To Each Her Own

Cardiovascular surgeon relies on experience to create treatment plan.

Following a divorce, stay-at-home mom Mollie* suddenly realized she needed to earn a living to support her family. She went back to school and earned a degree in psychology with the aim of becoming a counselor. But upon graduation, Mollie discovered counselors were plentiful and counseling jobs were scarce, so she went back to the drawing board.

“I went into nursing and got a Bachelor’s degree in nursing,” Mollie relates. “That’s what I did for the rest of my working career, and I did various types of nursing. I was a telephone triage nurse, and I worked in nursing homes. I worked in hospital settings and ended my nursing career in home care.

“I retired from nursing when I was seventy years old. Now, at seventy-three, I’ve taken up painting, and I can’t put it down. I haven’t taken any classes, but I just love it. If I see something I want to paint, I just do it.”

Nursing may have paid the bills and painting may occupy her retirement hours, but Mollie has always been a dancer at heart. For ten years, she owned a dance studio where she taught ballet and classical jazz.

She performed on occasion as well, and she’s convinced that all the time she spent dancing, leaping and pounding on hard surfaces since she was a young girl led to the distressing condition she developed as an adult – restless legs syndrome.

“My father, mother and sister were the only other people I knew who had restless legs,” Mollie shares. “But back in those days, no one knew what it was. We called it the jimjams, and we asked all our relatives, Have you ever had anything like this? But they told us, No, nothing like that.

“I didn’t have restless legs growing up. They started after I had children. At first, they occurred just at night when I sat down to relax for the evening. I learned to get up and move around because movement warded them off. Then, they started occurring in the morning and afternoon as well. It didn’t matter what time of day it was.

“More recently, I got terrible restless legs in the afternoon. They would start up and last for hours. I would roll around on the floor, screaming and crying. It felt like little worms were crawling up and down inside my legs, and I had to move them. I couldn’t sit still.”

Mollie’s case of restless legs syndrome was severe, and by the time she was 73, she had taken medication for the condition for more than 30 years. But the medication was failing to curb her symptoms and had drawbacks of its own, so Mollie sought treatment alternatives.

“I wanted to get off the medication because it has terrible side effects,” Mollie elaborates. “I tried everything, then a friend told me about Dr. Sharma and encouraged me to visit him and ask if he could do anything about restless legs, so I did.”

Ravi Sharma, MD, is a board-certified cardiovascular surgeon with expertise in blood vessel disorders affecting the legs. His practice is Premier Vein Centers, which has offices in Homosassa and The Villages®.

Dr. Sharma ordered an ultrasound examination of Mollie’s legs that showed a number of her leg veins were leaking and not enabling proper blood flow toward her heart, a condition called venous insufficiency. That happens to be a root cause of restless legs syndrome.

Venous insufficiency can be treated through a number of minimally invasive vein closure techniques. Dr. Sharma relies on his many years of experience when determining which technique to use for each patient to achieve the best outcome.

Mollie liked Dr. Sharma right off the bat. She was impressed by his knowledge and experience and by the compassionate way he treated her. She was also impressed by his honesty.

“Dr. Sharma was very personable and interested in me, and he didn’t rush me through our appointments,” Mollie recalls. “He was very upfront with me as well. He said, I have treated people with restless legs, but I can’t guarantee treatment will help with your severe condition. But I said, I’m willing to try anything if you are.

At the core of Mollie’s problem was the intricate series of blood vessels that make up the human circulatory system. Veins are the blood vessels that return oxygen-depleted blood back to the heart. There are three types of veins: superficial veins, deep veins and perforator veins. Superficial veins lie close to the skin, deep veins lie in groups of muscles, and perforator veins connect the superficial veins to the deep veins.

“Venous insufficiency occurs when the deep leg veins cannot pump blood back to the heart,” Dr. Sharma describes. “Chronic venous insufficiency has multiple causes. Over long periods of sitting or standing, the blood in leg veins can pool. 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.”

“I thought Dr. Sharma was a miracle worker because after my treatment was completed, I didn’t have restless legs anymore.” – Mollie

There are many signs and symptoms of venous insufficiency. Signs are the issues that can be seen, such as bulging varicose veins, swelling, and thickening and discoloration of the skin of the ankles or legs. Symptoms are those things that are felt, not seen. They include throbbing, aching, stinging, burning, itching, nighttime leg cramps and restless legs. These are all indications that the veins are not functioning properly.

“For patients who experience any of these signs or symptoms, it is important that they have their veins assessed,” Dr. Sharma emphasizes. “Leaving the condition untreated can lead to more serious difficulties, including leg ulcers, infection and a breakdown of the skin.

When seeking a physician for care, it is crucially important for people to choose surgeons who specialize in venous diseases. The physicians should also be experienced in the advanced procedures available to treat these diseases. In addition, they must also express genuine concern and compassion for their patients. Physicians with these qualifications achieve the best outcomes.”

Advanced Options

At Premier Vein Centers, a full range of advanced, minimally invasive treatment options for addressing varicose and spider veins are available. These treatment options include microphlebectomy, endovenous laser ablation (EVLA), sclerosing injections and VenaSeal.

Microphlebectomy has replaced stripping, an outdated, more invasive procedure during which doctors removed the large veins by making big gashes across the leg that often left the patient with large 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 informs. “And with this procedure, patients end up with tiny marks on the skin or no scars at all.”

During EVLA, a sterile laser fiber is introduced into the incompetent vein via 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 tiny, dilated blood vessels in the skin that become swollen with stagnant blood. 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 a small amount 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.

Dr. Sharma uses his expertise to determine which procedures to use based on each patient’s symptoms and health status. These advanced treatments are all 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 notes. “And they are happy to learn that they can resume activities right away.”

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

Miracle Worker

Using the ultrasound results as a guide, Dr. Sharma created a treatment plan to address Mollie’s restless legs syndrome. With his experience, he knew right away that EVLA was the best method of closure for Mollie’s leaking leg veins. Mollie was amazed by the treatment’s initial outcome.

“Dr. Sharma performed six painless laser procedures on my legs,” Mollie recalls. “He explained to me that he sealed off the bad veins that were pooling blood, and eventually, my body rerouted the blood flow through good veins.

“I thought Dr. Sharma was a miracle worker because after my treatment was completed, I didn’t have restless legs anymore. I thought, Surely, it isn’t this easy. I should have done this years ago.”

“Dr. Sharma adds, “Ms. Mollie followed all of the post-treatment instructions, which is also important in achieving the best outcome.”

*Patient’s name withheld at her request.


Print This Article
    • 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 certified by the American Board of Thoracic Surgery. He graduated from the University of Maryland in College Park and attended the University of Maryland Graduate School in Baltimore before receiving his medical degree fro... Read More