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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.

Low sodium diet is important because it's been the key factor to reduce the risk of cardiovascular diseases and that's related to the association between low sodium and the reduction of the blood pressure, which treat the high blood pressure problem.

So, generally speaking we always advise the patient to consider low sodium, even if you are healthy. And the reason is, on the long term, there is a higher chance of developing high blood pressure. And actually with the recent guidelines, believe it or not, one third of the population of the United States are, by definition, hypertension. So, I think considering not to add a lot of salt to your daily food is a good habit and definitely for those with heart disease, stroke or high blood pressure. That's, I think, a must because that will reduce the risk of having farther cardiovascular events.

Low sodium diet can reverse the problem of hypertension and high blood pressure. And the reason how that happens is reducing the salt will reduce the blood pressure reading then you're reducing your high blood pressure and that's the definition of hypertension.

The magic number, just to make it easier on the patient is less than two gram of salt. Which is basically one teaspoon of salt a day. That's what we suggest for patients with cardiovascular disease.

So, that will be 2000 milligram if you want to take it in that context because the one thousand gram is basically a thousand milligram. So, the rule is 2000 milligram just to make it easier or one teaspoon.

Symptoms that indicate that the patient is taking too much salt may include noticing that there is more swelling in the legs than usual, having shortness of breath or just feeling tired and discomfort and when the patient checks their blood pressure they found that their blood pressure is elevated.

Foods like vegetables, foods like grains and green food, that definitely has less salt than meaty food and the food that we buy from fast food places where there's a lot of salt already have a place in that. Canned food also contains a lot of salt in general and the reason is they use the salt to prevent the bacteria to grow. So, the concentration of the salt is generally higher in the canned food.

I would say that good resources to go with a low sodium diet, to have a variety of a lot of green and boiled meat instead of fried meat that have a lot of salt in general. At the same time, consider greenery, broccoli and food that tastes good. One of the advice that I give to my patients, 'cause every patient looks for a taste and I would say put a little bit of garlic powder instead of salt. It will give you that taste without making your blood pressure go as high, but make sure your garlic is not the garlic mixed with salt. Pick the one that's pure garlic. A little bit of it, on your broccoli for example, can give you the taste that you're looking for without getting your blood pressure elevated.

A good source for a list of low so diet can be find on United States Department of Health and Human Services. Which have a nice list of what you need to consider when you're buying low salt food and they divided them by vegetables and season, others, and that, I would suggest patients to go on, look into, for that reason.