Veins1: Welcome to the Veins1 vascular moderated chat. This is the last of four moderated chats on Veins1 in October. We welcome your questions and your input.

Veins1: Today's guest is Gregory A. Spitz, M.D., F.A.C.S. Dr. Spitz is a leading general surgeon, and the inventor of the surgical technique for varicose vein removal used with the TriVexÔ System. As a member of the Senior Attending and Teaching Staff at Rush-Copley Medical Center in Aurora, IL, Dr. Spitz specializes in minimally invasive vein surgery, advanced laparoscopy and minimally invasive hernia repair.

Veins1: Dr. Spitz is a member of the American Medical Association and a Fellow of the American College of Surgeons. He is also a member of the Illinois State Medical Society, Kane County Medical Society (Secretary of Treasury, President-Elect, Board of Directors), Fox Valley Medicine (Board of Directors), the Warren Cole Surgical Society and the American College of Phlebology (member and speaker).

Veins1: He is a graduate of the University of Illinois, College of Medicine, Chicago, IL. His internship and residency were performed at the University of Illinois, Metropolitan Group Hospitals, Chicago, IL.

Veins1: We welcome your questions.

kas517: Are there any creams or lotions that can treat bad veins? Spider veins especially?
Dr. Spitz: None that have been proven. Many have been tried including makeups and various potions...none have succeeded.

vein123: Dr. Spitz. My brother, age 41, is recovering from deep vein thrombosis. He has a blood clot in is left calf. Is it dangerous to wear knee high stockings for 24 hours a day for a few weeks or months? Someone told me that if I remove the stockings, a blood clot could go to his lungs. I also heard that if I leave them on all the time, he may get gangrene or blood infection.
Dr. Spitz: We recommend thigh high stockings for patients that have had clots. The knee-highs tend to bind at the knee crease.

Tom: Can weak/poor circulation in the veins cause weakness and or numbness in the arm and legs?
Dr. Spitz: You are more likely to have weakness or numbness from insufficiency in the arteries.

amidala: Is there a connection between restless leg syndrome and Raynaud's disease?
Dr. Spitz: No specific known relation at this time, but restless leg syndrome does not have a known cause and Raynaud’s is from known spasm of small arteries.

S. Lek: Hi Doctor, I am also interested in preventing DVT. I have long flights to go on-- some as long as 14 hrs. w/ no breaks. Are there exercises I can do, or stockings that I can wear that will prevent DVT??

Dr. Spitz: Just flexing the calf muscles and walking up and down the aisles every hour or 2...that is what I do.

bob242: What causes spider veins and is there a way to prevent them?
Dr. Spitz: Heredity, hormones are 2 major causes...and no one knows how to prevent them yet!
  

vein123: Is it ok to leave the stockings on all the time?
Dr. Spitz: It depends on the stocking and the patient...some are made to wear all the time. In general it is good to let the skin get some air.

S. Lek: One other question, Doctor. I lift weights and after I lift hard, my veins pop-up. They re huge for 1-2 hours -- should I worry about this?
Dr. Spitz: This is probably a variant of normal due to the high pressure you put on them.

benbo: Does Carpal Tunnel Syndrome affect the veins at all?
Dr. Spitz: Usually not…it affects the nerve in the wrist leading to the hand.

virginia: Why is it that women are more prone to PVD?
Dr. Spitz: Peripheral vascular disease is usually referring to the arteries and is still more common in MEN. Women are more prone to vein disease due to hormonal changes.

kas517: How is pelvic congestion syndrome treated?
Dr. Spitz: First it needs to be diagnosed by duplex ultrasound and sometimes requires a venogram...dye in the veins and x-ray. If the certain usual vessels are involved they can be treated by clotting them off with coils delivered by a catheter in the radiology dept. Sometimes surgery is required to tie them off.

Mik E. : Hi Dr., is lymphedema caused by bad veins?
Dr. Spitz: The lymph system follows the vein system...incompetent or bad veins can contribute to lymphedema or blockage of the lymph vessels.
  

asm: What is the best way to treat spider veins in young patients, such as 23 year-olds? Do you think new treatments will be available soon?
Dr. Spitz: A combination of laser and sclerotherapy (injections) works quite well in the right hands.
  

benbo: Is ligation ever used anymore for varicose veins?
Dr. Spitz: Just ligation is still used by some but it has been proven over and over to be unsuccessful long term.
  

virginia: Do vascular surgeons traditionally perform stent implants?
Dr. Spitz: Vascular surgeons or invasive radiologists.
  

Veins1: Dr. Spitz, there are a few questions about varicose veins and diabetes. What considerations should diabetics take when they have varicose vein surgery?
Dr. Spitz: Healing and skin condition have to watched carefully and of course tight control of the diabetes around any procedures...without artery disease we treat them as we do any other patients with vein problems.
  

ragden : Hello Doctor. Are bad hemorrhoids treatable by surgery? Thank you.
Dr. Spitz: Hemorrhoids can be removed surgically as an outpatient.
  

bob242: In DVT patients - does the body actually "reabsorb" a blood clot?
Dr. Spitz: The blood vessels will recannulate or open up after a certain amount of time and the blood clot is in so many words reabsorbed…slowly.
  

josie: What is an incompetent vein?
Dr. Spitz: The blood in a vein is supposed to return to the lungs and heart...an incompetent valve and vein make blood stagnant or flow back toward the feet causing clots, phlebitis and varicose veins from the pressure.

ragden : Doctor, also on hemorrhoids, is there some drug that I can put inside there instead of surgery? That would be better for me. Thank you.
Dr. Spitz: Prep H and other over the counter remedies may soothe symptoms but don't remove the problem.
  

Veins1: There is a question about weight gain and the acceleration of varicose veins. Can you address this?
Dr. Spitz: Undue weight gain certainly can make vein problems worse. The extra weight causes even more pressure on the vein blood that is already going the wrong direction.

vein123: Is DVT more common from long airplane trips than long bus trips - due to a pressurized environment?
Dr. Spitz: Immobility, trauma, cancer, clotting disorders are the most common causes of DVT... whether on a bus or plane probably doesn't change things too much. It is more commonly DOCUMENTED on airplanes.

kas517: Is discoloration of the leg normal after vein surgery?
Dr. Spitz: Some people start with discoloration... if blood is trapped under the skin from sclerotherapy or surgery it is possible. It should fade in time and there are treatments available to make this go away faster.
  

MaxP: Would phototherapy for removal of a birth mark be done by a vascular surgeon?
Dr. Spitz: It can be done by a plastic surgeon, vascular surgeon and some dermatologists. The key is someone experienced with the laser or phototherapy equipment.
  

Tom: Dr., can you elaborate how clogged arteries can cause weakness or numbness in the extremities?

Dr. Spitz: Less oxygen to the muscles from arteries that don't flow normally.

Gino Roh: My wife has small veins-- when she goes to the doctor for a check-up and they take blood she gets big discoloration marks. Why does this happen and do they have to take blood from her arm-- she gets stuck a lot of times and it hurts her. Thank you.
Dr. Spitz: Most likely the walls of her veins are just quite thin and break easily. Always ask for the most experienced person PRIOR to her getting blood drawn.
  

MaxP: I recently noticed a small sore near my ankle - is this a symptom of chronic venous insufficiency? What else should I look out for?
Dr. Spitz: Without seeing it ...I would be hard pressed to say. If you have other vein problems it well could be...a duplex ultrasound of the veins will most likely be able to help the diagnosis.
  

Gino Roh: One other question for my wife (she doesn't know I'm asking, but I know she won't mind) she has cold feet, and cold hands. I know that women get this often. I was told that it is a veins problem-- is that true? She has a small varicose vein in her leg and some veins that show on top of her hands-- are they the problem? Can she do anything about it?

Dr. Spitz: It could be a vein or artery problem. Seeing a vascular surgeon could easily diagnose this as normal or a specific problem.
  

MaxP: Are there vitamin supplements that can reduce the appearance of spider veins?
Dr. Spitz: None that have been proven. There a lot of supplements that claim lots of things...none of which can be substantiated.
  

Veins1: Dr. Spitz, there are a few questions regarding what other veins do to compensate for varicose veins - can you address this please?
Dr. Spitz: There are hundreds veins in the legs. When varicose veins exist they act like a clog in the system. When removed, the circulation becomes MORE efficient and thus better. The normal veins that are left can now do their job effectively without clogs blocking them.
  

raphael: Do incompetent perforator veins get worse with exercise?
Dr. Spitz: In general exercise has many more benefits than risks with vein disease... with incompetent perforators surgery or compression or a combination of the 2 will make exercise more comfortable and safe.
  

raphael: Also, I seem to have several puffy bumps on my right forearm, that are very noticeable when I flex. Is this serious?

Dr. Spitz: I couldn't venture a guess without seeing them...you should see your doctor and get an opinion.
  

S. Karm1 : Can I ask about avascular necrosis? A relative of mine plays a lot of sports although he's an older guy. He recently hurt his upper leg (I was there when it happened.) Now his hip is bothering him. I was told that he might have ripped a vein feeding the top of his thigh bone (femur) and that if that happened avascular necrosis of the bone might set in-- and that he should go get tests. Does he have to worry about avascular necrosis, and if he does, what tests does he need?
Dr. Spitz: That would be arteries in the hip joint...the bone dies and needs to be replaced. That is more appropriate for an orthopedic surgeon to answer any more on that problem.
  

Veins1: There are some questions about the cost to patients for the TriVexÔ procedure. What should patients do to investigate this?
Dr. Spitz: TriVexÔ is the minimally invasive technique to remove varicose veins. It is a short procedure with few incisions and good cosmetic results as well as pain relief. It is often combined with a valve procedure. Standard procedural codes are used for billing this procedure. It is not experimental. Insurance companies are reimbursing for this procedure every day all over the country...your vein surgeon has all the information they need to precertify you with your plan and educate you about the costs in different parts of the country. Each case is unique as different procedures are combined for treatment of the entire leg.
  

raphael: How does the VNUS procedure differ from TriVexÔ?
Dr. Spitz: VNUS is just using electrocautery to burn the inside of the saphenous vein that runs down the inside of the thigh. TriVexÔ actually removes the varicose veins that you see on your leg.

Veins1: Dr., what about the correlation(s) between pregnancy and vascular problems, in general, and varicose vein problems, in particular?
Dr. Spitz: Pregnancy will just by pressure alone cause varicose veins to get worse. The extra hormone changes also change the characteristics of veins and make them more prone to becoming varicose.
  

Veins1: Dr., is there anything you would like to add before we close for the night?
Dr. Spitz: Remember for your vein problems...don't go to an amateur... or someone who does this as a sideline...go to a well-trained surgeon who can offer all the options of diagnosis and treatment of your vein problem. Thank you.

Veins1: Thank you Dr. Spitz for your insightful responses tonight. And thank you audience for your participation in the Veins1 moderated chat.