURE THERE WAS NO CANCER IN THE ARM PIT AND THAT WOULD TAKE OUT THE LYMPHATIC SYSTEM AND PEOPLE WOULD HAVE SWELLING IN THE ARM AND PRESCRIBED A HOME PUMP THAT GOES AROUND THE ARM OR THE LEGS AS WELL THAT PUSHES THE FLUID BACK OUT SO IT'S HELPING TO PUSH THE FLUID OUT THERAPEUTICALLY TO RELIEVE THE SYMPTOMS.

USUALLY AN HOUR IN THE EVENING AND AN HOUR IN THE MORNING.

>> IS IT COMFORTABLE?

>> I HAVE NEVER MYSELF DONE IT.

BUT I'VE NOT HAD COMPLAINTS FROM PATIENTS AND USUALLY THEY SAY THEY'RE GOING TO WATCH TV FOR AN HOUR IN THE MORNING AND AN HOUR IN THE EVENING, IT'S TOTALLY FINE AND THEY FEEL BETTER AFTERWARDS BECAUSE THE TIGHTNESS GOES AWAY.

>> ISN'T THAT THE WAY DOCS ARE.

I'VE NEVER DONE IT ON ME, BUT I'LL TELL TO YOU DO IT.

>> I FEEL LIKE THEY WOULD TELL ME.

>> WHEN YOU TALK ABOUT LYMPHEDEMA ARE THERE VARIOUS STAGES TO THE SEVERITY AND WHAT DOES THAT MEAN?

>> SO THERE IS A SCALE FOR IT AND IT JUST MEANS HOW SEVERE OR HOW INTENSE THE SWELLING IS.

AND IT KIND OF DETERMINES WHAT YOUR TREATMENT PLAN SHOULD BE.

IF IT'S LESS SEVERE MEANING LOWER ON THE SCALE, YOU CAN DO THINGS LIKE ACE WRAPS, COMPRESSION STOCKINGS WE TALKED ABOUT FOR VENOUS DISEASE AND IF IT BECOMES MORE SEVERE THEY MAY NEED TO GO TO LYMPHEDEMA PHYSICAL THERAPY WHERE THEY HAVE MASSAGE TECHNIQUES AND PUMPS THAT WILL HELP MOVE THE FLUID TOUT MAKE IT MORE COMFORTABLE FOR THEM AND THE PUMPS AT HOME THAT WE TALKED ABOUT.

THE LYMPHEDEMA PUMPS CAN BE REALLY HELPFUL WITH THAT.

THERE ARE SURGERIES THAT VERY FEW VASCULAR SURGEONS IN THE COUNTRY DO WHERE THEY CAN DO BYPASSES AND THINGS IN THE L WR MPH SYSTEMS BUT IT'S FOR VERY UNIQUE AND SEVERE SITUATIONS AND VERY FEW SURGEONS DO IT.

>> IT SOUNDS COMPLICATED BECAUSE THESE ARE SMALL... >> MICROSCOPIC, VERY SMALL.

>> ARE THERE ANY CONSEQUENCES FOR A PERSON WHO HAS PROCEED LONGED OBSTRUCTION WITH THE LYMPHEDEMA?

>> SO KIND OF LIKE WITH HAVING THE SWELLING FROM THE VENOUS DISEASE, IT CAN CAUSE BREAKDOWN OF THE SKIN AND PEOPLE WILL GET SOMETHING CALLED CELLULITES WHICH IS AN INFLAMATION OF THE SOFT TISSUE CELLULITIS AND IT CAN PROGRESS INTO SEPSIS WHICH COULD BE LIFE THREATENING BUT BEE TRY TO MAKE SURE, ESPECIALLY WITH, YOU KNOW, WINTER, THAT WE MAKE SURE PEOPLE HYDRATE THEIR SKIN AND SWELLING IS DOWN AND IN THE SUMMER PEOPLE ARE MORE COMMONLY GETTING SKIN BREAKDOWN, SO THE SEASONAL EXTREMES ARE THE TIMES THAT WE WORRY ABOUT THE MOST.

>> I KNOW YOU MENTIONED THAT WHITE BLOOD CELLS ARE MOVING BACK AND FORTH IN THE LYMPHATIC FLUID.

IF A PERSON HAS LYMPHEDEMA, ARE THEY AT RISK FOR OTHER INFECTIONS, SEVERE LIKE ANTIBIOTICS.

>> MORE COMPLICATED TO TREAT IT BECAUSE THE SWELLING MAKES IT DIFFICULT FOR PATIENTS TO RELIEVE THE SYMPTOMS AND FOR THE INFECTION TO RESOLVE SO YES, THEY ARE.

>> AGAIN, THE PNEUMATIC CUFF, THAT WORKS OUT PRETTY NICELY FOR THESE PATIENTS?

>> IT REALLY DOES.

IF PEOPLE ARE CONSISTENT WITH THE TREATMENT OF IT, IT DOES.

>> AGAIN, NOT AGAIN SOMETHING YOU HAVE TRIED YOURSELF.

IF IT BECOMES SEVERE ENOUGH, THEN YOU SHOULD USE THE PUMPS BUT YOU CAN TRY THAT AND WEIGHT LOSS AND THINGS.

>> IS THERE A DIFFERENCE IF ONE HAS-- YOU SAID BEFORE ABOUT BILATERAL VERSUS UNILATERAL ONE SIDE.

DOES THAT MAKE A DIFFERENCE IN WHAT THE POTENTIAL CAUSE MAY BE IF SOMEONE HAS SWELLING IN THE LEGS.

>> IF SOMEONE HAS UNILATERAL ONE LEG SWELLING, YOU WANT TO IMMEDIATELY RULE OUT DEEP THROM BOCES MEANING A BLOOD CLOT IN THE LEG WHICH CAN BE LIFE THREATENING IF THAT DOES BREAK OFF LIKE WE TALKED ABOUT EARLIEE DO AN ULTRASOUND AND PHYSICAL EXAM FINDINGS TO SEE IF IT IS A BLOOD CLOT OR NOT.

IF IT IS UNILATERAL THERE ARE OTHER CAUSES.

LYMPHEDEMA CAN BE FROM PERHAPS SOMEONE HAD A SURGERY AND THEIR LYMPHATIC SYSTEM IS DISRUPTED OR TRAUMA ON THAT SIDE OR RADIATION FROM CANCER, THINGS LIKE THAT.

IF IT'S VENOUS DISEASE, THERE ARE THINGS THAT CAN HAPPEN LIKE WHERE IT'S MORE COMMON THAT YOUR LEFT LEG WOULD BE SWOLLEN BECAUSE THERE IS COMPRESSION OF THAT VEIN IN YOUR ABDOMEN GOING DOWN INTO THE LEG SO IT MAKES IT MORE DIFFICULT FOR YOUR BODY TO GET THE BLOOD FLOW OUT OF THE LEG TO THE CENTRAL SYSTEM.

SO YEAH, IT HELPS YOU SEPARATE YOUR DIFFERENTIAL.

>> YOU SAID DVT THING.

I WANT TO TALK ABOUT THAT MORE BECAUSE THAT'S A BIG DEAL.

>> THAT'S THE SCARY ONE.

>> TELL BUS THAT.

HOW DOES THAT COME BACK?

>> THE MOST COMMON CAUSES ARE IMMOBILITY, MEANING NOT WALKING AROUND, SO PEOPLE WHO HAVE HAD RECENT SURGERY OR A FRACTURE OR THINGS LIKE THAT.

IF THEY'RE NOT UP WALKING AROUND, SO AS WE WERE TALKING ABOUT THE MUSCLES IN THE LEGS OR ARMS WHEN WE ARE UP DOING THINGS HELP MOVE THE FLOOD DPLOA BACK IN BECAUSE THE VEINS DON'T HAVE A PUMP SYSTEM ESSENTIALLY.

OUR MUSCLES HELP MOVE IT.

ANOTHER CAUSE WOULD BE IF YOU HAVE A FAMILY HISTORY OF IT.

SOME PEOPLE ARE MORE PRONE TO CLOTTING.

GENETIC DISORDERS THAT MAKE PEOPLE MORE LIKELY TO HAVE BLOOD CLOTS, JUST BECAUSE OF THE NATURE OF WHATEVER DISEASE THEY COULD HAVE.

AND OBESITY IS ANOTHER ONE OF THOSE, NOT BEING UP WALKING AROUND.

CERTAIN MEDICATIONS THAT CAN CAUSE.

BIRTH CONTROL IS ONE OF THEM THAT I THINK PEOPLE OFTEN HEAR ABOUT.

SO HIGHER LEVELS OF ESTROGEN AND THINGS LIKE THAT.

>> ARE THERE ANY SYSTEMIC DISEASE OR ORGAN FAILURE THAT CAN GIVE RISE TO A PERSON HAVING SWELLING IN THEIR EXTREMITIES?

>> YES.

SO IF YOU HAVE HEART FAILURE, THAT CA CAUSE IT.

SO IF YOU THINK OF IT AS YOUR HEART BEING A PUMP, AND THEN YOUR BLOOD INVEST WILLS-- VESSELS AS HOSES.

IF YOUR PUMP IS NOT WORKING, IT'S DIFFICULT FOR EVERYTHING TO MOVE THROUGH SO STUFF POOLS PLACES SO THAT CAN CAUSE SWELLING.

IF YOUR KIDNEYS ARE NOT WORKING WELL, YOUR KIDNEYS GET THE FLUID OUT OF YOUR BODY, EXCESS FLUID AND IF THEY'RE NOT WORKING WELL, KIDNEY FAILURE CAN CAUSE FLUID OVERLOAD WHICH COULD CAUSE SWELLING AS WELL AND LIVER FAILURE CAN CAUSE IT AS WELL.

>> SO IF I WAS A PERSON WHO, DURING THE COURSE OF MY NORMAL WORK DAY, I GO TO BED AT NIGHT, MY LEGS ARE SWOLLEN AND THEN WHEN I WAKE UP IN THE MORNING MY LEGS ARE NORMAL SIZED?

DOES THAT MEAN I'VE GOT A PROBLEM OR DOES IT IMPORTANT TEND THAT DOWN THE ROAD I MIGHT HAVE A PROBLEM?

>> I THINK IT MORE DOWN THE ROAD PORTENDS YOU MIGHT HAVE A PROBLEM.

IF YOU ARE NOT HAVING SYMPTOMS JUST MERE SWELLING, THAT'S NOT NECESSARILY A ISSUE.

YOU CAN MITIGATE IT WITH COMPRESSION STOCKING.

IF IT STARTS TO BECOME UNCOMFORTABLE OR DISRUPTIVE, YOU CAN SEE A VASCULAR SURGEON AND EVALUATE THE CAUSES OF IT.

IT'S NUANCED AND WE CAN GET AN ULTRASOUND TO MAKE SURE THE VEINS ARE WORKING WELL, NO BLOOD CLOTS AND WE WOULD ALSO, YOU KNOW, LOOK AT LABS AND THINGS LIKE THAT AND SEE WHAT OTHER HEALTH PROBLEMS YOU HAVE TO KIND OF DIFFERENTIATE WHAT WE ARE THINKING THE CAUSE OF IT IS.

UNTIL IT IS CAUSING ISSUES, IT'S NOTHING TO BE CONCERNED ABOUT.

>> WHERE DO YOU STAND, SITTING IN THIS CASE, AS WE TRAVEL LONG DISTANCE.

WE ARE ALL FLYING AND WE ARE SITTING IN THESE LITTLE CHAIRS WHICH ARE VERY UNCOMFORTABLE.

WHAT ARE THE THINGS-- IS THERE A RISK FOR US GETTING CLOTS OR SWELLING IN THE LEGS AND WHAT SHOULD WE DO TO MITIGATE THIS.

>> YES, IMMOBILITY LIKE I SID EARLIER IS A RISK FOR HAVING A BLOOD CLOT.

I TELL MY PATIENTS TO WIGGLE THEIR FEET AT THEIR ANKLES, GET UP AND WALK THEY CAN IF IT IS A LONG FLIGHT OR LONG DRIVE.

I USUALLY RECOMMEND PEOPLE TO WEAR AT LEAST KNEE HIGH COMPRESSION SOCKS.

YOU CAN GO IT THEM FROM ANY STORE DRUGSTORE, WAL-MART, AMAZON, ANYTHING, TO HELP WITH THE BLOOD FLOW NOT STAGNANT AND PEOPLE WHO ARE AT HIGHER RISK, I RECOMMEND THAT THEY TAKE A BABY ASPIRIN.

>> NOW I NOTICE YOU SAID KNEE HIGH.

WE DON'T WANT SOMETHING AROUND OUR CALVES OR SOMETHING LIKE THAT KIND OF LOWDOWN THERE?

>> IT'S ACTUALLY FROM THE TOE UP TO THE KNEE IS KNEE HIGH AND THIGH HIGH GOES ALL THE WAY UP FROM THE TOE TO THE THIGH.

THAT'S A LITTLE MORE UNCOMFORTABLE FOR PATIENTS AND I THINK IT'S MORE DIFFICULT TO GET ON AND OFF AND PEOPLE ARE LESS LIKELY TO WEAR THEM CONSISTENTLY.

IF I CAN GET SOMEONE TO WEAR AT LEAST KNEE HIGH CONSISTENTLY, THAT'S A WIN.

>> ALL RIGHT Dr. MALEY, YOU ARE IN THE OPERATING ROOM, STANDING UP DOING THESE LONG CASES, ARE YOU WEARING COMPRESSION STOCKINGS?

>> ABSOLUTELY YES.

>> SO THE COMPRESSION DEVICE ON THE ARM, NO, COMPRESSION STOCKINGS YES.

>> EVERY DAY.

>> IS THERE ANYTHING WE SHOULD LOOK FOR BUYING A PAIR OF THESE.

>> I TELL PEOPLE NOT TO BUY THE ONES WITH A LOT OF PATTERNS BECAUSE THEY CAN BE MORE UNCOMFORTABLE.

THE SEAMS CAN IRRITATE YOUR SKIN.

I USUALLY SAY TO GET MEDIUM PRESSURE, SOMETHING THAT YOU CAN TOLERATE AND JUST MAKE SURE THEY FIT WELL.

>> WELL, THANK YOU VERY MUCH FOR BEING WITH US TODAY.

>> THANK YOU.

>> AND I WANT TO THANK YOU FOR BEING WITH US TODAY.

I HOPE THAT YOU HAVE A BETTER UNDERSTANDING OF THE CAUSES AND PERIPHERALLY DEEMA AND THE NEED TO SEEK TREATMENT SHOULD IT DEVELOP F. YOU WISH TO WATCH THIS SHOW AGAIN PLEASE GO TO ket.org.

IF YOU HAVE A QUESTION OR COMMENT ABOUT THIS OR OTHER SHOWS, WE CAN BE REACHED AT KYHEALTH AT ket.org.

I LOOK FORWARD TO SEEING YOU ON THE NEXT "KENTUCKY HEALTH."

EXERCISE THOSE FEET AND WEAR COMPRESSION STOCKINGS.

♪ ♪ ♪ ♪ "KENTUCKY HEALTH" IS FUNDED IN PART BY A GRANT FROM THE FOUNDATION FOR A HEALTHY KENTUCKY.

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