Light on His Feet

Laser energy treatment relieves weighty leg disorder.

Degeneration caused John Darnell’s spinal discs to begin collapsing, placing pressure on his spinal cord and nerves. To ease the pain that resulted, John tried a number of treatments, including physical therapy and surgery. The pain, however, outlasted all attempts to relieve it.

Dr. Kai McGreevy of McGreevy NeuroHealth in St. Augustine treated John Darnell for venous insufficiency and varicose veins using endovenous laser ablation (EVLA).

John Darnell

“I had several treatments on my back, including two surgeries by a spine surgeon, and still had pain,” John confirms. “I was going to my family doctor, and he referred me to a specialist who began treating me for the pain in my back.”

John’s doctor referred him to Kai McGreevy, MD, a board-certified neurologist and pain management specialist at McGreevy NeuroHealth in St. Augustine. Dr. McGreevy uses a variety of techniques to relieve his patients’ pain.

“Initially, I was treating John’s back pain using medial branch nerve blocks, which provided some relief,” reports Dr. McGreevy. “We have now completed those nerve blocks, and we’re close to performing radiofrequency ablation (RFA) on his spinal nerves, which is the next step in his back treatment.

“Prior to starting those treatments, however, we did a full medical history and physical on John, and it was at that time that he relayed to us that he had been experiencing a little heaviness in his legs.

“Many times, those kinds of symptoms can be attributed to the spine, but upon inspection, I saw he had discoloration and swelling in both legs. He then told me that he had been experiencing cramping and fatigue as well.”

“When Dr. McGreevy first noticed my legs, he said, “They don’t look good,” John confirms. “He mentioned the discoloration and told me, That’s not a tan. It’s a circulation problem. Your legs are holding blood. He told me I had varicose veins, which surprised me because I didn’t have any bulging veins on my legs at all.

“My ankles swelled, particularly in the morning when I woke up and started walking, but as the day went on, I really didn’t notice it as much. I guess with activity, my blood started circulating in my legs. But when I would lie down in bed at night, the swelling would build up. I also had cramps in my legs, but it wasn’t a continuous problem.”

As part of the body’s circulatory system, leg veins have the job of pumping blood upward, against gravity, toward the heart. They get help from the power of leg muscle contractions. To further assist with this task, there are a series of one-way valves in leg veins that keep the blood from flowing in reverse, or refluxing.

“With age, heredity or long hours of sitting or standing, these valves can weaken, and blood can flow backward and collect in the legs and ankles, causing symptoms,” describes Dr. McGreevy. “This condition is called venous insufficiency.”

A Common Condition

Venous insufficiency is a very common condition. 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.

Symptoms of venous insufficiency include pain, aching, swelling, heaviness, nighttime cramps, restless legs, discoloration and, in later stages, skin ulceration, but it’s “hugely underdiagnosed,” asserts Dr. McGreevy. Symptoms are often attributed to other disorders.

“Symptoms of venous insufficiency, the things that can be felt by the patient, can result in sensory changes such as numbness, tingling, weakness and fatigue,” he states. “These are all things patients describe to me every day when I examine them and perform nerve conduction studies.

“These symptoms may appear neurologic at first glance, but there’s no perfect box they fit into, so I don’t make assumptions that they’re caused by nerve injury.  If I test and discover these symptoms are not nerve related, they can be generated from multiple sources.

“If these symptoms are accompanied by visible signs such as swelling in the legs, I look at other possible sources. I have to rule out a cardiac condition such as heart failure, as well as a liver condition, protein imbalance and other disorders that can lead to leg swelling.”

In the absence of those sources, Dr. McGreevy continues, there’s a high index of suspicion for venous insufficiency, the treatments for which are generally covered by insurance. They’re covered not just for pain relief, but also for prevention because there are complications that can occur later in life that are very expensive to treat.

To diagnose venous insufficiency, Dr. McGreevy performs a Doppler venous ultrasound examination that allows him to see the flow of blood from the legs toward the heart. In John’s case, the simple, noninvasive exam revealed significant venous insufficiency in both legs.

Dr. McGreevy responded by recommending John wear compression stockings for about four weeks to help eliminate the swelling and heaviness in his legs. The stockings had little effect, however. At that point, Dr. McGreevy knew a different course of action was necessary.

Painless Rerouting Procedure

The new treatment plan for John’s legs included a procedure called endovenous laser ablation, or EVLA, in which the doctor introduces a sterile laser fiber into the problematic vein via a tiny puncture in the leg.

During EVLA, laser energy is delivered through this fiber, gently collapsing and sealing the vein. Blood flow from the sealed vein then reroutes through other, healthy veins in the leg, which reduces the impact of venous insufficiency on the patient.

“EVLA relieves the symptoms, including pain, swelling, fatigue, itching and weakness,” notes Dr. McGreevy. “It also improves the aesthetics of the legs, reducing any discoloration and breakdown of the skin, as well as the appearance of varicose and spider veins.”

John describes the EVLA treatments as painless and says they begin with an attendant “rubbing my skin with a solution to deaden the pain. Then, a technologist puts needles in my leg. He had a scope that traced the vein Dr. McGreevy wanted to block off, then he injected it with numbing medicine.

“After that, Dr. McGreevy came in and performed the laser treatment. There was a little bit of a burning sensation, but it was bearable. Afterward, they wrapped my leg in ACE™ Bandages. I had the treatment on a Thursday and had to keep the ACE Bandages on with compression until Sunday, then I could take the bandages off.”

Looking, Feeling Better

“We performed EVLA on both greater saphenous veins in John’s legs, and he experienced significant physical improvement,” Dr. McGreevy says. “John was pretty amazed by how much better his legs felt as well. He had reduced discomfort in his legs with less fatigue, swelling and cramping.

Dr. Kai McGreevy of McGreevy NeuroHealth in St. Augustine treated John Darnell for venous insufficiency and varicose veins using endovenous laser ablation (EVLA).

John’s vein treatment at McGreevy NeuroHealth was “ABSOLUTELY” successful.

“Sometimes, when we perform EVLA, it takes a little while for the results to be fully realized by patients. In John’s case, however, he had a very quick response. Within a week of performing EVLA on his right greater saphenous vein, he indicated he’d already started to feel a difference in his right leg.”

John says that his right leg didn’t look much better that Sunday after his first EVLA treatment, but confirms that it did look and feel much better by the following week, when he returned to McGreevy NeuroHealth to have the treatment on his left leg.

“My right leg cleared up miraculously,” John raves. “It was very clear and had lightened up considerably compared to the leg
Dr. McGreevy hadn’t treated yet. When I first went into the office, the receptionist said, Look what happened here. I walked into the little staff area, and everybody looked at my right leg and said, Wow!

“I looked at my leg and said, Gee, I really did have a problem. I didn’t know the problem with heaviness in my legs was that bad, but since I had the procedures on my varicose veins, my legs are a lot lighter and I can walk much better. I must have gotten used to the heaviness. I don’t have the swelling anymore, either.

“And all this time, Dr. McGreevy is still treating my back pain.”

John is impressed by Dr. McGreevy and his staff at McGreevy NeuroHealth. He finds the neurologist to be knowledgeable, kind, understanding and worthy of his trust.

“Over the years, I had a knee replacement and a broken ankle that was due to my back and loss of balance,” offers John. “I went to physical therapy for both of those conditions. Nobody noticed I had a problem with my leg veins except Dr. McGreevy.

“My EVLA procedures were ABSOLUTELY, in capital letters, successful. I recommend EVLA for varicose veins, and I recommend McGreevy NeuroHealth and Dr. McGreevy. I have complete confidence in him.”

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    • McGreevy Neuro Health

      Your neurological health is nothing to worry about when you visit McGreevy NeuroHealth, conveniently located between Saint Augustine and Jacksonville, Florida. Their facility hosts a qualified interventional pain physician who is also a board-ce... Read More

    • Kai McGreevy, MD

      Kai McGreevy, MD, is board certified in neurology and pain medicine by the American Board of Psychiatry and Neurology. His medical training includes completion of a neurology residency at the University of California, San Diego, and an interven... Read More