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Vascular, not just plain TTS?

Posted by JJC on 8/09/02 at 07:21 (092046)

My doctor is wondering if I have a circulation problem in my feet.
I tested positive for TTS (NCV) but do not have the usual symptoms
of burning, numbness. I have tremendous achiness, tiredness in
my ankles when I try to walk distances. I do not have swelling.
I am otherwise very healthy; an athlete until my feet gave me problems.
What kinds of diseases are suspect? Would a routine Vascualr Surgeon
be able to help me, or should I seek a better specialist?

Re: Vascular, not just plain TTS?

Sharon W on 8/09/02 at 16:04 (092074)

JJC,

I am facing the same kinds of problems.

I just had TTS surgery in my right foot/ankle and the posterior tibial nerve, vein, and artery had 6 large, swollen (and in some cases, hardened) venules tangled around them, strangling the nerve by putting it under too much pressure.

A doppler ultrasound of my saphenous vein showed that even the biggest vein in my right thigh has problems with backflow (a condition called venous insufficiency). I will investigate it further with a vascular surgeon once I am able to move around a little better -- at this point I'm still lying down with my feet up in the air most of the time.

The main thing that was noticable (to me) about my TTS related to varicose veins, was that my pain was always MUCH lighter in the morning -- in fact there were times when I had no AM pain at all. But in the afternoons and evenings, I had LOTS of pain, often including the classic shooting pains up the inside of my ankle, and/or shooting from my inner ankle toward my toes. I also recognize what you said about achiness -- and my foot always tired incredibly quickly whenever I had to be on my feet.

Good luck to you, whatever you decide to do.

Sharon

Re: Vascular, not just plain TTS?

JJC on 8/10/02 at 10:14 (092118)

How did the doc find your problem artieries? During the TTS operation?
Did it show up on an MRI? What kind of doctor performed the
doppler ultrasound?
I have no vericose veins. Although, my mother is full of them in
her legs.

Re: Vascular, not just plain TTS?

Sharon W on 8/10/02 at 23:10 (092164)

JJC,

The only problem I have in my arteries (that I know of) is in my kidney. I do have serious problems with the veins in my right leg, though. I guess at this point it has been confirmed that I have varicose veins, but they are NOT visible -- there are no purple vessels that can be seen through my skin. The first I knew about varicose veins was when an MRI of my right foot and ankle (with contrast) was done last December (ordered by my pod). The report came back that my posterior tibial vein, the one that runs through the tarsal tunnel, was varicose (swollen and distended).

My mother and sister have both had serious problems with varicose veins -- in fact, my sister had to have a number of them stripped from her legs at the age of 30. I thought I was the 'lucky' one who hadn't inherited that problem.

Not all varicose veins are visible through the skin. I don't know what tests you've had done to determine that you have 'circulatory problems' that may be related to your TTS, but so far I've had three tests done: that MRI, a doppler ultrasound of my saphenous veins, and a test called PVR (pulse volume recorder -- the technical name is 'doppler ultrasound plethysmography'). The PVR test was to check and see if any of the ARTERIES of my legs were hardened or abnormal. (My leg arteries are fine, but in my right leg the big vein in my thigh isn't working right.)

The doppler ultrasound was done by a technician at the local hospital.

Hopefully, if you do have circulatory problems they are only minor, and can be corrected fairly easily.

Sharon

Re: Vascular, not just plain TTS?

JJC on 8/11/02 at 10:47 (092184)

Who recommended you see the Vascular surgeon? Your podiatrist?
Who did he PVR and doppler, the podiatrist?

Re: Vascular, not just plain TTS?

Sharon W on 8/11/02 at 12:21 (092201)

JJC,

No, my family Dr. sent me to a vascular surgeon, at my request, when conservative measures for treating TTS had been nearly exhausted and I was trying to figure out who would be the right surgeon to remove a varicose vein from my tarsal tunnel. (He said he didn't do that type of surgery and didn't know of any other vascular surgeon in the area who would.) But that was really my only reason for consultating with him, at that point; it was before the doppler ultrasound and I did not yet know that I have venous insufficiency in the same leg.

It was also my family Dr. who ordered the doppler ultrasound and the PVRs test (after she had discussed it with my cardiologist).

It has been less than three weeks since my TTS surgery and I prefer to wait until I can get around better before persuing this further. Once I can walk, drive, etc. I intend to ask my family Dr. to again refer me to a vascular surgeon (preferrably a DIFFERENT one this time; I didn't like the other guy) so I can find out more about what's going on with my leg. I would ask her to send me to a veins specialist this time, instead, but I've already checked into it and there isn't one in our area.

If anyone on these boards has had any experience with treating varicose veins and/or venous insufficiency, and is willing to give their input, I would appreciate it. I've researched the web somewhat but so far I really haven't found any useful information about other tests that can be done -- mostly just stuff about compression hose (which I'm already using) and about various herbs (such as horse chestnut) that are supposed to be good for reducing the swelling associated with varicose veins and/or tightening flabby veins.

Sharon

Re: Vascular, not just plain TTS?

JJC on 8/12/02 at 10:29 (092284)

Thanks for the info. I'm scheduing an ultrasound.
I'll keep you posted.
:)

Re: Vascular, not just plain TTS?

Sharon W on 8/12/02 at 11:30 (092289)

JJC,

Good luck with the ultrasound. Who ordered the ultrasound -- a vascular surgeon, or your regular Dr.?

I hope you'll post the results -- and I'd be VERY interested to find out what your doctors decide to do for a next step, after the ultrasound.

I discussed my problem with my pod today and she mentioned several other tests that might be done -- but of course, she isn't really the appropriate person to order them.

If you would be willing to go into more detail about this by e-mail, I would love to hear from you. My address is syaw @ prodigy.net (but leave out the spaces; posting it here with extra spaces is a precaution against spammers).

Sharon

Re: not arteries, veins

Ed Davis, DPM on 8/14/02 at 22:36 (092510)

Sharon stated that varicose veins in the tarsal tunnel were the problem, not arteries.
Ed

Re: Had Doppler Ultarasound

JJC on 8/15/02 at 10:30 (092557)

The technician said 'all clear'; no circultion problems.
So, still searching for the cause of my wierd TTS...
:)

Re: Vascular, not just plain TTS?

Sharon W on 8/09/02 at 16:04 (092074)

JJC,

I am facing the same kinds of problems.

I just had TTS surgery in my right foot/ankle and the posterior tibial nerve, vein, and artery had 6 large, swollen (and in some cases, hardened) venules tangled around them, strangling the nerve by putting it under too much pressure.

A doppler ultrasound of my saphenous vein showed that even the biggest vein in my right thigh has problems with backflow (a condition called venous insufficiency). I will investigate it further with a vascular surgeon once I am able to move around a little better -- at this point I'm still lying down with my feet up in the air most of the time.

The main thing that was noticable (to me) about my TTS related to varicose veins, was that my pain was always MUCH lighter in the morning -- in fact there were times when I had no AM pain at all. But in the afternoons and evenings, I had LOTS of pain, often including the classic shooting pains up the inside of my ankle, and/or shooting from my inner ankle toward my toes. I also recognize what you said about achiness -- and my foot always tired incredibly quickly whenever I had to be on my feet.

Good luck to you, whatever you decide to do.

Sharon

Re: Vascular, not just plain TTS?

JJC on 8/10/02 at 10:14 (092118)

How did the doc find your problem artieries? During the TTS operation?
Did it show up on an MRI? What kind of doctor performed the
doppler ultrasound?
I have no vericose veins. Although, my mother is full of them in
her legs.

Re: Vascular, not just plain TTS?

Sharon W on 8/10/02 at 23:10 (092164)

JJC,

The only problem I have in my arteries (that I know of) is in my kidney. I do have serious problems with the veins in my right leg, though. I guess at this point it has been confirmed that I have varicose veins, but they are NOT visible -- there are no purple vessels that can be seen through my skin. The first I knew about varicose veins was when an MRI of my right foot and ankle (with contrast) was done last December (ordered by my pod). The report came back that my posterior tibial vein, the one that runs through the tarsal tunnel, was varicose (swollen and distended).

My mother and sister have both had serious problems with varicose veins -- in fact, my sister had to have a number of them stripped from her legs at the age of 30. I thought I was the 'lucky' one who hadn't inherited that problem.

Not all varicose veins are visible through the skin. I don't know what tests you've had done to determine that you have 'circulatory problems' that may be related to your TTS, but so far I've had three tests done: that MRI, a doppler ultrasound of my saphenous veins, and a test called PVR (pulse volume recorder -- the technical name is 'doppler ultrasound plethysmography'). The PVR test was to check and see if any of the ARTERIES of my legs were hardened or abnormal. (My leg arteries are fine, but in my right leg the big vein in my thigh isn't working right.)

The doppler ultrasound was done by a technician at the local hospital.

Hopefully, if you do have circulatory problems they are only minor, and can be corrected fairly easily.

Sharon

Re: Vascular, not just plain TTS?

JJC on 8/11/02 at 10:47 (092184)

Who recommended you see the Vascular surgeon? Your podiatrist?
Who did he PVR and doppler, the podiatrist?

Re: Vascular, not just plain TTS?

Sharon W on 8/11/02 at 12:21 (092201)

JJC,

No, my family Dr. sent me to a vascular surgeon, at my request, when conservative measures for treating TTS had been nearly exhausted and I was trying to figure out who would be the right surgeon to remove a varicose vein from my tarsal tunnel. (He said he didn't do that type of surgery and didn't know of any other vascular surgeon in the area who would.) But that was really my only reason for consultating with him, at that point; it was before the doppler ultrasound and I did not yet know that I have venous insufficiency in the same leg.

It was also my family Dr. who ordered the doppler ultrasound and the PVRs test (after she had discussed it with my cardiologist).

It has been less than three weeks since my TTS surgery and I prefer to wait until I can get around better before persuing this further. Once I can walk, drive, etc. I intend to ask my family Dr. to again refer me to a vascular surgeon (preferrably a DIFFERENT one this time; I didn't like the other guy) so I can find out more about what's going on with my leg. I would ask her to send me to a veins specialist this time, instead, but I've already checked into it and there isn't one in our area.

If anyone on these boards has had any experience with treating varicose veins and/or venous insufficiency, and is willing to give their input, I would appreciate it. I've researched the web somewhat but so far I really haven't found any useful information about other tests that can be done -- mostly just stuff about compression hose (which I'm already using) and about various herbs (such as horse chestnut) that are supposed to be good for reducing the swelling associated with varicose veins and/or tightening flabby veins.

Sharon

Re: Vascular, not just plain TTS?

JJC on 8/12/02 at 10:29 (092284)

Thanks for the info. I'm scheduing an ultrasound.
I'll keep you posted.
:)

Re: Vascular, not just plain TTS?

Sharon W on 8/12/02 at 11:30 (092289)

JJC,

Good luck with the ultrasound. Who ordered the ultrasound -- a vascular surgeon, or your regular Dr.?

I hope you'll post the results -- and I'd be VERY interested to find out what your doctors decide to do for a next step, after the ultrasound.

I discussed my problem with my pod today and she mentioned several other tests that might be done -- but of course, she isn't really the appropriate person to order them.

If you would be willing to go into more detail about this by e-mail, I would love to hear from you. My address is syaw @ prodigy.net (but leave out the spaces; posting it here with extra spaces is a precaution against spammers).

Sharon

Re: not arteries, veins

Ed Davis, DPM on 8/14/02 at 22:36 (092510)

Sharon stated that varicose veins in the tarsal tunnel were the problem, not arteries.
Ed

Re: Had Doppler Ultarasound

JJC on 8/15/02 at 10:30 (092557)

The technician said 'all clear'; no circultion problems.
So, still searching for the cause of my wierd TTS...
:)