Q: My mother is 53 years old. She has undergone 2 surgeries in her legs for varicose veins removal some 10 years back. She was always complaining about her inability to walk or sit or do other activities easily, after these operations. But as time passed she was getting better. But for the past six months there has been a blockage in blood flow from her legs. So that part alone was becoming blue. As there was no sufficient flow of pure blood, we showed her to a doctor and told her to exercise. My mom went for a 10 days physiotherapy treatment. There she had to strain her legs and hands. After that she has not been able to perform even normal daily activities without the pain killer tablets and calcium tablets. She is spending painful and sleepless nights. It has been nearly 2 months like this. What can we do to help her?

A:I have gone through the letter and feel that the information given is insufficient to make an opinion about the real problem with the patient. To me it does not seem like a simple problem of circulation as the lady is not very old and is average weight and does not have any predisposing factors that would make her vulnerable to vascular disease. I also do not feel that the surgery done 10 years ago would have that lasting influence on the symptoms. I feel that the patient has some long standing venous insufficiency which is made worse by inactivity and the predominant reason for this clinical state is the fact that her menopausal symptoms have aggravated sufficiently to make her life difficult. I do not have any clear objective evidence but this is not unusual in the ladies of this age who can only respond to comprehensive treatment of the clinical state rather then accusing the poor circulation and allowing her to suffer. I suggest that to start with she should have a good vascular Doppler done for both arterial and venous sides using a colour Doppler and the services of a good operator. She should also have general medical examination to make sure that she does not have any other organic illness. She should be reviewed by her psychiatrist and finally a gynaecologist. I believe she may need treatment of all conditions to be done simultaneously and not piece meal management. I do hope the above suggestions give some guidelines for this patient.