An Expert Patient (varicose veins)
A patient, new to me, came in for treatment of a small, recent ulcer near the ankle due to varicose veins. While he was taking his shoe off, I complimented him for wearing his elastic stockings. He confided that he really should wear them more than he actually did wear them.
I showed him about valves in the veins all over the body to protect them from back pressure of the column of blood above them to the level of the heart. Readers can do this demonstration on the back of the hand. Choose the beginning a larger vein where it accepts the run off from two fingers and press their junction with your middle finger. With the index finger stroke the larger vein toward the heart past the next junction. This segment of the vein will remain empty until the middle finger is released, demonstrating valves at vein junctions, which prevent retrograde flow. This anatomy relieves all excess back pressure when we are active because the muscle activity milks the blood along the way the index finger did. In the absence of valves as occurs with varicose veins elastic support is the next best thing, collapsing the veins preventing further distention and compelling a faster flow rate, inhibiting clotting, just the way a river flows faster at narrow places than at wide places.
About their own disease expert patients know what the doctor knows and apply that knowledge without constant intervention from the physician. Our brief experiment has shown why people with varicose veins need elastic stockings more for a long plane ride than while cutting wood. Normal people should also walk the aisles on long plane rides and even if they have a window seat.
Accepting the reality of a chronic disease is a quasi-religious experience the way accommodating to our mortality is such an experience for healthy people. The new attitude has to come from within. In this case we are talking about our expert patient biting the bullet and accepting the nuisance of wearing elastic support whenever appropriate.
John A. Frantz, M.D.
Chairman Monroe Board of Health
June 8, 2002
Hire a lawyer only if big money or jail time is at stake. Otherwise just wing it. You will save not only the professional fee but also the extra cost of perhaps unnecessarily cautious advice.
And insure only risks which you cannot afford to assume.
For a modern translation of the Bible merely dub in “accountants and lawyers” for “scribes and Pharisees”.