How to Find the Right Specialist

Joseph G. Magnant, MD, FACS, RVPI

Today, it is important for patients to take an active role in researching their medical care. Fortunately, the internet is a great resource that provides patients with information to research health care providers along with the current available treatment options.

Despite all the information regarding advanced medical treatments being readily available to patients through the wide variety of media including print, television and the internet patients can find themselves lost in the maze of provider and treatment options.

The recommendations from a primary care physician are very useful when choosing the right specialist. Primary care physicians have a broad exposure to patient problems and are a great source for specialist referrals. The primary care physician should be included in all patient correspondence and be informed about their patients’ test results and future treatment plans through ongoing communication from the specialist physician.

A good starting point when researching specialty providers is the practice’s website. The depth of content and the completeness of each physician’s training record are important aspects to review. From a practice website, patients should gather and determine what percentage of the practice is dedicated to the physician’s area of specialty training and whether that area is applicable to the patient’s specific health issues.

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What will you RESOLVE to do in 2016?

Joseph G. Magnant, MD, FACS, RPVI

As each New Year dawns, many of us spend the weeks or months preceding the turning of the calendar contemplating potential New Year resolutions. I have RESOLVED to renew and further my commitment to the education of the general public and physician community regarding the wide variety of presentations of correctable superficial venous insufficiency.

It is estimated that 35-40 million adults Americans suffer from significant venous insufficiency who present with symptoms such as painful varicose veins, swollen legs, skin discoloration, restless leg syndrome, nocturnal leg cramps and frequent nighttime urination. Until the year 2000, the only treatments for venous insufficiency were compression hose or stripping. Endovenous closure, which was introduced in 2000, has significantly changed the landscape for patients with vein. Since introduced, endovenous closure (the minimally invasive and effective procedure of sealing the leaky veins within the legs with a small catheter) has been used successfully to treat hundreds of thousands of patients, relieving their disabling symptoms prior to developing venous ulcers or bleeding.

Since the superficial venous system (rather that the deep system) is responsible for the majority of patients’ problems with advanced signs and symptoms of venous insufficiency, it seems only appropriate to offer patients thorough venous evaluation and definitive therapy earlier in the course of the disease process rather than making them suffer complications such as bleeding, ulceration and cellulitis. I would like to highlight an interesting patient that made a resolution to make their leg problems a priority.

C.D. is a 58 year old female who presented through a podiatrist (the 8th physician she had seen for her legs) for evaluation of venous insufficiency. She has been told by a number of physicians that she had “fat and swollen legs” but that since she did not have any visible bulging varicose veins, Venous Insufficiency was not a consideration. Clinically, her legs were swollen, red, tender and extremely tight to the point that she could not perform activities of daily living. She RESOLVED to search further for a curable cause and her podiatrist referred her for a venous evaluation. Her ultrasound subsequently confirmed severe superficial venous insufficiency. Other symptoms included severe leg cramps and nighttime urination. The endovenous closure was performed on both legs, 2 weeks apart and she returned for her post-op follow-up, smiling from ear to ear, with ankle bones she could actually see. The swelling had resolved and she remarked that she was wearing tennis shoes for the first time in nine months.

So… in 2016, will you RESOLVE to address the important issue of the health of your legs? RESOLVE to live without swollen, achy, tight, red legs. Make the RESOLUTION to live a life free from painful leg cramps, nocturnal urination and restless legs. We have extended the opportunity for patients and the general public to RESOLVE their leg complaints. Vein Specialists offers a personal virtual vein consultation on our websites weknowveins.com and eveinscreening.com. Take the first step from the privacy and convenience of your home.

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Orthopedic Pain and it’s relation to Venous Insufficiency

Fran, an active medical office manager for her husband’s OB-GYN practice, decided to retire near the Gulf waters in Cape Coral. Happy in her Florida home, Fran immediately became involved in her community. She found herself on the go all the time.

As she stayed busy with all of her activities, her knee began to swell and ache. It was getting progressively worse until it began interfering with some of the things she enjoyed doing.

“I was having terrific pain in my right knee, the right side of the right knee,” she describes. “I also had a pronounced lump in the back of the knee, and I was very uncomfortable. The pain was excruciating. I couldn’t even drive a car for any distance because I would have to keep stopping to get out and walk. I couldn’t climb up a flight of stairs. I couldn’t exercise. It really stopped all activities for me..”

The pain finally wore her down so she made an appointment with an orthopedic surgeon to investigate what she naturally assumed was an orthopedic problem. She also saw her podiatrist who was concerned that part of her problem might have been related to her venous disease.  She was referred to Vein Specialists for further venous assessment. Fran was shocked by what Dr. Magnant’s evaluation uncovered.

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Nighttime Urination? It could be your veins!

Find out how frequent nighttime urination can be related to venous insufficiency.

Frequent trips to the bathroom, especially at night, are often seen as a natural occurrence of either age or simply water consumption, and, because of this, are often ignored or seen as inconsequential.  Nighttime urination, however, can be the sign of a serious problem. Frequent nocturnal urination is a symptom of Venous Insufficiency.

Patients with venous insufficiency and high venous pressure will experience swelling in their legs due to water and protein (serum) leaking from their thin-walled veins into the surrounding tissue during periods of leg dependency such as sitting, standing, or walking. The serum that leaks out then returns to the venous circulation through the lymphatic system when the legs are even with or elevated above the level of the heart, typically when a person is lying down or sleeping. The hydrostatic pressure caused by a person’s height in a vertical position, the pressure that forces the fluid from the veins into the tissues in the first place, is not present when the body is in a horizontal position and tricks a person’s kidneys into thinking there is excess fluid in the arteries.

When serum mixes with the venous blood, a person’s kidneys then filter the excess water from the blood and store it in the bladder as urine. Once the bladder is full, sensory nerves alert the body to a need to urinate, and there is a heavy correlation between the amount of fluid accumulation in the legs and the number of times that a person has to urinate. While most people experience some form of edema in their legs or feet by the end of the day, having to urinate more than once during any given night could be the sign of a problem.

The onset of edema (swelling) in the legs due to venous insufficiency can be subtle and gradual, even taking years to develop noticeably, with frequent nighttime urination trips increasing over time. There are other behaviors that can cause excess fluids to be present in the veins and tissues, such as excessive salt intake and the use of certain types of stockings, but, if varicose veins are present, then it is probably safe to say that venous insufficiency is causing or at least contributing to a person’s nighttime urination trips.

If nighttime urination is disrupting your sleep and affecting your concentration throughout the day, then it may be time to seek treatment that could be related to venous insufficiency. Dr. Magnant of Vein Specialists in Fort Myers and Bonita Springs will be able to determine and diagnose the underlying cause of your nighttime urination, through minimally invasive treatment.

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Swollen, Achy Legs? It Could Be Your Veins!

Joan, a 45 year old cath lab scrub tech had been suffering with progressive leg swelling for at least 15 years. Although she did have a history of varicose veins in family, she did not have any signs of varicose veins, and had been told by a number of medical professionals that her excess weight was the main problem. Compression hose offered temporary relief for her. Exercise was difficult due to the heaviness, achiness and discomfort she had. Other symptoms included night time leg cramps and frequent nighttime urination. A detailed ultrasound evaluation confirmed severe bilateral great saphenous vein insufficiency and a subsequent radiofrequency endovenous ablation was performed on both legs 2 weeks apart with excellent results. She was seen for her 9 month follow-up recently and was elated with the relief of her heaviness and resolution of her night time urination.

Heart failure, kidney failure, excess salt intake and obesity are typically at the top the list of causes of swollen and achy legs. However, when one looks across the spectrum of patient ages, the most common and treatable cause of lower extremity swelling and achy legs is venous insufficiency, or venous reflux disease. Continue reading

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More Than Skin Deep

Thick, discolored or inflamed skin and wounds that won’t heal are visible signs of advanced, treatable venous insufficiency.

Recently a local stage performer in Lehigh Acres was taken aback by the large pool of blood that had formed at his feet as he performed on stage with his band. Swiftly, he was whisked away from the platform to the emergency room. Continue reading

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