Firehouse Effect

High venous pressure can lead to non-healing leg ulcers.

While preparing for work one day in 2007, Linda Ettinger mindlessly scratched her right leg over what she thought was a mosquito bite. A few moments later, she looked down and saw blood flowing from an open wound on her leg and gathering on the floor. Her husband took her to the hospital, where the wound closed. It eventually healed, but not for long.

Douglas H. Joyce, DO, at Joyce Vein & Aesthetic Institute in Punta Gorda, treated Linda Ettinger’s venous ulcer by treating her leg veins with single-needle laser ablation.

Following vein treatment, Linda is walking more than five thousand steps a day.

“Over the years, I saw several wound care doctors, but it was always the same story,” the 66-year-old New Jersey native shares. “They treated the wound with medicine and scraped away the dead skin. It would be fine for a while, but it kept coming back. It would heal, then open up again.

“The wound looked like somebody stuck a fireplace poker in my leg. It was pretty deep, and it was bright red and oozed infectious stuff. At one point, I was on antibiotics for a year. It felt like a hole burning in my leg. There was a lot of pain.

“I couldn’t sleep on my right side, so I had a lot of sleepless nights. I couldn’t swim or ride my bike, and I had a hard time walking because of my leg. I couldn’t even stand for more than ten minutes because it was so painful.”

Just when Linda was losing hope, her husband heard about Douglas H. Joyce, DO, at Joyce Vein & Aesthetic Institute in Punta Gorda. At The Ulcer Center at JVAI, Dr. Joyce treats leg wounds resulting from venous disease.
Dr. Joyce is a skilled vein specialist who combines compassion and expertise to treat patients with venous disease.

After evaluating Linda’s legs using ultrasound mapping, Dr. Joyce determined her wound, or venous ulcer, was related to leaking veins in her right leg, a form of venous disease.

“There are two systems of veins in the legs,” Dr. Joyce informs. “There are the high-pressure, deep veins in the middle of the leg, and the low-pressure, superficial veins near the surface of the skin. The two systems are connected by veins called perforator veins.

“Perforator veins have valves in them that allow blood to move from the skin to the deep veins during rest. When people walk, the deep veins are squeezed by the large muscles of the legs, and high pressure is generated to send blood toward the heart. The valves in the perforator veins are designed to close at that time to prevent the flow of high pressure blood outward to the delicate skin veins.

“If the perforator valves fail, high-pressure blood flows directly to the delicate skin veins causing the symptoms of venous disease. These include swelling, pain, chronic varicose veins, discoloration and ulceration.”

At The Ulcer Center at JVAI, Dr. Joyce uses leading-edge procedures and state-of-the-art technology to treat patients and give them the best chance at a positive outcome. That technology includes a procedure Dr. Joyce pioneered called single-needle laser
This procedure is a noninvasive method of sealing the diseased veins responsible for advanced venous conditions, including ulcers. He used this technique to treat Linda’s leg veins.

Under Pressure

The development of venous ulcers is all about pressure, Dr. Joyce stresses.

“The pressure in the superficial veins under the skin is very low,” he observes. “This is evident when a person suffers a cut on their skin’s surface. The cut bleeds a little bit then stops. The force in these outside veins runs at about 15mmhg (blood pressure measurement).

“The pressure in the deep veins, on the other hand, can be higher by a factor of twenty or more. When a person walks, the leg muscles squeeze the deep vein and the pressure increases dramatically to move blood all the way uphill to the heart. The pressure in the deep veins can be more than two times the blood pressure in the arteries.

“If the superficial veins fall under high pressure, the nearby arteries, which have a lower pressure, cannot perform their function of circulating fresh blood,” Dr. Joyce continues. “Fresh blood brings in oxygen to nourish the skin and removes waste products. If these processes cannot occur, skin cells begin to wither and die.

“The perforator veins run straight from the deep veins to the surface veins. When they become enlarged and start leaking, they act like a pressure washer against the skin. Arteries cannot compete against that pressure, skin cells cannot get nourished and die, and the skin opens up as an ulcer.”

“Dr. Joyce told me I had high-pressure venous disease,” Linda relates. “With that, my blood wasn’t flowing correctly going back to my heart, and because of the pressure, the blood flow was like a firehose against my skin. That caused the wound to open up.”

Sealing the diseased perforator veins with single-needle laser ablation turns off the firehose and normalizes the pressure in the superficial veins. Arteries can then function to bring oxygen and other nutrients to the skin, and venous ulcers begin to heal.

Miracle Steps

Dr. Joyce’s single-needle laser ablation had a tremendous impact on the debilitating effects of Linda’s leg ulcer. She’s amazed by the improvement in her condition.

“Since I’ve been seeing Dr. Joyce, it’s like a miracle,” Linda marvels. “When I first started going to him, I could barely walk. I got a Fitbit® for Christmas, and now, I’m up to five thousand steps. My husband can’t believe how much better I’m walking. And my sleeping is wonderful now.

Douglas H. Joyce, DO, at Joyce Vein & Aesthetic Institute in Punta Gorda, treated Linda Ettinger’s venous ulcer by treating her leg veins with single-needle laser ablation.

Before Vein Treatment

“I love baseball, and my husband treated me to a couple spring training games. We had to stand and wait until the box office opened. I stood for an hour and a half, and it didn’t even bother me. Before, I couldn’t stand for ten minutes.”

Dr. Joyce and his staff at The Ulcer Center at JVAI partner with their patients’ wound care centers to see the wounds to closure. Once Dr. Joyce treats a patient’s diseased veins, the efforts of the wound care centers are more effective. After her procedure, Linda returned for additional wound care.    

“Dr. Joyce’s treatment has definitely been successful,” she enthuses. “My wound is almost healed. The wound care doctor is now going to put a skin graft on it, but he wanted to wait until Dr. Joyce was done treating the veins in my leg. At my next appointment, I’ll get the graft, then I’ll be completely healed.

“Dr. Joyce is very gentle, and his staff is amazing. Going to The Ulcer Center at Joyce Vein and Aesthetic Institute was a great experience for me. I tell my neighbors, if they have sores on their legs, don’t wait like I did. See Dr. Joyce. He’s absolutely wonderful.”

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