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Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_4087_Библиотеки_им_академика_М_И_Перельмана

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Page78
Whenanoverweightpatientcomesfortreatmentofvaricoseveinsortheircomplications,thesurgeon'sheartsinks.Obesityhasnothingtodowiththedevelopmentof
varicoseveins,althoughitmaycauseanincreaseinintraabdominalpressure.However,itdoesmakethetreatmentofthemverydifficult.Ifinjectionsareneeded,the
veinsaremoreawkwardtofindandwecannotbandagetightlyenoughtogivetherightamountofcompressiononalegthat'sfatandflabby.Ifsurgeryisnecessary,
theoperationismoredifficultwhenwehavetofindveinsinthedepthsoffattytissues,andthecomplicationsofsurgery,particularlyinfection,arealwaysincreased.If
theveinshavealreadybrokendownintoanulcerbadulcersareseenparticularlyinoverweightpeople—then,again,itisdifficulttocompressthelegproperlyby
elasticbandagingandacureisoftenalongandtediousbusiness.
Wehavealreadystressedtheimportanceofexerciseinimprovingthemuscle
pumpingactiontoreturnbloodfromyourlegstoyourheart.Butgoodlongwalks,which
arealsoanimportantaidtogettingbetter,aremuchmoredifficultforsomeoneweighing280pounds(127kilograms)say,thanforsomeonearoundthe100150
pounds(4568kilogram)mark.
Soobesity,withallitsothercomplications,risksanddangers,isalsoaserioushandicapforthevaricoseveinsufferer.Weightreductionisanessentialbeginningto
successfultreatmentaswellas,initself,animportantsteptowardsimprovingyourgeneralhealthandwellbeing.Indeed,wetellveryobesepatientsthatwereally
cannotgettheirlegsimproveduntiltheirweightcomesdowntoareasonablelevel.
Whydosomepeoplebecomeoverweight?
Fatisthebody'sprincipalstoreoffuel.Itislocatedbeneaththeskin,butaccumulationsarealsofoundwithintheabdomen,atthebackoftheabdominalwallandin
thecentralpartofthechest.Theonlywaytoincreasethisfatstoreistotakeinmorefoodthanthebodyneedstokeepitselfgoing.Itisreallyamatterofsimple
arithmetic.Ifweburnenergyat2500caloriesadaybuthaveadailyintakeof3000calories,theextra500caloriesgoesintothefatstore.Theamountoffood
requireddependsonthesizeofthepersonandtheworkthatpersonisdoing.A6ft6in(2metre)tallCanadianlumberjackwillneedperhapsthree
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Page79
"HenrySims/theImageBank,©1999"
Someonewhosejobinvolvesstrenuousphysicalactivitywillneedaround
threetimesthecalorieintakeofasedentaryofficeworker(overleaf).
timesthecaloricintakeofa5ft2in(1.6metre)tallgirlworkinginacityoffice.Theidealistomaintainasteadybalancebetweencaloricintakeandyourbody'sfuel
requirement,thenyourweightwillremainsteadyyearinandyearout.
Unfortunately,obesityisaplagueofmodernsociety.Manypeoplehavedevelopedthehabitofeatingmorethantheyneedbecauseeatinghasnowbecomeoneofour
mostimportantandmostenjoyablesocialhabits.Furthermore,ourmodernlife,robbedofmuchofthephysicalactivityourancestorswereusedto,meansthatwe
actuallyneedfewerdailycaloriesthaneverbefore.Mostofususesomeformofmotorizedtransporttotakeustowork,andtaketheelevatorupstairs,inshortuse
everytechnologicalconveniencetodepriveourselvesoftheopportunityofburningoffthoseextracalories.Tomakemattersworse,ourdietisverylargelymadeupof
processedfoodsthatarerichinsugarandfat,thelattercontainingtwicethecaloriesofproteinorcarbohydrates.In
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Page80
"Barros&Barros/theImageBank,©1999"
formertimespeopleatelargeamountsofvegetablesandgrainproducts(suchasunrefinedwholewheatbread)whichfilledtheirstomachsatafairlylowcalorieintake.
Today'squickfoods(somearemoreaptlynamedjunkfoods),suchaschocolate,processedbread,hamburgersandfriedpotatoes,arelowinbulkandhighin
calories.Furthermore,ouralcoholconsumptionisdefinitelyontheincreaseandalcoholisveryhighincalories.
AmIOverweight?
Firstofallyouneedtoknowifyouareoverweight;andifyouare,thenitisagoodideatohavealowertargetweighttoaimfor.Thedistinctionbetweennormal
weightandoverweightishardtodefineprecisely,butthetableonpage81isausefulguidetoidealweightsformenandwomen.Althoughbeingyouridealweightis
excellentasfarasyourgeneralhealthandwellbeingareconcerned,theweightatwhichproblemsarelikelytooccurinthetreatmentforyourvaricoseveinsishigher
thanthoseshowninthetable.Whileitisdifficulttobecategor
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Page81
icalwhengivinggeneraladviceofthiskind,itwouldbefairtosaythatifyouare15%ormoreabovetheweightshownforyourheightandframe,youwouldgreatly
improveyourchancesofsuccessfulvaricoseveintreatmentifyoulostsomeweight.Aimtogetdowntonomorethan10%aboveyouridealweight.
Idealweighttable
Weighttableformenof25yearsandover(inindoorclothing)
Height Smallframe Mediumframe Largeframe
ftin (cm) lb kg lb kg lb kg
51 (155) 112120 (5154) 118129 (5459) 126141 (5764)
52 (157) 115123 (5256) 121133 (5560) 129144 (5965)
53 (160) 118126 (5457) 124136 (5662) 132148 (6067)
54 (163) 121129 (5558) 127139 (5863) 135152 (6169)
55 (165) 124133 (5660) 130143 (5965) 138156 (6371)
56 (168) 128137 (5862) 134147 (6167) 142161 (6473)
57 (170) 136145 (6064) 138152 (6369) 147166 (6775)
58 (173) 132141 (6266) 142156 (6471) 151170 (6877)
59 (175) 140150 (6368) 146160 (6673) 155174 (7079)
510 (178) 144154 (6570) 150165 (6875) 159179 (7281)
511 (180) 148158 (6772) 154170 (7077) 164184 (7483)
60 (183) 152162 (6974) 158175 (7280) 168189 (7686)
61 (185) 156167 (7176) 162180 (7482) 173194 (7888)
62 (188) 160171 (7378) 167185 (7684) 178199 (8190)
63 (190) 164175 (7480) 172190 (7886) 182204 (8392)
Weighttableforwomenaged25andover(inindoorclothing)
(Forwomenagedbetween18and25subtract1lb(1/2kb)foreachyearunder25)
Height Smallframe Mediumframe Largeframe
ftin (cm) lb kg lb kg lb kg
48 (142) 9298 (4244) 96107 (4449) 104119 (4754)
49 (145) 94101 (4346) 98110 (4550) 106122 (4855)
410 (147) 96104 (4447) 101113 (4651) 109125 (4957)
411 (150) 99107 (4548) 104116 (4753) 112128 (5158)
50 (152) 102110 (4650) 107119 (48 54) 115131 (52 59)
51 (155) 105113 (4851) 110122 (50 55) 118134 (53 60)
52 (157) 108116 (4953) 113126 (51 57) 121138 (55 63)
53 (160) 111119 (5054) 116130 (53 59) 125142 (57 64)
54 (163) 114123 (5256) 120135 (54 61) 129146 (58 66)
55 (165) 118127 (5358) 124139 (56 63) 133150 (60 68)
56 (168) 122131 (5559) 128143 (58 65) 137154 (62 70)
57 (170) 126135 (5761) 132147 (60 67) 141158 (64 72)
58 (173) 130140 (5963) 136151 (62 69) 145163 (66 74)
59 (175) 134144 (6165) 140155 (63 70) 149168 (68 76)
510 (178) 138148 (63 67) 144159 (6572) 153173 (6978)
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Page82
WhatcanIdotoLoseWeight?
Toloseweightisintheorythesimplestthingimaginable.Ifyouareoverweightthentakeinfewercaloriesdailythanyourequirefor,fuellingyourbody.Theextra
calorieswillthencomefromburningyourexcessstoreoffat,soeverydayalittleweightwillbelost.However,inpractice,itcanbeverydifficultand,let'sfaceit,
somepeoplefinditvirtuallyimpossible.Eatingisadelightfulpastimeandtosomethedepressed,thelonely,theworrieditisoneoftheonlyenjoymentsthat
remainstothem.Butthebenefitsofattainingareasonableweightreallyareworthmakingtheefforttoachieve.
Wedon'tadvisecrashdiets;youmayloseweightquicklybutyoucannotkeepthedietsupindefinitely,andtherelapserateishigh.Asteadyweightloss,weekinand
weekout,isamuchbetter,wiserandmorereliablemethod.
Fatpeopleoftenask:`Can'tIhavesomepillsorinjectionstoloseweight?'Theanswerisobvious:onlygettingyourcaloricintakebelowyourdailycalorierequirement
isgoingtodothetrick,andthatmeansitisuptoyou!Ofcourse,you'llneedencouragement,soasktherestofthefamilytocooperate.Anexcellentideaistojoina
localweightwatchersorganization.Youwillsoonfindyouarenottheonlyonewiththeproblemandmostpeoplediscoverthatbeingoneofacrowdwithaunited
purposeisoftremendousvalue.
ControltheCalories
People'scaloricrequirementsdifferaccordingtoage,sexandactivity,butmostwomenwillloseweightiftheytake10001200caloriesaday.Men,whosecalorie
requirementisusuallyhigherthanwomen's,oftenonlyneedtoreducetheirintaketoabout1500calories,buteveryonevariesinthisrespect.Nooneshouldhabitually
takefewerthan1000caloriesadaywithoutclosemedicalsupervision,infactit'snotabadideatocheckwithyourdoctorbeforestartinganyweightreducingdiet.
Thebestwaytofindoutthecaloricvaluesforfoodsanddrinksistorefertoacaloriecounterbooklet,manyofwhicharepublishedbyreputableslimming
organizations.Theyareavailableatmostmagazineoutletsandbookstoresoratyourlocalpubliclibrary.Eitherputyourselfontoacertainnumberofcalorieseach
dayandseehowwellyouloseweightorwritedowneverythingyoueatforafewdays,workout
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Page83
"ChrisCole—D2DuomoPhotographyInc./TheImageBank,©1999"
Regularexercisewillhelpyoutoloseweight.Joggingisexcellentforyourlegsand
veinstoo!
roughlythecaloriecontentandthenmakeyourselfamealplanwithabout500caloriesfewerperday.Againithelpsifyouenlistthehelpofyourdoctororadietitian.
Thedietyouchoosemustbeasensibleone.Youcouldmakeupadietwhereyouget1200caloriesfromchocolateandpotatochipsbutitwouldn'tkeepyouhealthy
forlong.Sohereareafewsimpleguidelinestofollow:
1.Trytoeatthreemealsaday,withsmallsnacksinbetweenifnecessary.Scientistshaveshown
thatpeopleloseweightbetteriftheyeatseveralsmallmealsadayratherthanonehugeone.
2.Eattwoportionsoffoodscontaininghighlevelsofprotein(andaslittlefataspossible)each
day.Thesefoodsareleanorwhitemeat,whitefish,eggsandlow
fatcheese.Pulsevegetables,
orlegumes,suchas
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cookeddriedbeansandlentils,areexcellentfoods,beinghighinproteinandfibrebutlowinfat.
3.Take1/2pint(11/4cups)/285millilitresofmilk(skimmedmilkhasfewercalories),somelow
fatyoghurtorasmallportionofcheeseeverydaytoprovidethecalciumyouneedforhealthy
bones.
4.Haveatleastthreeslicesofwholewheatbreadandsomecereal,preferablywholegrain,as
thesearefillingandprovidefibre.
5.Don'thavemorethan3/4ounces/20gramsoffatbutter,margarine,oilorlard,forexample
eachday;andcutrightdownonhigh
fatfoodslikeicecreamandcreamsauces.Alittlefatis
essentialinyourdietbutitisveryhighincalories.Don'tfryyourfood.
6.Cutouthighcalorierefinedfoodssuchassugar,chocolateandsweets(candies).
7.Reduceyourconsumptionofalcohol.Betterstill,cutitoutaltogether.
8.Makeuptherestofyourdietwithfruitandvegetables.Theyprovidevitamins,mineralsand
fibre,andarefillingyetlowincalories.
Makingyourdietasvariedaspossibleandbyfollowingtheserecommendationsyoushouldkeephealthywhilelosingweight.Ifatthesametimeyoucanincreasethe
amountoflegexerciseyoutakeeachday,thiswillhelpyoutoloseweightalittlefaster,tostayfitandtoimproveyourcirculation,thusmakingthetreatmentofyour
varicoseveinsmucheasierforyouandyourdoctor.
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Chapter8—
ImprovingtheCirculationinyourLegs
Inthischapter,wegiveyouadviceonlegexercisesandinformationaboutelasticstockings.Bothareimportantinthetreatmentofyourvaricoseveins.
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Legexercisesandelasticsupportstockingsbothhelpyou,thevaricoseveinsufferer,towardstheallimportantgoalofimprovedbloodcirculationinyourlegs.Inthis
chapterwewillshowyouhowtousebothtoyourbestadvantage.
LegExercises
Exercisesforthelegmuscles,andraisingyourlegswhileatrest,havebeenrepeatedlymentionedasaidstorapidrecoveryfollowinginjectiontreatmentorsurgery;as
ahelpduringpregnancy;toassistinthehealingofulcers(seepage102);andingeneraltokeepyourlegshealthyandcomfortable.
Thissection,writtenwiththehelpofHelenShilston,physiotherapistattheWestminsterHospitalinLondon,willgiveyousomeusefulguidelines.Itcannotbestressed
toooftenthatexerciseplaysavitalroleinthetreatmentofvaricoseveins,asithelpsthemusclepumpsofthecalvestoreturnbloodfromtheveinsinyourlegsbackto
theheart.Alltypesoffootandlegexercisesarebeneficial,asarethosecarriedoutinmoregeneralpursuitssuchaswalking,swimming,cyclingandjogging.Infact,as
farasthetreatmentofvaricoseveinsisconcerned,themoreactivity,thebetter.Othermorevigoroussportssuchastennisandsquashshouldbeplayedonlywhen
yourfitnesslevelpermits,andiftakingoneupforthefirsttimedotakeiteasytostartwith.
ExercisestoAidCirculation
Itisagoodideatogothroughafewsimpleexercisesfirstthinginthemorningtoincreaseyourcirculationbeforegettingoutofbed.Youcanalsodotheseatother
timesofthedaywhenyou'resittingwithyourlegselevated,astheydonotrequirealotofenergy.
GettingoutandAbout
Beforegettingupinthemorningyoushouldputonelasticstockings(seepages9596)ifyouhavebeentoldtodosobyyourdoctor,sothatyouhaveextrasupport
whenyou'reonyourfeet.Also,itisagoodideatovary(withinreason)theheightoftheheelsyouwear,sothatcomfortandgoodposturearemaintained,andtheleg
musclesarenotstrained.Onnoaccountshouldyoustandaroundforanylengthof
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Footbending
1.Pointyourfeetandtoesuptowardsyouasfarasyoucan.
2.Pointthemdowntowardstheendofthebed.Trytoperformthispumpingactionas
vigorouslyaspossible.Repeattentofifteentimes.
Thefollowingexerciseroutine(pages8790)canbeperformedbeforegettingupin
themorning,aswellasduringtheday.
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