YOUR VENOUS HEALTH NEWSLETTER

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Raymond Stevens
5 years ago
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1 YOUR VENOUS HEALTH NEWSLETTER In this issue: Featured Articles Getting Your Legs Ready For Summer By Steven Folstad, MD Pages 1 and 3 What is Phlebology? Pages 4-5 By Todd Hansen, MD In Every Issue Meet The Team Page 2 Get to know our staff and find out what they are working on to improve your care. CEAP Classification. Page 3 What Is? Pages 5-6 Learn the definitions behind the terminology we use. What Our Patients Are Saying.. Page 4 At Carolina Vein Associates we provide compassionate vein care in our state-of-theart facility, but don t take just our word for it, read quotes from our patients and discover why they chose us as their vein care specialists. Please check out our Facebook page for current events, specials, and even more tips on how you can keep your legs healthy! Brought to you by (704) Joe Knox Ave, Suite H Moorseville, NC Getting Your Legs Ready For Summer By Steven Folstad, MD I am frequently asked the question when do I need to come see you to get my legs ready for summer? Unfortunately, there is not a simple answer to that question. There are many factors that play into the decision of how early you should start treatments. Much of it will depend on how extensive your visible problems are, and if you have any underlying deeper vein disease. Many varicose veins, and spider vein clusters are caused by disease in the deeper non-visible veins. If the visible veins are treated without dealing with the deeper problems, the spider and varicose veins will often recur. Any deeper problems can be diagnosed quickly and painlessly with a duplex ultrasound. If clinically indicated, this can be performed in our office at the time of initial evaluation. In patients with only spider veins, and no other signs or symptoms of deeper disease, duplex ultrasound is often not needed. Duplex ultrasound is typically indicated in the following situations: Patients who have visible varicose veins (veins greater than 3mm in diameter), Any patient with achy, heavy feeling, or tired legs, especially when those symptoms are worsened with prolonged standing or sitting. These patients should have a duplex ultrasound regardless of the extent of their visible vein disease. Patients who experience leg swelling during the day, that improves or resolves at night while sleeping. Patients who experience restless legs at night, associated with any other symptoms or signs of vein disease. Here are a some other points of consideration when determining the timing of vein disease treatments: The usual progression of treatment is from deep to superficial, and from upper leg down to the lower leg. This means that any deeper vein problems would need to be addressed first, starting with the upper leg and moving downward. Spider veins are the most superficial veins and most commonly occur on the lower legs, that leaves them often the last veins to be treated. As a general rule, we treat deeper disease in one leg at a time. Deeper disease is most often, and most successfully, treated with endovenous laser therapy (EVLT). We can treat each leg on two Continued On Page 3

Meet The Team Todd Hansen, MD Treating people with vein disease has been some of the most consistently rewarding and enjoyable work of my medical career.

I am so proud of the team we have here at Carolina Vein Associates, and want to share with you the highlights of our recent work on developing our company Mission and Vision.

We deliver on this promise by providing the Highest Quality Vein Care in 3 areas of focus - through Patient Centered Care, Community Service, and Education.

Patient Centered Care is the buzzword of healthcare, and clearly is interpreted differently by various players in healthcare. At Carolina Vein Associates, we take an old-fashioned approach to this.

Absent from the exam room is the insurance company, ACA (Affordable Care Act), Hospital Administrator, or any of the many other entities with interests in the healthcare equation.

2 Meet The Team Todd Hansen, MD Treating people with vein disease has been some of the most consistently rewarding and enjoyable work of my medical career. It has become my passion to help people with vein disease to live with less pain, look and feel better, and be more active. I am so proud of the team we have here at Carolina Vein Associates, and want to share with you the highlights of our recent work on developing our company Mission and Vision. We exist To Improve the Lives of People with Vein Disease. We deliver on this promise by providing the Highest Quality Vein Care in 3 areas of focus - through Patient Centered Care, Community Service, and Education. In this issue I would like to shine a light on our version of Patient Centered Care. Patient Centered Care is the buzzword of healthcare, and clearly is interpreted differently by various players in healthcare. At Carolina Vein Associates, we take an old-fashioned approach to this. Patient Centered Care means that doctor and patient (not Provider or Consumer ) together decide the best approach to care. Absent from the exam room is the insurance company, ACA (Affordable Care Act), Hospital Administrator, or any of the many other entities with interests in the healthcare equation. We promise to offer you, our patient, the best care we know how to deliver. Working together, we can achieve the greatest results. Steve Folstad, MD I am very excited to be bringing comprehensive vein care to the wonderful people of the Lake Norman area. My family and I have lived in this area for close to 20 years, and we feel a very strong connection to the Lake Norman community. My partner and I have traveled the country perfecting the cutting edge techniques in vein care so we can offer the highest level of vein care to the people in our area. We are thrilled to have our new office open and accepting new patients. Mary Kay Hansen, MSN, FNP-BC Mary Kay is our sclerotherapy expert who brings over 16 years of nursing experience in emergency and trauma patient care. She is a certified Family Nurse Practitioner who enjoys helping people lead healthier lives. Providing cosmetic services allows her to help them also achieve the look they desire as well! Heather Barnette I am the office manager here at Carolina Vein Associates. I came into this job to do more than just manage an office. Some days I wear many hats, whether it's jumping in to help a coworker complete a task a little easier, assisting with procedures or helping a patient or patients family feel more relaxed and comfortable. I have even been known to go out at intervals to check on a waiting pet to ease a patients stress during a quick procedure. I started working in the medical field 17 years ago, not thinking it was something I would do for very long. I loved it more with every passing day. I believe in making our patients' needs my top priority. I love being part of the great team here at Carolina Vein Associates! If I can assist you in anyway please do not hesitate to contact me. Kathrine Comfort, RVT, RDCS I am a credentialed sonographer with over 19 years experience. I love what I do and believe that shows through in the treatment I provide to our patients. I continue to learn and grow as a sonographer through various CME (continued medical education) courses with a focus on venous disease and its treatment options.

Getting Your Legs Ready For Summer Continued consecutive days, but many people want to wait longer in between treatments.

It is very important that they wear compression stockings for one week after the procedure, and many people like to wait at least until they are done with the compression therapy on one leg before

This can be done with either sclerotherapy or microphlebectomy. The decision of which procedure is best for a certain patient is made at the time of the initial consultation.

Since we are now addressing problems that are visible on the surface of the skin, it should be expected that the treatment area will appear worse immediately after treatment, and gradually improve

For the treatment of spider veins, we use a combination of surface laser (a different machine than the EVLT laser) on the spider veins themselves, and sclerotherapy on the slightly deeper feeder

Like varicose veins, these are visible surface veins, and it should be expected that it will take a little time to realize the improved appearance of the treatment.

3 Getting Your Legs Ready For Summer Continued consecutive days, but many people want to wait longer in between treatments. Patients are up and walking immediately after an EVLT, and back to essentially normal activity the next day. It is very important that they wear compression stockings for one week after the procedure, and many people like to wait at least until they are done with the compression therapy on one leg before beginning the other. After any deeper disease is addressed, we are ready to begin to treat the more superficial and visible problems. The larger varicose veins are the next to be treated. This can be done with either sclerotherapy or microphlebectomy. The decision of which procedure is best for a certain patient is made at the time of the initial consultation. It is important that compression hose are worn for a week following either procedure, and the same timing preferences as with EVLT apply to varicose vein treatment. Since we are now addressing problems that are visible on the surface of the skin, it should be expected that the treatment area will appear worse immediately after treatment, and gradually improve over time. It should be planned for it to take four to six weeks for the area to develop the improved cosmetic appearance that we are seeking. For the treatment of spider veins, we use a combination of surface laser (a different machine than the EVLT laser) on the spider veins themselves, and sclerotherapy on the slightly deeper feeder veins that are often the cause of spider vein clusters. As with deeper vein disease, if the feeder veins are not treated as well as the spider veins, the spider veins will tend to recur. Like varicose veins, these are visible surface veins, and it should be expected that it will take a little time to realize the improved appearance of the treatment. Since these veins are much smaller than varicose veins, the healing time usually is shorter. An improved cosmetic appearance is usually seen within two to three weeks. To receive the maximum benefit of spider vein treatment, compression hose should be worn similarly to the previously discussed procedures. The area of spider veins that can be treated in one session is limited by the amount of sclerosant chemical that we can safely use at one time. In general, patients with a moderate amount of spider veins can expect to need between three and five treatments in order to reduce the spider veins to an acceptable amount. Patients with more extensive spider veins, or that want more complete resolution of their spider veins, will require more treatments. Spider vein treatment sessions can be done just a few days apart, but will need to be done on a different leg, or at least at a remote site on the same leg from the most recently treated areas. Three weeks should generally be allowed in between treatments in the same area. During the healing process of all of these procedures, it is very important that there is no unprotected sun exposure to the healing area! This is to avoid a permanent darkening of the healing tissue. Liberal use of high SPF, broad spectrum, sunscreen should be used until healing is complete. As you can see, the time that it will take to get your legs lake and pool ready will depend on many factors, such as the presence of any deep disease, and the extent of superficial disease. In general, the earlier you can get started, the more time there will be for complete healing. You cannot come in too early for an initial evaluation! We then can determine what all will need to be done, and can formulate a plan for getting it taken care of by shorts and swimsuit season. Call today to schedule an appointment; and Love Your Legs Again! CEAP CLASS What is CEAP? CEAP stands for clinical, etiology, anatomic pathophysiology. It is a method used to classify venous disease based on symptoms. See examples Class 1: Spider and/or reticular veins Class 2: Varicose veins. Class 3: Edema Class 4: Skin changes Class 5: Healed ulcers Class 6: Active Ulcer

What is Phlebology? What Our Patients Are Saying.. I am so glad I found Carolina Vein Associates to treat my varicose veins. The staff is so friendly and helpful.

4 What is Phlebology? What Our Patients Are Saying.. I am so glad I found Carolina Vein Associates to treat my varicose veins. The staff is so friendly and helpful. The doctors are easy to talk with and they answer all of your questions. They take the time with you to decide the course of treatment to get the best results for you. The office is very inviting and comfortable. It is equipped with all of the latest tools for the doctors and staff to understand your vein problem. I am totally happy with the continuing improvements that I see in the treatment of my varicose veins. I highly recommend you coming to Carolina Vein Associates for the treatment of your varicose veins. By Todd Hansen, MD As you look at your options for Vein Care, we hope this article will help you make an informed decision regarding your care. Phlebology is the study of vein disease, and a Phlebologist is the medical specialist with expertise in the diagnosis and treatment of problems related to the venous system. It is a bit confusing however, because of the close word association between Phlebology and Phlebotomy. Phlebotomy refers to the drawing of blood, and a Phlebotomist is a person trained to draw blood samples for tests or blood donations. A Phlebotomist has a High School Degree and has completed a Phlebotomy Training Program and usually some type of Certification. A Phlebologist is a Medical Doctor. Simply stated, Phlebology = Vein Care, and whether you use the term Phlebologist or Vein Specialist, you are referring to a Medical Doctor who specializes in the treatment of Vein Disease. How does one become a Phlebologist? Historically, Vein Care has largely been the red haired step child of medicine. No single specialty provides comprehensive training in vein disease and the full spectrum of treatment for its many aspects. For this reason, there are many different medical specialists who become Phlebologists, but no one specialty owns the pathway to becoming knowledgable and experienced in the treatment of vein disease. For instance, Dermatologists were some of the early users of injectable chemicals designed to close down or sclerose veins, and much of the science and technique of Sclerotherapy comes from the world of Dermatology. General & Vascular Surgeons were the specialists who developed expertise in Vein Stripping, but that procedure has essentially been replaced by modern day office techniques such as Endovenous Laser Ablation. The techniques involved in MicroPhlebectomy are largely those of minor surgery and were perfected first by Dermatologists. Cardiologists and Interventional Radiologists develop skills related to Ultrasound Guided Vascular Access, and many apply these skills to the treatment of Vein Disease. Other specialists that have developed expertise in the treatment of Vein Disease include practitioners from Internal Medicine, Family Practice, OB/GYN, and Emergency Medicine. Connie B. I am so happy with the results of my procedure. I am no longer suffering from daily leg pain. Stan D. Since there is not a defined pathway to becoming trained in the full complement of vein disease, practitioners are largely left to obtain their training and education through resources outside their primary specialty. Phlebology is a recognized medical specialty within the American Medical Association (AMA), however, it is not a recognized specialty within the American Board of Medical Specialists. Therefore, there is no official Board Certification in Phlebology. There are efforts underway to pursue this recognition as a specialty for board certification, and the American Board of Venous and Lymphatic Medicine is the single entity pursuing this status. They offer a standardized exam that is the only comprehensive test available specific to this area of medicine. How can an ER doc be a Vein Specialist? Thank you to everyone who helped make our toy drive a success! Steve & I have been practicing Emergency Medicine for almost 20 years. The practice of Emergency Medicine involves many procedures, done in uncontrolled and less than ideal circumstances on unstable patients. Transitioning to a Phlebology practice takes skills that an ER physician has, and utilizes them in a controlled and stable environment, on patients that are clinically stable who do not have life threatening problems. For those of you who appreciate sports analogies, if Emergency Medicine is Baseball, Phlebology is Softball. No less skill, but applied under different circumstances. Continued on Page 5

5 What Is Phlebology Continued. The knowledge base required to be a Vein Specialist adds to the procedural skill set the understanding of the anatomy and the various disease states related to veins as well as lymphatics (the other part of the circulatory system in the body that carries fluid back to the heart). This knowledge is largely obtained through self directed learning, educational conferences and participation in professional educational opportunities at leading clinics across the US and Internationally. What should I look for when seeking Vein Care? Look for a physician that is a member of the American College of Phlebology (ACP) or the American Venous Forum (AVF). These are two Professional Organizations that help to educate and support those interested in Vein Disease. While membership simply means that one has paid a fee to belong, it does indicate some level of commitment to a professional organization specializing in Vein Care. I would want my Vein Specialist to have at least this minimal level of participation. Look for a physician that is Board Certified in his/her primary specialty. Since no one can be Board Certified in Phlebology yet, we all come to Phlebology through another specialty. Board Certification in that area serves as another minimum level of competence and achievement. ABVLM Certification. Look for a specialist that has taken and passed the American Board of Venous and Lymphatic Medicine exam. This represents the only comprehensive test specific to Phlebology and indicates a commitment to the highest level of professional standards available. Ultrasound certification. Look for providers that have sought out ultrasound training and certified themselves as RPhS or RVT or RVPI - the most common certifications in ultrasound available to physicians. This again indicates a level of professional commitment setting providers and practices apart. IAC Vein Center credentialling. Standardized credentialling by a nonprofit organization reflecting meeting minimum standards of achievement by a practice. Why Carolina Vein Associates? Steve & I are both Board Certified in our primary specialty of Emergency Medicine. We are ACP members and we have both passed the written portion of the ABVLM exam. As our practice is brand new as of June 2014, we do not have the volume of patients yet to complete the certification process for ABVLM but expect to complete this in We have a certified Ultrasonographer (Kathy), and we will sit for the RPhS exam when we have a large enough patient volume. We are also on track to submit our application for IAC Vein Center Accreditation by the end of this year. What Is? Coagulate: to become clotted or congealed. Competence: In the normal vein no retrograde flow (reflux) is detected, either with Valsalva maneuver, with proximal compression, or with the release of distal compression. Absence of retrograde flow confirms adequate venous valve closure. CVI: Chronic venous insufficiency occurs when the valves in your veins fail to close properly and allows blood to flow backwards (reflux) rather than towards the heart as it should. Stagnant venous blood in the lower extremities may result in pigmentation changes, edema, pain, and ulceration. Dilatation: A vessel is stretched beyond normal dimensions. Duplex scan: An ultrasound examination. Technically speaking it is an ultrasound technology that combines two types of imaging processes, two-dimensional B-mode imaging and time velocity spectral analysis. This allows us to see inside your veins and to determine if blood is flowing in the proper direction. Dysesthesia: Abnormal sensations on the skin, such as feelings of numbness, tingling, prickling, or a burning or cutting pain. Edema: A local or generalized condition in which the body tissues contain an excessive amount of tissue fluid. Erythema: Reddening of the skin. Incompetent: Unable to perform natural function. Used to refer to venous values which no longer close completely, permitting blood to flow in a backyard direction (reflux). Muscle Pump: A mechanism to direct blood from the lower extremities towards the heart. The contracting muscles of the leg, especially the calf.

In the venous system of the lower extremity, stagnant blood flow as the result of immobility contributes to venous thrombosis.

6 What Is.? Continued Phlebitis: Inflamation of a vein. Rubor: Redness; term used to describe inflammation. Rupture: Tearing apart; bursting. Stasis: Refers to the stagnation of blood flow; cessation of normal blood flow. In the venous system of the lower extremity, stagnant blood flow as the result of immobility contributes to venous thrombosis. Stagnation of venous blood in the extremity because of valvular dysfunction results in pigmentation changes and ulceration. Thrombus: An intravascular blood clot. If the clot is in one of your deep veins it is referred to as DVT (deep vein thrombosis). Tortuous: Twisting or turning of the vessel. Venous: Pertaining to the veins. Drs. Steven Folstad and Todd Hansen are committed to improving the lives of people with vein disease through three distinct pathways, patient centered top shelf vein care, community service, and education. As part of their commitment to community service our physicians are pleased to announce that in addition to the Carolina Vein Associates clinic they will begin providing vein services to those in need in our community. Stayed tuned for more information We believe that being an informed patient is one of the best things you can do for your health. Our goal in providing this free informative newsletter is to help educate our community about venous disease and its treatment options. If we can assist you further please do not hesitate to call our office!

Chronic Venous Insufficiency Compression and Beyond

Disclosure of Conflict of Interest Chronic Venous Insufficiency Compression and Beyond Shawn Amyot, MD, CCFP Fellow of the Canadian Society of Phlebology Ottawa Vein Centre I do not have relevant financial