Fresh Legs

Laser procedures heal venous ulcers, eliminate swelling.

Jonathan Wagner became disabled from a back injury 13 years ago. His last job was with a concrete company for 21 years. Jonathan wasn’t injured on the job; he was injured when he tripped over something at his home. But he worked for 10 years with intense back pain.

“I had three back surgeries and a device called a spinal cord stimulator implanted in my back to help with the pain,” recounts Jonathan, 59. “I don’t use the stimulator anymore because I’m not experiencing as much pain as I was. Today, medication alone gives me a good quality of life. Everything I try to do, I can do.”

But Jonathan lives with other health issues in addition to his damaged back.

“I have breathing problems, which isn’t surprising since I smoked all my life,” he shares. “I go to a lung doctor, do breathing exercises and take medication for that. I also have chronic cancer in my lymph nodes and bones, but the doctors assure me that I’m not going to die anytime soon.”

Around the time Jonathan hurt his back, another problem surfaced; his legs began to swell terribly. Jonathan believed the swelling was due to excess salt in his diet. To ease the swelling, his doctor restricted his sodium intake and Jonathan wore compression stockings. As soon as he took off the stockings, however, his legs swelled up again.

“The swelling was so bad that my legs blew up,” Jonathan describes. “My feet were so swollen that they looked like big balloons with little nubs sticking out of them. Those little nubs were my toes. The pressure on my legs from the swelling made them ache.

“If I nicked my ankle and got a sore, it wouldn’t heal. There were a couple of sores that I had for over a year. I even went to a wound care center, where they used skin grafts and all kinds of medications to try to get them to heal.”

Recently, Jonathan learned about Douglas H. Joyce, DO, a board-certified vascular surgeon at Joyce Vein & Aesthetic Institute in Punta Gorda. Dr. Joyce specializes in the diagnosis and minimally invasive treatment of leg vein disorders. At The Ulcer Center at JVAI, Dr. Joyce uses specialized procedures to treat the underlying causes of venous ulcers, a complication of severe venous disease in the legs.

“The sores on my legs started healing after Dr. Joyce performed his vein procedures.” – Jonathan

“I called Dr. Joyce’s office and asked what they do,” Jonathan recalls. “Everything they told me was exactly the same as what was going on with me. I didn’t realize the sores and swelling were being caused by the same problem, so I made an appointment to go see them.”

“One of the first things Dr. Joyce did after he examined me was use a diagram to explain in layman’s terms how all leg veins have valves that help blood get to the top of the body. He said that when blood is pumped upward, they act as check valves keeping the blood from going backward in the veins. It was quite an education.

“I learned that sometimes, those valves get damaged. When they do, the blood that gets pumped up the vein, goes right back down the vein and stays in the legs. The legs then swell up from all the extra fluid, and that’s what keeps the sores from healing. They stay open due to the fluid pressure coming from the veins.”

Class Act

Jonathan’s visit to Dr. Joyce came off a recommendation from the Virginia B. Andes Community Clinic, a health clinic in Port Charlotte that provides care to disadvantaged individuals and those
without insurance.

“I work with the Virginia B. Andes Community Clinic to treat people with vein problems at no charge,” Dr. Joyce states. “Every once in a while, they identify a patient who really needs our care such as Jonathan, whose legs were in terrible shape.

“When he first came in, there were large ulcers on his legs that were inflamed, infected and draining. He had the acute skin changes that are indicative of Class 6 venous disease, which is the most serious stage of the disease.”

Jonathan reports that he has “normal legs” since Dr. Joyce performed the vein procedures.

In a person with Class 0 venous disease, there are no symptoms, no visible veins, according to Dr. Joyce. A person with Class 1disease will have spider veins, a mostly cosmetic problem associated with surface veins that may suggest another problem beneath the surface.qq

Sufferers of Class 2 venous disease will have varicose veins, and in a person with Class 3 disease, there is swelling in addition to the visible veins. In people with Class 4 disease, the skin changes color, usually turning a brownish hue and the skin thickens.

With Class 5 venous disease, the patient has an ulcer that heals, either with treatment or by itself, and in Class 6, ulcers form that do not heal unless a venous intervention is performed. That’s the stage where Jonathan was.
“We evaluated Jonathan’s legs using ultrasound and identified the veins that were not working properly,” Dr. Joyce observes. “The valves in those veins were allowing high-pressure blood that is supposed to stay in the center of the leg to short circuit out to the skin, increasing pressure in his skin veins and causing the ulcers.

“We used single-needle laser ablation to treat Jonathan’s perforator veins, the veins that connect the high-pressure deep veins to the low-pressure skin veins. Leaky perforator veins are almost always present in people with serious venous ulcers. We used standard laser ablation on Jonathan’s long veins that weren’t working correctly.”

Standard laser ablation involves inserting a fiberoptic laser catheter all the way into the vein and then slowly bringing it back out over the entire course of the vein, sealing it. Single-needle laser ablation places the needle in the center of the perforator vein. The laser is then turned on to seal the leak.

“Single-needle ablation is much more precise,” Dr. Joyce clarifies. “We can direct the laser anywhere we want because of the way the energy is delivered. Where standard ablation closes off the whole length of the vein, single-needle ablation is like spot-welding to seal a vein.”

“Normal Legs”

“Dr. Joyce performed six or seven procedures on one leg and instantly the swelling went down,” Jonathan reports. “He then performed five or six procedures on the other leg. That stopped the swelling in my legs, but my feet were still swollen, so he ordered another ultrasound. Through that he found two more bad veins, one on each side. He performed procedures on them, and that stopped the swelling in my feet just like that.”

Dr. Joyce used standard laser ablation and single-needle laser ablation to treat Jonathan’s venous ulcers. This treatment plan succeeded because it eliminated the root cause of his ulcers, severe venous disease.

“The sores on my legs started healing after Dr. Joyce performed his vein procedures,” Jonathan testifies. “Now, there’s nothing. No sores. No swelling. Just normal legs like everyone else’s. I haven’t had any problems since the procedures.

“The color of the skin on my legs is still a little different than normal skin.  Dr. Douglas Joyce at Joyce Vein & Aesthetic Institute in Punta Gorda treated Jonathan Wagner’s severe venous disease and venous ulcers using standard laser ablation and single-needle laser ablation.

Dr. Joyce assures me that over time my old skin cells will come off and new skin cells will grow and replace them. In the meantime, he suggests that I use lotion to keep my skin from drying out.”

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