Selected Podcast
When to Seek Care for Varicose Veins
Varicose veins can hurt and worsen, but when should you seek medical treatment? Learn about chronic venous disease, that affect the veins in your legs.
Featuring:
Ahmed Habib, MD
Ahmed Habib, M.D., Interventional Cardiologist, Genesis Vein Center. Transcription:
Scott Webb (Host): Chronic venous disease is a fairly common condition that's caused by poorly functioning vein valves in our legs. And though there's no cure for CVD, there are treatment options. And joining me today to explain CVD and how the Genesis Vein Center can help is Dr. Ahmed Habib. He's an Invasive Cardiologist, Board Certified Specialist in Vein Disease and the Director of the Genesis Vein Center.
This is Sounds of Good Health with Genesis brought to you by Genesis Healthcare System. I'm Scott Webb. Doctor, thanks so much for your time today. As I mentioned, we're going to talk about CVD. So let's talk here at the beginning about the incidence and prevalence of chronic venous disease.
Ahmed Habib, MD (Guest): So, venous disease affects about 30 million Americans. And unfortunately only about 2 million of them seek care. And out of that 2 million, we barely treated about half a million of these patients. So it's out there. It's twice more common than heart disease and five times more common than peripheral vascular disease, which people seek care for. So this is a big awareness issue with people out there.
Host: Yeah. And do you have a sense why people are not coming to see you, coming to see experts like yourself. So do you have a sense of why? Is it that it just hasn't been diagnosed, that they just don't know? They don't know to recognize the signs and symptoms?
Um,
Dr. Habib: Partly that's true, but also because this is a slowly progressive disease and it does not have the dramatic effects of like when you'd have a heart attack or a stroke or something like that. So people can live with symptoms for a long time until it reaches a point where they just cannot handle it anymore.
And that's when they seek care and that's usually late in the disease. So that's one of the reasons why, and then this is a very under-recognized disease. Not only just in the general public. But also, within the physician community. People usually go for cosmetic therapy when they have like spider veins or small varicose veins. But really the problem is a lot deeper than that.
Host: Yeah, it is. And you had mentioned to me when we were speaking before we got started here, that you've been at this for eight years, so you have a lot of experience. So, let's talk about what are the signs and symptoms of CVD?
Dr. Habib: Before we do that, let's take one step back and see who are the people that are at risk for developing CVD. It's a disease that more commonly affects women, four the one in ratio. The disease starts in their thirties and usually gets more progressive in their forties.
Usually they'll have a family history. If your mom had varicose veins or vein disease, then there's a 50% chance that the female siblings will have it. But if both parents have vein disease, then there is a good chance, over 90% of siblings will have venous disease. So family history plays a very important part and people who smoke, people whose profession involves a lot of heavy lifting, prolonged standing, people who lack regular cardiovascular fitness and exercise or as we gain weight. All of these things become very prominent and especially in women, multiple pregnancies become a very significant risk factors for development of vein disease.
Host: Yeah. I see what you mean. So let's talk about what are the signs and symptoms for those that are at risk?
Dr. Habib: So typically the symptoms would be heaviness in the legs that gets progressively worse as the day progresses, burning, aching type sensation in the legs, sometimes even cramping and pain, a lot of leg fatigue that prevents people from walking long distances. Itching of the skin, usually around your ankle area and restless legs.
And as this, these are the typical symptoms that one would get. And also another common symptom that gets unrecognized is swollen legs. People will have a lot of swelling and they get put on water pills and diuretics and the problem doesn't go away because it's a totally different pathophysiology.
So I think it's very important for both patients, as well as our physician community to recognize the signs and symptoms of vein disease. And the typical signs of this would be you would start off with just like spider veins. And then that develops into more of the bigger veins, which we call it the ropey varicose veins.
And then, then swelling of your legs and skin changes. And the, in the late state patients will develop what we call as venous ulcers, usually around the distal third of your leg and around the ankle area. And when that happens, it becomes extremely difficult to treat these patients and becomes a chronic source of disability.
Host: Yeah, it sounds like it. So let's talk about the complications, right? So if folks aren't diagnosed early and, or they're not treated early, what are the complications if you're seeing folks in the later stages?
Dr. Habib: Usually, the most dreadful complication is a blood clot in the leg and the second, most progressive complication of advanced disease is development of ulcers. So these folks end up either presenting with a blood clot in their leg or they present with an advanced ulcer around the ankle or distal third of the leg.
And it just, it's a very difficult problem to treat. And usually it's very advanced. Other than that, you would start to get in a lot of swelling in their legs, which gets untreated. And then also a lot of skin changes get like hyperpigmentation in their skin and becomes very leathery and contracted.
Host: Yeah. And I mentioned in my intro, obviously this is a common condition and there's no cure per se for CVD, but what are the available treatment options?
Dr. Habib: So that's the good part of venous disease. If we pick this disease early, we can definitely offer very significant improvement in patient's quality of life, as well as, morbidity over a period of time and those dreadful complications of blood clots and ulcers. And so on. There are three main treatments that are available in today's day and age. One, we would actually advise people to start wearing stockings that are at higher risk, especially in the people who are standing for long periods of time.
It also involves our professional community, our nurses, our physicians, and also healthcare workers and in many areas, as well as, people who work in the factories who stand long periods of time on, on concrete, I think using a support hose, even just what you can pick up at Walmart would be of some benefit, but usually a prescription sent is what you really need.
But after that, if you still have symptoms, we offer three different types of treatments. One is what we call as the heat treatment. The second is glue and the third treatment is called chemical foam. A lot of people are familiar with what we called the vein stripping. We used to do that back in the sixties and seventies, and even we do in some cases, which are very advanced now, but most of the time we can treat this with either heat, glue or with the chemical foam.
Host: Yeah, I think we've all heard about vein stripping and it just sounds maybe it's not, but it certainly sounds very painful. And so I think for all of us who may be suffering from this, who may come to see you, I think we're just all probably glad that that's not done very much anymore. Right?
Dr. Habib: That's correct. I mean, usually if she had been stepped, you would be in the hospital two or three days, and probably takes about a month to recover. But whereas, the current non-surgical treatment that we have, that we can offer our patients is they're back to work the same day or the next day. And there is no cuts, no stitches and no sutures and no anesthesia involved.
Host: That's really amazing. I did want to squeeze in here a question about insurance, because you know, you talked about spider and varicose veins and a lot of times maybe, some folks, maybe insurance company's view those as more sort of cosmetic concerns. So want to find out, you know, to your knowledge, how does insurance view coming to the Genesis Vein Center and being screened or diagnosed for CVD?
Dr. Habib: So the typical process would be the patient would either self-refer, or be referred by their primary care or their specialty physicians. And when we see them, then we make an assessment of how severe the diseases or if it is venous disease or something else. And then we have them go through a quick ultrasound scan, which takes about 30 to 40 minutes.
And that scan will tell us the condition of their veins and if they need any further treatment. And once we establish that, then we document the need and put them in compression stockings and give them an exercise program for about six weeks to three months. And then we have them return and reassess them.
And at that point, if they're still symptomatic, then we would submit to their insurance company, usually our records and ask for treatment for those patients. And in most situations, if it's medically indicated and patient is symptomatic after their initial treatment plan, then most insurance companies will approve that.
Host: Yeah. I see what you mean, depending on the severity, medically indicated and so on. Doctor, if you get close to wrapping up here, I know that you're the Director of the Genesis Vein Center. So I wanted to have you just tell us a little bit about the work that you do, the work you do at the center and what folks can expect.
Dr. Habib: The Genesis Vein Center was established about a couple of years ago. And that's one of the areas that I have developed along with a couple of my other colleagues. We see roughly about 300 patients a month and we do about a 140 to 150 procedures a month in the vein center and about 200 or so ultrasound exams every month. We have a nurse practitioner and two other physicians with me and a group of three nurses and four sonographers.
And we have a very competent and comprehensive center that's accredited in also very robust in terms of offering all types of modalities for treatment here at the Genesis Vein Center. Before we close, we do also offer cosmetic therapy. And that is usually not covered by insurances for treatment of spider veins and so on, but usually it would be the end stage after everything else has been done. Because if we just treat the spider veins and not the underlying problem, then they're all going to come back.
Host: Yeah, that's such a good point. Right? We see the spider veins on our legs, but there's an underlying cause that needs to be treated and we hope folks do that. This has been really educational today. Good to learn more about you and the work that you're doing there, obviously you guys are really busy, so I'll let you get back to that. Doctor, thanks so much for your time and you stay well.
Dr. Habib: Of course. Thank you so much.
Host: For more information, go to Genesishcs.org/veincenter. And thanks for listening to Sounds of Good Health with Genesis, brought to you by Genesis Healthcare System. If you found this podcast to be helpful, please be sure to tell a friend and subscribe, rate and review this podcast and check out the entire podcast library for additional topics of interest. I'm Scott Webb. Stay well.
Scott Webb (Host): Chronic venous disease is a fairly common condition that's caused by poorly functioning vein valves in our legs. And though there's no cure for CVD, there are treatment options. And joining me today to explain CVD and how the Genesis Vein Center can help is Dr. Ahmed Habib. He's an Invasive Cardiologist, Board Certified Specialist in Vein Disease and the Director of the Genesis Vein Center.
This is Sounds of Good Health with Genesis brought to you by Genesis Healthcare System. I'm Scott Webb. Doctor, thanks so much for your time today. As I mentioned, we're going to talk about CVD. So let's talk here at the beginning about the incidence and prevalence of chronic venous disease.
Ahmed Habib, MD (Guest): So, venous disease affects about 30 million Americans. And unfortunately only about 2 million of them seek care. And out of that 2 million, we barely treated about half a million of these patients. So it's out there. It's twice more common than heart disease and five times more common than peripheral vascular disease, which people seek care for. So this is a big awareness issue with people out there.
Host: Yeah. And do you have a sense why people are not coming to see you, coming to see experts like yourself. So do you have a sense of why? Is it that it just hasn't been diagnosed, that they just don't know? They don't know to recognize the signs and symptoms?
Um,
Dr. Habib: Partly that's true, but also because this is a slowly progressive disease and it does not have the dramatic effects of like when you'd have a heart attack or a stroke or something like that. So people can live with symptoms for a long time until it reaches a point where they just cannot handle it anymore.
And that's when they seek care and that's usually late in the disease. So that's one of the reasons why, and then this is a very under-recognized disease. Not only just in the general public. But also, within the physician community. People usually go for cosmetic therapy when they have like spider veins or small varicose veins. But really the problem is a lot deeper than that.
Host: Yeah, it is. And you had mentioned to me when we were speaking before we got started here, that you've been at this for eight years, so you have a lot of experience. So, let's talk about what are the signs and symptoms of CVD?
Dr. Habib: Before we do that, let's take one step back and see who are the people that are at risk for developing CVD. It's a disease that more commonly affects women, four the one in ratio. The disease starts in their thirties and usually gets more progressive in their forties.
Usually they'll have a family history. If your mom had varicose veins or vein disease, then there's a 50% chance that the female siblings will have it. But if both parents have vein disease, then there is a good chance, over 90% of siblings will have venous disease. So family history plays a very important part and people who smoke, people whose profession involves a lot of heavy lifting, prolonged standing, people who lack regular cardiovascular fitness and exercise or as we gain weight. All of these things become very prominent and especially in women, multiple pregnancies become a very significant risk factors for development of vein disease.
Host: Yeah. I see what you mean. So let's talk about what are the signs and symptoms for those that are at risk?
Dr. Habib: So typically the symptoms would be heaviness in the legs that gets progressively worse as the day progresses, burning, aching type sensation in the legs, sometimes even cramping and pain, a lot of leg fatigue that prevents people from walking long distances. Itching of the skin, usually around your ankle area and restless legs.
And as this, these are the typical symptoms that one would get. And also another common symptom that gets unrecognized is swollen legs. People will have a lot of swelling and they get put on water pills and diuretics and the problem doesn't go away because it's a totally different pathophysiology.
So I think it's very important for both patients, as well as our physician community to recognize the signs and symptoms of vein disease. And the typical signs of this would be you would start off with just like spider veins. And then that develops into more of the bigger veins, which we call it the ropey varicose veins.
And then, then swelling of your legs and skin changes. And the, in the late state patients will develop what we call as venous ulcers, usually around the distal third of your leg and around the ankle area. And when that happens, it becomes extremely difficult to treat these patients and becomes a chronic source of disability.
Host: Yeah, it sounds like it. So let's talk about the complications, right? So if folks aren't diagnosed early and, or they're not treated early, what are the complications if you're seeing folks in the later stages?
Dr. Habib: Usually, the most dreadful complication is a blood clot in the leg and the second, most progressive complication of advanced disease is development of ulcers. So these folks end up either presenting with a blood clot in their leg or they present with an advanced ulcer around the ankle or distal third of the leg.
And it just, it's a very difficult problem to treat. And usually it's very advanced. Other than that, you would start to get in a lot of swelling in their legs, which gets untreated. And then also a lot of skin changes get like hyperpigmentation in their skin and becomes very leathery and contracted.
Host: Yeah. And I mentioned in my intro, obviously this is a common condition and there's no cure per se for CVD, but what are the available treatment options?
Dr. Habib: So that's the good part of venous disease. If we pick this disease early, we can definitely offer very significant improvement in patient's quality of life, as well as, morbidity over a period of time and those dreadful complications of blood clots and ulcers. And so on. There are three main treatments that are available in today's day and age. One, we would actually advise people to start wearing stockings that are at higher risk, especially in the people who are standing for long periods of time.
It also involves our professional community, our nurses, our physicians, and also healthcare workers and in many areas, as well as, people who work in the factories who stand long periods of time on, on concrete, I think using a support hose, even just what you can pick up at Walmart would be of some benefit, but usually a prescription sent is what you really need.
But after that, if you still have symptoms, we offer three different types of treatments. One is what we call as the heat treatment. The second is glue and the third treatment is called chemical foam. A lot of people are familiar with what we called the vein stripping. We used to do that back in the sixties and seventies, and even we do in some cases, which are very advanced now, but most of the time we can treat this with either heat, glue or with the chemical foam.
Host: Yeah, I think we've all heard about vein stripping and it just sounds maybe it's not, but it certainly sounds very painful. And so I think for all of us who may be suffering from this, who may come to see you, I think we're just all probably glad that that's not done very much anymore. Right?
Dr. Habib: That's correct. I mean, usually if she had been stepped, you would be in the hospital two or three days, and probably takes about a month to recover. But whereas, the current non-surgical treatment that we have, that we can offer our patients is they're back to work the same day or the next day. And there is no cuts, no stitches and no sutures and no anesthesia involved.
Host: That's really amazing. I did want to squeeze in here a question about insurance, because you know, you talked about spider and varicose veins and a lot of times maybe, some folks, maybe insurance company's view those as more sort of cosmetic concerns. So want to find out, you know, to your knowledge, how does insurance view coming to the Genesis Vein Center and being screened or diagnosed for CVD?
Dr. Habib: So the typical process would be the patient would either self-refer, or be referred by their primary care or their specialty physicians. And when we see them, then we make an assessment of how severe the diseases or if it is venous disease or something else. And then we have them go through a quick ultrasound scan, which takes about 30 to 40 minutes.
And that scan will tell us the condition of their veins and if they need any further treatment. And once we establish that, then we document the need and put them in compression stockings and give them an exercise program for about six weeks to three months. And then we have them return and reassess them.
And at that point, if they're still symptomatic, then we would submit to their insurance company, usually our records and ask for treatment for those patients. And in most situations, if it's medically indicated and patient is symptomatic after their initial treatment plan, then most insurance companies will approve that.
Host: Yeah. I see what you mean, depending on the severity, medically indicated and so on. Doctor, if you get close to wrapping up here, I know that you're the Director of the Genesis Vein Center. So I wanted to have you just tell us a little bit about the work that you do, the work you do at the center and what folks can expect.
Dr. Habib: The Genesis Vein Center was established about a couple of years ago. And that's one of the areas that I have developed along with a couple of my other colleagues. We see roughly about 300 patients a month and we do about a 140 to 150 procedures a month in the vein center and about 200 or so ultrasound exams every month. We have a nurse practitioner and two other physicians with me and a group of three nurses and four sonographers.
And we have a very competent and comprehensive center that's accredited in also very robust in terms of offering all types of modalities for treatment here at the Genesis Vein Center. Before we close, we do also offer cosmetic therapy. And that is usually not covered by insurances for treatment of spider veins and so on, but usually it would be the end stage after everything else has been done. Because if we just treat the spider veins and not the underlying problem, then they're all going to come back.
Host: Yeah, that's such a good point. Right? We see the spider veins on our legs, but there's an underlying cause that needs to be treated and we hope folks do that. This has been really educational today. Good to learn more about you and the work that you're doing there, obviously you guys are really busy, so I'll let you get back to that. Doctor, thanks so much for your time and you stay well.
Dr. Habib: Of course. Thank you so much.
Host: For more information, go to Genesishcs.org/veincenter. And thanks for listening to Sounds of Good Health with Genesis, brought to you by Genesis Healthcare System. If you found this podcast to be helpful, please be sure to tell a friend and subscribe, rate and review this podcast and check out the entire podcast library for additional topics of interest. I'm Scott Webb. Stay well.