Varicose veins are very common and are hereditary. They often appear between the ages of twenty and thirty and usually get worse with age. They can also worsen following pregnancy and with prolonged standing. Compression stockings provide graduated compression (that is, more compression at the ankle level) and may help prevent the progression of varicose veins, whereas support pantyhose provide only haphazard, irregular compression (usually where it is not needed) and are of no benefit in varicose vein prevention. Compression stockings are essential for those with varicose veins and should be worn on a daily basis by people who have a tendency towards varicose veins or who are standing for long periods of time each day. They are also useful during pregnancy and for long airplane journeys. Mild compression stockings are very sheer and are available in many fashionable colours. These are good for everyday wear. During treatment for varicose veins and during pregnancy moderate compression stockings are recommended.People traditionally associate treatment of varicose veins with extensive surgery, causing unsightly scars and prolonged convalescence. Nowadays, the trend in treatment is to perform limited surgery in addition to sclerotherapy (injection of the veins). While surgery is essential for veins which originate in the groin, others can be successfully treated with sclerotherapy as an outpatient procedure, causing minimal interference with a person’s normal lifestyle.There are now also methods of identifying abnormal veins, by Doppler Ultrasound and Duplex scanning, which mean that surgery can be more accurately planned and only ‘faulty’ veins removed. As a result, surgery is less traumatic, there is less scarring and recovery is quicker.Sclerotherapy is an excellent alternative to surgery for minor varicose veins, requiring no hospitalization and a good, long-term cosmetic result. Minor veins can also be removed by a ‘microsurgical’ technique, whereby the veins are removed through a micropuncture and extracted with a hook which resembles a crochet needle (called a Muller hook). This latter technique leaves only imperceptible scars.
*63/150/5*
Several factors might dissuade a person from participating. The most frequent concerns are:1. Inconvenience: Many trials require extensive testing and frequent visits to the clinic. These requirements should be clearly stated in the informed consent papers. These tests and visits can be an enormous inconvenience to the participant.2. Risk: Clinical trials are scientific experiments. They exist because medical scientists need information about the effectiveness and safety of a new drug, or about the safety and effectiveness of an old drug used in a new way. Some of these drugs are potentially toxic, and although trials never test drugs on humans that have not been first tested extensively in the laboratory and in animals, unanticipated side effects are always possible. The degree of risk obviously varies with different drugs and different conditions.3. Assignment to the “wrong group”: For all controlled and double-blinded trials, there is always the risk that the participant will receive the placebo, the less effective drug, the more toxic drug, or the less effective dose. Some participants attempt to break the blind and find out what drug or dose they are taking, through a variety of mechanisms. The investigators understand participants’ reasons for doing this, but breaking the blind destroys the scientific credibility of the trials. If enough people break the blind, the trial might as well not be done.4. Costs: Usually drugs and costs for monitoring are provided at no expense to the participant. Some drug trials, however, expect reimbursement from the participants for the cost of medical care. You will need to establish what costs, if any, are involved before you agree to participate. In addition, if the drug is toxic, you will need to establish who pays the cost of care for any side effects.5. Restrictions on other options for treatment: Most trials require that someone who is participating in one trial not participate at the same time in other trials. Some trials exclude people who have received other experimental drugs. Other trials prohibit the participant from using certain drugs or from receiving certain treatments. You should carefully review any such restrictions before agreeing to participate in clinical trials. A reassurance: any participant in a trial can withdraw from participation at any time.*187\191\2*
It is important for alcohol counselors to be knowledgeable about occupational programs. Counselors can thereby better coordinate treatment efforts for the employed alcoholic or problem drinker. Does the client’s employer have a program? If so, who is the counselor, what services are offered? For any client it is important to know if there have been any work-related problems. If so, what is the current job status? Has a disciplinary procedure been instituted, or has the employee been informally warned and referred for treatment? In addition, to avoid future conflict, learn about any union involvement. Such information can help in formulating realistic treatment plans.It is important for the counselor to be sensitive to the policies and politics of the employed alcoholic’s work setting. Without this knowledge and awareness, there is the danger of violating the client’s confidentiality or, conversely, of not taking full advantage of the opportunity to cooperate with the employer on the client’s behalf. If there is a company policy, learn about it in order to plan realistically and avoid treatment/work conflicts. The type of medication, if any, will also be affected by the nature of the client’s work. A follow-up plan must consider the working person’s hours and geographical location. The flexibility and accessibility of the treatment facility can be a key factor in the successful rehabilitation of the employed alcoholic. Evening office hours and early-morning and weekend appointments may have to be arranged by the counselor, so that treatment will not interfere with the individual’s job.You may also find that some clients will have to receive outpatient care even when inpatient services are more appropriate. The employee may not be able to take the time off or may not have adequate insurance coverage. In fact, insurance companies who have been covering inpatient alcholism treatment are now attempting to change their policies to cover outpatient care exclusively, or at least preferentially. They cite the fact that it is less expensive and that little or no evidence indicates that inpatient care provides better treatment outcomes. As we hope this text has made clear, all alcoholics are not alike, and blanket assumptions regarding their treatment should not be made.Occupational programs have made significant progress in demonstrating that the “human approach” is good business. Yet there is still a great deal to be done, and it can be better accomplished with cooperation among those involved in the occupational program field and alcohol clinicians.*114\331\2*