Guest: Dr. Jennifer Watson
Presenter: Neal Howard
Guest Bio: Jennifer Watson, MD, is a vascular surgeon. Dr. Watson earned her medical degree from the University of Vermont College of Medicine in Burlington. She completed her general surgery residency through Brown University at Rhode Island Hospital in Providence and completed her vascular surgery fellowship through Grand Rapids Medical Education Partners in affiliation with Michigan State University College of Human Medicine in Grand Rapids, Michigan.
Segment overview: Dr. Jennifer Watson, a vascular surgeon discusses varicose veins, what causes them, common misconceptions, and treatments, including VenaSeal.
Health Professional Radio – Varicose Veins
Neal Howard: Hello and welcome to the program today, I’m your host Neal Howard here on Health Professional Radio for this Health Supplier Segment. Our guest today is a Vascular Surgeon with Spectrum Health Medical Group, she’s here with us to discuss varicose veins, what causes them, some common misconceptions and some of the latest in treatments. Welcome to Health Professional Radio Dr. Jennifer Watson.
Dr. Jennifer Watson: Well thank you and thanks for having me.
N: Thank you so much for joining us today. Tell us a bit about yourself, you’re with Spectrum Health Medical Group. Have you always been a vascular surgeon or is this something that developed as your career progressed?
W: So I went to general surgery training first and then after my general surgery training I did a fellowship in vascular surgery and ended up here in Michigan which is where Spectrum Health is located. I’ve been practicing here for quite a few years now at Irvine Center where we treat vein disease exclusively. So that is the definitely the focus of my practice.
N: We’re here today to talk about varicose veins. I can’t think of anybody who’s never heard of varicose veins unless maybe they’re a child. But even if you’re a child, I mean that’s when I first heard about varicose veins around listen to people talk about these varicose veins. What exactly are varicose veins?
W: Varicose veins are very common. What varicose veins are, are veins that are dilated due to insufficiency or failure of the valves within that venous systems. And essentially the blood pulled there causing these veins to dilate overtime and in some cases they become visible and that’s where we term them the varicose veins.
N: Is varicose veins the more common term for them or is there some other term that one might use when they’re getting a diagnosis or preparing for some type of treatment?
W: The term that we usually use is Chronic Venous Insufficiency (CVI) and that does refer to that specific valve failure and within the superficial system of less than half a second. So that essentially means that the valves are not closing every half a second as they should, and then that is termed Chronic Venous Insufficiency, which is generally the diagnosis that goes along with their closing in.
N: Remembering when I was hearing people talk about these varicose veins, it always seemed to be something annoying, something unsightly and nothing really serious. Seem to be something that everybody was going to get it at a certain age. Is that the case?
W: Not really. I know a lot of people do things that varicose veins just come with age and they’re part of the process but we now know that it’s actually genetics that pre-determine a lot of these. Not everyone who ages is going to get varicose veins. There are definitely some other characteristics that make you more risk for that, heredity being probably number one. The other thing is that while for some people varicose veins don’t bother them very much, it may just be a cosmetic or visual thing. For other people it does affect their quality of life in terms of like the heaviness, tiredness, they have edema, even ulceration and things like that. So there are definitely issues with these varicose veins depending on what the patient underlying diseases and their ultrasound findings.
N: So just a fact that the you’ve let me know that they can really be a problem almost at any age depending on your exercise level or things to that nature. What are some of the other misconceptions about varicose veins that we all probably also used to hearing?
W: Most people think it’s a women’s problem, we hear that a lot even from other practitioners that they’re surprised they found a man with varicose veins. Actually it’s very common in men, and when we will get our practice which a rather large practice, we see that 40% of our patients are male. So it’s not the minority at all, I think that’s one of the big misconception. The aging issue that you brought up is another one. The majority of the patients we’re treating are in their childbearing years, or maybe men in their 50’s. These are not necessarily all people who are at the advanced age. Most of the patients that we treat are still working. These are not all patients who are within a retired population that I think we sometimes think of.
N: And you say that most of them are still working, what about these professions that we tend to do a lot of standing maybe driving even sports? What are some other professions and occupations that contribute to varicose veins?
W: Anything with prolonged standing or prolonged sitting. So I think classically we think of nurses, hair dressers, teachers and those who tend to be kind of a more female population. We feel lots of truck drivers especially long distance truck drivers who are sitting all day. In this part of Michigan where I worked very industrial and so there are a lot of people working on hard factory floors standing all day on the assembly line, and in a forklift and we see those patients pretty commonly. Any job where you have prolonged sitting or standing without a lot of ability to move around tends to put you at a highest risk.
N: When you’re dealing with someone that’s suffering from varicose veins, not to take away from the seriousness of them but do they always herald something more serious? Is that always an indicator or sometimes an indicator or sometimes never indicator of anything other than the varicose veins themselves?
W: Sometimes it’s just the varicose veins themselves. Really, the only way to know is to get an ultrasound. It is difficult to tell just by looking at the patient like whether it’s simply one faulty vein or whether they have more going on. But the ultrasounds are very good and very telling of the disease both within the superficial and deep systems. I really recommend that if patients are symptomatic that they have an ultrasound just to see what’s going on. It is not always a huge deal, sometimes you could just reassure the patients they can use compression sock and keep things at bay.
N: You mentioned ultrasounds. Can varicose veins be invisible under the skin? I’ve always thought that you see them and that’s, “oh I’ve got varicose veins” because you see them. Can they be under the skin invisible until you do further testing?
W: Yes, they definitely can and I’ve read even up to 50% of the time that’s true. I don’t know if in my clinical practice it’s really that high but there are definitely patients who have abnormal tributary veins which is the more medical term for this varicose veins is branch vein and you can’t see them on the surface. Those patients often present just a swollen leg, a lot of edema, or maybe on alteration, skin discoloration. But they don’t always have those classic whirl v-veins that you can see.
N: What’s basically the treatment for varicose veins?
W: Treatment for varicose veins really go a very wide spectrum, they can be as simple as lifestyle modification, compression stocking. There are some medications that can help with Chronic Venous Insufficiency all the way up to procedures which involve actually feeling down, removing or destroying these faulty veins. And that all just kind of depends on the patient’s anatomy, they’re ultrasound findings, the symptoms, and issues that they’re having.
N: When I … myself, when I first heard about varicose veins, I was a child. Obviously there have been huge tried I would assume in the treatment of varicose veins or this chronic venous insufficiency. What are some of the advances that you’re aware of and possibly that you’re implementing there at spectrum health medical group?
W: Sure. Classically all these veins are removed surgically by things like vein stripping and phlebectomy. Those were relatively invasive surgeries where patients had to stay in the hospital, the post-op recovery was difficult and there are worse complications with those. Over the past 15 years, radiofrequency ablation and laser treatment has sort of taking over where being striping used to be and that is essentially using heat to close down or destroy these larger faulty veins. I had once been stripped and that has been sound to be so much less invasive. Patients really recover much more quickly, it’s an outpatient procedure. But that’s a yet been done for over a decade and really has a strong track record. Even more recent than that are some of these newer technologies like VenaSeal, which been adhesive that is used to seal down or close the vein or some of the newer foam injectable that do the same things. It’s all moving towards more minimally invasive outpatient office-based procedures.
N: You mentioned VenaSeal, you say that this is an adhesive? How does this adhesive work differently than some of the other methods, I guess compression methods?
W: Sure. When you use the heating technologies, you’re actually burning or destroying the vein with heat. You have to make sure that there’s adequate numbing medication all around the vein which is the tumescent fluid that we use. And putting that tumescent fluid in is the uncomfortable portion of the procedure because it does involve some needle pokes, there’s a stinging and burning from the local anesthetic and some pressure and the patient’s leg is a little swollen after that tumescent fluid is instilled. With the VenaSeal technique, you’re using an adhesive glue which is actually cyanoacrylate adhesive. What it does is it seals down the veins, so there’s no heat, there’s no worry about damaging surrounding tissues. You don’t have to worry about things like nerve injury, you don’t have to put this fluid in that you had to do with the heating technologies. It really simplifies the procedure, makes it more comfortable for the patient, both during the procedure and after the procedure.
N: In your experience have you noticed any fluctuation in the cost effective aspect of VenaSeal as opposed to maybe some other, maybe very necessary forms of treatment?
W: Yes. So VenaSeal is FDA approved, it is not currently covered by insurance carriers. The patients do pay out of pocket in my practice for VenaSeal as I’m sure they do in other location. And the reason they usually select to do that is just because they do not want to deal with the needles that you must in and the possible risk of nerve injury which some of the heating technologies. It’s a little hard to do a head-to-head price comparison because the insurance covered is so different. Whereas all the heating technology are generally covered by the insurance provider.
N: In wrapping up Dr. Watson, where can our listeners just go and learn more about VenaSeal and Spectrum Health Medical Group?
W: For VenaSeal, the best thing to do is to visit www.venaseal.com, this is a Medtronic product and it tells you all about it, there’s videos that you can watch. And then for Spectrum Health Medical Group we can also be found online at spectrumhealthmedicalgroup.org. [https://www.spectrumhealth.org/ ]
N: Thank you Dr. Watson and hoping you’ll return for some future segments.
W: Absolutely, thank you so much.
N: You’ve been listening to Health Professional Radio, I’m your host Neal Howard for this Health Suppliers Segment. In studio with Dr. Jennifer Watson with Spectrum Health Medical Group. Transcripts and audio of this program are available at healthprofessionalradio.com.au and also at hpr.fm, and you can subscribe to this podcast on iTunes.