Well, hello and welcome to Healthline I'm Jennifer Blomquist.

Thanks so much for joining us this evening as a beautiful summer night.

We have two guests tonight.

We're very fortunate in that regard.

And they came armed with a wealth of information and lots of good pictures.

Before and afters.

We're going to be talking about things like varicose veins issues along those lines.

So I think you're really going to be impressed with all this information they have to share and the images they brought with them.

Before I introduce you to our wonderful guests, I want to remind you, especially if you're new to the show, that we are live in the studio and we love when people call in with questions.

That's the whole reason we have people here is to help you.

Maybe you know somebody who has an issue that we're talking about or you yourself, so why don't you get some free advice?

Nothing else in life is free anymore.

So there are two ways that you can ask your question.

The best way, I think, is to just call us.

So we keep the phone number at the bottom of the screen.

9692720.

If you're outside of Fort Wayne, it is still a free call.

Just put an eight, six, six in front of there.

You'll talk to a call screener first, and then at some point just hang on and we will get to your call.

That's a great way to ask the question because you can stay on the line and our guests can talk to you back and forth.

Maybe they need to get more information from you to give you a better answer.

So if you feel up to it, I think that's a great way to go about it.

You can also just call and tell the call screener what you want asked, and they'll relay the question to us that way.

That's another option.

And also now we text you can text in a question.

We just started that this past winter.

So the number is a little bit different.

It's 9692730.

Again both of those numbers are going to stay up at the bottom of the screen.

I want to reassure you, if you do text us we are going to keep your phone number completely private.

Nobody will see it.

So you don't have to worry about that.

If you feel comfortable doing so, why don't you just give us your name or where you're calling from if you're okay with that.

So lots of ways to get your questions answered tonight.

Let's go ahead and introduce you to our guests.

So sitting next to me is Doctor Michael Shao.

You are a vascular surgeon.

So thank you for coming on.

And next to Doctor Shaw is Amber Glessner.

She's a nurse practitioner, so thank you.

Thank you so much to both of you.

Great to be here.

Thanks for having us.

I think most people probably know what varicose veins are.

I think all women do because especially any of us who've had babies, we you know, that's the one thing.

When you're pregnant, you think, oh, I hope I don't get very close veins.

They can be unsightly and they can also hurt.

So I think a lot of people at least have seen them maybe not dealt with them personally.

But you guys in this field I think, can we just talk about it's come a long way compared to, you know, what the options were years ago?

Oh yeah.

Absolutely.

Yeah.

Yeah.

So in traditionally varicose veins were treated with surgical stripping which can be really invasive and painful.

Oftentimes patients were admitted to the hospital under anesthesia.

But nowadays we can treat these patients with minimally invasive techniques that recoveries immediate.

And patients are up and walking right away and back to normal activities.

Because what you were talking about, the stripping, they would actually when they usually just make a little incision by each vein and pull it out.

Yes, it would require incisions and it would be time consuming and cause a lot of discomfort for patients.

Yeah.

Yeah, absolutely.

Was was uncomfortable for a lot of patients.

When you hear their stories about how they had numerous cuts and there was a lot of tugging and pulling and sometimes nerve damage, bruising, scarring, and basically they felt like they were just treating numerous vehicle Spains for numerous scars.

And back then they didn't have the diagnostic imaging that we have today.

And so it was really like a guessing game of stab and grab and just pulling things out.

So nowadays we actually have advanced, you know, sonography and vascular sonography who do venous mapping.

And so instead of bringing a patient in, knocking them out cold and just looking at them, guesswork basically now we have these elaborate mappings where we're not guessing.

And so basically the the sonography are finding the trunk or the axial vessel, the, the parts, you know, the factory settings that have gone faulty.

And then off of those are the varicose veins.

And so if you're only stripping or ripping the branches but you're leaving the malfunctioning trunk.

You weren't treating the problem.

And so a lot of those patients would say, oh yeah, she had her veins stripped.

And then a year or two later, they were stripped again.

They came back when they were actually not treated appropriately the first time.

Okay.

Yeah.

That's you know, that's what I wondered if this the procedures that are offered today, is it kind of a one and done or is there still a chance of recurrence.

Could could things come back?

That's a great question.

Normally the the with the modern venous ablation procedures the recurrence rate is very low.

The closure rates are excellent.

They're over 90 to 95% after five years.

It's not that the veins we treat recur, but they can develop.

Patients can develop other varicose veins over time.

Yeah.

What about ages.

And is it more common in women.

I mean I, I never I've never met a man that said he had various veins.

I'm sure there are men out there who have.

So if you guys want to talk about about.

Yeah, I think there's a female predominance.

It's 2 to 1 women to men that.

Yeah, but men get varicose veins too.

It's a common misconception that men don't get very close friends.

I think they're less likely to seek medical attention sometimes.

A lot of times, their wives will bring them in.

I can believe that.

Yeah, I can believe.

And sometimes they believe that the male demographic or patient sometimes wait till it's later stages before they seek help.

When when the female patients, I feel like become more symptomatic a little bit quicker possibly.

And we see that in women per se, more than men because of the hormonal fluctuations, the weight changes with pregnancies, and we're fluctuating with the weight gain.

And that causes a lot of Venus hypertension on, on the limbs and on the legs.

And so women, women who are aging and getting older because the faulty vein valves with time, I mean gravity were paying taxes on gravity.

And so it can become more faulty as we age as women and also women have multiple pregnancies, a lot of women do standing jobs, waitresses, you know, teachers, nurses, hairdressers.

Right.

And so prolonged periods of standing for sure can exacerbate those those conditions.

Yeah I wanted to address this this slide that came up.

So when you're talking about the numbers there, 11 million men, 22 million women over the age of 40.

But I've even seen people pretty young with like I've seen women in their 20s and 30s who've who've, you know, have ones that are pretty noticeable.

Yes.

That's a common misconception is that it only affects older, older patients.

But we see plenty of patients in their 20s and 30s present to us.

It is more common as we get older.

And also those patients with that strong family history.

I was going to ask about this in hereditary, of course.

And so you'll see patients coming in and saying, yes, my, my mother had a, my sister and my grandmother, you know, it's a hereditary thing.

And so that's a nice thing is if they know and they're aware of it, then they seek care a little bit sooner to say, I want to prevent X, Y, and Z from happening to me because I saw it happen to my family member.

I just know some of the treatments in the past have been pretty expensive and were not covered by insurance.

And we were talking about this before the show.

You know, it's not really plastic surgery.

You know, I hate to talk about it that way because, I mean, it sounds like there could be some risk factors of not doing anything if they're big enough.

So I don't know if you want to address that, but also just, you know, the importance of, of treating this even just from, you know, somebody feeling self-conscious.

Yeah.

Yeah.

A lot of patients have both physical symptoms concerns and cosmetic concerns combined.

Generally, insurance will cover treatments if it's not purely cosmetic, if they have physical similar.

Yes.

Is that that would you say that's the number one thing that patients complain about is not just the unsightly but discomfort.

Yeah.

Yeah.

Absolutely.

And so I think a lot of patients at 1st May have costs that aren't symptomatic.

So they'll say, oh, you know, these these don't bother me.

They're just not too pretty.

And then with time, you know, they start to develop some symptoms heaviness aching a tired feeling.

They'll say, you know, I don't feel too bad in the beginning of the day, but as the day progresses, my legs are given up before the rest of me.

It's time to sit down and prop my legs up.

My legs are telling me it's time.

Also swelling as the day progresses, a lot of our patients will say, yeah, I started noticing I had, you know, ankle swelling towards the end of the day.

Sometimes as the veins are pooling with blood, they stretch and they push up against the skin and the tissue, and that stretching of the skin can cause irritation and itching and dryness.

And so there can be different symptoms for different patients.

It's not one size fits all as far as symptoms.

Yeah.

And over time if you pull up slide slide eight okay.

You know it can progress on to advanced skin changes from inflammation in the skin.

And in slide ten or slide nine you'll see that in some patients it develops into chronic wounds that take a long time to heal.

Yes.

Yeah.

And the discoloration as well.

And so there's some hemostatic staining and some hyperpigmentation.

So the skin is being affected by that venous pooling.

I mean that almost you know, when I was looking at that, that reminds me of, of somebody who would have like really terrible psoriasis.

That's what the reminded me of when I was looking at that.

It really itchy and dry.

Yeah.

Yeah.

That's really, really sad.

What.

So I, I know across the board we do shows with in all specialties in medicine.

All the physicians and nurses have ever come on have said we always start conservatively.

So we're not just going to do the most extreme procedure.

So can you tell me the approach that you would take if somebody came in?

Are there more conservative methods they can try before doing something a little more invasive?

Yeah.

If we pull up slide 12, it'll show a picture of generally we start with conservative therapy with compression stockings, exercise, leg elevation.

Of course it doesn't treat the underlying valve problem in the vein okay.

If a patient has advanced disease such as ulcers, they don't have to go through conservative therapy.

You would jump right to the next next phase.

Seizures.

Yeah.

And so also we tell our patients if you can prevent prolonged periods of standing or sitting, sometimes our jobs don't allow us to do that.

But if we can mix up our activity throughout the day with a little bit of staining, a little bit of setting and try to avoid just prolonged dependency of the limbs, and obviously, anytime we can tell our patients to quit smoking, we always encourage that.

Oh, that's very hard on your vasculature and weight loss.

You know, the less weight we have on our limbs and the less pressure we're putting on them, the better.

I think people just yeah, you know, people think they have to do these extreme things.

But sometimes, like you were saying, making some simple modifications, I would think would, you know, have huge gains in most areas and help that symptom control because, you know, these things aren't going to undo the anatomy or change the disease, but it can help mitigate the complications of it.

So what if the conservative therapies are not really working?

And I don't I don't know what you're trying for a few months or does it very per patient.

And then and then what would be the next phase that you could try.

Yeah.

So generally we can try to conserve therapy for a few weeks to a few months.

But if it's not working and they still have persistent symptoms.

And a lot of patients, as you mentioned earlier, complain about the compression stockings and hot summer weather.

And they're not.

I can tell you my mom had to wear them for years.

And I just when I was little, I thought, I hope this never happens to me because yeah, they usually compression, they seriously compress.

So it may not be a long term solution in this type of weather.

So so then we would end up getting an ultrasound like Amber brought up in delineating the anatomy to plan for possible treatment options.

So are there one.

Does it do your treatment options vary according to the severity or is it do you classify it by different types of various veins?

How do you decide which therapy is going to work best?

That's a great question.

You know, we combine both the what we find on ultrasound as far as the anatomy, but also a patient's preference, you know.

So it's the entire clinical picture.

Yeah absolutely.

All right.

Well we've been so engrossed in our conversation, I have failed to address a caller who came in.

Somebody wanted me to ask the question for them.

So I'm trying to think of the screens a little dark here.

So I'll do it.

Let's see.

Can oh, can cold compression help to relieve swelling, pain and swelling?

We were kind of talking about that was one of the conservative therapies.

Yes.

Cold can help reduce inflammation and compression can help improve blood return back to the heart which is the underlying problem when these veins fail.

Okay.

And also with that I would add elevation and elevation.

You know, like you were saying, some people are on their feet all day.

I mean, if that's your case, how much time should you dedicate though to if you want to do that conservative therapy and do the elevation.

I mean, should you sleep like that or is it half an hour?

And maybe were you watching a program at night like this, like this one for half an hour?

Yeah.

I think the, the best thing to tell our patients is usually anytime you're sitting watching TV, you're on the computer, you're doing a puzzle, you know, just paying attention to how long our legs are dependent.

Because I feel like a lot of us that kind of gets away from us, right?

Sure.

And also encouraging patients to maybe set a timer, you know, if you're engrossed, new work or doing something, you have a lot of focus on it.

Every, you know, 45 minutes, an hour or so, get up and walk around a little bit and try to mix up that that time.

Because calf pump dysfunction basically means we're not pumping our calf and walking.

And that lack of pump can really exacerbate swelling.

And amber brings up a great point.

Exercise and walking actually helps improve blood flow back to the heart.

So patients often notice an improvement in their symptoms if they're active.

Oh sure, this is a great time of year to start a regiment.

You know, at least with the weather, you know, being so cooperative on most, most days.

So I just want to remind everybody that we did have one person call in, which is great.

But we we have phone lines.

All the phone lines are open.

And we welcome any text messages from you to get any questions answered.

So again, the number if you want to place a phone call is 9692720.

Again, it's a toll free call if you're outside of Fort Wayne.

If you put an eight, six, six in front of their.

And that texting option is really nice and easy.

So quick.

It's 9692730.

And again we keep your your number completely private.

So what what is the recovery look like after some of these procedures.

And I don't even know if you want to talk about maybe some of the procedures and then what to expect.

You know, do you still need to take some time off of work?

Or I would say generally, no.

Many of my patients go back to work the next day.

I've had nurses go back to work the same evening.

So we actually encourage patients to be up and walking right away and back to immediate normal activities.

And the procedures are much easier than in the old days.

Typically they take about 20 or 30 minutes and there's no anesthesia required.

You're awake for the whole thing, and you can have a conversation with the person doing the procedure.

Yeah, that's I've heard they always the patient stay awake, you know, which is not how it used to be years ago.

So and now we use anesthesia like topical anesthesia injecting to Mr.. Anesthesia throughout the leg to insulate it.

So the the heating element is, is insulated.

We're not injuring the tissue around it.

So there's different treatment modalities.

But a lot of our patients will say yeah it feels Bruce feels a little sore like a pulled muscle.

But there once the procedure is over with usually one incision site, not hundreds of incision sites.

So just one incision site to put the Kathryn to close the vessel.

And then after that, the compression socks walking movement.

So back in the day when we were talking about vein stripping, a lot of patients had complications because they were told misinformation due to the fact they didn't really know what they planned.

So a lot of patients would have procedures and it was bedrest.

Don't move.

Don't walk.

That's what I miss.

My mom did.

Yeah.

And that's you know, that's poor treatment of any surgical patient.

And that puts you at a higher risk of complications and more pain, more bruising, blood clot risk if we're not mobile after procedures.

And so a lot of our patients are pleasantly surprised that within a few weeks, their symptoms are really starting to decrease.

And the initial tugging or pulling or little tenderness is subsided.

Sure.

Well, you know, if your feet and legs hurt, I mean, that's really that can be debilitating.

Yeah.

It's just like, you know, we've done shows on, you know, back issues and it's like, it's just hard to ignore that kind of pain.

You know, it's just quality of life issue, right.

For sure.

Yeah.

And I would say you bring up a great point is one of the most gratifying parts of our job is seeing patients back after the procedures and seeing how happy they are.

Yeah.

Yeah, I bet that that was really rewarding.

So because, you know, it does get to the point, I think for some people where it changes their lifestyle or especially, you know, there are so many grandparents that are involved with their grandchildren today, maybe more so, like in my generation, you know, that didn't happen.

You know, my grandpa didn't play ball with us, you know, like my dad does with my kids, you know?

And so, yeah, they just they feel like they're missing out because they can't do, do those things.

And it's such a gradual disease.

I mean, chronic illness insufficiency slowly progresses throughout one's life.

Right.

And so I think a lot of our patients, they don't know how bad their symptoms are because they had been compensating for so long.

And so when they actually feel better, it's it's a big difference, you know, the less heaviness, less tiredness, you know, they feel like they have a little more pep in their step.

Sure.

And Amber brings up a great point.

Patients get accustomed to how their legs feel over many years.

And so they don't kind of put up with it.

Right.

And recall how they used to feel when they were when they were younger.

Yeah, I know there was a lot of stuff when we get older that we put off, but quality of life is important, you know, before I forget.

Do you work on both legs?

If there are issues in both, I would assume most people, if they have it in one leg, we just have it in the other.

And I don't know if.

Can you do a procedure on both legs?

We typically do one leg at a time okay.

To allow time for recovery.

Yeah okay.

Yeah.

But does it do you find that the same.

Like I don't know.

To me it seems like if you have it one leg you're almost always going to have it in the other one.

Yeah.

Many times.

Yeah.

Yeah.

Often patients have symptoms in both legs, but sometimes they're symmetric.

Sometimes one side is worse.

Yeah.

Yeah.

You know and I love the before I always love before and after pictures like home improvement shows and stuff like that.

I love like where it looks like a dump and that looks beautiful.

I don't know if you guys want to call up any of these.

I mean, I think if people can see how bad some of the legs can get and then the improvement, I don't know, doctor, if you want to, if there's anything in particular like maybe slide 817 or 18.

Yeah, sure.

Maybe slide 1818 okay.

I mean look at that.

If we bring up slide 18, I'm just impressed by by the change I mean look at look at that.

This was a gentleman who had both aching heaviness and throbbing in the legs, but also cosmetic concerns.

He said that when he wore shorts and the bus, people would stare at his legs.

So, you know, he was happy to have an improvement in both physical symptoms and the appearance.

And, you know, you even have some up here.

The one.

Yeah.

Is it slide 25 I mean, this is somebody that's sort of having issues at age 16.

That's almost tragic.

If if you guys if you can get it up.

If not it's not the end of the world.

But it's like 25 if you just have it up there.

Oh there it is.

Okay.

Sorry.

I mean that's just, you know, sad to think of somebody.

I mean, that's like my daughter's age.

I think that would be horrible if she had that.

Yeah.

And she was very active.

She was training to be a firefighter and and it kind of her symptoms got in the way of her daily activities.

She enjoyed hiking and running.

And so for her it wasn't a cosmetic concern.

It was more of the physical symptoms.

Yeah, absolutely.

You know, and I'm just was curious if any if Erica's veins play a role in things like restless leg syndrome or because that is miserable.

I only had that when I was pregnant.

But it's hard to explain to somebody how miserable that is.

You absolutely, you know, struggle to find relief.

So is that fear being related, or is that like a side effect?

Yeah.

So restless leg syndrome is a common symptom and numerous health conditions.

But venous insufficiency is one of those conditions and also nocturnal leg cramps.

And so a lot of our patients will say, you know, my legs don't feel too bad until I go to bed and I'm trying to sleep, and my legs are dancing and they're jerking, and I have nocturnal cramping.

And really, at the end of the day, the legs are basically telling you how unhappy they were with the day's activities, you know?

And so the patients will pay that price, and then they start to notice, oh, if I wear my compression socks, why, I'm upright when I take them off in the evening, try to go to bed, my symptoms start to lessen.

So that's a direct correlation that the Venus disease is that contributing factor.

And patients may not always associate those symptoms with their visible veins.

Yeah I didn't know there was a connection until you guys sent me some of the information.

Yeah.

And the other thing to know is some patients don't have visible varicose veins on the skin surface, but we can see them under ultrasound.

So they'll have these symptoms without the outward manifestations of Venus disease.

They just showed me the card for two minutes.

I told you, I told them the show goes very fast and it always does.

What advice would you give to people, just in general, ways to avoid this or even things to look for, you know, because maybe at your physical, you know, your annual physical, your physician may not notice it.

Or if you don't say anything, they may not address the issue.

I think it's a lot of symptoms with leg discomfort or heaviness or aching.

That's like a key sign is a key sign.

Obviously, some of the skin changes are a sign of possible venous disease underlying.

But it starts with a conversation with your health care provider and a full history and physical.

And this is something that I mean could it have detrimental side effects if you never addressed it.

You know, if you do have the I mean, people may say I can handle the pain, but only have about 30s to answer.

But I'm sorry.

I think that a lot of patients who have untreated hypertension for a long period of time, when it starts to affect the skin integrity and having wounds, that's when we really get concerned about infection and damage.

Yeah.

All right.

Well, take it seriously.

And we had a doctor on one time who said, you know, you know your body the best.

You know of anybody.

You know, the lumps and bumps.

And it's something that wasn't there last month, is there now?

You know, she got a check out for sure.

Absolutely.

Certainly.

Well, thank you so much for to both of you for coming on.

So Doctor Michael Shao and Amber Glessner, thank you so much.

Thank you for having us.

You have to come back.

We could talk.

We could have talked for another half hour easily.

So thank you so much to all of you for calling in and for watching tonight.

I know I learned a lot.

I hope you did too.

We have another program coming up one week from tonight, so be sure to join us then.

In the meantime, enjoy this beautiful summer weather this week.

Take care.

We'll see you next Tuesday.

Bye bye.