Transcription:
Should You Get a Vascular Screening? It Could Save Your Life.

Melanie Cole (Host):  Are you one of the 30 million Americans at risk for vascular disease?  Vascular disease prevents blood from flowing properly through the circulatory system and often it has no obvious signs or symptoms.  For this reason, it’s known as a silent disease and in many cases screenings may be the only ways to detect it.  My guest today is Dr. Richard Nitzberg.  He specializes in general and vascular surgery and runs the Summit Medical Group Vein Center and the Vascular Lab.  Welcome to the show, Dr. Nitzberg.  Tell us a little bit about vascular disease to begin with.  What is vascular disease?

Dr. Richard Nitzberg (Guest):   Well, you’ve kind of hit most of it right on the head.  Vascular disease, when we speak of vascular disease, we’re really talking about the circulatory system in the body and that is, basically, any blood vessel that goes to any organ can have vascular disease.  Sometimes, it’s the heart, sometimes it’s the legs, sometimes it’s the blood vessels to the brain.  When a blood vessel has some type of disease, sometimes it’s a blockage but sometimes it’s also something called an “aneurism.”  A vascular screening test can be very helpful in detecting that blockage or “aneurysmal” as we call it--dilatation or swelling.

Melanie:  So, vascular screening--tell us what that involves and who is at risk, who would be a candidate for vascular screening.

Dr: Nitzberg:  Vascular disease tends to start affecting patients in their early to late 50’s going into the 60’s and 70’s.  In fact, Medicare has a one-time vascular screening exemption when you have your first Medicare physical examination when you turn 65.  They will allow a screening examination for the aneurisms that occur in the abdominal aorta.  Anybody after the age of 50-55 is at risk.  Certainly, patients who are smoking, have high blood pressure, have high cholesterol or diabetes are at greater risk and those patients are probably going to be especially a good group that can be identified that would benefit from vascular screening.

Melanie:  What’s involved in the screening?

Dr: Nitzberg:  It’s a pretty simple test.  There are three tests that we do.  One looks at the circulation to the lower legs, one looks at whether or not there’s an aneurism in the abdominal aorta, which is in the abdomen and one looks to see whether or not there’s blockages in the carotid arteries in the neck.  This is all done by either ultrasounds or some cuffs in addition to the ultrasound that is applied either to the legs or abdominal ultrasound that’s applied just to the abdomen or a neck ultrasound which is just, obviously, to the neck.  These are painless tests.  They just put a little jelly on your neck and they look on a screen and they can tell a lot of different things that may detect silent or cold disease that a patient never knew about nor did their physician.

Melanie:  So then, if you’re doing this screening, what can it really look for?  How does it look for it and what do you do if you see something because this is non-interventive. You’re not in there.  What do you do if you detect something?

Dr: Nitzberg:  It’s non-intervention but it doesn’t mean it’s non-detecting.  So, basically, you can tell whether or not there’s a blockage in the neck and you can tell whether or not there’s an aneurism or swelling or dilatation, almost a ballooning out of the aorta.  You can tell whether or not someone has or is starting to have disease in their lower legs or blockages in their lower legs.  When you have that information, then we convey it to the patient.  They are given a sheet with the three tests and they can see what the tests showed.  At least at Summit Medical Group, the sheets are also forwarded on to their primary care physician. 

Melanie:  So, then, what do the results show?  What do you do once they get to their primary care physician? Then, that’s when you determine whether they go see a cardiologist or whatever treatment they might need?

Dr: Nitzberg:  Essentially, if it’s a minimal disease, it’s just something that can be followed. The primary care physician knows to follow that. At a certain interval, they will get what’s called a formal ultrasound at that time so they have sort of a better study.  The screening tests are just 15 minute studies each one.  When we do a formal test, it can take up to 45 minutes to an hour.  The only time we do a formal test is when a patient has evidence of a disease on a screening examination or they come to see a physician and the physician determines by their examination and by their history that the patient might have some type of vascular disease.  So, sometimes if there is minimal disease, we just follow it or maybe it doesn’t need to be followed at all.   If there’s significant disease, then the primary care physician will get in touch with someone like myself, a vascular surgeon, who may need to deal with the vascular problem in some fashion.

Melanie:  If someone feels healthy, Dr. Nitzberg, should they ask for the screening if they’re in their 50’s or 60’s or they were a prior smoker, should they ask for this screening?

Dr: Nitzberg:  I think a patient who has a family history of aneurisms, someone who’s a smoker, and, again, these are not exclusive – any of these factors. Someone who has a history of smoking, someone with diabetes, hypertension should really consider doing it in their early 50’s.  If they have none of those risk factors, probably in their late 50’s or early 60’s and certainly by the time they have their first Medicare examination at age 65, they should consider getting these tests.

Melanie:  Are there any symptoms that would warrant them to go to their doctor and ask?  Pain in the legs, claudication and shortness of breath--are any of these things symptoms of vascular problems because they can also mimic symptoms of stress and muscular problems and things?

Dr: Nitzberg:  Right.  There are symptoms of vascular disease. For instance, if someone has a tiny, mini stroke, that’s a symptom of vascular disease or they notice a polcipile mass on their abdomen, that’s a sign perhaps of vascular disease. If they have ulcerations on their feet, it may be an indication of poor circulation but the difference between a screening test and a regular test is a screening test is something that the patient has to ask for.  It’s not something that insurance will pay for because it’s a screening test.  In order to order any vascular test by a physician who sees a patient and suspects vascular disease, they have to document some type of symptom or sign that indicates vascular disease and then they will get a formal vascular examination or test.  But, for screening, it’s to look for silent or cold disease.  A patient has to say, “I’m worried about these three things and I’d like to get a vascular screening examination.”  It is an out of pocket expense to the patient but a very nominal amount just to they can get that information.

Melanie:  So then, if you’ve detected that they’ve got something going on– whether it’s high blood pressure, diabetes, or some form of vascular disease – what do you tell them about prevention and healthy lifestyle behaviors?  Something that they can possibly do to bring this risk down just a little bit?

Dr: Nitzberg:  The key thing is to identify those risk factors.  So, as I mentioned to you, one of the risk factors of high blood pressure, you want to make sure that your blood pressure is well-controlled and their physician knows the parameters that that blood pressure should be kept at.  If you’re a smoker, you’ve got to stop smoking.  It’s as simple as that.  We all know that smoking has a very high association with vascular disease, so patients who are smoking have got to get off the cigarettes.  If you’re a diabetic, then your diabetes has to be well-controlled.  Maybe it’s just that you’re overweight and that’s why you’re diabetic. Then, you have to lose weight and stop being a diabetic because of weight loss.  So, there are always risk factors that you, as a patient, can manipulate to some extent.  Sometimes, it’s hereditary and you’re just stuck with bad genes.  It is what it is.  That’s something that, again, a vascular screening test will sometimes pick up.

Melanie:  So, in just the last few minutes, Dr. Nitzberg, and its great information and so important that people hear what you have to say, give your best advice for the vascular screening that Summit Medical Group offers and the three types of screening and why they should come to Summit Medical Group and see you.

Dr: Nitzberg:  They don’t necessarily need to see me, they just need to go to the Vascular Lab.  Basically, I think if you have any of those risk factors that I mentioned, high blood pressure, smoking, family history, diabetes you should consider at a relatively early age, I say 50-55, getting a vascular screening test.  It’s a quick and easy test.  It will take about a half hour of your time to get the test.  You can call the vascular lab directly and say, “I want to get a vascular screening examination” or you can ask your own doctor to help you set that up.  It’s not something that he can necessarily order but he can facilitate you getting that test done at our laboratory.

Melanie:  Thank you so much, Dr. Nitzberg, for being with us today. You’re listening to SMG Radio.  For more information you can go to summitmedicalgroup.com.  That’s summitmedicalgroup.com and you can see more information about their vascular screening program.  This is Melanie Cole.  Thanks so much for listening.