Solving the Mystery of Leg Pain: Diagnosing Venous Insufficiency

JORDAN PYSZ / iFoundMyDoctor.com
April Nowajewski

JORDAN PYSZ / iFoundMyDoctor.com
April is thrilled to have “normal ankles” after Dr. Joyce’s procedures eliminated the swelling in her legs.

For most of her adult life, April Nowajewski has been forced to stay close to home by a multitude of health issues. “I had problems with my legs that made it hard for me to walk, and I suffer from back pain because I’ve had scoliosis since I was a child,” April laments. “All of that has greatly limited my mobility.” Scoliosis is a sideways curvature of the spine that most often develops during the growth spurt just before puberty. Severe curves can result in nerve compression, which can cause back and leg pain and numbness or weakness in the legs. Despite her limited mobility, April does enjoy an occasional outing to shop. “For fun, I love to go to Target,” she says. “That’s my number one thing to do. That and going to the bookstore. I love to read and color in the adult coloring books. I’m crazy about that. It doesn’t sound like an exciting life, but it’s exciting to me.” The problems with April’s legs progressively worsened over time. She was experiencing severe swelling in her feet and legs, particularly in her ankles. “The condition was very painful,” April reports. “On a scale of one to 10, the pain felt like it was a 20. Every time I moved my legs, I felt like I was going to cry because they hurt so bad. “My legs also felt very heavy, like steel boulders, and I could barely walk. I had to use a walker to get around. I wasn’t sleeping well either because of the pain in my legs.” The leg swelling led to cellulitis, an infection of the skin. “My doctor recommended I visit an infectious disease specialist for the cellulitis,” April relates. “To treat the infection, I got infusions every week for three months, and the infection cleared up. But then I developed lymphedema.” Lymphedema is a swelling of the arms and legs caused by a blockage in the lymphatic system, which plays a crucial role in the immune system and fluid regulation. Lymphedema is often a complication of venous disease. “My doctor believed the lymphedema was due to my veins, so he sent me to Dr. Joyce,” April recounts. Douglas H. Joyce, DO, FACOS, FACPh, is a board-certified cardiovascular surgeon at Joyce Vein & Aesthetic Institute in Punta Gorda. Dr. Joyce specializes in treating venous disease with minimally invasive procedures. He addresses all stages of the condition, from spider veins to venous ulcers. “Ms. Nowajewski came to see me earlier this year,” Dr. Joyce recalls. “Her biggest concern was the painful bilateral swelling in her feet and ankles. She has a history of cellulitis due to the swelling, where her skin became inflamed and painful. “At the time I first saw her, she was experiencing significant discomfort and sleep disruption. Many people have trouble sleeping because of restless legs, or aching and cramping in their legs. Oftentimes, that is due to venous disease.”

Two Vein Systems

There are two primary vein systems in the legs: the high-pressure central vein system, located deep within the muscles, and the low-pressure superficial vein system, which runs just below the skin. Blood from the superficial system, including the saphenous veins, eventually merges with the central vein system, which carries it back to your heart. Additionally, perforator veins serve as bridges, facilitating blood flow from the superficial system into the central system. To aid this process, leg veins are equipped with one-way valves that prevent the blood from flowing backward and pooling in the veins. When these valves become weakened or damaged, it leads to a condition known as venous insufficiency in which the blood collects in the legs and causes swelling, discomfort and varicose veins. “We evaluated Ms. Nowajewski using ultrasound and venous mapping and discovered that she had a significant number of incompetent veins in both legs,” Dr. Joyce notes. “She had problems with her saphenous veins, which are the long veins in the leg. She also had issues with her perforator veins.” Dr. Joyce treated April’s venous insufficiency using two minimally invasive procedures: standard laser ablation and single-needle laser ablation, the latter a technique pioneered by Dr. Joyce. “We used standard laser ablation to close Ms. Nowajewski’s saphenous veins because they were severely incompetent,” Dr. Joyce reports. “During that procedure, we slide a laser fiber into and along the length of the vein and use laser energy to seal the entire vein. The flow of blood is then rerouted to healthy veins.” To treat April’s perforator veins, Dr. Joyce used single-needle laser ablation. During this procedure, Dr. Joyce takes a specially designed needle, and using ultrasound guidance, places it into the targeted vein. He then applies an anesthetic and turns on the laser for 15 to 20 seconds, which spot-welds the area of the vein being treated and seals it. As he does with all venous insufficiency patients, Dr. Joyce recommended correcting every one of April’s incompetent veins. “We use the laser to close the veins that are not working correctly, and that allows the remaining veins that are working to take over and drain the leg properly,” Dr. Joyce explains. “By eliminating the veins that are dysfunctional, we create a leg that is more efficient at returning blood to the heart.”

PHOTOS COURTESY JOYCE VEIN & AESTHETIC INSTITUTE
April’s legs before and after her treatment.

“He Healed Me”

The treatments worked wonders on April’s legs, Dr. Joyce reports. “I was quite impressed when we finished treating her first leg because the swelling had disappeared,” the doctor confirms. “She could not wait for me to treat her other leg because she wanted them to match.” And match they did. “My legs feel and look so much better than they did before that I could almost cry,” April gushes. “They’re pretty much back to normal thanks to Dr. Joyce’s procedures. The swelling in my legs has really gone down. I have normal ankles now, too. “And the pain in my legs is a lot better than it was. Before it felt like 20 on a scale of one to 10. Now, it’s about a five, so I can walk a lot farther than I could before, and I don’t need to use the walker. I only use that when I’m going to walk long distances, like through the mall. I don’t need it just around town, and I’m sleeping better, too.” April is thrilled with the results of her treatment. She’s also impressed with the doctor who provided it. “Dr. Joyce is an angel sent from heaven,” April raves. “He healed me, and he’s wonderful. He really listens and explains everything he’s going to do and what will happen. Most doctors won’t sit with you for five minutes, but he sits as long as you want. I really like that. “If people have a family member with bad veins, I recommend they visit Dr. Joyce. He’s been a godsend for me.”