Leg Pain? It Could Be Your Veins

Address venous insufficiency through minimally invasive treatments.

Molly* dreamed of becoming a legal secretary. She prepared for her career by taking all the business law classes and general business courses offered by her high school. The preparation paid off. She got a job as a legal secretary right out of school.

“I went to work for the FBI,” recounts Molly, 70. “But to get promotions within the government, you have to move around. I stayed with the FBI for two years and then worked in the General Accounting Office.”

While Molly was technically a legal secretary, her job with the GAO involved statistics, which she didn’t particularly enjoy. She stuck it out in the GAO for 3½ years and then accepted a position in one of then-President Jimmy Carter’s programs. When Carter left office in 1981, Molly moved on to the Small Business Administration.

“While I was working with the government, a friend recommended me to a patent and trademark law firm in Washington, DC,” Molly relates. “As a legal secretary, I did everything to make the attorneys’ lives easier. I helped them with their calendars, scheduled their appointments and helped prepare patent applications. I loved my job.”

She didn’t love the daily commute, though. Molly lived 59 miles from her office, and over time the drives and long hours she put in each day wore her down.

“When I went in for my interview, I had to sign an agreement that I would work eight to 15 overtime hours a week,” Molly shares. “I was 36 when I started with the law firm, so it was no problem at the time. But as I got older, it became harder. By the time I was 61, I was ready to retire. That was in 2011.”

Following retirement, Molly made another dream a reality by relocating to the Sunshine State. Shortly after, however, a distressing leg issue hampered her dream life in Florida.

“My legs hurt,” Molly expounds. “I couldn’t even touch my legs because they hurt so bad. It felt like muscle pain, but it wasn’t. I was in so much pain that I wouldn’t even go shopping anymore. It wasn’t worth it. I wouldn’t go to restaurants. I couldn’t get out of the chairs because my legs hurt so bad. On a scale of one to 10, my leg pain was a 50.

“The procedure didn’t hurt at all, and I had no bruising.” – Molly

“It also felt like there was water inside my legs. My ankles and feet swelled up terribly. I was miserable all the time, and the pain kept getting worse. I used so much Aleve® that it stopped working. The pain reached a point that I was afraid I would have to start using a walker.”

For years, Molly complained to various internists about the pain and swelling in her legs, but she never received any advice that helped.

“All I ever heard was, You’ve got to lose weight,” she recalls. “So I lost weight, but that didn’t help the pain. Then, I got a new internist, and he referred me to Dr. Sharma.”
Ravi Sharma, MD, is a board-certified cardiovascular surgeon at Premier Vein Centers in Homosassa and The Villages®. Dr. Sharma has expertise in blood vessel disorders affecting the legs.

“When I called to make an appointment, Dr. Sharma answered the phone,” Molly remembers. “I told him I was in a lot of pain and was scared of doctors. He talked to me for 35 minutes. He made me feel so relaxed that by the time I went in for my appointment, I wasn’t scared anymore.”

Ultrasound Indications

Dr. Sharma began his evaluation by ordering an ultrasound of Molly’s legs. The ultrasound indicated that a number of deep leg veins were leaking and restricting blood from flowing back toward her heart, a condition called venous insufficiency.

Chronic venous insufficiency has multiple causes.

“Long periods of sitting or standing can cause the blood in leg veins to pool,” Dr. Sharma educates. “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.”

There are many signs and symptoms associated with venous insufficiency. Signs, which can be seen, include bulging varicose veins as well as swelling, thickening and discoloration of the skin of the ankles or legs. Symptoms, which are felt, include throbbing, aching, stinging, burning, itching, nighttime leg cramps
and restless legs.

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

Advanced Treatments

Dr. Sharma offers this advice to people seeking care for any of these signs or symptoms.

“It is crucial that people choose surgeons who specialize in venous diseases and only venous diseases,” he contends. “I recommend staying away from physicians in large practices that offer a variety of services and perform venous treatment as a side service. Vein treatment must be tailored to the individual. There is no one-size-fits-all approach.

“In addition, the physicians people choose should be experienced in the advanced procedures available to treat venous diseases. They must also express genuine concern and compassion for their patients. Physicians with these qualifications achieve the best outcomes.”

A range of advanced, minimally invasive treatments are available at Premier Vein Centers. 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 maintains. “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, which are small twisted veins that are visible through the skin.

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. After treatment, blood that used to flow through the faulty veins is diverted to healthy veins in the leg.

At Premier Vein Centers, which provides a free initial consultation and accepts most insurance, including Medicare, Dr. Sharma relies on his expertise to determine which procedures will work best based on each patient’s symptoms and health status. All advanced treatments offered at Premier Vein Centers 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 reflects. “And they are happy to learn that they can resume activities right away following the procedure.”

Return to Form

Molly was among those pleasantly surprised by the ease of the procedure. She admits that she had heard some “horror stories” about old-fashioned venous treatments but was relieved when Dr. Sharma’s methods proved to be pain-free.

“When Dr. Sharma turned off the machine and said, That’s it, I couldn’t believe it,” she enthuses. “It was so easy; the procedure didn’t hurt at all, and I had no bruising. I had the procedure one day, and the next day I was driving and meeting friends for lunch. I was so impressed.”

Dr. Sharma began Molly’s treatment in March. It didn’t take long for her to return to all of her activities without restrictions.

“I’m back to helping my friend with her cleaning business full-time. I do the vacuuming for her,” Molly reports. “I’m doing more now than I’ve done in a year, and I’m doing it without having to use any pain medicine. And I don’t have any swelling in my right foot, either.”

One of the treatments Dr. Sharma chose for Molly was microphlebectomy. Molly is delighted that there are no scars on her legs from the procedure. There are only small marks that are barely visible.

“They look like pinholes from tiny pins,” Molly describes. “My friends can’t believe it.

“I told Dr. Sharma that I’d love to visit his office and talk to new patients who are scared to undergo some of these procedures. I’d tell them, Relax. Dr. Sharma is a good doctor. He’ll make you feel comfortable. Everyone there makes you feel comfortable. The atmosphere at Premier Vein Centers doesn’t feel like a doctor’s office. The staff is fun. They joke around, and I love it!”

© FHCN article by Patti DiPanfilo. Before and after images courtesy of Aerolase. mkb
*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