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23 May, 2010

VARICOSE OR VENOUS ULCER

Definition of Venous Ulcer / Varicose Ulcer :-


Venous ulcers (stasis ulcer or varicose ulcers) are wounds that are thought to occur due to improper functioning of valves in the veins usually of the legs. They are the major cause of chronic wounds, occurring in 70% to 90% of chronic wound cases.[1] Venous ulcers develop mostly along the medial distal leg, and can be very painful.http://en.wikipedia.org/wiki/Venous_ulcer

Pathophysiology  :-

The exact etiology of venous ulcers is not certain, but they are thought to arise when venous valves that exist to prevent backflow of blood do not function properly, causing the pressure in veins to increase.[2][3][4][5] The body needs the pressure gradient between arteries and veins in order for the heart to pump blood forward through arteries and into veins. When venous hypertension exists, arteries no longer have significantly higher pressure than veins, blood is not pumped as effectively into or out of the area, and it pools.
Venous hypertension may also stretch veins and allow blood proteins to leak into the extravascular space, isolating extracellular matrix (ECM) molecules and growth factors, preventing them from helping to heal the wound.[2][5] Leakage of fibrinogen from veins as well as deficiencies in fibrinolysis may also cause fibrin to build up around the vessels, preventing oxygen and nutrients from reaching cells. Venous insufficiency may also cause white blood cells (leukocytes) to accumulate in small blood vessels, releasing inflammatory factors and reactive oxygen species (ROS, free radicals) and further contributing to chronic wound formation.http://en.wikipedia.org/wiki/Venous_ulcer#Pathophysiology

A case of Venous Ulcer/ Varicose ulcer treated  at S.P.K.V.C.C :

In 30th of April 2010, an elderly gentleman named Mr.K.K Nair, aged 72 years met our chief physician, Prof.Dr.Ranga Prasad Bhat, in the clinic, presenting with 2 ulcers near the dorsal crease of the Right ankle, both of which was 1cm breadth x 1cm width, with sloping edge devoid of any granulation tissues and filled with pus & bloody discharge. He further had another venous ulcer in the medial aspect of the Right Ankle, 1 cm below the medial malleolus, measuring 2cm breadth x 2cm width, with sloping edge devoid of granulation tissue.

Further more, he had intense itching in the vicinity of the areas with ulcer associated with deep and excruciating pain. The pain was excruciating in nature due to the fact that the ulcer was much deep (nearly 8 mm). He had no history of Hypertension or Diabetes, nor even any cardiac pathologies.But, his nature of job is such that, he was required to sit for a longer time (hanging his forelegs down), devoid of any physical activities.

Dr.Bhat adviced him the following medications along with a specific foot exercise, since the patient does not walk much.
                  1) P.K.Asavam -Internal usage
                  2) V.M.Rasayanam -Internal usage  
                  3) Jathyadi thailam -External Application
                  4) R.S capsule -External Application
Foot Exercise :- Dr.Bhat thought that it would be appropriate to advice the patient to do a foot exercise simulating the walking process, so that the stagnated venous blood causing congestion locally can be dispelled and displaced from that area and get circulated.
Method advised :-  The client was asked to stand facing the wall and place his hands over the wall, so as to prevent falling due to imbalance while doing the procedure. Later,he was asked to raise his body with the tip of all toes together, so that the foot is hyper extended. By doing so the muscle in the lower leg below knee gets compressed and the venous blood flows higher into the next compartment.

(Basic Physiology of Venous Circulation :- one-way valves direct the flow of venous blood upward and inward. Blood is collected in superficial venous capillaries, flows into larger superficial veins, and eventually passes through valves into the deep veins and then centrally to the heart and lungs. Superficial veins are suprafascial, while deep veins are within the muscle fascia. Perforating veins allow blood to pass from the superficial veins into the deep system.Within muscle compartments, muscular contraction compresses deep veins and causes a pumping action that can produce transient deep venous pressures as high as 5 atmospheres. Deep veins can withstand this pressure because of their construction and because their confining fascia prevents them from becoming excessively distended.)


            Image taken on 30th April 2010  showing venous ulcer on medial asp of ankle joint






                         Image taken on 30th April showing venous ulcer on dorsal asp of ankle joint





Observation :-

Two days after starting the treatment, Mr.Nair responded well to the medicines, thereby showing signs of control in the formation of pus. As a result of foot exercise,which he did religiously 20 times in a day,he was nearly 80% relieved from the excruciating pain and there was much considerable reduction in the oedema near the ankle joint.


And on the seventh day of treatment (i.e 07 may 2010) the ulcers in the dorsal aspect of foot got completely healed, where as the  one in the medial aspect has partially healed and is still to be covered with external layers of skin, which can be clearly seen from the images given below.


                         Image taken on 07th of May showing venous ulcer on dorsal asp of ankle joint




                            Image taken on07th of May showing venous ulcer on dorsal asp of ankle joint




Conclusion :-

It becomes apparently evident by the above case, that Varicose Ulcers can be healed with Ayurveda medicines and treatment methods at a quicker rate of healing. Even though the medicines given by Dr.Bhat has considerably given a quicker relief in this particular client, the Dr. humbly owes the credit to Mr.K.K.Nair, saying that it was his highest co-operation given during the treatment, that has made the healing of ulcer faster, by following the advices given religiously.


Hail Ayurveda.

The journey of explaining Ayurveda will continue in the up coming posts


Warm regards to all those who read this. 
"Let humanity live in peace and health".
“Sarve Janaah Sukhinoh Bhavanthuh ”.
"सर्वे जनाः सुखिनो: भवन्तु:"
"ಸರ್ವೇ ಜನಾಃ ಸುಖಿನೋ: ಭವಂತು:"

"வாழ்க நலமுடன்".    

-Prof.Dr.Rangaprasad Bhat.


















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