What is chronic venous insufficiency? Donald Trump diagnosed with condition
was diagnosed with chronic venous insufficiency,
the White House
said on Thursday, after he noticed swelling in his legs.
The White House released a memo from the president's physician, Sean Barbabella, who said a medical examination revealed no evidence of a more serious condition such as deep vein thrombosis.
'The president underwent a comprehensive examination, including diagnostic vascular studies. Bilateral lower extremity venous Doppler ultrasounds were performed and revealed chronic venous insufficiency, a benign and common condition, particularly in individuals over the age of 70,' the memo said.
It is a fairly common condition among older adults, but requires a thorough check-up to rule out more serious causes of swelling in the legs. Here are some things to know.
READ MORE
Chronic venous insufficiency, or CVI, happens when veins in the legs cannot properly carry blood back to the heart. That can lead to blood pooling in the lower legs.
In addition to swelling, usually around the feet and ankles, symptoms can include legs that are achy, heavy-feeling or tingly, and varicose veins. Severe cases could trigger leg sores known as ulcers.
Overcoming gravity to pump blood from the feet all the way up to the heart is a challenge, especially when someone is standing or sitting for long periods. So legs veins are lined with one-way valves that keep blood from sliding backward on that journey.
Anything that damages those valves can lead to chronic venous insufficiency. Risk factors can include blood clots, vein inflammation known as phlebitis or being overweight.
Doctors must rule out serious causes of leg swelling, such as heart problems, kidney disease or blood clots. Ultrasound exams of the leg veins can help confirm chronic venous insufficiency.
According to the Cleveland Clinic, treatment can include wearing compression stockings, elevating the legs and achieving a healthy weight.
Also exercise, especially walking, is recommended – because strong leg muscles can squeeze veins in a way that helps them pump blood. Medications and medical procedures are available for more advanced cases.
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Irish Times
2 hours ago
- Irish Times
How eating disorders are changing: ‘I'm not the stereotype. I'm a man, I'm plus-sized'
When William Dwyer Joyce was a teenager, skinny jeans and Indie bands were what was cool. To be slim was fashionable. As a someone who didn't fit into that stereotype, and who was always 'plus-sized', Dwyer Joyce turned to food as a coping mechanism. The now 32-year-old was diagnosed with binge-eating disorder when he was 21, though he says he struggled with mental health difficulties long before that diagnosis. 'For me, my binge eating was very secretive. It was going to the shop, getting large amounts of things like chocolate, crisps, cookies, whatever. And going home and secretly eating it to the point where I could not eat it any more,' he says. 'It created a coping mechanism that was quite harmful because my body image was very poor. It was about numbing. In a sense it was self-harm. If you eat to the point of pain, it's not a nice thing to go through.' READ MORE Compounding this difficulty, Dwyer Joyce also struggled with alcohol addiction and drug misuse issues. These challenges, he says, all came from the same place: a desire to be able to exert control. He is now five years sober. 'When I got sober, it was like I was in a house that was on fire. Sobriety put the fire out, but now I'm standing in rubble and I have to build the house again,' he was when he seriously sought help for his eating disorder. 'In April 2020 I got sober for the last time. A year after that, in 2021, I had a year of sobriety under my belt. My 30s were knocking on my door and I thought, I cannot live like this forever and the only person who can change this was me.' One difficulty he found when seeking help, he says, was the questioning attitude and scepticism he faced by some healthcare professionals because he doesn't fit the common eating-disorder stereotype: a young woman or teenager with anorexia. 'I am the opposite of the stereotype in that I'm a man, I'm plus-sized, I wasn't restricting food,' he adds. 'There is all this messaging around fatness or plus-sized people that if you're fat it's a moral failing or you're lazy or you don't care about how you look. But that's just not true.' William Dwyer Joyce: 'I am the opposite of the stereotype.' Photograph: Dara Mac Dónaill This stereotype is beginning to change, according to Laura Casey, director of services at Lois Bridges, an eating disorder treatment centre in Sutton, north Co Dublin. The number of young men seeking help at the centre has increased in recent years, she notes. Casey attributes this rise to the increasing gym culture seen online – in which men are constantly fed images of bodybuilders with very little body fat – combined with the masculine tendency of men to keep their feelings to themselves. 'But when they do go and reach out, they're not heard the same. Their voices can be dismissed a bit easier,' she says. Another changing trend is the prevalence of a condition known as avoidant/restrictive food intake disorder, or Arfid, which is often diagnosed among people who are neurodivergent. 'It's sometimes called the beige diet; they eat a lot of chicken nuggets and chips. But we're moving away now from language that describes these people as being a picky eater, and acknowledging in many cases they have a sensory aversion to something.' Laura Casey, director of services at Lois Bridges eating disorder treatment centre in Sutton, Dublin. Photograph: Dara Mac Dónaill According to Casey, Arfid can have a significant impact on an individual, particularly in a social setting. 'Sometimes a person's diet is so restrictive they won't eat. There is a lot of shame and stigma if all they are able to eat is a chicken fillet roll. So, nutritionally, they can be at the same risk as anorexia. It affects their vitamin intake and electrolytes,' she says. When it comes to certain foods, some people with this diagnosiscan have a panic attack or feel like they're choking. 'They can only eat yoghurts and drinks,' she adds. Awareness of eating disorders has increased since the Covid-19 pandemic, when there was a rise in the number of referrals for treatment to HSE eating-disorder teams, who provide specialist treatment. HSE data shows there were 894 referrals to such teams last year, a 33 per cent increase on 2023. There was also a 24 per cent rise in accepted referrals, where patients proceed to treatment after an initial consultation. A total of 562 patients were assessed last year, of which 90 per cent were female and 59 per cent were children under the age of 18. One-third were teenagers aged between 15 and 17. Still, the service also saw the number of adults accessing treatment increase by 51 per cent. You're either too sick for the psychiatric hospitals or you go into a general hospital and there's no help there for these things — 'Rebecca' Of those assessed, 503 had an eating disorder, 118 more diagnoses than in 2023. Some 63 per cent (318) presented with anorexia nervosa; 18 per cent (97) with an 'other specified feeding or eating disorder' (OSFED); 8 per cent (42) with bulimia nervosa; 3 per cent (16) with Arfid; and 2 per cent (10) with binge-eating disorder. Many eating disorders begin the teenage years. But disorders often don't end there. Rebecca, not her real name, was first brought to Child and Adolescent Mental Health Services ( Camhs ) at age 15. However, she believes this 'did a lot more harm than good'. Although she acknowledges there are many good people working in the service, she was unhappy with the attitudes she faced in relation to her anorexia. Then the coronavirus lockdown happened, shutting down vast swathes of regular life. 'Everything was gone, and I deteriorated very rapidly.' Following this, she underwent a 'string of hospital admissions and A&E presentations' to help with her diagnosis, but she says it was like a 'revolving door'. 'You're either too sick for the psychiatric hospitals or you go into a general hospital and there's no help there for these things. You're stuck between nothing that will help,' she says. 'When you go into a general hospital, it's really only for one thing: to be fed against your will. But it's so important to get to the root cause of it. It was very difficult to find help that suited me. And then when people do offer you that help, it's hard to accept it if you've had bad experiences. I'm still struggling a lot.' The almost 21-year-old makes a comparison to alcoholism: relapse can be a common challenge for people, and oftentimes the difficulties of the illness are persistent. 'But there's no AA meetings [for eating disorders] around the country that you can pop into. You're kind of just left alone,' she adds. Dr Art Malone, a consultant psychiatrist and chair of the eating disorder specialist interest group at the College of Psychiatrists, says one of the biggest challenges is that some areas of the State have inadequate access to the necessary specialist services. 'Not all areas that have a specialist service are fully resourced to deliver the sort of service they would need to do. The biggest one is probably the lack of higher-level care needed for severe cases, so the lack of inpatient treatment is something all teams have to contend with,' he says. Dr Malone says that for the 'very small minority of patients' who have very severe, acute illnesses there is 'no higher-level care available in the way that it should be'. 'What ends up happening is there can be funding sought in other places such as private places or abroad but there can often be fairly lengthy delays in arranging that and then even when it is arranged – because it's taking people out of their home environment – it can be quite tricky then to transfer their treatment back to their own home set-up,' he says. 'Body positivity was such a thing, but now we've gone back almost 20 years,' says Alicia Woods, clinical nurse specialist at Lois Bridges. Photograph: iStock Dr Malone says there's a big push to try to make early intervention a priority, as this can prevent people from needing inpatient care. He cites international research that found the relapse rate for people with severe illness who receive inpatient treatment is around 50 per cent in their first year. 'But it's important to note that services where they do exist are extremely hardworking. Things have come on such a huge distance in a very short time, but it's coming from such a low base in terms of service accessibility that there is still a way to go.' [ Eating disorders: 'I wouldn't speak to my worst enemy the way I talked to myself' Opens in new window ] In recent years, the Government has taken steps to improve eating-disorder services. Currently, 14 of the 16 specialist eating disorder teams recommended in its internal plans are funded. Minister of State for Mental Health Mary Butler says no patients have been treated abroad this year so far for specialist eating-disorder care. 'I'm very proud of the progress we are making in establishing a full suite of services to support people with eating disorders, from early intervention in the community to the development of specialist inpatient beds for acute care,' she says. However, things are far from perfect, those working in the sector say. Figures from the HSE show that one-third of funded posts at eating disorder regional specialists teams are currently unfilled. In the adult eating disorder team in the Sligo, Leitrim, South Donegal health area, there are more vacancies than people in post: 3.2 whole-time equivalent staff are in place, with seven unfilled posts in the area. Furthermore, there are only three adult specialist eating disorder beds in the country, all of which are in St Vincent's hospital, Dublin. The rules for these beds, which are for those who are acutely unwell, require patients to be within that hospital's catchment area to be treated there. As a result, people with eating disorders outside that area who go into public hospitals for treatment are typically referred to a general psychiatric unit. Often they are unable to access specialised care in such settings. However, The Irish Times understands a plan has been devised by the HSE to increase the number of public eating-disorder beds nationally. Minister of State for Mental Health Mary Butler says no patients have been treated abroad this year so far for specialist eating-disorder care. Photograph: Brian Lawless/PA Wire At least 20 new specialist beds will be established in the coming years, under proposals submitted by the HSE for Ms Butler's approval. The beds will be spread between Dublin and the rest of the country, but all of them will have a national catchment area. For some people, recovery feels impossible. Aoife, which is not her real name, developed eating disorder behaviours when she was 12, after she sought to lose weight for her Confirmation. 'My family weren't very nice about my body. But also society. You'd be in drama class and I was the biggest so I would have to try on the costume and if it didn't fit me then nobody would get it. Then there were things like the Special K diet, or Kate Moss's saying about skinny being better,' she says. The 32-year-old Cork woman says she was diagnosed with anorexia at the age of 15, and went into hospital when she was 16, which she describes as 'the worst point in my life ever'. 'I couldn't control anything. I had a tube in my nose, I wasn't allowed to walk anywhere. I basically just lay in bed. I soiled myself because it would expend too much energy to go to the bathroom. It was only about weight restoration, not about treating the eating disorder,' she says. She struggled through college but was determined to continue her studies. I've been told I'll never recover. I have chronic anorexia. So you ask yourself, what's the point in trying? — 'Aoife' After graduating as a teacher, she realised she needed to get better before she could work full-time. In 2016, she returned to inpatient care. She improved somewhat, she says, but was not in recovery. She was admitted again two years ago, but had to leave early due to panic attacks. For her, she says, a history of trauma is playing a role in her current condition: her sister died when she was very young. 'I overate when she died; that was soothing myself. My life felt out of control, I didn't know who would die next. Food was something I could control,' she says. But it is 20 years since the onset of those challenges. These days, she feels quite hopeless about her current trajectory. 'I've been told I'll never recover. I have chronic anorexia. So you ask yourself, what's the point in trying? Normal eating is no longer normal for me. This has become my normal and it's very hard to see outside of it,' she says. [ Eating disorders in later life: Some of my peers have had teenage weight levels for decades Opens in new window ] 'It's pointless to be here every day. I keep wondering, how did things come to this? I'd love for someone to tell me what to do because I just don't know where to go or what to do. I look inward wondering what I could do differently. What did I do to deserve this?' Trying to find somewhere to go is something many patients experience. Alicia Woods, clinical nurse specialist at Lois Bridges, says the centre is a private facility, but they receive 'phone calls everyday of the week from people who don't have private health insurance'. 'We treat a range of eating disorders. And in terms of age, we've treated from 18 up to people in their early 70s,' she says. 'The majority of older people with eating disorders have had it their whole life but they just haven't had the information, education or support to seek help. Some people do develop it later in life.' Though Woods says the reasons why individuals develop eating disorders are complex and nuanced, she believes social media is playing a role. 'Body positivity was such a thing, but now we've gone back almost 20 years. The videos on social media, encouraging people to obsessively run 5K a day, or the 'what I eat in a day' videos [and the food quantity] is not enough to feed a toddler,' she says. She is also concerned about the potential impact the widespread availability of weight loss jabs like Ozempic might have on vulnerable individuals. 'We know that people can put in fake weights and get these prescriptions. If someone already has a low [body mass index] ... the potential of that is frightening,' she adds. But even when people can access treatment, often recovery is not linear, according to 38-year-old Edel Higgins. She was diagnosed with an eating disorder when she was around 25. She didn't know much about such disorders at the time, but says she had 'always tried to change my physical appearance'. [ Families: the untapped superpower in eating disorder recovery Opens in new window ] It took four inpatient stays before she reached a point where she sees herself as being in recovery. She says: 'It doesn't just take one go. People often feel guilty when they have to go back. But it's such a complex illness.' The Tallaght woman is four years in 'proper recovery', but she says for her that doesn't mean the eating disorder is 'completely gone', but just now she has the 'resilience' to acknowledge and challenge those urges when they arise. She writes poetry to help her cope. She looks at inspirational quotes hung up on her wall. 'Sometimes I wish I could wake up, go about the day, not having all of these overwhelming feelings – the eating disorder and mental health [difficulties]. But it doesn't work that way. It can be frustrating. But it's about findings ways to deal with it.' Bodywhys (The Eating Disorders Association of Ireland) – – (01) 210 7906 – alex@
Irish Times
2 days ago
- Irish Times
How many steps a day do you really need for improve your health? It's not 10,000
Walking more could reduce your risk of dementia , depression and dying from cancer , as well as being good for your heart , according to research. And you may not need to walk as far as previously thought to reap those benefits. The UK's NHS recommends a brisk 10-minute walk every day. Many people aim to walk 10,000 steps, but struggle to achieve it. Now researchers have calculated that even 7,000 steps could be enough to protect health. Scientists examined data from more than 160,000 adults and found that walking 7,000 steps a day was associated with a reduced risk of a number of serious health conditions and death. Whereas previous studies have mainly examined the links between step count and heart health or overall death rates, this systematic review and meta analysis, published in the Lancet Public Health, sought to comprehensively examine how taking more steps per day could reduce the risk of a range of other health conditions as well. READ MORE Compared with those who walked 2,000 steps a day, the researchers found that achieving the 7,000 daily step target was linked to a 37 per cent reduction in risk of dying from cancer, while the risk was 14 per cent lower for type 2 diabetes, 38 per cent for dementia, 22 per cent depression and 28 per cent for falls respectively. It was also associated with a 25 per cent lower risk of cardiovascular disease and a 47 per cent reduction in overall risk of dying. Although step count does not measure the quality or intensity of exercise, the findings underscore the importance of being active. There is a 'return on investment' with every additional 1,000 steps taken and even 4,000 steps per day reduced the risk of disease, compared with very low activity levels, the researchers observed. Although the risk continues to decrease above 7,000 steps, the rate at which it reduces that risk starts to slow. Melody Ding, professor of public health at the University of Sydney and lead author of the research, said that those who already walked 10,000 steps should not go back to 7,000, but that 7,000 was a more practical target for those who were currently inactive. 'Those who are currently active and achieving the 10,000 steps a day, keep up the good work – there is no need to modify your step counts. However, for those of us who are far from achieving the 10,000 targets, getting to 7,000 steps/day offers almost comparable health benefits for the outcomes we examined,' Prof Ding said. [ I walk to work in Dublin every day... daydreaming can't be done on a bus Opens in new window ] Responding to the findings, Dr Daniel Bailey, reader in sedentary behaviour and health at Brunel University of London, said the research helped debunk the myth that 10,000 steps per day should be the target for optimal health. 'The real-world implications are that people can get health benefits just from small increases in physical activity, such as doing an extra 1,000 steps per day,' Dr Bailey said 'To achieve the best reductions in risk, aiming for 5,000-7,000 per day can be recommended, which will be more achievable for many people than the unofficial target of 10,000 steps that has been around for many years.' Dr Andrew Scott, senior lecturer in clinical exercise physiology at the University of Portsmouth, pointed out that not all activity was captured by step counts. 'The steps per day is useful when people's exercise is weight-bearing, however cycling, swimming and rowing are not well-represented by the steps-per-day model.' June Davison, senior cardiac nurse at the British Heart Foundation, said: 'We know that regular walking is one of the easiest ways to help maintain a healthy lifestyle and reduce your risk of heart disease. 'Adults should aim to build up to a total of 150 minutes of moderate-intensity activity every week, but getting active isn't always easy. Incorporating activity snacks, such as walking while taking phone calls, or taking a brisk 10-minute walk during your lunch break, can all count to reduce your chances of developing heart disease.' – Guardian
Irish Times
2 days ago
- Irish Times
Biological treatment service for rabies ceases, leading to fears for people exposed to virus
People exposed to rabies are at risk of being 'missed, lost to follow up or inappropriately managed' after a service providing biological treatment for such patients stopped operating, a senior HSE official has said. Until the start of this month, a service operated out of Cherry Orchard Hospital, Dublin, was responsible for the assessment of patients and delivery of 'critical' biologics to patients with acute post-exposure treatment of rabies, diphtheria and botulinum. On July 3rd, Colm Henry , chief clinical officer at the HSE, wrote to the country's regional executive officers and regional clinical directors following the retirement of the doctor who ran the Cherry Orchard service. Following his retirement on July 4th, the service would cease to operate, Dr Henry said. READ MORE 'While this service had never been commissioned as a national service, it had, in effect, provided advice and treatment on management of potentially or actually exposed patients for many years from all over the country,' his letter said. Dr Henry said in light of the 'importance' of this service, the National Health Protection Office has been working with key partners and stakeholders to support implementation of a new regional service model. 'There are risks, while these discussions are taking place, of gaps in service and therefore potential for a person with a rabies prone exposure being missed, lost to follow up or inappropriately managed,' his letter said. Dr Henry requested the regional executive officers to work with stakeholders and structures to 'ensure provision of service and further development of same to address issues and risks identified'. According to his letter, there are areas in which there has been consensus in relation to the establishment of regional services, including a proposed role for emergency departments, which will see and assess new presentations. However, he also highlighted a number of 'issues requiring further consideration/agreement' such as the provision of out-of-hours services or infectious diseases on-call hours for weekends and bank holidays. In a statement, a spokesman for the HSE said the service for rabies exposure was 'formally reorganised on a regional footprint to better meet the needs of local populations'. The spokesman said a working group will work with implementation committees to 'mitigate any risk relating to access to assessment and care for patients, potentially created by the standing down of a previously available service, which had been in place for many years'. Rabies is a rare viral infection, but a person's risk of contracting it becomes significant if they travel to parts of the world where rabies is common in land-based animals. If a person is exposed to an animal in such countries, they must immediately seek medical advice and report this contact to a local hospital or clinic to enable assessment. Diphtheria is an acute bacterial disease, mainly affecting the respiratory system. The most recent case of diphtheria in Ireland was in 2016. Botulism is a rare but life-threatening condition caused by toxins produced by Clostridium botulinum bacteria. There has been a surge in botulism poisonings in England over the past six weeks.
