Negative Impact Of Severity Of Pain On Mood Social Life And General Activity In Parkinson’s Disease
This case control study designed for clinicians and rehabilitation specialists to effectively identify pain from the patient’s point of view determined that PD patients had significantly higher pain severity scores compared to controls. PD patients with depressive symptoms had significantly higher pain severity and pain interference scores than controls without depressive symptoms. PD patients reported greater scores on Global BPI pain interference and all components of the pain interference subscale. Therefore, PD and depression seem to be correlated with higher perceived pain, severity and interference. A report on this study, by Jose Marques Lopes, PhD., was published in Parkinson’s News Today, September 21, 2018.
Q Other Than Difficulties With Movement Are There Any Other Physical Symptoms
A. Other problems – so called ‘non-motor symptoms’ – are common and can have a major effect on quality of life. These symptoms can occur at any stage of the condition and can even start before movement symptoms are noticed.
Non-motor symptoms include:
- sensory symptoms , which occur in up to 40 per cent of people with the disease;
- tiredness not relieved by resting ;
- sleep problems , which affect about 70 per cent of people;
- constipation, which is due to the digestive tract slowing down and decreased mobility;
- bladder problems that can result in needing to urinate urgently and/or more often, urinary incontinence or difficulty urinating;
- orthostatic hypotension , which causes a sudden fall in blood pressure when changing positions – usually standing up – causing fainting ; and
- depression and anxiety, which are not just due to having a chronic illness but are part of the disorder.
Constipation , urinary problems and sleep problems can be made worse by some of the medicines used to treat Parkinson’s disease.
Revisiting Pain In Pdthe 50 Shades Of Pain Experienced By Parkinsons Patients
Pain is a quality of life issue for people with Parkinson’s disease and can be under treated by doctors who may assume that is worsens as the disease progresses, although for some pain is an initial symptom of PD. This article helps focus your physician’s attention in the right direction to accurately diagnose your pain.
Pain Management In Patients With Parkinsons Disease: Challenges And Solutions
This review focuses on the diagnosis and management of Parkinson-related pain. It reviews the incidence and prevalence of PD, general pain and PD-related pain, the pathophysiological pathways of pain in PD, physiological pathways of pain relief, measurements of pain, clinical diagnosis of PD-related pain, and treatment strategies.
Q What Are The Different Types Of Medicines Used To Treat Parkinsons Disease
A. Because the symptoms of Parkinson’s disease are caused by a lack of dopamine in the brain, most drug treatments — so-called ‘antiparkinsonian medications’ — are aimed at replacing dopamine, prolonging its action or acting like dopamine.
Levodopa, also known as L-dopa, is the most effective medication available, improving symptoms in more than 80 per cent of people within 6-8 weeks. Levodopa is converted into dopamine by nerve cells in the brain. To prevent it from being converted to dopamine before it reaches your brain, it needs to be given in combination with another medication . These combination medications are called Sinemet and Madopar, respectively.
Other medicines available for the treatment of Parkinson’s disease include dopamine agonists, MAO-B inhibitors, COMT inhibitors, anticholinergics and amantadine. Although these medications are generally not as effective as levodopa, they do benefit some people. They are especially useful if levodopa is causing intolerable side effects or isn’t controlling symptoms on its own. These medicines are often used as initial therapy to control relatively mild symptoms, especially in younger patients.
A range of treatments is also available for non-motor symptoms such as depression, sleep problems, constipation and sexual dysfunction.
Q Are There Any Problems Associated With Using Levodopa In The Long Term
A. The use of medications means that most people with Parkinson’s disease can expect many years of active living. Unfortunately, the initial positive response to levodopa does not always last — its effects often become unpredictable, and various side effects start to appear after about 5 years of treatment. The main side effects associated with long-term levodopa therapy are dyskinesias and the ‘wearing-off’ effect.
Dyskinesias are involuntary twitching and jerking movements of the head, face and limbs. These uncontrolled movements are the most common adverse effect of prolonged levodopa therapy. Taking a lower dose of levodopa or combining levodopa with another antiparkinsonian medication — a dopamine agonist — may improve the problem of dyskinesia.
The ‘wearing-off’ effect, or end-of-dose failure, refers to a decrease in the length of time that each dose of levodopa controls symptoms. This results in periods of impaired movement that abruptly alternate with periods of improved mobility.
Taking smaller, more frequent doses of levodopa or controlled-release levodopa can help. There is a formulation of levodopa plus carbidopa that can be used in people with more advanced Parkinson’s disease who have severe fluctuations in response to levodopa. The medicine is a gel that is given directly to the small intestine via a feeding tube. By giving the medicine continuously through a feeding tube, the amount of medicine in the body is constant, reducing the wearing-off effect.
Q What Lifestyle Adjustments Can I Make To Help Improve My Symptoms
A. Although there are medications which are very effective for treating the symptoms of Parkinson’s disease, the effects of these medications usually diminish with time. For this reason, your doctor may recommend some lifestyle changes before starting you on medication.
Regular exercise can help you to maintain flexibility and mobility. It also improves posture, balance, strength, agility and even mood. A moderate level of exercise is best — try walking, swimming, tai chi or dancing. Always remember to ask your doctor about an appropriate fitness programme before you start.
Loss of appetite and subsequent weight loss can occur as a result of depression or a decreased sense of smell. Try to maintain a healthy and nutritious diet, with plenty of fibre to prevent constipation. Your doctor may need to prescribe an antidepressant medication if depression is severe or contributing to poor appetite and weight loss.
What Should I Know About Storage And Disposal Of This Medication
Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture .
Store cassettes containing levodopa and carbidopa enteral suspension in the refrigerator in their original carton, protected from light. Do not freeze the suspension.
Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA’s Safe Disposal of Medicines website for more information if you do not have access to a take-back program.
It is important to keep all medication out of sight and reach of children as many containers are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location – one that is up and away and out of their sight and reach. http://www.upandaway.org
Q How Can I Stop Parkinsons Disease Affecting My Everyday Life
A. The problems with movement do affect everyday life, but with the help of health professionals you should be able to make adjustments to your daily routine and alterations around your home to help keep you active and independent.
- Speech can become monotonous, slurred or soft, and some people stutter if they have difficulty articulating words. A speech therapist can suggest verbalisation exercises and tongue movements to help you to speak louder and enunciate more clearly.
- As the disease progresses, you may find that eating becomes difficult due to problems with chewing and swallowing. A speech therapist may also be able to help with these problems.
- You may find walking difficult, especially taking the first step. A physiotherapist can give you exercises to strengthen your muscles and improve flexibility, as well as tips on how to improve posture, balance and mobility. Installing railings in the bathroom and hallways or using a walking aid can also help, and removing rugs from your home can prevent tripping.
- There is footwear available that can help improve gait and balance problems, and clothes with fastenings that should be easy to manage . An occupational therapist can help with suggestions and devices to make everyday tasks easier.
- Your handwriting can become small, shaky, and eventually illegible due to the combination of tremor, rigidity and bradykinesia. Using a large-body pen or pencil or a felt-tip pen may help.
What Lifestyle Changes Can I Make To Ease Parkinsons Symptoms
Exercise: Exercise helps improve muscle strength, balance, coordination, flexibility, and tremor. It is also strongly believed to improve memory, thinking and reduce the risk of falls and decrease anxiety and depression. One study in persons with Parkinson’s disease showed that 2.5 hours of exercise per week resulted in improved ability to move and a slower decline in quality of life compared to those who didn’t exercise or didn’t start until later in the course of their disease. Some exercises to consider include strengthening or resistance training, stretching exercises or aerobics . All types of exercise are helpful.
Eat a healthy, balanced diet: This is not only good for your general health but can ease some of the non-movement related symptoms of Parkinson’s, such as constipation. Eating foods high in fiber in particular can relieve constipation. The Mediterranean diet is one example of a healthy diet.
Preventing falls and maintaining balance: Falls are a frequent complication of Parkinson’s. While you can do many things to reduce your risk of falling, the two most important are: 1) to work with your doctor to ensure that your treatments — whether medicines or deep brain stimulation — are optimal; and 2) to consult with a physical therapist who can assess your walking and balance. The physical therapist is the expert when it comes to recommending assistive devices or exercise to improve safety and preventing falls.
Improve the quality of your sleep.
Opening The Medicine Box In The Mind: The Psychology Of Pain
In this 50-minute lecture, Beth Darnall, PhD explains how our experience of pain goes beyond the physical sensation of pain. It has emotional and psychological components that affect our ability to treat pain. She cites research to demonstrate that and shares 13 specific tips to reduce the experience of pain and increase treatment effectiveness. Audience questions follow the lecture.
Q Is Surgery Beneficial For People With Parkinsons Disease
A. Neurosurgery is increasingly used for people who have erratic and disabling responses to prolonged levodopa therapy. Options include deep brain stimulation , pallidotomy and thalamotomy. These procedures are generally only available in large, specialist centres.
Deep brain stimulation is where electrodes are inserted in the parts of the brain that control smooth motor control. These electrodes are connected to a device that is implanted under the skin near your collarbone.
The main difference between deep brain stimulation and traditional surgery is that you are able to activate and control the device, which sends tiny bursts of electricity to your brain to help control tremor and dyskinesias.
For people taking levodopa, it can help stabilise medication fluctuations and dyskinesia. Rigidity and bradykinesia can also improve with this treatment.
Unfortunately, this procedure is generally not helpful for people who have not responded to levodopa, except for those whose main symptom is tremor. Deep brain stimulation is not suitable for people with dementia, a psychotic illness or a major medical condition.
Pallidotomy, which involves destroying overactive cells in a region of the brain called the globus pallidus, is generally reserved for people with advanced disease that is not controlled by medicines. It can also treat the dyskinesias that result from long-term levodopa therapy, and allow continued use of levodopa.
What Are The Primary Motor Symptoms Of Parkinsons Disease
There are four primary motor symptoms of Parkinson’s disease: tremor, rigidity, bradykinesia and postural instability . Observing two or more of these symptoms is the main way that physicians diagnose Parkinson’s.
It is important to know that not all of these symptoms must be present for a diagnosis of Parkinson’s disease to be considered. In fact, younger people may only notice one or two of these motor symptoms, especially in the early stages of the disease. Not everyone with Parkinson’s disease has a tremor, nor is a tremor proof of Parkinson’s. If you suspect Parkinson’s, see a neurologist or movement disorders specialist.
Tremors
Read more about Parkinson’s tremors
Rigidity
Bradykinesia
mask-like expression of the face
Postural Instability
Walking or Gait Difficulties
Dystonia
Vocal Symptoms
The Preponderance Of Injury In The Past Of People With Pd
Neck issues or damage can be caused by injuries, but the injury site doesn’t have to be local to the neck itself, since it is an integral part of the kinetic chain of the human body – problems anywhere else which affect posture can, in turn, profoundly affect how we tense our necks and cause strains on it by the way we are holding up the head. I’ve frequently asked people with Parkinson’s Disease to think carefully about any pains and injuries which they might have incurred either before or concurrent with their PD diagnosis. I’ve found that the overwhelming majority of us have suffered a prior accident or physical trauma. Injuries to jaw, neck, shoulders, back, hips, knees or feet predominate. All these severely affect posture and hence the kinetic chain and are liable to make our necks prone to permanent strains and stiffness. So in my view, even if chemical “cures” were invented tomorrow, people with PD would still present with the postural problems, still suffer from the old injuries which have been masked by the narratives of neurology, and would probably quickly decline into pain and problems again, unless these past injuries are properly attended to.
Q What Is The Outlook For People With Parkinsons Disease
A. Most people can continue to work full time and lead relatively normal lives for many years after being diagnosed. The disease does not affect your life expectancy, and your age at diagnosis does not seem to have any effect on your long-term outlook. However, due to the progressive nature of the disease, many people do eventually become disabled.
What Are The Surgical Treatments For Parkinsons Disease
Most patients with Parkinson’s disease can maintain a good quality of life with medications. However, as the disease worsens, medications may no longer be effective in some patients. In these patients, the effectiveness of medications becomes unpredictable – reducing symptoms during “on” periods and no longer controlling symptoms during “off” periods, which usually occur when the medication is wearing off and just before the next dose is to be taken. Sometimes these variations can be managed with changes in medications. However, sometimes they can’t. Based on the type and severity of your symptoms, the failure of adjustments in your medications, the decline in your quality of life and your overall health, your doctor may discuss some of the available surgical options.
What Is The Outlook For Persons With Parkinsons Disease
Although there is no cure or absolute evidence of ways to prevent Parkinson’s disease, scientists are working hard to learn more about the disease and find innovative ways to better manage it, prevent it from progressing and ultimately curing it.
Currently, you and your healthcare team’s efforts are focused on medical management of your symptoms along with general health and lifestyle improvement recommendations . By identifying individual symptoms and adjusting the course of action based on changes in symptoms, most people with Parkinson’s disease can live fulfilling lives.
The future is hopeful. Some of the research underway includes:
- Using stem cells to produce new neurons, which would produce dopamine.
- Producing a dopamine-producing enzyme that is delivered to a gene in the brain that controls movement.
- Using a naturally occurring human protein – glial cell-line derived neurotrophic factor, GDNF – to protect dopamine-releasing nerve cells.
Many other investigations are underway too. Much has been learned, much progress has been made and additional discoveries are likely to come.
What Future Medications May Be Available For Parkinsons
There are numerous studies investigating new treatments for Parkinson’s disease.
There has been new information about the role of autoimmunity and T-cells in the development of Parkinson’s disease, possibly opening the door to a role for biologics.
Stem cells are also being investigated as a treatment option for Parkinson’s disease.
How To Deal With The 6 Common Causes Of Leg Pain In Pd
Severe leg pain is a common complaint from people with PD. Lately, it is understood that central pain is common to Parkinson’s disease, and can even be the first sign of PD, usually bilaterally. This blog post lists six causes of lower limb pain, and the importance of treating it. Treatments depend on properly identifying the source of pain. Some treatment suggestions are included.
What Medications Are Used To Treat Parkinsons Disease
Medications are the main treatment method for patients with Parkinson’s disease. Your doctor will work closely with you to develop a treatment plan best suited for you based on the severity of your disease at the time of diagnosis, side effects of the drug class and success or failure of symptom control of the medications you try.
Medications combat Parkinson’s disease by:
- Helping nerve cells in the brain make dopamine.
- Mimicking the effects of dopamine in the brain.
- Blocking an enzyme that breaks down dopamine in the brain.
- Reducing some specific symptoms of Parkinson’s disease.
Levodopa: Levodopa is a main treatment for the slowness of movement, tremor, and stiffness symptoms of Parkinson’s disease. Nerve cells use levodopa to make dopamine, which replenishes the low amount found in the brain of persons with Parkinson’s disease. Levodopa is usually taken with carbidopa to allow more levodopa to reach the brain and to prevent or reduce the nausea and vomiting, low blood pressure and other side effects of levodopa. Sinemet® is available in an immediate release formula and a long-acting, controlled release formula. Rytary® is a newer version of levodopa/carbidopa that is a longer-acting capsule. The newest addition is Inbrija®, which is inhaled levodopa. It is used by people already taking regular carbidopa/levodopa for when they have off episodes .
What Are The Different Stages Of Parkinsons Disease
Each person with Parkinson’s disease experiences symptoms in in their own unique way. Not everyone experiences all symptoms of Parkinson’s disease. You may not experience symptoms in the same order as others. Some people may have mild symptoms; others may have intense symptoms. How quickly symptoms worsen also varies from individual to individual and is difficult to impossible to predict at the outset.
In general, the disease progresses from early stage to mid-stage to mid-late-stage to advanced stage. This is what typically occurs during each of these stages:
Early stage
Early symptoms of Parkinson’s disease are usually mild and typically occur slowly and do not interfere with daily activities. Sometimes early symptoms are not easy to detect or you may think early symptoms are simply normal signs of aging. You may have fatigue or a general sense of uneasiness. You may feel a slight tremor or have difficulty standing.
Often, a family member or friend notices some of the subtle signs before you do. They may notice things like body stiffness or lack of normal movement slow or small handwriting, lack of expression in your face, or difficulty getting out of a chair.
Mid stage
Mid-late stage
Standing and walking are becoming more difficult and may require assistance with a walker. You may need full time help to continue to live at home.
Advanced stage
Treatment Depends On Properly Identifying The Type
If pain is bilateral always assume it is central pain; pain due to PD. In my experience Azilect works great for this type of pain. Other medications which can be employed for this pain as well.
Massage therapy works for all types of leg pain-my favorite therapy but can be costly. Water therapy may also work for all types except central pain. Physical therapy can alleviate dystonia pain, as well as musculoskeletal and radicular pain.
If pain is due to dystonia related to levodopa intake, find out when it occurs—end of dose or at peak dose. Typically adjusting medication doses will resolve problem. However, if dystonia is an initial symptom of PD, initiating treatment with levodopa will resolve. If medication adjustment does not work well for levodopa induced dystonia, another treatment option is DBS . Pain due to dystonia independent of cause can also respond well to Botox injections, as well as centrally acting muscle relaxants. To avoid and alleviate pain caused by stiff muscles, a great treatment option is activity in the form of stretching exercises—any number of activities will do such as tai-chi or yoga. For me when I start having radicular pain shooting down my leg it is time to up my levodopa dosage.
If you are having leg pain make sure to discuss it with your physician.
Pain In Parkinsons Disease: A Spotlight On Women
This 2-page interview with neurologist, Dr. Jori E. Fleisher, discusses pain in Parkinson’s disease with some interesting statistics about women and pain. Dr. Fleisher outlines the 4 primary types of pain in PD, how depression interferes with pain management, the role of exercise and medications in pain management as well as alternative therapies.
What Should I Expect At A Podiatry Appointment
It is a good idea to try to make appointments at a time of day when you are least likely to experience tremor or other involuntary movements as the podiatrist may need to use sharp instruments. It may also be helpful if your carer is with you for the first appointment so that they understand how they can help you between appointments.
The initial appointment will last around 30 minutes, although this will vary depending on where you live. Additional assessment and treatment sessions will normally take between 20-30 minutes.
The podiatrist will take a full medical history, including your Parkinson’s and any other health problems, as these can affect your feet. They will need to know what medications you take so make sure you take a list of medications with you.
They will assess your feet, including the condition of your skin and nails, circulation and nerves. They will also watch the way you walk and the position and movement of your feet .
The podiatrist will then suggest a care plan including treatment of any immediate problems, future appointments and day-to-day care such as nail cutting, exercise and the use of creams.
In some countries home visits may be arranged if mobility is very limited.
Second Type Of Leg Pain Is Caused By Dystonia
When related to levodopa, it usually occurs as a wearing off but can also occur at peak dose. In most cases this leg pain is unilateral and has direct correlation to medication intake. When pain is due to dystonia, it is more common in early morning. This type of leg pain is usually accompanied by toes curling and foot abnormally posturing.
Shaking Hands Or Tremor Swelling And Swelling
- Medical Author: Melissa Conrad Stöppler, MD
Reviewed on 12/14/2020
Shaking hands or tremor can be related to nervous system disorders. Examples include Parkinson disease or benign essential tremor. Swelling of the feet and hands may not be related but could occur at the same time. Shaking can sometimes be a side effect of medications. Seek your doctor’s advice if you are experiencing troubling symptoms, and do not stop taking any prescription medication unless directed to do so by your doctor.
While the list below can be considered as a guide to educate yourself about these conditions, this is not a substitute for a diagnosis from a health care provider. There are many other medical conditions that also can be associated with your symptoms and signs. Here are a number of those from MedicineNet:
Q Can Parkinsons Disease Affect My Sex Life
A. Reduced libido and impotence can result from physical and/or psychological factors of Parkinson’s disease. In addition, some of the medicines used to treat the symptoms of Parkinson’s disease can cause sexual dysfunction in men, and vaginal dryness in women. Fatigue can make matters worse.
It may help to try having sex in the morning after taking your medication. Medicines are available to help men with erectile difficulties, and vaginal lubricants may be of help to women.
Q Is There Any Research Into New Treatments
A. Embryonic stem cell transplantation is one of a number of potential treatments for Parkinson’s disease that are being investigated. Embryonic stem cells have the potential to develop into any type of human cell, including dopamine-producing nerve cells. These cells could potentially be transplanted into the brains of people with Parkinson’s disease, as a replacement for their lost nerve cells.
Gene therapy and novel drug treatments are also being actively investigated.
With continued research, improved treatment options and even a cure for Parkinson’s disease may not be too far away.
What Are The Symptoms Of Parkinsons Disease
Symptoms of Parkinson’s disease and the rate of decline vary widely from person to person. The most common symptoms include:
Other symptoms include:
- Decreased facial expressions: You may not smile or blink as often as the disease worsens; your face lacks expression.
- Speech/vocal changes: Speech may be quick, become slurred or be soft in tone. You may hesitate before speaking. The pitch of your voice may become unchanged .
- Handwriting changes: You handwriting may become smaller and more difficult to read.
- Depression and anxiety.
- Sleeping disturbances including disrupted sleep, acting out your dreams, and restless leg syndrome.
- Pain, lack of interest , fatigue, change in weight, vision changes.
- Low blood pressure.
Parkinsons Disease: How It Affects The Feet
Saturday, April 09, 2016
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Angela Davis |
PARKINSON’S disease is a chronic progressive disease of the nervous system. It is marked by tremors, muscle rigidity and slow, imprecise movement. It is usually diagnosed in middle-aged and elderly people, and is associated with the degeneration of the basal ganglia in the brain and the deficiency of the neurotransmitter, dopamine.
Parkinson’s disease cannot be cured, but it can be treated and the symptoms may be reduced. Treatment includes surgery, physiotherapy, occupational therapy, and medication.
Most people with Parkinson’s will find that they have problems with their feet. This results in difficulties with their gait, walking, posture, and cramps.
Patients may experience a loss of balance and find that their stride gets shorter as well as that the amount of time their feet remain in contact with the ground increases.
People with Parkinson’s tend to lose the typical heel-to-toe pattern of walking due to stiffness in the ankles. This can lead to a shuffling, flat-footed action and cause foot, ankle, leg, and knee pain. Most patients will feel like they are walking on their toes due to the excessive stiffness.
Stiffness and muscle contraction in the calf muscles make it harder to flex the ankle, affecting the body’s ability to absorb the shock of coming into contact with the ground. This, in turn, causes callus and tissue breakdown .
DYSTONIA
SWELLING
FOOT CARE TIPS FOR PEOPLE WITH PARKINSON’S DISEASE
Innate Immunity In Pd: Microglia Activation
Microglial cells are the principal actors of innate immunity in the CNS responsible for the protection and restoration of neurons . They can be activated by various external or internal insults such as neuronal dysfunction, trauma or certain toxin. Also, a wide range of molecules including viral or bacterial proteins, ?-syn, cytokines and antibodies are able to induce the activation of microglia . Consequently, microglial cells produce different molecular mediators with chemotactic and immunomodulatory functions. One of them is tumor necrosis factor which in PD plays important roles contributing to the regulation of synaptic plasticity . PD brains are characterized by the presence of HLA-DR+ microglial cells and raised levels of CD68, an activation marker for microglia and macrophages, having a direct relation with ?-syn aggregations and the duration of disease . Moreover, an increased expression of MHC-II molecules in microglial cells has been observed in chronic neuroinflammation but not in the CNS of healthy subjects . Individuals with single nucleotide polymorphism at MCH-II locus are prone to develop PD, which indirectly proves the importance of adaptive immunity in these patients .
Q Are Memory And Thinking Affected As Well
A. Some degree of impaired memory and thinking can be a problem, most often affecting people who have had the disease for at least 10 years. About 20 per cent of people with Parkinson’s disease have severe loss of mental capacity, while about half have minor problems with memory and reasoning.
Depression also affects many people with Parkinson’s disease. Depression may develop as a reaction to the diagnosis or physical disabilities, but is more likely to be part of the disease process itself.
People with Parkinson’s disease may also be affected by anxiety or other emotional changes.
Mental health problems, including psychosis, are a side effect of some medicines used to treat Parkinson’s disease. These side effects often affect older people or those with dementia. Medicines can be changed or adjusted if there is any sign of psychosis or other serious side effects.
One Leg Swelling From Venous Insufficiency
Venous insufficiency means that the valves in the veins are not working properly. This results in reverse flow within the vein and in accumulation of fluid and pressure in the leg. Venous insufficiency can manifest as edema with or without varicose veins. Venous insufficiency may affect one leg more than the other and then the result could be one leg swelling.
Varicose vein cluster over the medial aspect of the left lower thigh and upper calf