Travel Reference
In-Depth Information
Varicose Veins
The veins of the extremities have numerous small valves within them to ensure that
blood flows only in the direction of the heart. The blood pressure in veins is so low that
the increase in intrathoracic or intraabdominal pressure associated with straining or strenu-
ous exercise would reverse the direction of the venous blood flow if these valves were not
present.
In some individuals the valves in the leg veins become incompetent, the direction of
blood flow is no longer controlled, and the veins become dilated and tortuous (varicose).
The return of venous blood from the limb to the heart may be impaired, causing persons
with varicose veins to complain of aching in their legs, particularly after they have been on
their feet for a prolonged period.
The greatest significance of varicose veins in the wilderness lies in the tendency for this
disorder to increase fatigability of the legs and limit endurance. A second problem is the
greatertendencyforveinsinthelegstothromboseastheresultofstasisassociatedwiththe
reduced venous blood flow typical of varicose veins. A less common problem is caused by
the presence of greatly enlarged blood vessels just beneath the skin. Minor injuries that or-
dinarily would go unnoticed can penetrate one of these veins and produce relatively severe
bleeding. Although the hemorrhage can be easily controlled, a person with varicose veins
should be aware of this danger.
In the wilderness, persons with painful varicose veins should be encouraged to elevate
their legs on pillows or a soft pad during rest stops to decrease the pressure within the
veins. The pillow must not be placed immediately behind the knee where it would com-
press the veins and reduce circulation. Relief may be obtained with a smooth elastic band-
age or elastic stocking, which should be applied when the person is lying supine and the
veins are collapsed. (The bandages or stockings should be removed at night.) A hard knot
or cord that is inflamed and tender indicates that the blood in one or more of the enlarged
veins has clotted. Thrombosis of such superficial veins is rarely a problem except for the
discomfort. However, swelling of the foot or leg beyond the area where clotting has oc-
curred is indicative of associated clotting of the deeper veins. Redness, swelling, and ten-
derness in the calf may be an indication of thrombophlebitis with its risk of clotting and
embolism. To avoid pulmonary embolism, the individual should be treated as described in
Individuals with varicose veins should consult a physician about proper management of
their condition.
HEART HEALTH AND PHYSICAL ACTIVITY IN THE WILDERNESS
The common denominator of outdoor ventures is physical activity, which increases the
need for blood, oxygen, and nutrients in the muscles. The resulting demands placed on the
heart and circulation may precipitate cardiovascular emergencies such as angina or an in-
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