Understanding Vein Health

[00:00:03] Pete Waggoner: Hello and welcome to beyond the checkup brought to you by Stelli’s health, where neighbors care for neighbors. I’m Pete Waggoner, ready to guide you to a healthier, happier life. Today we’re here and happy to inspire and explore as you thrive in your health journey. So let’s dive right in with, we have three providers, Dr. Jason Halverson, Dr. Dale Lawrence, and Dr. Teresa Devine to talk about our topic today, which is veins. And there’s a lot to get into, so we will get into the podcast right away. First of all to the three of you. Hello and welcome aboard. 

[00:00:36] Dale Lawrence: Good afternoon. Hi Pete. Thanks. 

[00:00:38] Pete Waggoner: Thank you. So before we get into like the meat and potatoes of what we’re talking about, why are veins and vein health so important to our bodies?

[00:00:48] Jason Halverson: I guess I’ll start with that. Veins are actually an important part of our vascular system. I think most of us would, we think about vessels, blood vessels, we think about how important our heart is, and what our arteries do because [00:01:00] that’s the main place where we get blood and then oxygen delivery to important things like our brain and our kidneys.

[00:01:07] Jason Halverson: You know, our muscles to make us move, but the second half of that vascular system is really the veins and without the veins, blood doesn’t get back to where we’re at, right? So we pump out from a large aorta and then it pumps into successfully smaller vessels until you have these little tiny capillaries.

[00:01:25] Jason Halverson: Or maybe one blood cell goes through at a time, and then they transition into the veins. The trouble with that vein part is that there’s no active pumping mechanism at that point, uh, where our heart pushes it out. Our veins are suddenly at the mercy of gravity. So this is part of the reason why they’re more important to having good vein health.

[00:01:43] Jason Halverson: It helps get that blood flow back to our heart so it can pump it back out again. 

[00:01:47] Pete Waggoner: That is something I never knew really specifically, so that’s very helpful and I think that’s going to help us get into the next steps here. And we’re start first with the most common vein conditions and things that [00:02:00] folks should be aware of.

[00:02:01] Pete Waggoner: How would you classify those as being, you know, are there a lot and what’s the most common? What should we be watching out for? 

[00:02:08] Jason Halverson: I think probably the most common, right, common things that, you know, everybody would know, probably knows the terms very commonly varicose veins and spider veins. So most people see the, you know, big, ropey, lumpy, twisted veins that might show up on our calf or on our thigh.

[00:02:26] Jason Halverson: Those are probably the biggest ones that people most find most ugly, and oftentimes painful. And then spider veins, they’re really kind of that. They look like little cobwebs, potentially, they’re, uh, smaller veins, often without symptoms. But then you have other, you know, varicose veins can become painful or swollen.

[00:02:44] Jason Halverson: It can result in veins causing leg swelling, your foot swelling, or cap or ankle swelling. And then as these things progress, I mean, other vein disease things include skin changes. So we have chronic venous insufficiency or chronic vein [00:03:00] insufficiency where you have, you know, that gravity has taken over and we can’t actively get blood flow back up.

[00:03:06] Jason Halverson: And you start to see, often as you might see, that it’s just pigmentation on the leg or people start getting discoloration and then skin texture changes. And eventually, the most worrisome thing about this is those skin texture changes can then become ulcers or people, you know, sores, these kind of wounds that just don’t, don’t heal.

[00:03:24] Pete Waggoner: So those are related to vein issues then. 

[00:03:26] Jason Halverson: Yep, they’re all vein issues might be some other things, but that’s most commonly we see those, we think you probably have something wrong with all your veins function. 

[00:03:33] Pete Waggoner: So when we speak of varicose veins or spider veins, so we can visually see those and we now visually know what the differences of those are.

[00:03:41] Pete Waggoner: What do those actually, or how do they impact the functionality? Well, are there a difference between those or is that just a cosmetic thing? 

[00:03:50] Dale Lawrence: The difference between varicose veins and spider veins, varicose veins is kind of a general term, for veins that aren’t working properly, just generally. But usually we use that term for [00:04:00] veins that are bigger. Bigger veins that are usually located in the legs, those are the ones that we, we see, and, you know, as Dr. Halverson spoke of, they can kind of be ropey, sometimes they’re blue, or discolored. 

[00:04:12] Dale Lawrence: Whereas spider veins are tiny, tiny blood vessels in the skin. And the problem is the same, the veins aren’t functioning properly. That’s why we can see them in either circumstance. But really the difference is the caliber of the vein, the size of the vein.

[00:04:27] Dale Lawrence: That’s what differentiates spider veins from varicose veins. 

[00:04:31] Pete Waggoner: Are there symptoms that come along with vein problems that people should watch for? Obviously, we know the visual, but is there anything you can have in terms of feeling as well in that regard? 

[00:04:42] Teresa Devine: Yeah, symptoms of venous insufficiency or vein problems that people can be on the lookout for are if you have like aching, if you have the visible signs of vein disease, the things that we’ve talked about like varicose veins, skin discoloration, wounds [00:05:00] that don’t want to heal, rashes, scabs, a lot of people also describe a heaviness that their legs just feel heavy and uncomfortable.

[00:05:09] Teresa Devine: Someone once said, uh, to us that it felt like tree trunks. Just kind of having to lug those around. A lot of people will get swelling in their ankles, especially the legs, the feet. Some people get restlessness, like a feeling that they want to keep moving their legs. Some people get cramping.

[00:05:25] Teresa Devine: So those are a few of the things to be looking out for. 

[00:05:28] Pete Waggoner: Can I ask a personal question on that whole part? It’s interesting because I’ve heard about the restless leg and you know, kind of that feeling and I sometimes I’m not sure if I’m just thinking about it and then I want to move it, or if that’s the case.

[00:05:42] Pete Waggoner: So how can you differentiate between maybe something that’s a little psychological, but actually reality, in either way, should you come in and get that looked at? 

[00:05:50] Teresa Devine: Yeah. Restless legs and even swelling, a lot of the symptoms I described, there are a lot of reasons why people can have them, not just vein disease.

[00:05:58] Teresa Devine: So if someone has [00:06:00] restless legs, it might not have anything to do with their veins. But when we put the whole picture together. And people have multiple of these symptoms with the visual symptoms or signs of vein disease. That’s what kind of leads us in that direction. But some people have breastless leg syndrome for a variety of other reasons.

[00:06:16] Teresa Devine: That can be, you know, anemia or other issues. But I would say if it’s something that’s more significant, persisting, you know, not just when you’re thinking about it, if it’s stopping you from falling asleep at night, kind of impacting your life, then it’s definitely time to come into your doctor to talk to them.

[00:06:33] Pete Waggoner: Okay. So there’s, there’s some obvious things that are lifestyle impacting where people would know that. How about those lifestyle changes? Is there anything you can do to prevent any of these things from occurring? We always hear it, everything I asked, the number one thing I always hear is diet, but I’ll be curious to hear what the three of you have for this one.

[00:06:52] Jason Halverson: Wow, you could probably make the list then since you’ve heard these before, this is true, like the, the lifestyle changes are thinking about these things, sometimes can [00:07:00] be very helpful at preventing the difficulties for veins, or even making them be less severe. Certainly there’s, genetics play a big factor in it, but there’s, are things that we have.

[00:07:10] Jason Halverson: And like you already mentioned, weight maintenance is a serious, factor for veins, right? So we talked earlier, veins don’t have any pressure, right? There’s nothing pushing pressure out of the vein at that point. Right. And so if we have extra body mass, it’s going to more readily compress these very thin pliable vein walls and obstruct the vein from, from coming back.

[00:07:31] Jason Halverson: This is why the regular exercise, you know, the more walking and activity that we’re doing, helps improve circulation, you’re moving the muscles and you’re actively pumping blood flow there. Probably the easiest thing in the world is elevating your legs, because you can sit there and do nothing.

[00:07:45] Jason Halverson: You just keep them up a little bit, if you have like a job, or maybe you’re standing all day, almost everybody, even if they don’t have pain troubles, will come back in, you put your feet up a little bit, they should just feel better because they don’t have gravity on there. 

[00:07:57] Jason Halverson: There’s also compression stockings. [00:08:00] So these are things that, in the past, like, not that people don’t hate them now, but people used to really hate them because all they ever had was ugly old grandma socks, right? They might be, you know, white or tan. But now if you go, go check on Amazon or wherever, Google search, compression stockings, you can get all sorts of polka dots and stripes and, you know, things to match your, whatever your mood is for the day.

[00:08:23] Jason Halverson: So, um, it helps a little bit. And you might often people see, I see people running all the time wearing them. Long distance runners sometimes feel like their legs are more energized just by doing that. And then last thing is just make sure you keep good care of your skin, right? If there’s dryness or things, that are starting to impact the integrity of your skin, making sure that things are clean and moisturized can sometimes go a long ways just to help your skin be better.

[00:08:49] Pete Waggoner: So what I’m hearing is, is if you, uh, put one of those leg sleeves on like an NBA player, you can pull it off. If someone could design that, they’ve got a million dollar business right there. [00:09:00] Hey, I’m just looking like I’m in the NBA now. What kind of treatment options then do you do, typically for vein issues?

[00:09:08] Dale Lawrence: Well, Pete, what used to be available for people when they had vein issues was something called vein stripping. And lots of people know an aunt or a grandma who had vein stripping done years ago. They all hated it because it hurt, it didn’t heal very fast, and a lot of times, it didn’t fix the problem.

[00:09:26] Dale Lawrence: The reason it didn’t fix the problem is they would go in and see the vein specialist, it was then oftentimes a vascular surgeon, and they would kind of eyeball and take a look and see, okay, that looks like where things are. Then they bring them into surgery and they’d eyeball them again. And then they take out the vein that they thought was the problem.

[00:09:44] Dale Lawrence: But no one ever, there was no technology that allowed them to actually see if that was the vein that was causing problems. Fast forward to the early 2000s, and technology changed. We were able to start treating varicose veins non [00:10:00] surgically. And, as a result, we, started using ultrasound to evaluate the blood flow in people’s veins. So we can actually when someone thinks they have a vein problem, they come talk to us. We’ll set them up for an ultrasound on the ultrasound tech. We’ll look at the blood flow in their veins in their legs and see if the blood is going the right way. When I say the right way, I mean up towards the heart.

[00:10:24] Dale Lawrence: Oftentimes, if there’s a problem with the veins, if they’re dilated, when they start to dilate the function, they don’t function as well. There’s little valves inside there. And when the, when the veins dilate, the valves don’t close right. And gravity will pull that blood back down into the legs. And if we see that on the ultrasound, that’s something called venous reflux or venous insufficiency.

[00:10:45] Dale Lawrence: And that is a reason then to go ahead and do treatments. Treatments that we have available now, if you’re having problems with one of the big veins in your legs, and we see that there’s reflux on the ultrasound, we can use [00:11:00] radio frequency to go in and burn the veins, and that helps kind of, shut them down.

[00:11:06] Dale Lawrence: Sometimes instead of radio frequency, people can use a laser, which delivers heat to the inside of the vein and damages it and causes it to shrink. Some places have started using a medical grade glue, essentially, and it closes the vein down, it just seals it shut. And if we’re talking about the spider veins or the smaller veins, you can inject a chemical irritant into it, even something as easy as hypertonic saline, a really concentrated salt water that irritates the inside of those blood vessels. And when that happens, they shrink down and it shuts off. And it’s pretty easy to do those treatments now. 

[00:11:41] Jason Halverson: I just, expand on, Dr. Lawrence, you made a really good point about prior to having ultrasound to evaluate where the problem was, people just had the symptoms treated. And often times these symptoms are just these bulgy, nasty, ugly veins that we see, and you strip those out, but [00:12:00] that’s not the problem.

[00:12:00] Jason Halverson: Those are the symptoms. The problem is really deeper within the leg at a vein, often the great saphenous vein is a place where there’s commonly veins. Vein insufficiency, that’s pushing that backward pressure in and causing the downstream parts to, dilate it. I know you often talk to your patients about it being the Mississippi, right?

[00:12:19] Jason Halverson: We close up the top of the Mississippi River, and then it takes away all the pressure downstream, because the problem is really, you know, the swampy part way down in Louisiana. That’s just the symptom. But the problem is all the water rushing down downstream from that. That’s it.

[00:12:34] Jason Halverson: And my other thing, the other thing is like, uh, you talk about sclerotherapy, people often think that they’re going to do that when they come to see me. They’re going to do this sclerotherapy, like a week before their son’s wedding. Usually, you want to start planning on doing your, if you want to get rid of your spider veins for the summer, you want to wear shorts or capris, you probably want to be doing that in January, February, and March so that your legs can recover and heal from that and start living great.

[00:12:59] Pete Waggoner: Well, that was [00:13:00] partially my next question is how long are these treatments? Is it over a course of time? And then clearly, if you want to cosmetically look better, you’re going to have to wait a little bit, it’s not going to be in a day or a week or whatever. So how long is a typical treatment?

[00:13:14] Teresa Devine: When someone comes in and has a venous ablation, which is what we do when you heat down to close the vein, that’s the problem vein, like the great caffinous vein, that procedure, people start to feel better, sometimes within days even, but we would expect them to start to feel some relief within a couple of weeks, and definitely by a month.

[00:13:36] Teresa Devine: The symptoms can continue to improve even up to about four months after the procedure. Sometimes those skin changes are not as quick to recover, but the swelling and the visible varicose veins are improved really quickly after the procedure. That procedure specifically is not a cosmetic procedure.

[00:13:55] Teresa Devine: We do it for people’s symptoms, but as kind of a [00:14:00] nice side effect, the varicose veins do oftentimes look smaller because again, you’ve taken off the pressure of the blood flowing into them. So then they’re just kind of softer and less visible and less apparent. 

[00:14:12] Teresa Devine: Things like the sclerotherapy Dr. Halverson was talking about, that’s the more superficial vein, so that’s what he was referring to. 

[00:14:19] Pete Waggoner: Are there any side effects or risks associated with the treatments we’re discussing here?

[00:14:23] Teresa Devine: So during the procedure, you can expect to feel needle pokes. So there is a little bit of discomfort, but that’s usually really well tolerated. Most people do well with that. After the procedure, there will be some bruising. You can think of it kind of like getting an IV. Lots of people have had blood drawn or had an IV placed before.

[00:14:41] Teresa Devine: Sometimes you get a lot of bruising, sometimes you get a little bit. So it’s the same thing. You may have a little or a lot of bruising. The, chance of bleeding during the procedure is pretty minimal. We make a very small incision, so the bleeding is pretty small. Infection, we really don’t see that as a side [00:15:00] effect, but it is always a possibility.

[00:15:01] Teresa Devine: We use all sterile equipment, so making sure that there isn’t any bacteria on the skin or anything like that. Sometimes people will have a little bit of numbness around the site where we enter into the leg, but that oftentimes goes away with time as well. There is a really rare side effect of possibly getting a blood clot after the procedure.

[00:15:22] Teresa Devine: That’s more related to if you’re not moving around afterward, when you’re sitting still and the blood isn’t moving, then it can create a clot. That’s one of the reasons why we always make sure we do follow up ultrasounds for patients. If that were to occur, then we can make sure that we get them on the right treatment of medications to make sure that that’s taken care of.

[00:15:42] Teresa Devine: This procedure generally gives good results in symptom management for a long period of time, but it’s definitely not guaranteed to fix everything forever. Veins can have trouble down the road, and other veins can start to be a problem as you get older and things change. 

[00:15:59] Pete Waggoner: I [00:16:00] assume this is an outpatient situation too, is that correct?

[00:16:03] Teresa Devine: It is, yep. We do it right in the clinic, in an outpatient procedure room. You’re awake during it. It takes, you know, not too much time, less than an hour for sure. 

[00:16:12] Pete Waggoner: Wow. Okay. So then as far as early diagnosis and determining this, does that make, it’s probably an obvious question, but how do you know to diagnose it early and how important is that in vein conditions?

[00:16:27] Jason Halverson: Probably as with most everything, uh, medical, the earlier you recognize something is happening, the better your chances are of creating, for sure short term, but also long term improvement to the problem. And particularly with, uh, you know, veins, because the symptoms are often very subtle. They start a little bit at a time, right?

[00:16:50] Jason Halverson: So veins, troubles happen a lot more for women than men. And oftentimes, it starts out a little bit with the first pregnancy, [00:17:00] and then maybe you have a second pregnancy a little bit worse, and perhaps you have a job where you spend a lot of time standing. And the trouble with, uh, our humans is that we adapt so well to things.

[00:17:10] Jason Halverson: So we just get used to there being achy, heavy pains. We think we might be just getting a little bit older, but those, if you start talking to your friends who don’t have any troubles, like, I don’t have that problem. You might say, okay, well maybe there is something going on, and then it’s worthwhile coming in, talking to medical professional who knows some things about veins and says, you know what, I think you would benefit from getting an ultrasound. Because certainly if you wait longer, like some things you talked about before the complications, if you start to get skin texture changes, or an ulcer or a sore that develops, then that’s a harder problem to deal with, right?

[00:17:47] Jason Halverson: We can fix the vein, and then the ulcer may heal better or more readily, but you’re still going to have skin texture changes, and there’s going to be discoloration, and you’re going to end up having [00:18:00] residual effects of that. And then sometimes even if you start to do things early and recognize it we could say, okay, I’m I know now that I have pain insufficiency, I have seen what’s happened to my grandmother’s legs, or my aunt or my neighbor like, you know what, I’m gonna do I’m gonna refocus myself on exercising more regularly, watching my weight and diet, and just doing those quality of life things to help minimize progression. 

[00:18:24] Pete Waggoner: So, Dr. Halverson, one of the things you mentioned, I think, earlier, and you alluded to it again with grandma here, genetics definitely plays a role if you see it, obviously, it’s, you got a shot, right? So, it doesn’t hurt to keep your eyes open to what your family history is, correct? 

[00:18:39] Jason Halverson: Yeah, absolutely. I think it’s, I don’t know if you guys would say, but I think it’s uncommon for me to see somebody, um, who has troubles with their veins that doesn’t have a mom, dad, aunts or uncles or somebody else who has been experiencing those, right?

[00:18:54] Jason Halverson: Because we, you know, we’re, we’re on the outside, like we’re on the inside. So if you look a lot like your mom and she’s got vein [00:19:00] troubles, you know, you’re probably inherit the same, whatever it is that causes the valves to go bad or your collagen to be a little bit weaker. All those things are, they’re determined for us.

[00:19:09] Jason Halverson: Doesn’t mean you’re going to be stuck, but uh, it does mean it places you at higher risk for sure. 

[00:19:14] Pete Waggoner: Well, you can at least have your eyes open. You know, it’s, it’s always not a bad idea to be aware of that. Two more questions. This one is just sort of a generic one. So, uh, I have friends that are what I would call very veiny, let’s say, you know, it’s like the muscle down the bicep, that type of thing, or they have them in their legs.

[00:19:35] Pete Waggoner: And so sometimes you’re not sure what’s going on in the leg there. How do you tell the difference between what we’re speaking of with what the varicose and the spider veins things look like from a person that’s very veiny? I guess I don’t, can’t think of a better word to say it, but. 

[00:19:51] Teresa Devine: So if you’re looking at a normal healthy vein, but it’s just more prominent, that’s different than an unhealthy ropey varicose [00:20:00] vein or spider vein.

[00:20:01] Teresa Devine: Got it. Just the visual appearance of it. 

[00:20:04] Jason Halverson: Yeah. I think veins have a lot of, you know, they’re like a road, they might have some bends and forks in them too, but a diseased vein or one that’s non functional, it’s like, like blowing up a balloon and it gets all wrinkly and squiggly and it’s got all sorts of bulgy parts to it.

[00:20:20] Jason Halverson: It’s like, that’s, that’s a lumpy vein. That should not be like that. Some people just have veins close to the surface and some are thinner. But you know, you can tell if it’s not a smooth, you know, nice tube like vein, there’s something wrong with it. 

[00:20:32] Pete Waggoner: It’s pretty obvious is what you’re saying. So you can tell, okay.

[00:20:36] Pete Waggoner: Final question for the three of you. We spoke a little bit about how things were earlier. And then now, uh, there’s obviously things you’re doing now. Are there any advancements that you’re seeing being brought in beyond what you’re working with today that gets you, uh, intrigued and excited?

[00:20:52] Dale Lawrence: Well, I’d say the radio frequency or the heat and the laser treatments, that’s kind of the, the new, gold [00:21:00] standard in treatment for veins and vein problems. The newest thing would be the the medical grade adhesive I spoke of earlier, sealing off the veins, it allows you to target smaller places. So that may be where things are headed, in the future, but I think people should know that whatever we offer them now, it’s way better than what grandma or their aunt had to endure in the seventies and eighties, and even before that, 

[00:21:30] Pete Waggoner: My grandma went through it.

[00:21:31] Pete Waggoner: So when you guys brought that up, I was like, Oh, I know exactly what we’re talking about here. So it’s incredible when you look back to our years, you know, things were even advancing in the seventies and eighties, but I mean, it’s nothing compared to what’s happening now. And it’s, I mean, my favorite part about doing these podcasts is I learned so much more about what’s going on in the healthcare industry and we can focus it down into specific areas such as this. Because all of this [00:22:00] impacts certain people differently. And everybody has something they’re going to have to deal with at some point.

[00:22:05] Pete Waggoner: So, I find it very helpful and we’ll just do a quick around the horn for the three of you before we wrap up, if there’s anything you want to add to close out the show. 

[00:22:13] Jason Halverson: I guess, uh, I would say if you think you have a concern and you’re not sure that you, you know, want to go see somebody, you know, say a vascular surgeon or a vein clinic or vein specialist, virtually any family physician or internal medicine physician that are doing, you know, what most people call primary care, they’re going to be able to help evaluate you and tell you if they think that there’s something that you should consider getting evaluated or I’ll talk to you about doing other, the lifestyle mitigation improvement problems that we have. So this is a common problem. Everybody would say knows a little bit, something about it, but that’s a good place to start with somebody that, you know, well, as your physician. 

[00:22:49] Pete Waggoner: Excellent, 

[00:22:50] Dale Lawrence: I’d echo again, that this is not a, this treatment doesn’t have to be scary.

[00:22:55] Dale Lawrence: This is not a scary treatment. It’s something that we can take care of for [00:23:00] people in the office, in the matter of an hour, an hour and a half. So it’s not insurance does cover it. As long as you have symptoms and you have insufficiency on the ultrasound, insurance will cover it. So, if you’re interested or you’re worried about it, you should talk to us.

[00:23:17] Pete Waggoner: Look at Dr. Lawrence just tearing down the barriers to coverage. This is fantastic. That’s great stuff. Dr. Devine, do you have anything to add? 

[00:23:24] Teresa Devine: Yeah, I think like Dr. Halverson said, talking to your primary care doctor, if you have any concerns and some things you can get started on right away and wearing those compression stockings, elevating your legs, staying active, so that if things do progress where you can kind of say that you’ve already tried some of the more straightforward things, then you’re kind of one step ahead by that point.

[00:23:44] Pete Waggoner: Great stuff to the three of you. Thank you so much. And that’s going to be a wrap for today’s episode of beyond the checkup brought to you by Stellis Health, where we believe in neighbors, caring for neighbors. I’m Pete Waggoner thanking each of you for joining us on this journey to better health. 

[00:23:59] Pete Waggoner: Thanks [00:24:00] again to Dr. Jason Halvorson, Dr. Dale Lawrence, and Dr. Teresa Divine. Remember your journey to wellness doesn’t stop here. We’re always here to support guide and inspire you and be sure to reach out to your Stellas health provider, for your personalized care. 

[00:24:14] Pete Waggoner: Don’t forget to subscribe to beyond the checkup for more health insights and stories. Share this episode with friends and family, and let’s spread the word on living healthier, happier lives together until next time, stay healthy, stay connected and continue to thrive. Thanks for listening so long, everybody.