Goodbye Leg Pain

Laser energy repairs damaged veins.

Washington, DC native Albert* owned construction businesses in Maryland and New Hampshire, but he wound up retiring from AT&T in 1989. Seven years later, he moved to Florida, where his spinal discs began to collapse and place pressure on his spinal cord and nerves.

To ease the resulting pain, Albert tried a number of treatments, including physical therapy and surgery. The pain, however, outlasted all attempts to relieve it.

“I had several treatments on my back, including two surgeries by a spine surgeon, and still had pain,” Albert 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.”

The specialist Albert’s doctor referred him to is 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.

During their initial consultation, Dr. McGreevy learned from Albert that in addition to his back pain, he was also experiencing heaviness in his legs, an issue that can be the result of problems with the spine. Upon further inspection, however, Dr. McGreevy found that Albert’s legs were also discolored and that he’d been experiencing swelling, fatigue
and cramping.

“When Dr. McGreevy first noticed my legs, he said, “They don’t look good,” Albert recalls. “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,” Dr. McGreevy describes. “This condition is called venous insufficiency.”

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 Albert’s case, the simple, noninvasive exam revealed significant venous insufficiency in both legs.

Dr. McGreevy responded by recommending that Albert 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 new course of action was necessary.

“I sat down with Albert and discussed his entire scenario with him,” the doctor notes. “We developed a game plan for his leg veins.”

Symptom Reliever

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

“My right leg cleared up miraculously. It was very clear and had lightened up considerably compared to the leg Dr. McGreevy hadn’t treated yet.” – Albert

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,” Dr. McGreevy informs. “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.”

Albert describes the procedure as painless.

“After rubbing my skin with a solution to deaden the pain, a technologist put needles in my leg,” he explains. “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.”

Dr. McGreevy performed EVLA on the greater saphenous veins in both of Albert’s legs. The result, the doctor says, was an almost immediate and quite significant improvement in the condition of Albert’s legs.

“Sometimes when we perform EVLA, it takes a little while for the results to be fully realized by patients,” Dr. McGreevy says. “In Albert’s case, however, he had a very quick response. Within a week of performing EVLA on his right greater saphenous vein, he indicated he already started to feel a difference in his right leg. He was pretty amazed by that and eventually had reduced discomfort in his legs with less fatigue, swelling and cramping.”

Prevalent Problem

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,” according to Dr. McGreevy, who notes that 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 to be neurological 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.

Double Trouble

Pittsburgh, Pennsylvania native Robert Vamos spent years working in the supply end of the automotive industry in Michigan before relocating to Florida, where he started a second career in real estate in 2012.

It wasn’t long, though, before showing properties became uncomfortable for Robert, who soon after making the move to Florida began to experience an ever-increasing degree of numbness and aching in his feet and legs.

“I contracted a disease from Type 2 diabetes called Charcot foot syndrome, which is a type of neuropathy, or loss of sensation, in my legs and feet,” Robert explains. “As a result, I lost the arch in my right foot. And for some reason, my legs always ached terribly after that.

“My podiatrist referred me to Dr. McGreevy. He ran a bunch of tests on me and determined that the nerves in my lower back, at my L4 and L5 lumbar vertebrae, were pinched. I wasn’t having any pain in my back, just a little stiffness maybe, but Dr. McGreevy said the pinched nerves were contributing to the aching pain in my legs.”

In treating Robert, Dr. McGreevy recommended a nonsurgical procedure called radiofrequency ablation, which uses radio waves to produce heat that is delivered through a probe to the target spinal nerves.

In Robert’s case, the target was the nerves exiting the spinal cord near the vertebrae of his lower back. The heat from the probe creates a spot on the nerves that impedes the transmission of pain signals to the brain. This reduces discomfort from the affected area of the spine.

“Dr. McGreevy said he hoped to avoid surgery for me, and he wanted to try the radiofrequency procedure to put the pinched nerves to sleep,” Robert confirms. “He said the pain relief would last from six months to two years. For me, it lasted a year and a half. Just recently, my legs started hurting again, and he gave me a second radiofrequency treatment.

“This time, however, he noticed a varicose bump on my right leg and didn’t like the way it looked. He said, I’ve done artery studies and nerve studies, so let’s do a vein study. He did and found that the veins in both of my legs weren’t working properly. He also detected swelling in my ankles, which he said would have been worse if I wasn’t swimming a mile every day.”

Diagnosis and Treatment

After seeing some of the visible signs of venous insufficiency in Robert and learning that he was also experiencing aching and heaviness in his legs, Dr. McGreevy performed a Doppler venous ultrasound examination that allowed him to see the flow of blood from Robert’s legs toward his heart.

“I feel great right now. I no longer have any of that aching pain in my legs.”
– Robert

That simple, noninvasive exam revealed what Dr. McGreevy described as “significant reflux” in Robert’s legs. As he did with John, he then suggested correcting the problem by performing EVLA.

Robert says he has a very strong will, and as a result, he refused to let any of the symptoms caused by his venous insufficiency alter his active lifestyle. As soon as the EVLA treatment was completed, however, he realized how easy it was to relieve the pain and discomfort associated with the venous disease.

“Dr. McGreevy did the procedure right in his office, and there was very little discomfort associated with it,” Robert verifies. “I could have walked right out of his office and gone to the golf course. I didn’t need to take any pain medication or anything like that. Afterward, I had to wear compression stockings for a couple of weeks, but that was it.”

Miraculously Successful

Photo by Nerissa Johnson.

Free of leg pain, Robert can walk Layla again

Robert and Albert were already seeing Dr. McGreevy for pain management when their venous insufficiency was detected. The aching pain in Robert’s legs had two contributing factors – his varicose veins and the pinched nerves in his back. Dr. McGreevy treated both factors, and Robert responded positively. His pain was alleviated, and the swelling in his legs dissipated.

“I feel great right now,” Robert enthuses. “I no longer have any of that aching pain in my legs. I achieved really good results. But, I had both the radiofrequency ablation and my veins treated at the same time, so if you ask me which treatment helped me more, I couldn’t tell you.

“I just know the combination of the two really helped. Dr. McGreevy told me the radiofrequency ablation can be repeated if necessary, but the results of the vein treatment will last forever.”

Albert’s right leg didn’t look much better the Sunday after he had the first EVLA treatment, but it did by the following week, when he returned to McGreevy NeuroHealth to have the treatment on his left leg.

“My right leg cleared up miraculously,” Albert 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.”

Robert and Albert are impressed with Dr. McGreevy and his staff at McGreevy NeuroHealth. They find the neurologist to be knowledgeable, kind, understanding and worthy of their trust.

“Dr. McGreevy is a wonderful doctor,” Robert states. “He’s very gentle, and he explains everything he’s doing as he goes along. He’s a pain specialist, and as people get older, a lot of us get different kinds of pain in our bodies that Dr. McGreevy can treat. I recommend him to anybody, and I already have to numerous people.”

“Over the years, I had a knee replacement and a broken ankle that was due to my back and loss of balance,” Albert adds. “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.

*The patients name was changed to protect his privacy.

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