Selected Podcast
Venous Disease
Chronic venous disease, or CVD, is very common but it often goes under or undiagnosed because the signs and symptoms can often resemble other diseases or ailments. Dr. Tejas Shah explores the symptoms of venous disease more in depth so that you can hopefully get it diagnosed early by a medical professional.
Featuring:
Fun facts:
Dr. Shah enjoys running, carpentry, and landscaping.
Tejas Shah, MD
Dr. Shah was first introduced to medicine from his uncle who was a cardiologist. His interest quickly peaked in vascular surgery. Rerouting blocked vessels using both minimally invasive and traditional open surgical techniques was both fascinating and incredibly rewarding. Dr. Shah has the great fortune of having one of the few jobs in the world where he knows that from the moment he wakes up. He always considered himself forward thinking and has often identified newer treatment modalities that are both less invasive and safer for the patient. This has translated to better outcomes and faster recovery. Shah takes great pride in treating patients as individuals, providing compassionate care over the course of their entire life. He considers each of his patients as a member of his own family, where building a lasting relationship is well carried on beyond the procedure.Fun facts:
Dr. Shah enjoys running, carpentry, and landscaping.
Transcription:
Scott Webb: Chronic venous disease, also known as CVD, is very common, but it often goes under or undiagnosed mainly due to the fact that the signs and symptoms resemble so many other things. And joining me today to help us better understand CVD is Dr. Tejas Shah. He's a vascular surgeon with AMITA Health.
This is vital signs from a meta health. I'm Scott Webb.
Doctor, thanks so much for your time today. You know, I know American doctors diagnose upwards of 200,000 venous disease cases each year, yet some scholars feel that chronic venous disease, CVD, is frequently overlooked during regular checkup visits. Why do you think that is?
Dr. Tejas Shah: One of the biggest reasons for underdiagnosis of chronic venous disease is because a lot of the symptoms related to venous disease are crosshatched with other possible causes of those symptoms. Typical symptoms of chronic venous disease include achiness of the legs, particularly at the end of the day, tiredness, itching, burning, and these symptoms can mimic other disease processes, including musculoskeletal processes.
And with that, oftentimes, doctors and providers will look at other diseases first, but chronic venous disease is quite common in the United States and affects a significant portion of the population. And for that reason, it's one of those diseases that is treatable, yet overlooked due to its masking of symptoms that are very similar to other diseases out there.
Scott Webb: Yeah, I see what you mean. And I'm sure that's one of the challenges for doctors is that a lot of the symptoms, the signs and symptoms that we have, mimic other things, right? So what are the most common manifestations of CVD? And how do they impact patients longterm if the disease goes untreated?
Dr. Tejas Shah: The most common symptoms and manifestations of chronic venous disease does include feeling really achy and tired at the end of the day. That's the classic sign and symptom. And the typical patient that comes to my office is a man or a woman who's just complaining of pain usually after having a long day of standing at work or doing activities and they come home, and they put their legs up on the table or on the sofa or on an ottoman and it really helps them with their symptoms, they feel better. And they notice that kind of classically really helps. There are other signs and symptoms that are more subtle and not so typical, but those include things like burning and itching and swelling. And these are signs that are often very classic for a venous disease or sort of harbingers of venous disease as well.
When venous disease goes untreated, its longterm manifestations include essentially a worsening of your symptoms and really it's a quality of life issue. Most of the time venous disease is not deadly like cancer or heart disease and things of that nature, but it severely impacts people's quality of life. If you can't walk with the same kind of a spring in your step and feel good about it, it's going to impact what you do and how you do it. Your ability to enjoy life, enjoy the things that you normally do, a golf game, going out and having a walk, is severely impacted. And therefore, that affects what you do. And all of that sort of snowballs to become further and further debilitating for people. In its worst forms, you can get cellulitis, which is essentially a skin infection, and ulcers when it goes unnoticed for years and years.
Scott Webb: Yeah. So it sounds like a good conversation with patients, a sort of a patient history, them being sort of conscious, cognizant of the fact that, "Yeah, so when I experienced these symptoms and I put my legs up at home, then I feel better," right? So that would be good information for their providers to have.
But on top of that, besides just patient history, anecdotal as it may be, what are some of the imaging and other diagnostic options and evaluations that you have? Do you recommend one or the other? And if so, why?
Dr. Tejas Shah: The good news about chronic venous diseases is that it's very easily diagnosed through simple studies, particularly with ultrasound. So essentially, an easy ultrasound test, which is non-invasive, no radiation risk and done relatively quickly and routinely can help diagnose the vast majority of venous disease out there, including DVTs or deep vein thrombosis, reflux in the veins, which means where the veins kind of are allowing blood to collect down instead of going back up towards the heart. And all of this can be diagnosed fairly quickly and efficiently with an ultrasound, which is readily available in most areas.
Scott Webb: Yeah. And I'm sure there've been some trends just in general in CVD. We talked about it's often overlooked and the reasons why. So what trends have you observed in the medical treatment of CVD?
Dr. Tejas Shah: The treatment has really taken great leaps now that we are much more aware of it. One of the mainstays of treatment of venous disease in terms of its medical therapy includes compression with compression stockings and leg elevation. Oftentimes, those two easy things can help 80% of the people out there with venous disease, which is a big number. And what helps in doing those medical therapies is to get the right fitted stockings with the right kind of pressure to be able to mimic the essential functions of the veins back again.
Leg elevation is also key. I often tell my patients as sort of a quick easy way of remembering how high and how often it is, you know, tips of the toes above the nose and you do it only at night. And so you pretty much elevate your legs pretty high up every evening, basically whenever you go to sleep and you wear compression stockings during the day. And like I said, those two things with medical therapy really helps a vast majority of patients with venous disease.
Scott Webb: I love that. Tips of the toes above the nose. I'm going to be saying it to myself all day today. Tips of the toes above the nose. That's awesome. Tell us about the therapy guidelines for advanced CVD and how these treatment options, you know, going back to that quality of life that you talked about before, how those treatment options really do improve quality of life.
Dr. Tejas Shah: Once patients have essentially tried and failed medical therapy, then there are other advanced ways of fixing their venous disease depending on where their disease is located. Nowadays, we use minimally invasive techniques, including laser therapy, radio-frequency ablation and sclerotherapy using chemical agents to burn away those incompetent or veins that are just not doing the job that they're supposed to and to allow for the blood to return through a better working, more competent veins, to make the legs much more efficient, essentially. So it's sort of like improving the efficiency of the "engine" of your legs. And through these minimally invasive often 20 or 30-minute procedures that can be done as an outpatient, patients feel almost immediately better. Most can go back to work the same day, if not, the very next day. And it totally changes their outlook and their quality of their life.
For more advanced disease, there are more moderately invasive options where we can take intra-operative cameras, sort of what's called intravascular ultrasounds where we take very careful pictures inside the veins to evaluate them to look for more advanced deeper venous disease, if necessary, depending on what the patient has.
And so I'm really excited about where venous therapy has gone in the last several years because, we know a lot more now about how a simple blood clot, if you would, can affect somebody's quality of life five or ten years down the line, because it used to be that we would tell patients to just take some blood thinners and see you in the morning type of thing. But nowadays, we're being much more aggressive about treating blood clots and things of that nature, because we know that the long-term consequences of chronic venous disease does exist. And so therefore, we try to really aggressively treat them when necessary.
Scott Webb: Yeah. That's good to hear. And you and I were discussing before we got rolling here, just how amazing science and medicine is and how quickly things change. And This has been really educational today, doctor, and you stay well
Dr. Tejas Shah: Thank you.
Scott Webb: For more information, go to amitahealth.org/pro.
This is vital signs from a meta health. I'm Scott Webb Stay well.
Scott Webb: Chronic venous disease, also known as CVD, is very common, but it often goes under or undiagnosed mainly due to the fact that the signs and symptoms resemble so many other things. And joining me today to help us better understand CVD is Dr. Tejas Shah. He's a vascular surgeon with AMITA Health.
This is vital signs from a meta health. I'm Scott Webb.
Doctor, thanks so much for your time today. You know, I know American doctors diagnose upwards of 200,000 venous disease cases each year, yet some scholars feel that chronic venous disease, CVD, is frequently overlooked during regular checkup visits. Why do you think that is?
Dr. Tejas Shah: One of the biggest reasons for underdiagnosis of chronic venous disease is because a lot of the symptoms related to venous disease are crosshatched with other possible causes of those symptoms. Typical symptoms of chronic venous disease include achiness of the legs, particularly at the end of the day, tiredness, itching, burning, and these symptoms can mimic other disease processes, including musculoskeletal processes.
And with that, oftentimes, doctors and providers will look at other diseases first, but chronic venous disease is quite common in the United States and affects a significant portion of the population. And for that reason, it's one of those diseases that is treatable, yet overlooked due to its masking of symptoms that are very similar to other diseases out there.
Scott Webb: Yeah, I see what you mean. And I'm sure that's one of the challenges for doctors is that a lot of the symptoms, the signs and symptoms that we have, mimic other things, right? So what are the most common manifestations of CVD? And how do they impact patients longterm if the disease goes untreated?
Dr. Tejas Shah: The most common symptoms and manifestations of chronic venous disease does include feeling really achy and tired at the end of the day. That's the classic sign and symptom. And the typical patient that comes to my office is a man or a woman who's just complaining of pain usually after having a long day of standing at work or doing activities and they come home, and they put their legs up on the table or on the sofa or on an ottoman and it really helps them with their symptoms, they feel better. And they notice that kind of classically really helps. There are other signs and symptoms that are more subtle and not so typical, but those include things like burning and itching and swelling. And these are signs that are often very classic for a venous disease or sort of harbingers of venous disease as well.
When venous disease goes untreated, its longterm manifestations include essentially a worsening of your symptoms and really it's a quality of life issue. Most of the time venous disease is not deadly like cancer or heart disease and things of that nature, but it severely impacts people's quality of life. If you can't walk with the same kind of a spring in your step and feel good about it, it's going to impact what you do and how you do it. Your ability to enjoy life, enjoy the things that you normally do, a golf game, going out and having a walk, is severely impacted. And therefore, that affects what you do. And all of that sort of snowballs to become further and further debilitating for people. In its worst forms, you can get cellulitis, which is essentially a skin infection, and ulcers when it goes unnoticed for years and years.
Scott Webb: Yeah. So it sounds like a good conversation with patients, a sort of a patient history, them being sort of conscious, cognizant of the fact that, "Yeah, so when I experienced these symptoms and I put my legs up at home, then I feel better," right? So that would be good information for their providers to have.
But on top of that, besides just patient history, anecdotal as it may be, what are some of the imaging and other diagnostic options and evaluations that you have? Do you recommend one or the other? And if so, why?
Dr. Tejas Shah: The good news about chronic venous diseases is that it's very easily diagnosed through simple studies, particularly with ultrasound. So essentially, an easy ultrasound test, which is non-invasive, no radiation risk and done relatively quickly and routinely can help diagnose the vast majority of venous disease out there, including DVTs or deep vein thrombosis, reflux in the veins, which means where the veins kind of are allowing blood to collect down instead of going back up towards the heart. And all of this can be diagnosed fairly quickly and efficiently with an ultrasound, which is readily available in most areas.
Scott Webb: Yeah. And I'm sure there've been some trends just in general in CVD. We talked about it's often overlooked and the reasons why. So what trends have you observed in the medical treatment of CVD?
Dr. Tejas Shah: The treatment has really taken great leaps now that we are much more aware of it. One of the mainstays of treatment of venous disease in terms of its medical therapy includes compression with compression stockings and leg elevation. Oftentimes, those two easy things can help 80% of the people out there with venous disease, which is a big number. And what helps in doing those medical therapies is to get the right fitted stockings with the right kind of pressure to be able to mimic the essential functions of the veins back again.
Leg elevation is also key. I often tell my patients as sort of a quick easy way of remembering how high and how often it is, you know, tips of the toes above the nose and you do it only at night. And so you pretty much elevate your legs pretty high up every evening, basically whenever you go to sleep and you wear compression stockings during the day. And like I said, those two things with medical therapy really helps a vast majority of patients with venous disease.
Scott Webb: I love that. Tips of the toes above the nose. I'm going to be saying it to myself all day today. Tips of the toes above the nose. That's awesome. Tell us about the therapy guidelines for advanced CVD and how these treatment options, you know, going back to that quality of life that you talked about before, how those treatment options really do improve quality of life.
Dr. Tejas Shah: Once patients have essentially tried and failed medical therapy, then there are other advanced ways of fixing their venous disease depending on where their disease is located. Nowadays, we use minimally invasive techniques, including laser therapy, radio-frequency ablation and sclerotherapy using chemical agents to burn away those incompetent or veins that are just not doing the job that they're supposed to and to allow for the blood to return through a better working, more competent veins, to make the legs much more efficient, essentially. So it's sort of like improving the efficiency of the "engine" of your legs. And through these minimally invasive often 20 or 30-minute procedures that can be done as an outpatient, patients feel almost immediately better. Most can go back to work the same day, if not, the very next day. And it totally changes their outlook and their quality of their life.
For more advanced disease, there are more moderately invasive options where we can take intra-operative cameras, sort of what's called intravascular ultrasounds where we take very careful pictures inside the veins to evaluate them to look for more advanced deeper venous disease, if necessary, depending on what the patient has.
And so I'm really excited about where venous therapy has gone in the last several years because, we know a lot more now about how a simple blood clot, if you would, can affect somebody's quality of life five or ten years down the line, because it used to be that we would tell patients to just take some blood thinners and see you in the morning type of thing. But nowadays, we're being much more aggressive about treating blood clots and things of that nature, because we know that the long-term consequences of chronic venous disease does exist. And so therefore, we try to really aggressively treat them when necessary.
Scott Webb: Yeah. That's good to hear. And you and I were discussing before we got rolling here, just how amazing science and medicine is and how quickly things change. And This has been really educational today, doctor, and you stay well
Dr. Tejas Shah: Thank you.
Scott Webb: For more information, go to amitahealth.org/pro.
This is vital signs from a meta health. I'm Scott Webb Stay well.