Hidden Harm

Leg ulcers are a result of underlying venous disease.

Last November, Brenda Ryan noticed a small sore on her right leg near her ankle. She didn’t know what caused the wound, and didn’t think much about it. She treated it herself, but it didn’t go away. Instead of healing, it got larger and uglier. Brenda finally sought the advice of her family physician.

Photo by Fred Bellet.

The ulcer on Brenda’s right leg is completely healed.

“My doctor gave me some salve and wanted to keep an eye on it,” recalls Brenda. “When I went back the next week, the sore had gotten bigger. She decided to send me for a biopsy because she said it looked like skin cancer to her.
“I went to a local surgeon who did a deep tissue biopsy. She said it would be a couple of days before the results came back, but the following day, I called her. I told her the area was very painful and swollen. She said that was normal after a deep tissue biopsy.”
Brenda’s condition continued to deteriorate over the next few days. She struggled to get through a day of work as a server at a local restaurant. By the end of her shift, she could barely walk because of the pain and swelling. Her leg was also severely discolored.
“The sore on my leg was very painful. It was a short, stabbing pain,” she describes. “My leg was also very swollen. The surgeon and my family doctor put me in the hospital and gave me a strong IV antibiotic. I was in the hospital for almost a week, but the wound got worse.
“They sent me to a wound care clinic where they cleaned it, used different salves and tried every other kind of treatment, but nothing helped. After twenty-two weeks at wound care, the doctor there said, I think we need to send you to a vein clinic. Dr. Joyce has wonderful results with wounds like this that won’t heal.
Douglas H. Joyce, DO, of Joyce Vein & Aesthetic Institute in Punta Gorda understands that non-healing wounds, or ulcers, on the legs are often the result of an underlying disease of the leg veins. He combines his empathy and expertise in the Ulcer Center at JVAI, a unique center committed to patients who suffer with this facet of venous disease.
“During my first appointment, Dr. Joyce looked at the wound on my leg and said, I can fix this,” remembers Brenda. “He was so down-to-earth and so confident he could do something, it put me at ease.”
To help Brenda understand her condition, Dr. Joyce explained that there are two systems of veins in the legs. 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.
“Valves in the deep veins are designed to close tightly to keep blood flowing toward the heart,” he educates. “When the valves are not working properly, which is venous disease, pressure eventually builds up in the superficial veins.”
This pressure can lead to symptoms such as swelling, varicose veins and a feeling that the legs are getting progressively heavier. Over time, venous disease slowly worsens. Left untreated, it can lead to skin discoloration, thickening and, ultimately, ulceration.

Painting Over Mold

Dr. Joyce describes leg veins as a ladder, with one side being the high-pressure, deep veins and the other the low-pressure, superficial veins. The connecting perforator veins serve as the rungs in between. The perforators have valves that keep blood flowing from the low-pressure veins to the high-pressure veins.
“If those valves aren’t working properly, blood goes from the high-pressure side to the low-pressure side,” he explains. “When it does, it hits the veins under the skin at one point, so the pressure at that spot becomes extremely high.
“Because of this high pressure, the arteries can’t get fresh blood to the area, and they can’t take waste products out, so the cells begin to die. Then, all it takes is a small trauma – a nick, a cat scratch, hitting the side of a table while walking, anything that opens the skin – to create a wound. Some patients even get wounds that spontaneously open.”
A pioneer in treating all of the causes of venous disease of the leg, Dr. Joyce developed several treatment techniques, including single-needle laser ablation. This procedure is a noninvasive method of sealing the diseased veins responsible for advanced venous conditions. He used this technique to close the veins causing the ulcer in Brenda’s leg.
“My first vein procedure was at the end of May. I had six procedures in all,” says Brenda. “After the third one, I could see a difference. Dr. Joyce told me the treatment was working, just be patient. I said, You’ve already done more in three treatments than they did in twenty-two at the other place.
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. He corrects the underlying vein problem that is causing the wound. This allows the treatment provided by wound care centers to be successful and lasting.
“If a venous ulcer heals without fixing the vein disease that caused it, statistics show that up to forty percent may open back up in the first year,” reports
Dr. Joyce. “I tell patients it is like painting a wall that has mold on it. It looks great, but it does not last. One day, you walk into the room, and there are spots of mold coming out on the wall again. It is the same reason: You never fixed the problem underneath. Fix the real problem and you get a lasting result.Before and after images courtesy of Joyce Vein & Aesthetic Institute.
“Our approach at the Ulcer Center at JVAI is to find the underlying problem with the veins and do everything we can to fix it in the easiest way possible for the patient. And we’ve been very successful. Our cure rate is in the high ninety percent range.”

Miracle Worker

According to Dr. Joyce, Brenda’s was a classic case of underlying venous disease leading to a skin ulcer. She required laser procedures on multiple veins to correct her problem. Dr. Joyce performed six procedures on her and achieved positive results.
“After the sixth procedure, my wound was completely healed,” enthuses Brenda. “Now, the swelling is gone, and I have no pain. The discoloration on my ankle has faded, but Dr. Joyce said it will take a while for the redness and darkness to go away.
“My procedures were very successful. Every time we see Dr. Joyce on TV, my boyfriend tells me to stand up and salute him. He’s a miracle worker!
“I’ve recommended him a hundred times since my treatment. I tell people, If you have a sore on your leg that won’t heal, don’t even waste your time going to wound care. Go straight to Dr. Joyce at Joyce Vein and Aesthetic Institute!

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