Stuck On Excellence

Expertise, manner considered when choosing physician to treat legs.

Annette* began her career with Johnson & Johnson at its subsidiary Ethicon, where she attached microscopic needles to tiny sutures used during eye surgery. When Ethicon cut back its workforce five years into her tenure, Annette transferred to Johnson & Johnson’s Band-Aid plant.

“I ran the high-speed production line,” the 63-year-old New Jersey native shares. “The Band-Aid material came in one big roll, which I threaded into the machine. The machine cut the Band-Aids into three sizes and put them into boxes, which were then weight checked and sealed. I placed the finished boxes on a skid, took the skid to the warehouse and started again.”

Annette’s jobs at Johnson & Johnson were perfect for her because she likes to work with her hands, even during her free time.

“I’m a really crafty person; I enjoy doing crafts,” she reports. “I used to do needlepoint and cross-stitch, but now I’m into Zentangle, which involves drawing various designs. I may draw a flower and then keep doing the entire page with flowers, or I could divide the page into three or four different patterns. I love it because it makes me feel comfortable.”

Annette worked at the Band-Aid plant for a little more than 10 years before Johnson & Johnson closed it and moved operations to South America. Instead of a layoff, Annette took early retirement at 56. Two years later, after her husband retired, they moved to Florida.

“We have a nice home in Florida in The Villages®,” Annette reports. “I love it. My neighbors are excellent; they’re like family. We have holidays, including Christmas, together. One neighbor will host Thanksgiving and one will have Easter. We make it like a family gathering because our kids are scattered all over.”

For years, Annette’s legs have been peppered with spider veins, small blood vessels that become damaged and are visible on the surface of the skin. Unhappy with their appearance, Annette twice had her spider veins treated while living in New Jersey. Recently, she began experiencing other symptoms in her legs.

“I began to feel a lot of pain in the back of my left leg,” Annette recounts. “I thought maybe it was a blood clot, but I kept letting it go. I said, It will get better, but instead it got more painful. I didn’t have bulging veins on my leg, but there were a few visible veins below my left knee. My ankles were also swelling a little.

“It didn’t matter if I was being active or doing nothing, I still felt that pain in my left leg. It was there if I walked a lot, and it was there at night when I watched TV and put my legs up on the recliner. It was scary.”

Scary enough to eventually prompt Annette to seek medical attention. She chose to visit Ravi Sharma, MD, a board-certified cardiovascular surgeon at Premier Vein Centers who impressed Annette with his previous treatment of her husband’s bulging varicose veins.

Dr. Sharma, who has expertise in blood vessel disorders affecting the legs, has offices in Homosassa and The Villages. During Annette’s first visit, Dr. Sharma ordered an ultrasound that showed a number of her leg veins were leaking and disabling the proper flow of blood back toward Annette’s heart, a condition called venous insufficiency.

“Dr. Sharma found one major vein in my left leg that wasn’t working properly and a big vein in my right leg that was affected,” Annette reports. “Then he said, This is what we have to do to fix the problem, and recommended a laser procedure.”

Damaged Valves

“The venous insufficiency that Annette was suffering from occurs when deep leg veins, which lie in groups of muscles, cannot pump blood back to the heart,” Dr. Sharma describes. “Chronic venous insufficiency has multiple causes.

“The blood in leg veins can pool after long periods of sitting or standing. This increases the venous blood pressure and weakens the vein walls and valves, thereby damaging the valves. Damaged valves prevent proper blood flow back to the heart.”

Venous insufficiency has many signs and symptoms, indicators that the veins are not functioning properly. Signs, which can be seen, include bulging varicose veins, swelling, and thickening and discoloration of the skin of the ankles or legs. Symptoms are felt, and they include throbbing, aching, stinging, burning, itching, nighttime leg cramps and restless legs.

“If patients are experiencing any of these signs and symptoms, it is critically important that they have their leg veins assessed,” Dr. Sharma contends. “Leaving the condition untreated can lead to more serious complications, including leg ulcers, infection and a breakdown of the skin.

“And when seeking a physician for care, it is crucial that people choose surgeons who specialize in venous diseases and only venous diseases. I recommend staying away from physicians in large practices that offer a wide variety of services and perform venous treatment as a side service. The physicians people choose should also be experienced in the advanced procedures available to treat venous diseases.

“In addition, they must also express genuine concern and compassion for their patients. Physicians with these qualifications achieve the best outcomes.”

Based on her husband’s experience with Dr. Sharma, Annette was convinced he met those qualifications and more.

“Dr. Sharma is very knowledgeable,” she reports. “I can ask him any question, and he knows the answer. It helps that he’s a cardiovascular surgeon. I figured if he can work on the heart, he knows all about veins. And he’s very easy to talk to. My husband felt very comfortable with him, and so do I.”

Insignificant Incisions

To address varicose and spider veins, Premier Vein Centers offers a range of advanced, minimally invasive treatments. These options include microphlebectomy, endovenous laser ablation (EVLA), sclerosing injections and VenaSeal.

Microphlebectomy has replaced vein stripping, an outdated, more invasive procedure during which doctors removed the large veins by making big gashes across the leg, often leaving sizable scars.
“With microphlebectomy, the incision is tiny – about the size of the tip of a scalpel – and we can do much more through that small incision,” Dr. Sharma assures. “And with this procedure, patients end up with tiny marks on the skin or no scars at all.”

EVLA is performed using a sterile laser fiber that is introduced into the incompetent vein through a small puncture in the leg. Laser energy is then delivered through the fiber, painlessly closing the vein in less than an hour, using local anesthesia.

Sclerosing injections are used to treat spider veins.

Dr. Sharma uses ultrasound-guided sclerotherapy (UGS) to guide the injections that gently close the problem vessels.

VenaSeal is a non-thermal closure system that relieves symptoms by delivering small amounts of a specially formulated medical adhesive, or “super glue,” to the diseased vein. This permanently seals the vein. This procedure does not require multiple needle sticks, and in some cases, support stockings are not necessary.

Using his expertise, Dr. Sharma determines which procedures will work best based on each patient’s symptoms and health status. These advanced treatments are performed in a comfortable office setting and result in little or no downtime and discomfort.

“Our patients are often very relieved to discover that there is no general anesthesia involved in our minimally invasive treatments,” Dr. Sharma says. “And they are happy to learn that they can resume activities right away following the procedure.”

Premier Vein Centers provides a free initial consultation and accepts most insurance, including Medicare.

“It Doesn’t Hurt”

Using EVLA, Dr. Sharma sealed two incompetent veins in Annette’s left leg and one vein in her right leg. He is still treating her residual spider veins with UGS, but Annette is very excited about the results of the completed treatments.

“My legs feel great,” she raves. “I have no problems with them and I’m doing everything now. I can walk up and down steps. I can walk distances, and it doesn’t hurt. I walk every day, and I try to do five miles when I walk. I don’t have any pain when I sit down to watch TV and put up my feet. And the swelling in my ankles is gone.


“My legs feel great.” – Annette


“I still have some spider veins, but they’re OK. As long as I don’t have pain, I’m not worried about spider veins.”

During Annette’s procedures, Dr. Sharma engaged her in conversation as he worked, which eased Annette’s anxiety.

“Dr. Sharma talked to me, and I talked back to him as well,” she confirms. “He and his assistant had me giggling about this and that the whole time, which I found very calming.

“I would recommend Dr. Sharma to anybody because he’s a very good doctor. He’s friendly and has a great attitude. He always has a smile and something nice to say. The same is true for his staff. All of them are excellent.”

*Patient’s name changed at her request.
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    • 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