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INTRODUCTION

The ideal treatment of venous valvular reflux disease is the elimination of gravity. The only known setting in which zero gravity can be sustained is in outer space. Certainly major shifts of body fluids occur in astronauts on sustained missions. Although space flight has never actually been tried for treating venous insufficiency, it is reasonable to predict that all symptoms from the disorder would improve. Of course, the earth-bound sufferer must adapt methods of treatment which necessarily compromise this theoretically perfect solution.

The point is made that gravity can be used to help control of the effects of venous insufficiency. This intervention is simply through elevation of the limb. It is not an easy intervention for the bi-ped to apply rigorously.

BED REST

Probably continuous bed rest is as effective as space travel to relieve the symptoms of venous reflux. Indeed, it is a common experience for people with this disorder to notice striking improvement in swelling and discomfort after spending several days in bed, enforced by influenza, injury or other confining ailments. Still, a lifetime of bed rest is hardly an acceptable price to pay for relieving leg swelling, aching, and ulcer. Nor is it necessary. Some compromises can be made that promote control of venostasis.

Prolonged bed rest may be desirable during the initial phase of treating venous insufficiency with complications: severe stasis dermatitis or ulcer. During this time, a bedside television set, reading/writing stand or books-on-tape can ease the burden of recumbent confinement.

We know that prolonged bed rest itself can result in venous thrombosis. Thus it paradoxically exposes the patient to the danger of another episode of thrombophlebitis. Immobility also leads rapidly to loss of muscle tone. With these problems in mind, intermittent exercise is important. This subject is addressed in Chapter 21.

Several days up to a week of strict bed rest is enough to see some improvement in complications or venous hypertension. The time for periodic, upright activity can gradually be increased as healing occurs.

PERIODIC RECLINING

While continuous bed rest is impractical, periodic reclining is extremely helpful. Almost everyone can find a way to adapt the habit of lying down for brief periods during the day. Reclining for half an hour once or twice a day can often be accomplished during a lunch break, recess or on returning home from work. Usually, the resourceful person can adapt some productive task during this period.

When complications—such dermatitis or ulcer—are present, leg elevation is recommended for at least 2 hours twice during the day. As improvement occurs, the time can be reduced.

REDUCE STANDING

Patients with venous insufficiency are often advised to avoid standing as much as possible, but it is a challenge to translate this instruction into a practical ...

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