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In a healthy individual, the veins allow the blood to go back from the periphery to the heart, and to do such a function there are valves inside those veins that only allow the blood one way. For several reasons those valves can get damaged, and once they get damaged the blood will be going with gravity to the periphery, and this is the beginning of the venous disease.

Symptoms of venous disease can vary a lot, can be as simple as some swelling, discomfort, and aching in the legs, or it even can be big varicose veins that can be very unsightly. In the more extreme end, there will be damage to the skin itself. It can be sores that don't heal, and even bleeding from those veins.

The first line of treatment for this condition would be conservative management, meaning to increase exercise, increase physical activity, wearing of support hose, and if it's a mild form of the disease avoiding standing, the symptoms can be controlled. If it's not controlled, there will be second and third line treatment options that we have.

If the conservative management does not work, patients still have symptoms, then we can start with ablation, which is basically closing those bad veins that are leaking into the legs. We do that by different methods. The most commonly used are the radio frequency ablation, and the laser therapy. The compliment treatment to this will be sclerotherapy, and also phlebectomy, or stripping of the veins.

The risk of untreated venous disease can vary from just continued symptoms and discomfort to progression of the disease causing permanent damage. Skin changes are very common in advanced forms of the disease, skin pigmentation, thickening of the skin, and unhealthy skin can lead to infection, and this infection can lead to more complication and fibrosis of the area. Additionally, a big morbidity, especially in elderly populations, will be with sores, or untreated ulcers, that can be very serious as well.

Cardiotoxicity is any sort of untoward effect on the heart that might damage the heart muscle, the heart lining, the heart blood vessels. We can see it sometimes with radiation therapy. We can see it sometimes from other causes, diseases. Basically anything that causes negative effects on the heart could be considered cardiotoxicity.

Generally speaking, radiation damage only effects the heart when it's directed at or near the heart. Radiation therapy to one of the extremities or to the head or some other part of the body, it's pretty targeted so it doesn't have any direct effects on the heart. It can have other effects that can affect the heart. It can affect blood cells. It can affect your immune system, that sort of thing, but direct toxic effects to the heart are generally only considered when there's radiation in or near the heart.

Not everyone who receives radiation is at risk for cardiotoxicity. As I mentioned before, generally only when you have radiation that is directed at or near the heart do you have to worry about that. You can have some other indirect effects, but cardiotoxicity itself it specific to radiation in the chest area.

Typically, all patients who receive radiation are monitored for cardiotoxicity. It's pretty standard procedure whether you're receiving chemo radiation or just radiation to get a cardiac evaluation prior to the start of therapy. That might include an ultrasound of the heart or a stress test or any other tests that your cancer doctor or your heart doctor deem necessary. Typically speaking, following the completion of therapy we'll repeat those tests to see if anything has changed.