Is It Insufficiency?

Vein disease is often misdiagnosed.

Lifelong educator John Rodgers, EdD, retired from his last position 21 years ago, but that didn’t stop the New York native from teaching. Before finally shelving his textbooks and moving to Florida in 2005, he dedicated additional years to enlightening young minds.

Dr. Ravi Sharma of Premier Vein Centers in Homosassa and The Villages treated Dr. John Rodgers and Robin Lesher for venous insufficiency using minimally invasive procedures.

The pain Robin felt in her legs is now gone.

“I started out my career as a high school mathematics teacher in New York City,” he shares. “I ended up a high school principal, and when I retired in 1996, I went to work teaching math in college. I was retired, but my wife is nine years younger than me, and she had a few more years to work, so I went back to teaching.”

When Dr. Rodgers and his wife moved to Florida, he decided he would take up golf to stay active. He purchased a set of golf clubs and took lessons. He enjoyed the sport, but began having trouble when he tried to play.

“I gained a lot of weight,” he states. “I weighed close to three hundred twenty pounds. I couldn’t bend over to pick up the golf ball. Then, my legs started to hurt, so I just didn’t play. My cardiologist referred me to Dr. Sharma.”

The cardiologist sent Dr. Rodgers to board-certified cardiovascular surgeon Ravi Sharma, MD, at Premier Vein Centers. In addition to Dr. Sharma’s expertise in vein disease and other vascular disorders, he also has extensive experience helping patients improve their overall health. That includes achieving and maintaining a healthy weight.

Since then, Dr. Sharma has chosen to devote his attention full-time to vein disorders. He no longer offers weight loss counseling.

Dr. Rodgers liked Dr. Sharma from the start and immediately felt confident in his skilled hands.

“My first meeting with Dr. Sharma was very pleasant, and I was very impressed by him,” he recalls. “I felt comfortable with him right away, especially because my cardiologist recommended him to me. I said to myself, Dr. Sharma must be a pretty good doctor if Dr. Walker recommends him.

“My first impression of Dr. Sharma was that he is a physician who is extremely knowledgeable and certainly cares for his patients. He explained everything as we went along, and he always had a joke or friendly remark. He became almost like a friend.

“In the space of a year, I lost sixty pounds, but my legs continued to bother me. Even after losing the weight, I still had pain. I couldn’t walk very well because my legs would ache. It often woke me up at night.

“My internist diagnosed it as sciatica, and was treating me for that. Then, I went to my podiatrist because I wear plates in my shoes, and the podiatrist said, You don’t have sciatica. You’ve got varicose veins. You should go see Dr. Sharma. I said, I’m already seeing him.

The next week, when Dr. Rodgers returned to Premier Vein Centers for his weight loss check-up, he saw Dr. Sharma about his legs. Dr. Sharma confirmed
Dr. Rodgers suffered from vein disease in both legs. He recommended endovenous laser ablation (EVLA) and microphlebectomy.

Animal Lover

Robin Lesher loves animals, and she enjoyed her job at an animal hospital outside of Chicago. But she’s certain being on her feet all day for 25 years contributed to the distressing leg symptoms she began experiencing five years ago.

“I stood on my feet doing everything around the animal hospital, assisting in surgery and in the lab, and putting patients in rooms,” recalls Robin, now retired and living in Florida. “It was an active job, but ten hours a day on your feet takes a toll.”

That included aching pain and swelling in her legs. These symptoms bothered her considerably but at that time, she chose to ignore the problem and live with the discomfort. Unfortunately, her condition got worse over time until recently, when it reached a point where she could no longer ignore it.

“I developed severe pain in my right leg around the back and side of my knee,” describes Robin. “It was so bad at night that it was difficult to sleep. I felt a pulling sensation, and my leg throbbed. I couldn’t walk or go shopping. I didn’t want to do anything except sit; it was too painful to do anything else.

“My ankles looked bruised all the time. The veins in my legs weren’t bulging out, but they were pretty bad. I’d put up with the swelling for so long that I didn’t appreciate just how much swelling there was. I finally realized I had to go to the doctor and have something done.”

Robin remembered noticing a vein center near her home called Premier Vein Centers. The facility looked clean and welcoming, so she decided to investigate its physician, Dr. Sharma. She was impressed by what she discovered.

“I researched Dr. Sharma online and saw he was a cardiovascular surgeon who decided to work with veins,” notes Robin. “I knew he must be very knowledgeable to be a cardiovascular surgeon. It made me very comfortable to know Dr. Sharma knows what he’s doing.

“He also has good reviews.”

To Robin, Dr. Sharma was just as impressive in person. He first gave her an ultrasound examination to determine if her problem was venous disease. He then described everything that was happening with her veins in great detail. The doctor recommended two procedures, EVLA and ultrasound-guided sclerotherapy (UGS), to treat her diseased veins, and he described everything in a way she could understand.

“Dr. Sharma explained that my veins are like a tree, and he wanted to treat the top of the tree trunk before taking care of the branches,” offers Robin. “He treated my upper thighs first; he closed the bad veins there.”

Backward Blood Flow

The human circulatory system is composed of a series of blood vessels. Veins are the blood vessels that return oxygen-depleted blood back to the heart. There are three types of veins: superficial veins, deep veins and perforating veins. Superficial veins lie close to the skin, deep veins lie in groups of muscles, and perforating veins connect the superficial veins to the deep veins.

When the leg veins cannot pump blood back to the heart, it is a condition called venous insufficiency. Chronic venous insufficiency (CVI) has multiple causes. Over long periods of sitting or standing, the blood in leg veins can pool. This increases the venous blood pressure and weakens the vein walls and valves, thereby causing damage to the valves. Damaged valves prevent proper blood flow back to the heart.

There are many signs and symptoms of venous insufficiency, including bulging varicose veins, swollen legs, aching, stinging, burning, itching, nighttime leg cramps, restless legs and/or thickening and discoloration of the skin of the ankles or legs. These are all indications that the veins are not functioning properly.

“It is important that patients who experience any of these symptoms have their veins assessed,” emphasizes Dr. Sharma. “Leaving the condition untreated can lead to more serious difficulties, including leg ulcers, infection and a breakdown of the skin.”

Venous insufficiency is more common than many people think, notes the cardiovascular surgeon. It is estimated that more than 30 million Americans suffer with symptomatic venous insufficiency. Venous vascular disease is five times as prevalent as peripheral arterial disease, or PAD, and more than two times as prevalent as coronary artery disease.

“Unfortunately, venous disease is underdiagnosed and, often, misdiagnosed, as in Dr. Rodger’s case, when his internist told him he had sciatica,” observes Dr. Sharma. “Many providers, even those with years of experience, don’t recognize the symptoms affecting the legs as relating to a vein problem and diagnose something else.”

Advanced Options

“Our patients are so relieved to find out there is no general anesthesia involved in our minimally invasive treatments, and they can resume activities right away,” says Dr. Sharma.

Premier Vein Centers offer a full range of more advanced, minimally invasive treatment options for addressing varicose and spider veins. These advanced treatments are performed in a comfortable office setting with little to no downtime or discomfort, resulting in a quick recovery and long-term results.

“Microphlebectomy is used to treat varicose veins using very tiny incisions to remove the veins, versus a stripping, which was a much bigger ordeal,” explains Dr. Sharma. “We use this in patients who have symptomatic, large veins in the leg.

“With this procedure, the incision is tiny – it’s the size of the tip of a scalpel – and we can do much more through the skin incision and deeper tissues without having to make that incision big. In the old days, doctors made big gashes across the leg, and it was very ugly, and people would have large scars. With this procedure, patients end up with tiny marks on the skin or no scars at all.”

According to Dr. Sharma, there are several other options available to treat venous insufficiency. He determines which procedures to use based on each patient’s symptoms and health status.Dr. Ravi Sharma of Premier Vein Centers in Homosassa and The Villages treated Dr. John Rodgers and Robin Lesher for venous insufficiency using minimally invasive procedures.

EVLA introduces a sterile laser fiber into the incompetent vein via a small puncture in the leg. Laser energy is delivered through this fiber, painlessly closing the vein in less than an hour, using local anesthesia. Both Dr. Rodgers and Robin underwent this procedure.

Spider veins, which are tiny, dilated blood vessels in the skin that become swollen with stagnant blood, can be treated with sclerosing injections to gently close the problem vessels. Dr. Sharma uses ultrasound-guided sclerotherapy to image the vein and guide his injections.

Premier Vein Centers provide a free initial consultation and accept most insurance, including Medicare.

Back in Action

Dr. Sharma chose EVLA and UGS to treat Robin’s venous disease. She was pleased with how he made each experience easy. During her ablations, he described what he was doing step by step and continually made sure she wasn’t in pain. That relaxed her and made her trust the doctor even more.

“Every couple of seconds, Dr. Sharma asked if I was alright. I think he really wants to know if his patients are having any discomfort. In fact, I have two tattoos, and getting them hurt worse than those procedures did.

“So far, I’ve had procedures done on my two upper thighs, as well as injections in the lower left leg. I still need to have my lower right leg done. Then, I’ll go back and have my legs checked to make sure everything is flowing wonderfully,” enthuses Robin.

The pain and swelling Robin suffered had restricted her mobility because it became too painful for her to be on her feet. But the EVLAs Dr. Sharma performed sealed her diseased veins and rerouted her blood flow through healthy veins. As a result, Robin experienced pain relief soon after the procedures.

“I was able to walk right away,” she comments. “Right after my vein procedures were done, I walked a couple of blocks, which I couldn’t do before. Now, I have no pain, and I walk a mile and a quarter every single day, sometimes twice a day.”

Robin couldn’t be happier with
Dr. Sharma’s care and the results of the vein procedures. Her only regret is having waited so long to check out Premier Vein Centers.

“I put up with the leg problems for five years, and that’s so sad,” she relates. “I could have had these simple procedures done years ago and felt this good.

“I’ve been telling everyone that
Dr. Sharma at Premier Vein Centers took care of my legs, and now I can walk and exercise. I’ve actually gotten up and painted my whole patio. I can do everything now that I couldn’t for years. And now that I’m active again, I’ve lost thirty-four pounds – and counting!”

Twice Is Nice

As with Robin, Dr. Sharma used two procedures to treat Dr. Rodgers’ venous insufficiency, but in his case, Dr. Sharma performed EVLA and microphlebectomy. The outcome, however, was the same with both patients.

Dr. Ravi Sharma of Premier Vein Centers in Homosassa and The Villages treated Dr. John Rodgers and Robin Lesher for venous insufficiency using minimally invasive procedures.

Dr. Rodgers shows off his legs by the pool.

“Dr. Sharma does one leg at a time,” reports Dr. Rodgers. “He did my left leg first so I would be able to drive myself home. Afterward, I had minor swelling, but I was already wearing compression stockings due to my atrial fibrillation. The stockings helped.

“I finished the whole course of surgery. The procedures weren’t painful. I sat there and watched Dr. Sharma do them. I thought they were fascinating.

“My legs are perfect. They feel great,” states Dr. Rodgers. “I have a few little scars that look like large freckles, but I have no pain. I haven’t had any pain since
Dr. Sharma did my first leg.

“Now, I sleep through the night with no problem. I used to have to sleep with an ice pack on my legs, but not anymore.”

While Dr. Rodgers has not returned to golfing or started any big exercise program, he does do some walking, now that he can do it without pain. He also keeps busy with other healthy activities such as swimming.

“We have our own swimming pool at the house, and we have a beautiful gym and pools within the development where we live,” he notes.

When he first met Dr. Sharma,
Dr. Rodgers was seeking a healthy way to lose weight. Since then, he has adhered to the guidelines he learned and maintained the weight loss he achieved with the doctor’s help. When he became concerned about the veins in his legs, Dr. Rodgers was already in the best place to get the care he needed.

“I recommend Dr. Sharma and Premier Vein Centers to anybody.”

“Both Dr. Rodgers and Robin were ideal patients in that they were ready to get rid of their leg pain, and of great importance to their success, they followed all after care instructions,” states Dr. Sharma.

FHCN article by Patti DiPanfilo. Photos by Jordan Pysz. Graphic from mkb


Print This Article
    • Premier Vein Centers

      Many people inherit vein disorders. The incidence is higher in women than men. In the United States, nearly 50 percent of the adult population suffers from painful and unsightly vein diseases. The most common forms are spider veins and va... Read More

    • Ravi Sharma, MD

      Ravi Sharma, MD, is board certified by the American Board of Thoracic Surgery. He completed his undergraduate studies at the University of Maryland at College Park and attended the University of Maryland Graduate School, Baltimore, before r... Read More