Scott Webb (Host): Vascular conditions tend to affect women more than men. But in all cases, my guests today can help patients with the cosmetic and medical effects of venous diseases. I'm joined today by Dr. Adam Hicks. He's a board-certified vascular surgeon with Franciscan Health. And I'm also joined today by Cassie Himes. She's a nurse practitioner with Franciscan Health.

This is the Franciscan Health Doc Pod. I'm Scott Webb. It's nice to have you both here today. We're going to understand vascular conditions, and we're going to do that by me asking you questions and you answering them. Specifically today, we're going to talk about venous disease, maybe varicose veins, things like that. So, I'm going to start with you, doctor, and just have you just broadly tell us, like, what does that mean? I say venous disease. So, what does that mean?

Dr. Adam Hicks: Venous disease is very common. It's about 10% to 30% of the worldwide population we believe is affected. And the venous system is the side of your circulatory system that is returning blood flow from your feet back to your heart. And unfortunately, there's not a pump to do that. It uses the pumping mechanism of your calves as well as valves within the veins to bring blood flow back to the heart. But what can happen for some folks is after long periods of their life where they've been standing or on their feet for long times, the blood flow can tend to kind of pool at the feet as the valves become non-functional.

And so, in those patients, they can get symptoms such as heaviness, aching, pain at the end of the day, swelling. And so, we like to identify those patients because there are good treatment options.

Host: Yeah, I'm glad you pointed that out. Like, we know the heart pumps it to the feet, but how does it get back from the feet to the heart, right, as you say? And explain here and what can happen over time, folks, you know, whether it's age, standing a lot, whatever it might be. So then, Cassie, who's at the highest risk of venous disease?

Cassie Himes: I feel like women are at a high risk for this. Lots of factors go into it, such as pregnancy, genetics, like Dr. Hicks said, standing for long periods of time, driving for long periods of time. And there's a high percentage of women rather than men that do end up with some vascular disease or venous insufficiency.

Host: Yeah. I wanted to ask you, I mentioned there a tease in the intro about varicose veins, and I don't have varicose veins, but I've certainly seen them, and I've often wondered, and I wanted to ask an expert, since you're here, they look like they might be painful, and I don't know if they are painful or not, but I want you just to give us a connection here between venous disease, varicose veins, like kind of what are they? Do they hurt? That sort of thing.

Dr. Adam Hicks: Yes. As a provider who both takes care of patients with varicose veins and somebody who has varicose veins myself, I have a long family history of varicose veins in my mother and grandmother. It looks painful, and often it is, but it's not painful like a bee sting necessarily. It's more of an aching heaviness that you'll feel in the legs, and especially towards the end of the day if you've been on your feet all day, it's heavy achiness that patients will report.

Now, not every varicose vein is symptomatic, and oftentimes the varicose veins are kind of the canary in the coal mine that's, you know, underlying. There's larger veins underneath the skin surface that are refluxing more. So often when you see a varicose vein, that's actually just like a tree branch or a root. And really, the big problem is the main tree trunk within the leg that needs to be managed and treated. So, that varicose vein oftentimes can be painful, not always. But when they are painful, that's why we have treatment options.

Host: Yeah, absolutely. And Cassie, let's talk about maybe the signs of venous disease. Like, we're talking about varicose veins, it's kind of hard to miss those, as Dr. Hicks is pointing out. Maybe that's a sign of a bigger issue with the bigger tree. But in general, are there some signs that maybe women in particular often miss?

Cassie Himes: So, I feel like women more than men care about the little spider veins that they have on the legs too. And I know spider veins can be very cosmetic, but sometimes patients come in and those spider veins or those little tiny branches are also a sign of a deeper issue too, depending on if they're tender, if they're achy in those areas, if they bulge more at certain times. It could honestly be telling us that there's a deeper issue, and that's where it's our job to kind of say, "Hey, let's look into this and see if these aren't just little tiny spider veins."

Host: Yeah. As you say, it may be entirely cosmetic for some. Others, there may be some issues. And certainly, this could be some "smaller signs" that folks and women might miss. And I want to stay with you, Cassie, and ask, "Is there a link between venous disease, hormones, and pregnancy?"

Cassie Himes: There is. So, I mean, when you're pregnant, obviously, you have that extra pressure of carrying a baby, and that extra pressure puts a lot of pressure on your veins. You'll see pregnant patients that complain more of aching and being heavy and tired, and their veins are bulging more. And honestly, when you're pregnant too, your hormones make your veins more lax. So, it causes them to bulge a little bit more and be more weakened, for lack of a better term.

Host: Yeah. So definitely, a connection there. So, Doctor, let's talk about prevention and intervention. You as a vascular specialist can help us. That's why you're on, and it's why you do what you do at the vein clinic, which we're going to get to. But let's talk about that. Like, what can we do? Is there anything we can do? Is it compression socks, standing less? Like, how do we prevent some of these venous issues, these venous diseases, if you will?

Dr. Adam Hicks: Yeah. So, I always like to kind of put the different treatment options into two different buckets in that we have to, you know, look at all the options really. The first bucket would be sort of lifestyle modification. So, that would be things like if you're standing for long periods of time, actually trying to walk rather than staying stationary, getting your feet up at the end of the day, getting your feet above your heart at the end of the day. Wearing compression stockings is a huge component of this, because that helps provide extrinsic compression to help get the blood flow back up and kind of give the calf something to pump against. So, those are some of the things that are in kind of the more lifestyle modification bucket.

The other side of that are, you know, vein treatments. And so, when a vein has had such destruction of the valves that it's really non-functional, it's large, it's bulging, we have different tools where we can close down that non-functional vein and try and divert blood flow to veins that are functional. And so, those things can involve heating elements, glue, foam, and then sometimes actually direct removal of the vein in the operating room.

Host: Yeah. You say, heating elements, glue, foam. It's like, are we working on an art project or are we intervening for venous disease? It's really interesting. And, Doctor, I want to have you tell us about the vein clinic. Like, what can folks expect when they walk through the door and how you help them?

Dr. Adam Hicks: Yeah. So, we always like to see a patient have a clinic visit. Cassie or myself be happy to see anybody and kind of review the symptoms that they're experiencing. We try to, you know, do a very holistic approach where we look at all of the different, you know, health conditions that may be contributing to their symptoms, because there's lots of patients who come with bad venous disease that also have other issues going on. So, we as, you know, medical providers are making sure that we're not missing any of those other things because sometimes if there's trouble with the heart, it can back up to the legs, things like that. So, we try and get a good physical history. And then, kind of the cornerstone of imaging for the veins is ultrasound.

So, we have wonderful ultrasound techs that are in our office, and we do the ultrasounds here at the office at our vein clinic. And that's a great tool because it can help us identify which of the veins are refluxing. There's two different systems of the veins. There's the ones close to the skin surface, and then there's the deeper ones. And so, we are able to evaluate all of those veins and come up with a best treatment plan for the patient.

Host: That's awesome. And want to give a last word to you, Cassie, in terms of the vein clinic, what you do, how you do it, patient care, all that good stuff. Just, you know, kind of put a period at the end of the sentence for us.

Cassie Himes: So, I feel like our office is one of the best offices, and I say that biasedly, but everyone in our office is amazing. We treat our patients so well. They come in, lots of patients leave and they feel like they know all of us because we just are so personal with them and we really try to take the best care that we can of the patient and treat them appropriately and efficiently and get them feeling better as a whole.

Host: That's awesome. Yeah, learning from you guys today that, you know, some of these things might just be cosmetic and maybe a little unsightly, and folks want to deal with them because of that. And other times it could be a sign of something bigger, the bigger tree, you know, other circulatory issues, whatever it might be. So, certainly can help everybody there at the vein clinic. Appreciate your time, your expertise. Thanks so much.

Cassie Himes: Yeah. Well, thank you for having me.

Dr. Adam Hicks: Thanks, Scott.

Host: And to learn more, visit franciscanhealth.org/heartcare. And if you found this podcast helpful, please share it on your social channels. And be sure to check out the full podcast library for additional topics of interest. This is the Franciscan Health Doc Pod. I'm Scott Webb. Stay well, and we'll talk again next time.