Dr. David Greuner – Dr. Radio

Dr. Greuner featured on Dr. Radio

 

 

Full Transcript

Participants:

Dr. Nieca Goldberg

Dr. David Greuner

Carol

Dr. Nieca Goldberg:

Welcome back to Beyond the Heart. I’m your host, Dr. Nieca Goldberg, and in this segment, we’ll be speaking about exercise and overdoing it with Dr. David Greuner, who’s managing director and cofounder of New York City Surgical Associates. He’s also a double board-certified surgeon who specializes in minimally invasive surgery and cardiovascular and general surgery. Welcome to the show, David.

 

Dr. David Greuner:

Hi, Nieca. How are you?

 

Dr. Nieca Goldberg:

I’m great. A lot of doctors tell patients to exercise, but you don’t just talk the talk. You practice what you preach. Tell our listeners about some of your fitness interests.

 

Dr. David Greuner:

I was always an athlete. I was an NCAA runner and a swimmer in college. During residency, I put on, I guess, the freshman 15. I had to get rid of that. It was a little bit tough for me, getting back into the swing of things, but now I deal with sports that aren’t really that taxing on your body, but tend to give you a really good workout. I have a lot of bikes. I cycle a lot, and I swim a lot. I found it’s really good for non-impact, especially with our aging bodies.

 

Dr. Nieca Goldberg:

Are you involved in extreme fitness? Or are you just doing regular?

 

Dr. David Greuner:

I do triathlons, and I do some Olympic distance triathlons, which I think a lot of people would regard as extreme. I do some, not really fitness, but I do heli skiing, heli snowboarding, things like that.

 

Dr. Nieca Goldberg:

Wow.

 

Dr. David Greuner:

That’s a lot of fun, too.

 

Dr. Nieca Goldberg:

You don’t still do it, do you?

 

Dr. David Greuner:

Yeah. I still do it.

 

Dr. Nieca Goldberg:

You still do it? Wow. How do you encourage your patients to keep moving? Do you do cardiac surgery?

 

Dr. David Greuner:

No. I mostly do endovascular surgery now.

 

Dr. Nieca Goldberg:

Endovascular surgery, but a lot of your patients are incapable of extreme exercise.

 

Dr. David Greuner:

Most of our patients are on the younger end of things, because our practice deals specifically with minimally invasive surgery. We have two patient populations in general. One is the massive weight loss patient, which develops a lot of the cardiovascular issues that result. In your body, when you lose fat, especially a massive amount of fat, you also rearrange the vasculature inside of your body, because you have fat pads that separate blood vessels. On a massive weight loss patient, we deal with a lot of patients that lose those fat pads and now they produce anatomic obstructions such as May-Thurner syndrome and nutcracker syndrome.

 

Dr. Nieca Goldberg:

What are those?

 

Dr. David Greuner:

Similar to when you have anorexia and your kidney drops because of the loss of the fat pads. May-Thurner syndrome is a problem with iliac vein obstruction, which is a vein draining your leg. It’s the main one. The highway draining leg. Normally, your iliac artery, or the artery supplying blood to the legs sits right next to that vein, and there’s a fat pad separating it, because arterial pressure is much, much higher than venous, about 20 times as high. If you lose that fat pad inside of you, the artery now compresses the vein because it will always win, because it’s 20 times as dense.

 

Dr. Nieca Goldberg:

Higher pressure.

 

Dr. David Greuner:

Yep, and it will squash the vein. What these people is a lot of leg numbness, leg pain, and especially after a massive amount of weight loss or congenital reasons, they will have an inability to work out, etc. I know this, and I got really passionate about it because it happened to me. I was training for a marathon, and I got down to a very, very low body fat and I actually started to get a huge amount of leg pain as a result. It’s kind of like lumbar disc pain. It’s a little bit heartbreaking, because every time you’re increasing your cardiac output or making your heart beat faster due to exercise, it makes the problem much, much worse. I tell people it’s like a shower that you had in college that worked fine most of the time, it’s just when you take a really long shower, it flooded the whole thing. That’s what happens. Most of the time, you’re okay, but when you tend to exercise a huge amount and you over-deliver blood to your extremities or your legs, it becomes a huge issue.

 

Dr. Nieca Goldberg:

Let me ask you a personal question. Did you make the diagnosis yourself?

 

Dr. David Greuner:

I actually did, yeah.

 

Dr. Nieca Goldberg:

Okay. Then, you didn’t treat yourself. What did you do? What happens when you make the diagnosis?

 

Dr. David Greuner:

One of the surgeons treated me, actually. I had also had another back injury. I had a spinal fusion from an injury I had tele skiing, believe it or not. That happened a few years ago, and then I had this problem with both legs, but it was much worse on my left side because I had a lot of scar tissue from my spinal fusion. Normally, you would tell these people just to gain a little bit of weight back, and that will separate the blood vessels and they’ll be okay, but because they did a diagnostic angiogram on me on the left side, because of the scar tissue. It was not going to get better. One of my doctors went ahead and put a stent in me, and I’m a lot better now. Back to running and biking and all that stuff.

 

Dr. Nieca Goldberg:

That’s great. And no pain?

 

Dr. David Greuner:

No pain at all.

 

Dr. Nieca Goldberg:

Yeah. It’s challenging, because we all encourage people to exercise, but we have to make sure—diet and exercise to lose weight and exercise for cardio health and all this stuff, but I think it’s very important in our explanations or our counseling to patients that we also factor in some injury prevention.

 

Dr. David Greuner:

Absolutely, especially as we get older. Our bodies, whether we like it or not, become more frail and more sensitive to injury as a result of a variety of things, as I’m sure you know. You have to take things that aren’t quite as risk-heavy as you get older, as much as I hate to admit that.

 

Dr. Nieca Goldberg:

How do you counsel your people? How do you counsel your patients?

 

Dr. David Greuner:

I take a very personal interest in this stuff, because it’s a personal hobby of mine, nutritional analysis and helping people with their exercise programs. I take the whole patient into consideration. Their body weight, whether they have musculoskeletal issues, whether they have posture issues, what goal they’re trying to achieve versus cardiovascular fitness versus weight loss. I try to come up with a plan for them. It’s just something I do just because I like it, and it’s resulted actually in a huge building of this practice, because these types of people refer more people, and it’s led to quite a following.

 

Dr. Nieca Goldberg:

Yeah. What are some of the common complaints or concerns your patients share when it comes to the idea of exercise?

 

Dr. David Greuner:

A lot of people, not specifically exercise related, but in terms of weight loss, I think a huge, huge problem in America today is the idea of portion control, because the market is flooded with all these low-fat, low-calorie options, but nobody really talks about portion control. Globally, the group of people I think, there’s a huge misconception about the amount of calories in what amount of food. If I could come up with one that’s basically playing the weight loss, people that want weight loss in this country, they just don’t understand the caloric intakes that they need to have. The other difference with exercise and diet is, I don’t think exercise should be really used as a weight loss technique. I tend to separate the two. Weight loss is probably 80% diet and 20% exercise.

 

Dr. Nieca Goldberg:

The exercise really helps to maintain the weight loss. It doesn’t help initially with the weight loss.

 

Dr. David Greuner:

It helps them maintain a healthy lifestyle, but me, I tend to gain weight when I exercise a lot, because my metabolism is going crazy. I try to separate those two, and I try to educate people about caloric intake and portions and basically, tell them to look at exercise as a functional enhancement activity versus an actual weight loss activity. Usually, when people diet first, they get into healthy feeling. They get down to a weight that’s manageable with activity. Then, I actually gradually increase their activity to a point where it’s doable for them on a long-term basis.

 

Dr. Nieca Goldberg:

Yeah. It’s really about maintaining the improved lifestyle changes, because often people fall off the wagon there. We’re going to welcome Carol from California. Hi, Carol.

 

Carol:

Good morning. Thanks for taking my call.

 

Dr. Nieca Goldberg:

It’s our pleasure.

 

Carol:

I was struck by the comment that your speaker was saying about—

 

Dr. Nieca Goldberg:

Dr. Greuner, yeah.

 

Carol:

Dr. Greuner, thank you. My husband has unexplained swelling in his lower leg. The swelling will become so bad that the outer skin will split and the leg will bleed, and it’s very frustrating to try to control this problem. He had an ultrasound to check for clots. He had all the usual blood tests. Didn’t show an infection, but I’m wondering if an ultrasound was the definitive route for something like May-Thurner syndrome.

 

Dr. David Greuner:

No, it’s not, actually. The problem with ultrasound is, they’re only reliable at examining the leg from the groin down. The vast majority of May-Thurner syndrome or even some DVTs will happen higher, like between the belly button and the groin. In that area, you can’t really see it reliably. It’s like looking through a foggy window with ultrasound, because all abdominal organs are on top of everything.

 

Carol:

He’s had this problem for years, and no one has come up with an answer for what it would be. I just recently heard of May-Thurner syndrome and started researching it. What type of specialist should he see to pursue this problem? He’s seen all kinds of specialists. He’s neuropathic. Not diabetic, but neuropathic. He’s got an idiopathic neuropathy. Can’t feel his feet or his legs up higher than his knees. Lost feeling in his fingers. He’s not exactly well. He’s got this autoimmune thing, but no one has suggested referring him for this specific thing, but it’s dangerous. It causes infections, and then he has surgeries to take off another part of his foot. I need to know who do I ask to be referred to?

 

Dr. David Greuner:

There’s really only a few practices in the country that specialize in this kind of thing, and there’s actually the University of Washington close to you. I believe there’s a specialist, Dr. Meisner. He’s quite good. It has to be a vascular surgeon or an interventional radiologist that specializes specifically in venous disease, because most—

 

Carol:

Okay. I’m looking for a vascular surgeon or an interventional radiologist. They can take a look at this and try to figure out what would be causing this intense swelling that actually causes the skin to split?

 

Dr. David Greuner:

Correct.

 

Carol:

Thank you.

 

Dr. Nieca Goldberg:

David, can you please explain what the May-Thurner syndrome is again?

 

Dr. David Greuner:

May-Thurner syndrome is just usually congenital, but it can be acquired, meaning happening as an adult through a large amount of weight loss. It’s basically the artery that’s normally running parallel to the vein now changing its orientation and becoming more perpendicular and basically squashing the vein and obstructing it.

 

Dr. Nieca Goldberg:

That could lead to leg swelling, because your blood isn’t going back to the heart, right, David?

 

Dr. David Greuner:

A hundred percent, yes.

 

Dr. Nieca Goldberg:

Also, obviously, you mentioned it causes symptoms of numbness, pain, and feeling uncomfortable. Thanks for calling in Carol, and asking your question. I want to welcome our other listeners to join our conversation, and they can give us a call to speak with Dr. David Greuner, who’s managing director and cofounder of New York City Surgical Associates. He’s a double board-certified surgeon that specializes in minimally invasive surgery and cardiovascular and general surgery. The numbers are 877-NYU-DOCS. It’s 877-698-3627. Or you can email us at docs@siruisXM.com. David, a couple of people brought up this issue of leg swelling, and a lot of people, they go online when their legs are swollen and all of the sudden, they think that they have heart failure or a DVT. Give us some ways when you should consider your leg swelling serious and you need to seek urgent care versus maybe you just need to elevate your legs.

 

Dr. David Greuner:

Most of these problems are not emergent, and they’re basically subjective in nature. What I tell patients, May-Thurner, as you actually screen everybody, is extremely prevalent. It’s probably present in about 40% of women, and it’s mostly due to the different hip to shoulder ratios and the different angles of the blood vessels. Males don’t tend to get it as often, and they tend to get it at very specific sites. It’s very specific presentation. It’s more present on the right leg on males. On the women, it usually happens on the left leg. Probably a 10:1 incidence in terms of women’s preponderance. May-Thurner basically, if you screened everybody and you wouldn’t need to treat everybody, because most people are asymptomatic, and there’s two presentations where it becomes an issue. One is if you have, May-Thurner can result in a clot because the blood is not flowing that well. Once you have a clot as well as a May-Thurner lesion—

 

Dr. Nieca Goldberg:

That’s a DVT, right?

 

Dr. David Greuner:

Correct, yeah. Then, it becomes really symptomatic. Basically, it is what we call permissive disease, kind of like your generic predisposition to forming cancer. You have to have two issues, usually. Usually, one is a specific vein problem. It doesn’t usually cause a problem on its own, unless you’re really, really active and you’re challenging your circulation all the time. When it becomes a problem is when you have another issue, like I did with my spine surgery and the scar tissue around my veins. Then, it became huge. Or, if you have May-Thurner and then you develop a DVT as a result, then it will become a huge problem.

 

Dr. Nieca Goldberg:

What about people who don’t have May-Thurner but have leg swelling and think they have a DVT?

 

Dr. David Greuner:

Most people, yes, it can be an issue. One of the things I want to stress to people is that, which this patient brought up which was very useful, actually, is ultrasound doesn’t rule out major DVT at all. If you have a blockage of the veins higher up, clearly you will have some flow disturbance in the leg, which will be seen by a very good ultrasound technician, but a lot of them are maybe not that good to pick that up. To really rule out anything, you need to see a specialist. In general, the rule of thumb is, if it’s bothering you significantly, go see somebody about it, because in general, you have a very short timeline to treat clots. Clots are like cement. After about a week, they tend to get really hard and very difficult to remove. You treat them within a week, it’s very easy to get rid of it, typically. In general, time is of the essence.

 

Dr. Nieca Goldberg:

After you were diagnosed with the May-Thurner syndrome and you were treated, how long did it take you to get back to exercising?

 

Dr. David Greuner:

I was back the next day.

 

Dr. Nieca Goldberg:

Really?

 

Dr. David Greuner:

Yes. It’s basically like relieving the kink in a hose. I felt much better coming off the table.

 

Dr. Nieca Goldberg:

Did the experience change and make any—cause you to make any changes in your exercise regimen?

 

Dr. David Greuner:

It got a lot more vigorous after that.

 

Dr. Nieca Goldberg:

Really?

 

Dr. David Greuner:

Yeah. One of the things I wouldn’t recommend is, I went snowboarding. I had a trip planned with the guys in our practice. They’re all into a lot of social stuff together. I went snowboarding, and that wasn’t the smartest thing, because the stent was sitting and swaying to my body.

 

Dr. Nieca Goldberg:

Yeah. When I have patients that get cardiac stents, we hold off a few weeks before they start cardiac rehab.

 

Dr. David Greuner:

Yeah, but that’s a little bit different, because it’s a very, very small vessel. Any risk of thrombosis or anything is a huge problem because it’ll create a—

 

Dr. Nieca Goldberg:

A heart attack.

 

Dr. David Greuner:

A heart attack, yeah. For iliac veins, it’s a different situation. The vessel is about the size of two of your fingers together. It’s a lot higher flow, and you’re relieving a very tight vessel. In general, the congestive leg will have an increase in flow. These people, is it okay if I get a little bit technical in terms of blood delivery or no?

 

Dr. Nieca Goldberg:

As long as you explain it.

 

Dr. David Greuner:

Okay. When your veins are chronically obstructed or they’re narrowed, your arteries compensate, so to speak, over time. Basically, your arteries will deliver blood at a higher pressure to a leg than they normally would deliver in somebody that did not have a vein obstruction. What we see a lot in people with longstanding vein obstructions like May-Thurner is when you relieve the vein obstruction, their leg will get very red and very hot for a few days afterwards, because what happened is, your body hasn’t realized that it can pump at a lower pressure now to the leg. In general, they’re very, very low risk for clot after this procedure because the blood is getting flushed at a very rapid rate throughout the leg, and your body hasn’t figured out that it doesn’t need to push it that hard anymore.

 

Dr. Nieca Goldberg:

One of the things I didn’t ask you yet, and you also believe very strongly in is, how we breathe is very crucial to our health. What do you mean by that?

 

Dr. David Greuner:

How we breathe is—

 

Dr. Nieca Goldberg:

Everyone’s breathing, David.

 

Dr. David Greuner:

True, but our lungs have what’s called, there’s a residual space in the lungs that is present with every breath, and that’s a fixed capacity. It’s basically, the air capacity in your lungs will not change regardless of the breath. In an average human, it’s about 150 milliliters or ccs. If you take a deep breath of let’s say one liter, which is a very, very deep breath in an average person, and 150 ccs of that is not being used for oxygen exchange. You have a total of about 850 ccs. You take a regular breath, which is probably about 400 ccs, so the 150 ccs of non-oxygen exchange stays the same, but now the percentage of air that you inspired actually contributing to oxygen delivery because it doubles by you taking a deeper breath. Is that easy to understand, or no?

 

Dr. Nieca Goldberg:

Yes. You’re telling us to take a deep breath.

 

Dr. David Greuner:

Yep. Take a deep breath, because by taking a deep breath, you’re increasing the oxygen delivery, not just by the deeper breaths, but by an exponential fashion because the air that’s not actually contributing to oxygenation becomes smaller the deeper your breath is.

 

Dr. Nieca Goldberg:

Smaller percentage. A lot of people never think about how they breathe.

 

Dr. David Greuner:

Yeah. This is a trick that athletes have used for years. Any endurance athletes will tell you same, that they’re trained in breathing techniques, such as belly breathing, etc., and it’s all about increasing your oxygen exchange. When you’re performing at a very high level, these little details make a huge impact on the actual performance of an endurance athlete.

 

Dr. Nieca Goldberg:

You have a practice where people, you said it catered to people who may have these vascular injuries because of extreme exercise and because they are participating in extreme exercise or they’ve lost a lot of weight. What are some of the common complaints or concerns your patients share with you when it comes to exercise?

 

Dr. David Greuner:

Very, very often, I’ll see two types of patients. I’ll see patients that will be the patient that called in, where they will have some sort of issue and then they would have a DVT and now, everything is much worse. A sedentary person, if they had two problems, would be having ulcers and things like that on their leg, or tremendous amount of swelling. Then, the other type of patient we’ll see is somebody that’s lost a lot of weight but can’t progress to the next level because they can’t exercise anymore because they’ve made their vascular issue worse. Or we’ll see somebody that never had an issue, has not sustained a huge amount of weight loss and just had a congenital issue, but they only have a problem because they are so taxing on their body. A marathon runner that had May-Thurner syndrome and runs 50 miles a week, they’ll have issues regardless because they’re demanding so much from their body. It’s really three different areas that we see patients in.

 

Dr. Nieca Goldberg:

I think your own injury has really motivated you to do even more for your patients. What would you say to encourage to our listeners out there to improve their health, David?

 

Dr. David Greuner:

Medicine has gone through such a change in the last 10 years. It’s now not all about preventing mortality. People are focusing tremendously on quality of life now and preventing morbidity. This was a path pioneered by some of the younger doctors of the last 10 years that are focusing more, like yourself, on wellness. It’s the next bastion, I guess, in healthcare that people are trying to reach disease before they ever get to those end stages.

 

Dr. Nieca Goldberg:

Yeah. We hope we can help slow down the process of disease through these lifestyle changes.

 

Dr. David Greuner:

Lifestyle changes and small things. This is a little bit off-topic, but for instance, I had another issue after my spinal surgery where I have an issue with arthritis on one of the joints. Typically, the only option with that was a spinal fusion, but now, I’m able to go to a pain management doctor. He does what’s called a nerve ablation. Just a little nerve supplying my joint, he sticks into a needle and burns it every six months or so and I’m back to normal.

 

Dr. Nieca Goldberg:

That’s great. I’m glad that you could keep up with all this, David, and your practice. We’re running out of time. I want to thank you very much for joining us today.

 

Dr. David Greuner:

Thank you so much for the opportunity. I really appreciate it.

 

Dr. Nieca Goldberg:

Thanks.

 

Dr. David Greuner:

All right. Bye-bye.

 

Dr. Nieca Goldberg:

Bye.

 

 

END OF RECORDING


NYC Surgical Associates: Pearl River Location

 

We’re excited to announce our new state-of-the-art location in:

Pearl River, New York

 

 

NYC Surgical Associates’s 6th location is conveniently located at 150 South Pearl Street, Pearl River, NY 10965. We are excited to extend our services to Rockland County and Greater New York.

 


NYC Surgical Associates: Safe and Effective Care

Experience the very latest in medical technology and minimally-invasive surgical techniques. Our Pearl River location will specialize in the following treatment categories, and more!

  • Varicose Veins
  • Spider Veins
  • Hernia Treatment
  • Lymphedema
  • Lipedema
  • Breast Reduction
  • Excess Skin Remove
  • Fibroid Treatment
  • Excess Sweating

 

For more information, please contact us today at 917-983-6310.

 


What Are Varicose Veins?

What are varicose veins?

Varicose veins are painful, dilated and twisted veins that appear as bulges underneath the skin. They are the result of chronically dilated and inflamed small veins that have slowly stretched out under years of pressure. They usually become an issue for cosmetic reasons, but many people complain about pain and discomfort related to them as well.

Varicose veins are inherited genetically and they are more common in women.  Things that increase the pressure in the veins of the legs tend to increase your risk of having varicose veins.  Pregnancy and obesity are two very common factors that can herald the arrival of varicose veins.  The increased intra-abdominal pressure makes it harder for blood to get back up from the legs and increases the pressure in the leg veins. Veins are relatively thin walled and not suited to handle higher pressure, so they accommodate increased pressure by dilating and stretching out.

Because the progression of varicose veins is slow at early stages, people usually don’t complain much about them until they have reached a more advanced stage. Varicose veins cause pain and itching. They are usually associated with an underlying chronic venous insufficiency, and it is often the presence of varicose veins that leads people to get their venous reflux treated.

How do they affect you?

The presence of varicose veins can cause many different problems. They can spontaneously bleed and ulcerate, lead to chronic wounds and scars, and can cause skin pigmentation and discoloration.  They can even increase your risk of having a deep venous thrombosis or pulmonary embolism. Sometimes the varicose veins themselves can become infected, inflamed and thrombosed.

What are your treatment options

The good news is that they are easily treated with modern minimally invasive techniques in the hands of a skilled surgeon. The treatment no longer requires incisions and is usually done through a needle or an IV.  The new techniques have low risk and no downside. It may require a few treatments, but they usually last less than an hour and there is almost no recovery time required.

 

Interested in a consultation?

For more information about varicose veins and NYC Surgical’s treatment options, please contact us at 877-221-3955.


What is a Hernia?

What is a hernia?

Hernias are most commonly recognized as a bulge that pops out of your abdomen or groin, but what exactly are they?

 

How do you get a hernia?

Hernias are a protrusion of a cavity’s contents outside of the cavity that they normally reside in.

One way that hernias form is from increased pressure within the abdomen, which pushes through a natural weakness in the abdominal wall muscles and forms a bulge outside the abdominal compartment. This type of hernia usually presents later in life and is often associated with obesity and heavy lifting.

Another way hernias form is embryologically due the failure of a natural hole to close. Both pathways result in a bulge, where the contents of the abdomen show up as a painful mass that pops out every time a patient does anything to increase the pressure in their belly. These types of hernias have been present since birth.

Hernias are often associated with other medical problems, anything that makes you strain or cough frequently has the potential to give you a hernia. Hernia’s in women often occur during a pregnancy.

There are also a couple less common types of hernias that can protrude through openings in your pelvis or your back.

The active process where body parts herniate through a defect is called a herniation. Hernias form through a weakness or defect in the muscular or fibrous layers that normally keep the contents inside the cavity.

 

How do you treat a hernia?

Unfortunately, hernias don’t resolve on their own and the mechanical process of a hernia means that unless the defect is repaired, hernias don’t go away and they tend to get larger.

Hernias can be dangerous because of a couple complications that are associated with them. Normally hernias will go back inside the defect that they come through. This is called “reducing” a hernia. A hernia that can be easily reduced, or reduces on its own when you lay down, is unlikely to cause a problem, but when a hernia is unable to be reduced it is referred to as incarcerated.

An incarcerated hernia is a problem because it is stuck outside the cavity it belongs in. Say that a segment of your intestine is incarcerated; this means that its blood supply and its supply of oxygen has to travel all the way across the compartment that it originated from, then through a tight opening in order to get to its target destination, your intestine. This makes that loop of intestine very easy to cut off from its blood supply, and once that happens, swelling and increased pressure from ischemia cut off the blood supply even further and strangle that intestine. Unsurprisingly, this process is called, “strangulation.”

But neither of these outcomes need to occur. Hernias are one of the oldest surgical problems in history and surgeons have been describing and fixing them for as long as there has been written history. The primary challenge to fixing a hernia is how to close the hernia defect without tension. Anything that pulls the edges of the defect apart will also pull through the sutures that are placed to close the hernia.

Multiple innovative techniques have been described to address the problem of reducing tension on a hernia closure, and the best hernia surgeons tailor each repair to each individual patient, using all the techniques at their disposal.

 

Suffering from a hernia?

For more information about NYC Surgical’s hernia treatment options, please contact us at 877-221-3955.


Spider Veins: what are your treatment options?

Spider veins are problematic and cause significant distress when they appear on the legs. People often go to great lengths to have beautiful legs, and it is frustrating to do everything right only to have a cosmetic issue arise that negates all of the hard work that was put into your legs.

So what can be done about spider veins, and how do these different treatments compare with each other?

Spider Vein Treatment Options

 

Sclerotherapy

Traditional sclerotherapy is the most effective treatment available and it has been used for over 100 years. It’s inexpensive, reliable, involves minimal pain and has few associated complications. Traditional sclerotherapy takes 10-20 minutes to perform.

Commonly used agents for sclerotherapy include detergents and osmotic agents.

Polidocanol is the most commonly used detergent in our practice, it also functions as a local anesthetic. Detergents work by scarring the inner wall of the spider veins which causes them to be reabsorbed by your body after a month or so. Polidocanol is a relatively mild and forgiving agent.

The detergent sclerosants like polidocanol are often mixed with air to form a foam.  This is called foam sclerotherapy.  Foam sclerotherapy accomplishes three things. It reduces the amount of agent that is required, it increases the amount of surface area where the sclerotherapy agent comes in contact with the inside of the vein, and it displaces the blood in the vein to improve chances that the vein will scar down and disappear.  Foam sclerotherapy is usually reserved for larger spider veins.

The most commonly used osmotic agent for sclerotherapy is hypertonic saline. It also works by damaging the inner wall of the spider vein. Hypertonic saline is a slightly stronger agent, and works better than polidocanol but requires greater experience to use. Hypertonic saline burns slightly when it is injected. Because the ingredients are found naturally in your body, allergic reactions are unlikely. For spider veins on the face, sclerotherapy with hypertonic saline has excellent results.

Laser sclerotherapy is used in some centers for spider veins. Its use is limited, because it has a higher cost, is more painful and is not as effective as traditional sclerotherapy. It does work well for spider veins on the face.

Compression Garments

Graduated compression garments are sometimes used to treat spider veins. They are painless and can help improve pain associated with underlying venous reflux but they can also be annoying to wear all the time

Lifestyle Changes

Lifestyle changes, like diet, exercise and leg elevation don’t make spider veins go away, but they can slow the progress of spider veins.

Other Options

There are other treatments that involve passing electrical current through a wire to induce scarring that will eliminate spider veins, but they involve an increased cost without a clear benefit. Unfortunately topical treatments and supplements that are advertised as being able to eliminate spider veins are completely useless.

Despite recent advances in technology. Traditional sclerotherapy is still the best treatment and the one that we use the most.

Want to Learn More?

For more information about looking and feeling your best, please contact NYC Surgical Associates or call 877-221-3955.


How to Shed Weight after the Holidays

How to Shed Weight after the Holidays

An endless selection of cookies, eggnog, pies, and gigantic meals makes weight gain during the holidays almost inevitable. Research shows people in the United States can gain significant weight during the holidays, especially around Thanksgiving and Christmas. Here are some simple steps you can take for weight loss after the holidays.

Steps to Weight Loss after the Holidays

Drink water before and during meals to add volume and weight to your meal, which helps you feel full faster.

Set realistic goals, such as one or two pounds per week. Starving yourself in hopes of achieving fast results is bad for your health and usually backfires.

Take small steps to achieving those goals. Avoid the temptation to make sweeping changes in your life, as these can be hard to sustain over time. In fact, starvation even for a couple of days puts your body in prime craving mode, which leaves you in grave danger of binge eating. Instead, make one small change each week, such as exchanging your nightly cupcake for an apple.

Eat more often to prevent excessive hunger that leads to overeating. If you find yourself eating huge suppers because you are ravenously hungry, for example, try eating a low calorie mid-afternoon snack and reduce the size of your evening meal.

Eat nutritious meals. Good nutrition helps you stay feeling fit and energized even as you cut calories.

Give food cravings a time out. Food cravings often develop out of boredom or stress, and typically go away within a few minutes. When food cravings hit, identify your emotions and environment. Learn to avoid and control food cravings by going for a short walk or finding another distraction when similar emotions and environments arise – your craving for food will subside.

Set one-third of your meals aside when you go out to eat. In an effort to satisfy every customer, many restaurants offer super-sized portions. Ask your server for a to-go bag when you order your food and put a third of it in the bag when your food arrives.

Reduce your alcohol intake. Alcoholic drinks are high in calories; mixed drinks are the liquid equivalent of a rich dessert. Alcohol also lowers your inhibitions, leaving you vulnerable to snacking temptation.

Increase your activity levels so that you burn more calories than you take in.

Get enough sleep. Harvard School of Public Health cites several studies that show a strong connection between inadequate sleep and weight gain.

Have a cup of black coffee or tea, no sugar, if you run out of energy in the middle of the day. Coffee and tea have zero calories and plenty of caffeine.

Consult with a health care professional for more weight loss tips that help you lose weight and keep it off after this holiday season.

 

Want to learn more?

For more information about looking and feeling your best, please contact NYC Surgical Associates or call 877-221-3955.


How to Tell If You Have Spider Veins

Spider veins are fairly common in the western world, and we see them all the time in our practice, but how do you know if you have them?

They can be difficult to see, as they usually measure less than a millimeter wide, and often occur in the legs in locations that are difficult to see behind the knee or on the back of your thighs or calves. To examine these areas by yourself with a mirror is challenging as it’s a couple feet away looking at a reflection, not necessarily with optimum lighting.

Spider veins have a predilection for the ankles and feet, so you may first notice the veins in these areas. On closer inspection they range in color. They can be blue, purple or even red. Often they will form a small cluster in close proximity where they seem to be almost connected and appear web-like, which is why they have been referred to historically as spider veins.

You may have your attention first called to your spider veins by friends or family members who notice them, which can make you self-conscious and sometimes people can end up preferring pants as a result. This is unfortunate and unnecessary because these veins can be treated effectively with sclerotherapy injections.  

People with darker skin or significant freckles can have a more difficult time seeing their spider veins. Freckles in particular act as a natural camouflage. For this reason people with spider veins often spend more time in the sun or in tanning beds to hide them.

Spending a lot of time on your feet or in a seated position can lead to spider veins, so if you have a job or lifestyle that requires a lot of time standing, you are much more likely to have spider veins. The same is true for people who have spider veins that run in their families.

If there is any suspicion of spider veins, they should be evaluated fully. It doesn’t take a long time  to evaluate them, and we can treat them with sclerotherapy on the same visit, usually in less than an hour. It’s definitely preferable to being limited to pants year-round.

 

Want to Learn More?

For more information about looking and feeling your best, please contact NYC Surgical Associates or call 877-221-3955.


5 Exercises for Healthier Veins

Why are Healthy Veins Important?

About half of all adults in the United States have some sort of vein disease, according to the Society of Interventional Radiology, and about a quarter of all American adults have varicose veins. The good news is that regular physical activity can give you healthier veins, especially if you do enough of the right exercises.

Veins transport blood from the far reaches of your body back to your heart. These blood vessels must be healthy to move blood upwards against the force of gravity. A series of one-way valves help the veins do this by opening and closing to trap blood in small segments inside the blood vessels, so that the blood does not flow backwards towards your feet.

Unhealthy veins and poorly functioning valves allow blood to accumulate and pool in your lower legs. The pressure of pooling blood causes the veins to bloat, twist, and turn into spider veins and varicose veins.

Exercise is good for veins because it promotes good blood circulation. Contracting and relaxing your muscles also stimulates the opening and closing of the valves. When you contract your muscles, the pressure of the tightening muscle squeezes against the veins to push blood upwards towards your heart, and the valves open to allow blood to move from one segment of vein to the next. Relaxing your muscles causes the valves to close again to prevent blood from flowing backwards, a condition known as reflux.

Five Exercises to do Today for Healthier Veins Tomorrow

While most forms of physical activity are good for your health, some exercises are particularly good at promoting good veins health.

1. Leg lifts

Sit or lie on a mat on your back with your legs straight out. Slowly lift one leg and hold it in the air, allowing the blood to move from your feet towards your hips before lowering your leg back down to the floor. Repeat the exercise with your other leg.

2. Standing calf raises

Rest your hands against a wall or sturdy object. Rise onto your tiptoes, hold the position for a moment, and then lower back down again.

3. Bicycle legs

Lie on your back and raise your feet in the air, bending your legs at your knees. Pedal your legs as if you were riding a bicycle. You can also do this exercise one leg at a time, alternating legs between sets.

3. Side lunges

Stand with your legs about hip-width apart. Step to the right while keeping your toes pointed forward and holding your body low. Straighten your left knee to shift your weight to the right, flexing your hip and knee into a side lunge. Hold the position for a moment before returning to center; repeat the lunge by moving your body to the left.

5. Walking

Walking pumps the muscles in your calves and lower legs to open and close the valves within the veins there.

These five exercises, along with other forms of activity, can improve the health of your veins and reduce the appearance of varicose veins and spider veins.

Want to Learn More?

For more information about looking and feeling your best, please contact NYC Surgical Associates or call 877-221-3955.


Pelvic Pain

What is pelvic pain?

Pain occurring in the lower abdomen (the area from below your belly button to above your legs) is called pelvic pain. Pelvic pain is a symptom shared by a laundry list of potential causes. Some of these are cause for concern, especially if you normally do not experience pain, and suddenly have intense pain which quickly gets worse. Such pain can be due to a serious condition, such as ectopic pregnancy. This is potentially life threatening, and should immediately be treated by a doctor. While sometimes the case, fortunately, most pelvic pain does not represent a life or death issue.

Often, pelvic pain is a chronic issue, occurring regularly and lasting more than 3 months. Chronic pelvic pain is capable of interfering with daily life. Work, social gatherings, and sex are a few activities affected by chronic pelvic pain. When this goes on long enough, some patients can even experience a psychological impact.

What are the symptoms?

Common symptoms include discomfort, such as heaviness and aching, as well as occasional sharp pain. Often pain intensifies and abates with menses, urination, or intercourse, though not always. Additionally, there are many atypical ways that people experience pelvic pain and there is no “one size fits all” approach to this problem. A few atypical symptoms include pain in a nearby area such as the lower back, or the hip, which is actually due to a pelvic process, a constant feeling of bladder fullness, and a constant feeling that you need to have a bowel movement, even when you do not.

Treatment

Fortunately, many causes of pelvic pain can be investigated and treated. With so many possibilities, the actual cause may take some time to find. A few examples include uterine fibroids, endometriosis, and pelvic congestion syndrome. If any of this sounds familiar, don’t give up! Once found, the underlying cause may not be so scary. In many cases minimally invasive procedures may be all that is needed for treatment, so you can go on to lead a better quality of life.

Have questions?

For more information about looking and feeling your best, please contact NYC Surgical Associates or call 877-221-3955.


Spider Veins: 10 Must-Know Facts

Spider Veins: Here’s what you need to know

1. You got them from your parents
Spider veins are genetic. While certain activities can make them worse, they aren’t your fault, you inherited a predisposition for them from your parents.

 2. They aren’t varicose veins
While spider veins are usually related to underlying venous insufficiency, they are not varicose veins. Varicose veins are larger dilated veins that bulge out and curve underneath the skin

3. Treatment of underlying venous reflux will help
Treating the underlying venous reflux won’t make your spider veins go away permanently, but it will significantly slow their advance.  They won’t come back as frequently.

4. Sclerotherapy is an effective treatment
There are other ways to treat spider veins, but other treatments are not as effective. In particular, laser is not as effective.

5. They don’t go away overnight
They often appear to vanish immediately with sclerotherapy, but the process actually takes 1-3 months for them to go away.

6. They get worse with age
Spider veins are progressive, they tend to multiply and increase in size with age.

7. They can appear almost anywhere
Although they appear most commonly on the legs, spider veins can appear on the face, hands, breast and almost anywhere else. Don’t worry, we can treat those also!

8. Pregnancy and obesity can make them worse
Anything that increases the pressure on the venous system can make them appear for the first time, or exacerbate them.

9. Most people have them
About 80% of the population has spider veins. 

10. They are small dilated blood vessels in the skin
They are less than a millimeter in size, but can be highly visible depending on your skin complexion.

Have questions?

For more information about looking and feeling your best, please contact NYC Surgical Associates or call 877-221-3955.