Warmer will eventually get here and that means spring breaks, summer vacations and more reason to wear dresses, skirts, shorts, and bathing suits!
However, many people will do whatever it takes to cover up because they have varicose and spider veins.
Dr. Richard Nitzberg runs the Vein Center at Summit Medical Group and offers solutions to give you lovely legs.
Selected Podcast
Lovely Legs for Spring
Featured Speaker:
Dr. Nitzberg also runs the Summit Medical Group Vein Center, which provides treatment for spider and varicose veins with leading-edge laser treatment. In addition, he is Chief of General Surgery at Overlook Medical Center in Summit, New Jersey.
He has been featured in the Castle Connolly "Top Doctors in the New York Metro Area," Castle Connolly "America's Top Doctors," and New Jersey Monthly "Top Doctors" listings. Dr. Nitzberg's Castle Connolly listings have been reprinted in US News and World Report and Inside Jersey.
Organization: Summit Medical Group Vein Center
Richard Nitzberg, MD
Richard S. Nitzberg, MD, is the Vice Chair of Summit Medical Group Surgery, and specializes in general and vascular surgery as well as hernia and laparoscopic surgery. During his 20 years of practice, he has performed more than 1800 hernia surgeries and more than 1700 laparoscopic gallbladder surgeries.Dr. Nitzberg also runs the Summit Medical Group Vein Center, which provides treatment for spider and varicose veins with leading-edge laser treatment. In addition, he is Chief of General Surgery at Overlook Medical Center in Summit, New Jersey.
He has been featured in the Castle Connolly "Top Doctors in the New York Metro Area," Castle Connolly "America's Top Doctors," and New Jersey Monthly "Top Doctors" listings. Dr. Nitzberg's Castle Connolly listings have been reprinted in US News and World Report and Inside Jersey.
Organization: Summit Medical Group Vein Center
Transcription:
Lovely Legs for Spring
Melanie Cole (Host): Do you have unsightly varicose or spider veins? They can worsen over time and even become painful. My guest is Dr. Richard Nitzberg. He’s a board-certified general and vascular surgeon and the Vice Chair of Summit Medical Group Surgery. Welcome to the show, Dr. Nitzberg. Tell us about varicose veins and spider veins. What are they?
Dr. Richard Nitzberg (Guest): Well, there’s a gamut or spectrum of veins that people experience on their legs. The spider veins are the really tiny little veins. They almost look like a little spider’s web. They’re typically blue or green, and they’re not bulging. They’re flat on the surface of the skin, and they’re mostly unsightly. They don’t really cause a lot of pain or discomfort. The varicose veins, on the other hand, are those big, bulging green veins that actually hurt, especially when a patient is on their legs for a long period of time or standing for a long period of time. Sometimes after a woman’s menses, they’ll complain of the discomfort. Oftentimes, after exercise, because you’re pumping more blood to the leg, the veins become more distended. And when they become more distended, they’re more painful. So that’s sort of the gamut that one runs in terms of spider and varicose veins.
Melanie: What causes these, Dr. Nitzberg?
Dr. Nitzberg: Well, unfortunately, the biggest cause is hereditary. If your mom had them or your grandmom or even sometimes grandpa, they tend to pass this on, as one will, to their own offspring. There’s not a lot you can do to prevent these things from happening. Patients always say, “Well, maybe it’s because I cross my legs.” That’s more of an old wives’ tale than anything else. You really can't do much to prevent these other than try to get your legs up when you can, and if you can wear compression stockings, if you have a tendency towards these problems, then that might prevent them from getting worse. But other than that, it’s really mostly hereditary.
Melanie: Are there any risks or complications to having varicose and spider veins, Dr. Nitzberg? What red flags would you say would send somebody to the doctor about them?
Dr. Nitzberg: Well, there’s certainly no risk with spider veins. Spider veins primarily are cosmetic in nature. Varicose veins, the most common problem is really just pain and discomfort, which is not really a significant risk. In other words, you can live with your pain and discomfort, treating with elevation or with compression stockings if you so desire. But on occasion, varicose veins are even more prominent. Spider veins rarely can bleed, and that’s always scary when it occurs because it can be quite a bit of bleeding. You won’t bleed to death, but it can be a lot of blood. But that’s rare. You can develop ulcerations sometimes related to the varicose veins. You can also develop what’s called the superficial thrombophlebitis, which is essentially a blood clot that occurs in the superficial varicosity. It’s not life-threatening. It can't hurt you. If you recall, it’s what Richard Nixon had many, many years ago. You don’t even need to take Coumadin or an anticoagulant for that. It’s really just a nuisance, more than anything else, but it’s certainly not life-threatening.
Melanie: When would you come to see a doctor? And when you do, what treatments are available? Because you’re very uncomfortable from them or you really don’t like the way that they look, what are you doing for them?
Dr. Nitzberg: You kind of hit on it in terms of when they come. Most patients come because a) they don’t like the way they look, or b) they’re having a lot of pain and discomfort. Occasionally, they come for those other three problems: ulceration, thrombophlebitis, or bleeding, but that’s pretty rare. Most of them come because of the pain and the discomfort. And then it depends on what they have. For spider veins, spider veins are typically treated on a cosmetic basis with injections, primarily, and/or laser. I say and/or. I think the injection works much better. For instance, in our office, we have both injection and laser possibilities, and I tend to do injections more often because they work better. In terms of varicose veins, it just depends. It depends on how big they are. Sometimes they can be treated just with what’s called injection sclerotherapy. Sometimes I’ll just have patients wear compression stockings. But if they’re having significant problems, there are surgical options as well.
Melanie: And so how long does the sclerotherapy work for? Does it take more than one visit, or is it something that you keep coming back and, once it’s done, come back again and have them redone?
Dr. Nitzberg: The number of visits really depends upon the amount of spider veins you have. Everyone does it differently, by the way, but what we do in our office is we do a 15-minute session. Oftentimes, if you just have a moderate number or amount of spider veins, we can limit you to just one visit. But it’s not a hundred percent when you do it. It’s about maybe 70 to 80 percent effective. So oftentimes, patients are happy with that and then they don’t come back unless there is a recurrence. Typically over time, it could be three, four years, sometimes sooner, whatever process is causing the spider veins to occur continues. So we haven’t stopped that process. All we’ve done is gotten rid of the spider veins temporarily. Sometimes, patients never come back. Sometimes, they get one treatment and they’re good for a really long time or maybe even forever. But oftentimes, over a period of three or four years, if the spider veins keep coming back and they were happy with the result, they’ll come back for what we call a touch-up.
Melanie: What happens after the procedure, Dr. Nitzberg? Can they return to normal activity, exercise? How long do they have to wait? Do they wear pressure socks? What all goes on that recovery?
Dr. Nitzberg: Sure. The treatment is actually called compression sclerotherapy, so compression after the treatment is really important. Typically, what we do is we place the patients in thigh-high compression stockings, which they must wear for 72 hours. I tell my patients, wear it for 24 hours, take them off quickly to shower, and then put them right back on again. It’s really important to keep them on for 72 hours. I tell them not to exercise for the first 24 hours, but after that, they can exercise as long as they keep the stockings on. After 72 hours, the stockings come off.
Melanie: Okay. So no exercise for just that 24 hours, and then the stockings can come off. Any creams or lotions, massage? Will any of that affect what you’ve just done for them?
Dr. Nitzberg: No, not really. Not that I'm aware of. You can put creams on your legs afterwards, but that’s not going to affect the efficacy of the treatment.
Melanie: So then outside of the sclerotherapy, what other treatments, if it’s a little bit more severe, do you do there at Summit Medical Group?
Dr. Nitzberg: Well, again, if you have varicose veins and if they’re not amenable to injection sclerotherapy and they’re really bothering you -- and when I say really bothering you, you have to oftentimes show the insurance company that you’ve been trying to treat these non-operatively, such as been wearing compression stockings for two to three months and taking pain medications, typically, to try to deal with the discomfort. And then oftentimes, patients come back with continued discomfort in despite the compression stockings, and then we move on to a surgical option. Typically, the surgical option is we want to get rid of what’s causing the problem. What’s usually causing the problem is that there is a very superficial vein in the leg called the great saphenous vein. And that vein has this one-way valve that keeps the blood moving back up to the heart. Arteries bring the blood down, the veins bring the blood back to the heart. That’s what circulation is. But oftentimes, the patients with varicose veins, the great saphenous vein, this very superficial vein that is just underneath the skin, has valves that are not working properly. So the blood is not only returning to the heart but it’s also refluxing or going back down the leg. When it does so, it pressurizes the little branches that come off the vein, and those veins, over time, become distended because of that back pressure, and they become varicose veins over time. So to treat this, you have to do something to the great saphenous vein. You have to either remove it, strip it, or you can take a laser, put it inside the vein, fire the laser, and close the vein down. That prevents further reflux. Essentially, you don’t take the vein out, but it stops the vein from refluxing. And then typically, what we do then is we make little incisions, what are called stab incisions, probably five or six-millimeter incisions, directly over the varicose veins, and we pull those out at the same time. So you’re doing two things. You’re getting rid of the varicose veins by pulling them out, but you’re also getting rid of the source of the problem, which is the great saphenous vein. And it’s important to realize you can do that. You can strip the vein out, you can close it down with a laser, because it’s not a vein that you need. There are plenty of veins in your leg. You’ll never miss this one particular vein if you treat it.
Melanie: So your body itself develops this collateral circulation and finds other ways to get around if you strip this one particular vein.
Dr. Nitzberg: Yeah. It’s not even really considered collateral circulation. It’s really the main circulation that everybody has. It’s called the deep venous system. That’s really what provides the majority of your blood return from your legs. So it’s just that it’s almost like the great saphenous vein is the collateral circulation. You certainly don’t need it.
Melanie: That is amazing information. In the last minute or so, Dr. Nitzberg, please give us your best advice for spider veins, varicose veins, and why the listeners want to come see you at Summit Medical Group.
Dr. Nitzberg: Well, the best advice is that there’s not a whole lot you can do to prevent these veins from coming or occurring other than change your relatives, if you know what I mean. It’s hereditary. But what you can do when you start to get these varicose veins is you wear compression stockings and you elevate the legs, then you can reduce or limit the number of veins you have, or at least the amount of distension that we see, and then maybe the discomfort that you will feel. I'm happy to treat patients with these problems. I will tell you there’s a lot of vascular surgeons who do this. I’m not the only one, but I’m happy to see patients at the Summit Medical Group about this problem that would like to come see me.
Melanie: And you gave great information, Dr. Nitzberg. Thank you so much. You’re listening to SMG Radio. For more information, you can go to summitmedicalgroup.com. This is Melanie Cole. Thanks for listening.
Lovely Legs for Spring
Melanie Cole (Host): Do you have unsightly varicose or spider veins? They can worsen over time and even become painful. My guest is Dr. Richard Nitzberg. He’s a board-certified general and vascular surgeon and the Vice Chair of Summit Medical Group Surgery. Welcome to the show, Dr. Nitzberg. Tell us about varicose veins and spider veins. What are they?
Dr. Richard Nitzberg (Guest): Well, there’s a gamut or spectrum of veins that people experience on their legs. The spider veins are the really tiny little veins. They almost look like a little spider’s web. They’re typically blue or green, and they’re not bulging. They’re flat on the surface of the skin, and they’re mostly unsightly. They don’t really cause a lot of pain or discomfort. The varicose veins, on the other hand, are those big, bulging green veins that actually hurt, especially when a patient is on their legs for a long period of time or standing for a long period of time. Sometimes after a woman’s menses, they’ll complain of the discomfort. Oftentimes, after exercise, because you’re pumping more blood to the leg, the veins become more distended. And when they become more distended, they’re more painful. So that’s sort of the gamut that one runs in terms of spider and varicose veins.
Melanie: What causes these, Dr. Nitzberg?
Dr. Nitzberg: Well, unfortunately, the biggest cause is hereditary. If your mom had them or your grandmom or even sometimes grandpa, they tend to pass this on, as one will, to their own offspring. There’s not a lot you can do to prevent these things from happening. Patients always say, “Well, maybe it’s because I cross my legs.” That’s more of an old wives’ tale than anything else. You really can't do much to prevent these other than try to get your legs up when you can, and if you can wear compression stockings, if you have a tendency towards these problems, then that might prevent them from getting worse. But other than that, it’s really mostly hereditary.
Melanie: Are there any risks or complications to having varicose and spider veins, Dr. Nitzberg? What red flags would you say would send somebody to the doctor about them?
Dr. Nitzberg: Well, there’s certainly no risk with spider veins. Spider veins primarily are cosmetic in nature. Varicose veins, the most common problem is really just pain and discomfort, which is not really a significant risk. In other words, you can live with your pain and discomfort, treating with elevation or with compression stockings if you so desire. But on occasion, varicose veins are even more prominent. Spider veins rarely can bleed, and that’s always scary when it occurs because it can be quite a bit of bleeding. You won’t bleed to death, but it can be a lot of blood. But that’s rare. You can develop ulcerations sometimes related to the varicose veins. You can also develop what’s called the superficial thrombophlebitis, which is essentially a blood clot that occurs in the superficial varicosity. It’s not life-threatening. It can't hurt you. If you recall, it’s what Richard Nixon had many, many years ago. You don’t even need to take Coumadin or an anticoagulant for that. It’s really just a nuisance, more than anything else, but it’s certainly not life-threatening.
Melanie: When would you come to see a doctor? And when you do, what treatments are available? Because you’re very uncomfortable from them or you really don’t like the way that they look, what are you doing for them?
Dr. Nitzberg: You kind of hit on it in terms of when they come. Most patients come because a) they don’t like the way they look, or b) they’re having a lot of pain and discomfort. Occasionally, they come for those other three problems: ulceration, thrombophlebitis, or bleeding, but that’s pretty rare. Most of them come because of the pain and the discomfort. And then it depends on what they have. For spider veins, spider veins are typically treated on a cosmetic basis with injections, primarily, and/or laser. I say and/or. I think the injection works much better. For instance, in our office, we have both injection and laser possibilities, and I tend to do injections more often because they work better. In terms of varicose veins, it just depends. It depends on how big they are. Sometimes they can be treated just with what’s called injection sclerotherapy. Sometimes I’ll just have patients wear compression stockings. But if they’re having significant problems, there are surgical options as well.
Melanie: And so how long does the sclerotherapy work for? Does it take more than one visit, or is it something that you keep coming back and, once it’s done, come back again and have them redone?
Dr. Nitzberg: The number of visits really depends upon the amount of spider veins you have. Everyone does it differently, by the way, but what we do in our office is we do a 15-minute session. Oftentimes, if you just have a moderate number or amount of spider veins, we can limit you to just one visit. But it’s not a hundred percent when you do it. It’s about maybe 70 to 80 percent effective. So oftentimes, patients are happy with that and then they don’t come back unless there is a recurrence. Typically over time, it could be three, four years, sometimes sooner, whatever process is causing the spider veins to occur continues. So we haven’t stopped that process. All we’ve done is gotten rid of the spider veins temporarily. Sometimes, patients never come back. Sometimes, they get one treatment and they’re good for a really long time or maybe even forever. But oftentimes, over a period of three or four years, if the spider veins keep coming back and they were happy with the result, they’ll come back for what we call a touch-up.
Melanie: What happens after the procedure, Dr. Nitzberg? Can they return to normal activity, exercise? How long do they have to wait? Do they wear pressure socks? What all goes on that recovery?
Dr. Nitzberg: Sure. The treatment is actually called compression sclerotherapy, so compression after the treatment is really important. Typically, what we do is we place the patients in thigh-high compression stockings, which they must wear for 72 hours. I tell my patients, wear it for 24 hours, take them off quickly to shower, and then put them right back on again. It’s really important to keep them on for 72 hours. I tell them not to exercise for the first 24 hours, but after that, they can exercise as long as they keep the stockings on. After 72 hours, the stockings come off.
Melanie: Okay. So no exercise for just that 24 hours, and then the stockings can come off. Any creams or lotions, massage? Will any of that affect what you’ve just done for them?
Dr. Nitzberg: No, not really. Not that I'm aware of. You can put creams on your legs afterwards, but that’s not going to affect the efficacy of the treatment.
Melanie: So then outside of the sclerotherapy, what other treatments, if it’s a little bit more severe, do you do there at Summit Medical Group?
Dr. Nitzberg: Well, again, if you have varicose veins and if they’re not amenable to injection sclerotherapy and they’re really bothering you -- and when I say really bothering you, you have to oftentimes show the insurance company that you’ve been trying to treat these non-operatively, such as been wearing compression stockings for two to three months and taking pain medications, typically, to try to deal with the discomfort. And then oftentimes, patients come back with continued discomfort in despite the compression stockings, and then we move on to a surgical option. Typically, the surgical option is we want to get rid of what’s causing the problem. What’s usually causing the problem is that there is a very superficial vein in the leg called the great saphenous vein. And that vein has this one-way valve that keeps the blood moving back up to the heart. Arteries bring the blood down, the veins bring the blood back to the heart. That’s what circulation is. But oftentimes, the patients with varicose veins, the great saphenous vein, this very superficial vein that is just underneath the skin, has valves that are not working properly. So the blood is not only returning to the heart but it’s also refluxing or going back down the leg. When it does so, it pressurizes the little branches that come off the vein, and those veins, over time, become distended because of that back pressure, and they become varicose veins over time. So to treat this, you have to do something to the great saphenous vein. You have to either remove it, strip it, or you can take a laser, put it inside the vein, fire the laser, and close the vein down. That prevents further reflux. Essentially, you don’t take the vein out, but it stops the vein from refluxing. And then typically, what we do then is we make little incisions, what are called stab incisions, probably five or six-millimeter incisions, directly over the varicose veins, and we pull those out at the same time. So you’re doing two things. You’re getting rid of the varicose veins by pulling them out, but you’re also getting rid of the source of the problem, which is the great saphenous vein. And it’s important to realize you can do that. You can strip the vein out, you can close it down with a laser, because it’s not a vein that you need. There are plenty of veins in your leg. You’ll never miss this one particular vein if you treat it.
Melanie: So your body itself develops this collateral circulation and finds other ways to get around if you strip this one particular vein.
Dr. Nitzberg: Yeah. It’s not even really considered collateral circulation. It’s really the main circulation that everybody has. It’s called the deep venous system. That’s really what provides the majority of your blood return from your legs. So it’s just that it’s almost like the great saphenous vein is the collateral circulation. You certainly don’t need it.
Melanie: That is amazing information. In the last minute or so, Dr. Nitzberg, please give us your best advice for spider veins, varicose veins, and why the listeners want to come see you at Summit Medical Group.
Dr. Nitzberg: Well, the best advice is that there’s not a whole lot you can do to prevent these veins from coming or occurring other than change your relatives, if you know what I mean. It’s hereditary. But what you can do when you start to get these varicose veins is you wear compression stockings and you elevate the legs, then you can reduce or limit the number of veins you have, or at least the amount of distension that we see, and then maybe the discomfort that you will feel. I'm happy to treat patients with these problems. I will tell you there’s a lot of vascular surgeons who do this. I’m not the only one, but I’m happy to see patients at the Summit Medical Group about this problem that would like to come see me.
Melanie: And you gave great information, Dr. Nitzberg. Thank you so much. You’re listening to SMG Radio. For more information, you can go to summitmedicalgroup.com. This is Melanie Cole. Thanks for listening.