Happy and healthy

In 2014, our year-end blog post was the testimonial of a happy patient whose quality of life was markedly improved by venous treatment. It was such a nice way to end the year that we’re doing it again!

“I am a freelance creative professional, so I’m always on my feet, and as an active person I’m always on the go. Before I went to Dr. Cindy, I had a vein on my leg that was so gnarly and huge that it looked like a topographical map on my leg. I sought treatment because I was also experiencing cramping in my calves that was so severe I couldn’t run or swim nearly as much as I used to.

After I got an ablation on both legs, I started to see improvements in symptoms that I never even knew were related to my vein problems. Not only did my leg cramps go away, my feet stopped hurting and swelling up like balloons. My shoe size went down half a size—and I have ankles again! I have new legs as far as I’m concerned. I don’t tire as quickly, I have more endurance, and I have more cardio, which is surprising to me. I didn’t know how much better I could feel.” – Nathan E., 41, Portland, ME

To read more stories about satisfied patients, click here to read “Perspectives: Real Cases of Vein Treatment.”  Dr. Asbjornsen and all of us at the Vein Healthcare Center wish you a healthy holiday and a brilliant new year. See you in 2016!

High heels and crossed legs

High-heeled shoes are often associated with bad veins, but have you ever wondered why? It’s all about the ability to move the ankle, also known as ankle motility. The calf muscle acts as a pump to push blood against gravity from the feet and legs, back up to the heart.

If the ankle does not have full range of motion, it is considered an independent risk factor for venous disease. When one is wearing high heels, the calf muscle cannot be fully extended, which decreases its power within the pumping mechanism. 

In a similar vein (sorry!) many patients at the Vein Healthcare Center have asked if crossing their legs causes varicose veins. The answer is: we don’t currently know. There is no research supporting this claim, but anecdotally, Dr. Asbjornsen will occasionally see a patient who crosses one leg over the other and experiences issues with her or his small saphenous, a vein that begins at the back of the knee and extends down the backside of the leg. Continuous pressure on this vein may damage the valves, or at least impede flow, which could create permanent damage. 

To learn more about risk factors for vein disease, including environmental risks, feel free to explore the Vein Healthcare Center’s website, or request an appointment online. Or if you’d like to talk with someone in person, call us at 207-221-7799. We look forward to hearing from you!

Educational video about veins

We’re going to continue sharing multimedia resources for learning more about veins.

Several years ago, the American College of Phlebology (ACP), in partnership with KAET-TV in Phoenix, AZ, produced a video called "Vein Health: Discoveries, New Technologies & Breakthroughs." The hour-long program leads viewers through the basics of vein disease, and then addresses specific treatment options, misconceptions, and questions from the studio audience with two physician panels.

“Vein Health: Discoveries, New Technologies & Breakthroughs" is hosted by Dr. Helane Fronek, a true pioneer in the field of phlebology. We hope you’ll learn a lot as you watch this video. If you have any additional questions about vein disease or treatment, give us a call or send us an email at the Vein Healthcare Center.

Podcasts about vein health

Whether you’re exercising at the gym, cleaning your house, or commuting in your car, podcasts are an easy, efficient way to be informed or entertained. There are two excellent podcasts about vein health and the practice of vein care.

The “Healthy Veins, Healthy Legs” podcast is adapted from an hour-long radio show hosted by Dr. Robert Kistner of the Kistner Vein Clinic and Mike Buck. The show covers all aspects of venous disease, ailments of the legs, and the latest and most effective treatment options. The conversations are lively and were recorded in Hawaii!

“VeinCast” is a monthly podcast intended for those involved in the treatment of venous and lymphatic disease. The podcast, sponsored by the American College of Phlebology Foundation, is co-hosted by Dr. Todd Hansen of Carolina Vein Associates and Dr. Albert Malvehy of Miami Beach Vein Institute.

Last year, Drs. Hansen and Malvehy were participants in the inaugural ACP Leadership Academy. The teammates (mentored by Vein Healthcare Center’s very own Dr. Asbjornsen) share a background in Emergency Medicine and were interested in sharing information using the podcast format.

Said Dr. Hansen: “I have been a avid podcast enthusiast for many years, so I had a natural affinity for this project. Access to ‘on demand’ information suits my needs and allows me to make best use of time by listening to informative and freely available information on a wide range of topics.”  

“VeinCast” explores topics related to vein care, practice management, new technologies, and the wide range of issues that physicians face practicing phlebology. In addition to being a convenient resource for anyone interested in the practice of vein care, the podcast provides added value to current members of the American College of Phlebology (ACP). Dr. Hansen also hopes that it will drive membership by attracting new professionals to the ACP: “This podcast is one small way that we can contribute to the future of phlebology.”

Click here to listen to “Healthy Veins, Healthy Legs.”

Click here to listen to “VeinCast.”

Athletes and blood clots

In our last post we told you about World Thrombosis Day, and before that we talked about the effect of athletic activity on veins. Now we take a look at the topic of athletes and deep vein thrombosis, or DVT.

Deep veins are located under the muscle and connective tissue layers in the legs. A blood clot in a deep vein—known as deep vein thrombosis, or DVT—can be dangerous because the high pressure in the system could cause the clot to break free from the vein wall and enter the blood stream. The DVT could then travel up through the legs into another part of the body such as the lungs, where it would become a pulmonary embolism (PE).

           

DVT or PE symptoms are often misinterpreted as something less serious. A blood clot in the leg may feel like a “Charlie horse,” shin splints, or a twisted ankle. Symptoms from PE are often attributed to a pulled muscle in the chest, asthma, or a “touch of pneumonia.”

           

In half of DVT and PE cases, no symptoms present at all—but both conditions are medical emergencies. Any of these symptoms should be regarded as a DVT or PE until proven otherwise, especially if someone is in a risk category (including whether there is a history of blood clots in your family).

Remember, being active and fit does not prevent someone from developing blood clots. Athletes, coaches, and trainers should be aware of these risk factors:

·       Traveling long distances to and from a sports competition

·       Dehydration (during and after a strenuous sporting event)

·       Significant trauma

·       Immobilization (in a brace or cast)

·       Bone fracture or major surgery

·       Family history of DVT or PE

·       Presence of an inherited or acquired clotting disorder

Treatment of blood clots depends on many variables, including your health background and the extent and location of the clot. And, of course, prevention is the best medicine. Go to our latest issue of Vein Health News to learn more.

World Thrombosis Day – October 13th

Last year we told readers about the first World Thrombosis Day. The effort continues this year with the second annual WTD scheduled to take place on October 13th (the birthday of Rudolf Virchow, the German physician who pioneered the pathophysiology of thrombosis).

The goal of this educational campaign is to raise awareness about blood clots and to reduce the number of undiagnosed cases. Community events, lectures, health fairs, and scientific meetings will help spread the word around the world about this preventable condition.

Here’s a quick review of thromboses, a.k.a. blood clots. A blood clot in a deep vein is known as deep vein thrombosis, or DVT. DVT can be dangerous because the high pressure in the system could cause the clot to break free from the vein wall and enter the blood stream. When that happens the DVT becomes a venous thromboembolism, or VTE. The embolism (a blood clot that has “broken free”) could then travel up through the legs, back to the heart and then to the lungs where it blocks some or all of the blood supply to the lungs. This is called a pulmonary embolism, or PE, and it can often be fatal.

To learn more about this common—and commonly overlooked—medical condition, go to www.worldthrombosisday.org. There you’ll find facts about VTE, as well as personal stories of blood clot survivors and their families.

Running on all cylinders

This Saturday the Vein Healthcare Center is co-sponsoring the South Portland MAINEiacs first-ever 5K run, just around the corner from the VHC offices!

We’ve had running, exercise, and athletes on our mind lately, as our latest issue of Vein Health News is hot off the press. In our cover story package, we look at how exercise affects veins (and vice versa); whether athletic compression is worth considering; and how even athletes could be affected by DVT.

Click here to read more about athletes and veins. And get out and enjoy a walk or run in the increasingly crisp autumn air!

Q&A with the newest member of the VHC team

Meet Alison Scheib, PA-C! As a certified Physician Assistant, Ali supports Dr. Cindy Asbjornsen, founder of the Vein Healthcare Center. As a trained sclerotherapist, she performs ultrasound-guided and light-assisted sclerotherapy, a procedure for treating venous insufficiency, particularly smaller “spider veins.”

In addition to spending time with her husband (a fellow PA-C at a veterans hospital) and their two children, Ali loves outdoor activities like swimming and waterskiing. Read on to learn more about Ali.

Q:  What is a Physician Assistant?

A:  A physician assistant, or PA, is a nationally certified and state-licensed medical professional. PAs practice medicine on healthcare teams with physicians and other providers and can prescribe medication. I earned my PA degree from the University of South Alabama and practiced Family Medicine for 15 years in Camden, Maine. 

Q:  How do you help patients at VHC?

A:  I perform ultrasound-guided and light assisted-sclerotherapy on patients, sometimes in follow-up to EVLA treatment. Dr. Asbjornsen and I work together as a team to treat each patient to achieve the best outcome. 

Q: What is your goal for each patient?

A: To make them feel better, both mentally and physically. After treatment, I want them to feel comfortable wearing shorts if that’s important to them. I want them to experience activities that they couldn’t do before because their legs were too sore or tired. I want them to be—and feel—healthier!

Q: Why are you a good fit for VHC?

A: I have the primary care background to see the patient as a whole person, not just the one ailment they’re seeking help for. And like the rest of the staff, I like to spend time with patients to make sure they are comfortable and understand their medical disease and treatment options. 

Q: What do you like the most about vein care?
A: I love being able to focus on one aspect of a patient's healthcare while still treating the "whole" person. I’m also excited that phlebology is still a fairly new specialty, and I’m looking forward to working with Dr. Asbjornsen on doing research that can continue to advance the field.

Environmental risks for vein disease

There are a number of risk factors for vein problems. Aging is one of the leading risk factors for the development of vein issues. Heredity is another. (If one parent has vein disease you have about a 33% chance of also developing vein problems. If both of your parents have vein issues, then your chances go up to 90 percent.)

While aging and family history are risk factors that can’t be controlled (try as we might), venous disease can be aggravated by environmental risks. It is much more common in “industrial countries” like the U.S., where riding in cars and sitting in front of a computer or television seem like a way of life.

             

We explored the risks involved in sitting in a previous post, but standing for long periods (with or without high heels) is also a risk factor. Research has shown that the more hours one stands, the more likely it is that a vein issue will develop. Likewise, lying in one position for too long can cause serious vein problems. Patients in the hospital or on bed rest, for example, may experience a slowdown in blood flow that can lead to blood pooling in the extremities.

As Dr. Asbjornsen explained in her chapter “Risk Factors and Other Causes for Vein Problems” in the book Healthy Veins…Healthy Legs, it is possible to reduce some risk factors for vein disease.

There are many treatment options today that are minimally invasive and highly successful, but education and prevention are the most important keys to vein health. Even if you are not experiencing symptoms, a venous screening can evaluate the condition of your venous system, help you avoid blood clots, and help you begin lifestyle changes that can prevent symptoms from occurring. 

The risks of…sitting?

Are you sitting down? Chances are, you are! It seems like our whole world was designed to keep us in a seated position, usually in front of a screen, whether during work or leisure time.

Earlier this year, a recent article found that this overwhelmingly sedentary behavior increases our risk of getting preventable conditions, even if we exercise. The studies showed that physical inactivity (the fourth-leading risk factor for death for people all around the world, according to the World Health Organization) can lead to premature death from cardiovascular issues and cancer, as well as cause chronic conditions such as Type 2 diabetes.

Too much sitting can also increase the risk of getting varicose veins—and if you already have vein issues, you may notice that symptoms get worse after sitting for prolonged periods of time.

Why? The heart pumps oxygen-rich blood throughout the body through the arteries. Veins then carry blood from all the extremities back up to the heart. The blood in the legs travels up against gravity, so when the valves in the veins become damaged, blood flows back into the legs which leads to a “pooling” of blood in the veins that can manifest as varicose veins or spider veins. 

When you sit (or stand) in the same position for a long time, the blood doesn’t circulate properly and, over time, this can lead to varicose veins.

There are a several ways to help reduce the risk of getting varicose veins from sitting for too long:

• Sit properly. Focus on good posture and avoid crossing your legs or sitting in ways that can compress veins for prolonged periods.

• Elevate. Occasionally, rest your legs above your heart – for as long as 30 minutes or as briefly as three minutes. (For more tips on elevation, click here.)

• Take a break. Take frequent walking breaks to avoid sitting or standing for periods of more than two hours.

• Pump it. If you can’t move around that often – or are flying on an airplane – try flexing and pointing your foot to get the blood moving in your legs. (Click here to learn more about “the foot pump.”)

Of course, the best way to reduce your risk of getting varicose veins from sitting all day is to move around more – and be aware of just how much time you spend sitting down.

Vein Health News, a resource for patients and doctors

Dr. Cindy Asbjornsen of the Vein Healthcare Center in Portland, Maine is passionate about educating people about vein health. That’s why three years ago she started Vein Health News for primary care physicians in Maine and New England. Although the magazine was originally intended for physicians, we've found that patients really like it too.

Vein Health News covers such topics as: minimally invasive treatments for varicose veins, modern compression, leg ulcers, deep vein thrombosis, and more. Plus, the regular column “One Patient’s Perspective” explores vein care from a patient’s point of view. If you’re interested in a free subscription to Vein Health News, just click here.

Are you a Physician? 

Primary care doctors are on the front lines of reducing the growing number of people suffering with symptoms of venous disease. Vein Health News serves as a resource for well-researched meaningful information that you can pass on to your patients. If you would like the publication delivered to your office, click here to subscribe.

Education is an important first step toward better vein health and an improved quality of life.

Changes in the skin

Did you know that changes in the skin might be a clue to venous disease?

If you notice redness around the ankles, see other color changes on your legs, or find that your skin has become harder or thicker in the lower leg, it’s likely you are experiencing a common symptom of venous disease. These skin changes can be mild, or they can cause pain and involve larger areas of the skin.

Other skin changes, such as dermatitis (inflammation of the skin), cellulitis (bacterial skin infection), dry or scaly skin, or brown “stains” on the skin, can be signs of advanced venous disease.

If you do observe these types of changes—especially if you are experiencing other vein symptoms, such as aching or throbbing legs, or if vein problems run in your family—consider talking to your primary care doctor, or visiting a physician who specializes in vein health.

Summer and veins

After a long and especially frigid New England winter, it will officially be summer in just a few weeks. What does that mean for those who suffer from vein disease symptoms, such as throbbing, aching legs, legs that tire easily…or having to wear shorts?

We’ve compiled a few @VHC blog posts to help you navigate vein issues (and treatment) during the summer months:

• Don’t let varicose veins ruin your summer. Click here to read.
• Vein treatments in the summer, Part 1. Click here to read.
• Vein treatments in the summer, Part 2: Click here to read.

And for those who are traveling this summer, prevent blood clots on long trips by plane, train or automobile. Click here to read.

If you have any questions about vein health, whatever the season, you’re welcome to contact the Vein Healthcare Center. And happy almost summer!

Fashionable...compression?

Graduated compression stockings are ugly, beige, and only for “old people,” right?

Wrong. In the past several years, compression companies, such as Juzo, SIGVARIS, Carolon and Jobst, have been developing stockings and socks in styles, patterns, finishes, and colors that look more like fashion accessories than medical devices (while still being clinically effective when purchased and put on correctly.)

Newer brands like REJUVA and ITEM m6 (a spin-off of compression manufactuer medi) are also taking compression trends to the streets. Both companies were mentioned in an article about compression in the NYTimes Style section!

Read more about how compression has evolved in Healthy Style: Compression Steps Up, the latest cover story in Vein Health News. Just click here to read the story.

Seeing is believing

Understandably, sometimes the easiest way for people to decide to get their vein problems treated is for them to see with their own eyes what is possible. We invite you to take a look at the results experienced by several patients of the VeinHealthcare Center in our new e-booklet Perspectives.

In addition to sharing the true stories of people with vein disease, you’ll see the treatment results of eight different patients—with before and after pictures, of course. Click here to see for yourself.

All in the family

Like the color of your eyes, varicose veins are a trait that runs in the family. Since venous disease does have a strong genetic component, it’s important for people to be aware of venous disease and its symptoms and, as with any illness, to know the family history.

If someone in your family has experienced vein disorders or has visible veins on their legs, your risk of the disease is much higher. For example, someone with first-degree family members with vein issues will find the risk is significantly increased.

But just because you watched your mother and your mother’s mother (and so on) suffer from painful and unsightly veins, that doesn’t mean you’re destined to the same fate. Even if you are not currently experiencing symptoms, an evaluation with an experienced phlebologist (vein specialist) can tell you the condition of your venous system, as well as possible interventions and prevention. Modern vein treatments, such as endovenous laser ablation and sclerotherapy, are minimally invasive and extremely effective.

True Stories

Have you thought about getting treatment for your varicose veins, leg ulcers, or other, less visible symptoms of vein disease? If you’re considering whether or not to seek treatment for your vein issues, it might help to hear about other people who have suffered from vein disease and found relief.

We’ve put together an e-booklet called Perspectives, in which we share the experiences of real patients of Dr. Cindy Asbjornsen. You’ll read about patients whose legs look and feel better as a result of having their vein problems diagnosed and treated. But it isn’t just their legs that have improved—so, too, have the quality of their lives. 

Click here to read their stories.

Preventing leg ulcers

It's not easy to live with leg ulcers. Open wounds can be painful, difficult to heal, and the likelihood of recurrence is significant. But prevention is possible.

One warning sign that you may be developing a venous ulcer is noticeable skin changes in the lower legs, such as dryness or thickening. Another sign of ulceration may be discoloration of the legs, typically dark red, purplish, or a brown, woody appearance. Other possible indications are aches or pains in the legs, especially when standing or sitting for prolonged periods.

Varicose veins are another possible warning sign. Varicose veins, as with any form of venous disease, are often hereditary. If you have varicose veins—or a family history of varicose veins— consider getting evaluated and treated for them before they lead to ulceration.

Risk factors for venous ulcers include older age, a history of deep vein thrombosis (DVT), venous insufficiency, and previous ulcers or leg injury. Though you can’t change your genetics, you can modify other things. If you have a job where you’re on your feet all day, wear graduated compression stockings.

There is often a misconception among patients and physicians alike that there is nothing you can do for venous ulcers. The fact is wound care specialists use a variety of modalities to heal patients’ wounds, including aggressive compression therapy, skin grafting and “low-tech” therapies like elevation.

It is important to remember that although wound care specialists can treat and even heal wounds, unless the underlying cause is addressed, it will only reoccur. If the wound is identified as a venous ulcer, then treating the incompetent vein valves that contribute to venous ulcers is key for lasting results.

Experts agree that the earlier the intervention and treatment, the better chance a wound has to heal and stay closed. And, of course, patients with venous ulcers are best managed by a multi-disciplinary team of primary care physicians, wound care centers, and professionals who specialize in venous care.

Leg ulcers, an advanced stage of vein disease

Leg ulcers can occur at any stage of life and, without treatment, can cause overwhelming problems. 

When blood pools in the lower leg over a long period of time, the condition is referred to as venous stasis. When blood leaks into the tissue of the skin it can cause swelling and damage to the tissue. Tissue damage can result in wounds, or ulcers, that are chronic and do not heal if the condition is left untreated. Ulcers may be painful or itchy and often require constant care and dressing.

There are three large classes of ulcers: diabetic, arterial, and venous. Of the three types, venous, or vein-related, is the most common. In fact, venous disease is thought to account for approximately 80% of chronic leg ulcers. Venous ulcers can be caused by venous insufficiency or by a wound that has been exacerbated by venous insufficiency. 

Leg ulcers are often an indication that vein disease has reached an advanced stage. However, the key to properly treating and managing them is to first get them diagnosed. Though ulcers may appear similar, each one has a different cause and thus, very different treatments.

Clinical appearance is the first clue to distinguishing between venous and arterial ulcers. Typically, venous ulcers can appear anywhere between the knee and the ankle, while arterial ulcers are usually found between, or on the tips of, toes.

Another sign is discoloration. Venous-related wounds tend to be ruddy, and the surrounding tissue may be red or hyper-pigmented due to hemosiderin (a pigment formed by the breakdown of hemoglobin). In contrast, the wound bed of an arterial ulcer tends to be black, grayish, or yellow.

The most effective way to diagnose a venous ulcer is with a duplex Doppler ultrasound, which reveals whether or not the blood is flowing in the proper direction, or if there is any pooling occurring.

Ulcers do not heal on their own, but even those who are already experiencing this late-stage symptom can have excellent success with treatment. If you have skin breakdown or infection due to ulceration, you should visit your doctor immediately.

Using ultrasound for vein treatment

Ultrasound is an essential tool in vein care, as well as non-invasive and comfortable for the patient. In addition to mapping a patient’s veins and diagnosing vein disorders, ultrasound is used throughout the treatment of veins, acting like the physician’s “eyes inside the leg.”

After a diagnostic ultrasound is performed and the doctor establishes a treatment plan to fix the problem, ultrasound may be used. In endovenous laser ablation for example, seeing where the healthy vein connects with the unhealthy vein is very important; ultrasound is the best modality to visualize this area.

Another example is ultrasound-guided sclerotherapy, which uses the guidance of ultrasound to find leaking veins that are not visible and can’t be seen with a hand-held light used to view veins near the surface (transcutaneous illumination). Ultrasound-guided sclerotherapy is often used to treat perforator veins, or veins that connect the superficial system (above the muscles in the leg) to the deep system (veins under and between the muscles of the leg).     

After the vein treatment and a designated amount of time for healing, the physician will use ultrasound again to assess the effectiveness of the treatment plan.

What is ultrasound mapping?

Vein disease, which often manifests as varicose veins, is defined as the impairment of blood flow towards your heart. Oxygenated blood is constantly being pumped from the heart to the rest of our bodies through arteries. It is the job of our veins to carry deoxygenated blood back up to the heart.

Healthy veins have valves that open and close to assist the return of blood to the heart. Vein disease occurs when these valves become damaged, allowing the backward flow of blood in the legs where it can pool, leading to a feeling of heaviness and fatigue and causing varicose veins or other skin changes.

Ultrasound is a tool used to diagnose if and where a vein valve (or multiple valves) in the legs is damaged. High-frequency sound waves are used to create images that allow the doctor to see which veins have flow going in which direction—like a road map for the venous system.

A healthy vein will only allow flow from the feet towards the heart. Faulty veins are often connected, so finding the “source” of the problem is a complicated, but critical, step in establishing where exactly treatment should start.

Ultrasound is the gold standard for evaluation of chronic venous disease, and it is important to have a qualified sonographer perform the mapping in order to have accurate diagnostic results. To learn more about what to expect at a vein evaluation, visit our previous post on the topic.