Episode Transcript
[00:00:00] Speaker A: You.
[00:00:01] Speaker B: Welcome to the Birmingham Medical News Podcast. We are hosted by Kasoof and Company. We're doing it in their studios. Kasuf is an accounting firm, a CPA firm that's been in business for over a hundred years. They've got a big, big healthcare practice, along with a number of other practices. And today we're talking with Dr. Austin Hunt. He is the own owner of Alabama Vein and Restoration Med Spa. And before we get started, we want to mention that our sponsor today is Jobs, and Dr. Hunt actually uses Jobs. They make compression therapy solutions. And I'd just like to ask you, Dr. Hunt, a little bit about how you use Jopes with your patients.
[00:00:46] Speaker C: Yes, sir. Compression devices can be used for either the extremities or the arms. So, like, postmestectomy, if you have Lymphedema post breast resection, you can wear compression to help keep the swelling out of your arms. For the legs, we use it for various reasons. I wear the compression hose when I bicycle, but we also use them postoperatively after endovenous, laser bllation, chemical sclerotherapy. We use them to help the patient recover. Post procedure, you can also use them for long distance trips. People don't realize when you're flying or you're in a car for various amounts of hours, you're at risk for developing DVTs or superficial thrombophabitis. And wearing compression hose for long distance trips actually reduces the probability of developing these complications while in a prolonged situation.
[00:01:35] Speaker B: All right, so like I said, our guest is Dr. Austin Hunt. And, Dr. Hunt, tell us a little bit about your background.
[00:01:43] Speaker C: Yes, sir. I was born in Southern Indiana, right across from Louisville, Kentucky.
At a young age, I decided I want to be a doctor, mainly because of my father's. Dad passed away when he was eight years old of rheumatic heart disease. Eric Valve. So I went to med school in Indianapolis, which is Indiana University med school.
And then after you graduate, you left for what's called a residency. And before you come up with a heart surgeon, you have to be a general surgeon for five years. And I came down and interviewed at Caraway. And I loved Caraway. The staff was wonderful. Dr. Laws and all the other attendings there were wonderful. So I selected that as my place to do my general surgical training.
Go ahead.
[00:02:26] Speaker B: Sorry. How'd you end up down here from Indiana, though?
[00:02:28] Speaker C: Well, so what happens in residency? You look for spots to train at.
Somebody had mentioned that Caraway was a great program, and it really was tremendous training. I had a great time. And that's where I was exposed to Dr. Kingsley, who was a vascular surgeon at Caraway, and Dr. Harvey, and they helped train me. And then I completed my training in thoracic and cardiovascular surgery at the University of Kentucky.
And so then after that, I went out and spent a couple years in Colorado, and I'm just a bluegrass type of guy. So when you got out to Colorado, it's all desert, and I just couldn't handle that. So I came back, and I trained residents for four years in Memphis oh, wow. Tennessee.
[00:03:08] Speaker A: Okay.
[00:03:08] Speaker C: And then Dr. Kingsley and I ran each other somewhere, and he was talking to me, and I was starting to already look at venous disease because actually, in Colorado, it was amazing. It was, like, around 2004, and nobody at this time was doing vein surgery. Very few guys were doing it. And so there was a guy in Colorado and healed a venous wound. And that was when I was saying he healed a venous wound. And that amazed me. So Kingsley got me interested and then brought me here and trained me. I trained with him for six months, and then I've been doing vein surgery since.
[00:03:39] Speaker B: Okay, we were going to talk to you today about venous reflux disease, or reflux disorder. So the first question is simply, what is venous reflux disease?
[00:03:49] Speaker C: Venous reflux disorder is a condition where, through dilation of the one way valves and the saffinous vein, blood reverses flow. So, in other words, what happens is, when we stand up, gravity wants to pull the blood from our head to our feet. When we lay completely flat, the venous pressure in our head and our feet is the same. But when we stand up, blood falls from our head to our feet. So to prevent the blood from flowing the wrong direction and staying in our legs, we have 21 valves in the saffinous vein and roughly 13 to 16 in the small saffronous vein. And this prevents what we call regurgitation, or reflux down the vein. So what happens with saffronous vein reflux disorder? Either through dilation or damage to the one way valves, blood now persistently flows backwards in the saffronous veins. In addition, you have arterial blood flow coming from the arteries into the venous system. So we have congestion in the leg. So what happens is we have excessive amounts of pressure within these veins and fluid. And then what happens is most people don't realize this. The vein is only it's a weak structure, not like the arteries, which can handle 120 to 180 mercury of pressure. The vein can handle only around eight to 12 mercury. So what happens is the pressure gets so great that the water leaks out of the veins into the tissue, and that's what causes leg swelling. Also, red blood cells can leak out, and then they deposit iron in our skin. So if you've ever seen somebody's legs start turning brown, the techno term is hemocytrine deposits. And that actually will cause the discoloration of your skin.
[00:05:23] Speaker B: Let me ask you this. How does venous reflux impact patients?
[00:05:28] Speaker C: Well, that's a good question. It comes down to several things. One is there's something called the natural history of a disease, which means if a physician doesn't intervene, where does the disease end? And venous disease has a wide spectrum. It can be. Some people never have symptoms. Some people develop spider veins. But the end stage, the worst stage is they get significant skin destruction. They get what's called a venous ulcer conform. People who have ulcers on the inside of their leg or the back of their leg, not on the foot, but in what we call the Gator distribution. From the ankle to the knee, it's the Gator distribution. You can develop wounds that won't heal. And when you treat the venous disease, they just dry up and go away. It's pretty amazing. So what happens with it is through swelling, the skin stretches and then the arterial blood flow can't get to your skin and your skin starts to die. And I don't know if you've ever seen a leg or if people if they look, they'll look at your own legs, you'll start to notice your skin texture becomes from soft. It starts getting hard. And I've actually had patients skin so hard that you can't introduce a needle into their skin. It becomes almost like a piece of leather wrapped around wood. And so what happens is that's the end stage disease. So they bump your leg, you get a venous wound that won't heal.
And it's awful, it's painful and not like see, diabetes affects the bottom of the foot. Diabetes affects small vessels. So you get ulcers on the bottom of your foot or on the tip of your toe. And a lot of people confuse venous ulcers with diabetic ulcers and they're not the same. And so diabetic ulcers are harder to treat. Venous ulcers, you do endivenous laser ablation or some form ablation of the SAP in his vein and the wound will heal.
[00:07:08] Speaker B: You mentioned that in some cases you don't see it. There's no symptoms.
[00:07:18] Speaker C: Yeah, we're all different. That's the amazing thing about humans. We're all different and we have different. Part of it is how significant the disease is. And it's interesting. Like what we do is you look with an ultrasound and some people have massive skin destruction and their veins aren't very dilated. And other people have extremely dilated veins and they have very little. So it's how our body deals with it. And then the other factor that comes into it is lymphatics. We have three vascular systems in our bodies arteries, which bring oxygen nutrients to our cells. And then we have the venous system which basically takes the blood back to the heart to be remanufactured along with everything and be reoxygenated. Then we have lymphatics. And the lymphatics are the third system. So when we have swelling in our leg, arteries and veins can't reabsorb that water. So how does it get back to our heart? So what happens is the lymphatics absorb the water. There are little clear channels all in our legs and they keep going and basically they connect to lymph nodes. So the lymphatic channels collect a lymph nodes and we all have pretty good understanding of lymph nodes. Then it enters into our belly, and it becomes the Kylie cisternuta, then empties into the chest cavity called the thoracic duct. And then eventually it empties into the left subclavian vein. So if you don't have a lot of swelling, it may be that you have really good lymphatics. The problem is, over a long period of time, the number one cause of lymphatic disease in our country is untreated venous disease. So if those Lymphatics keep working and working, eventually they get damaged because sorry.
[00:08:39] Speaker B: Breaking that was kind of my question, or my thought is that if there's no symptoms, I'm guessing they're not going to see anybody.
[00:08:48] Speaker C: No. Some people, they don't even realize they have it. Or the other thing is, people don't realize what the symptoms are. And so I had one lady, we treated her, and she was like she couldn't wait to get the other leg fixed. She assumed all her life, and it was arthritis that she'd been dealing with, and she had knee pain and leg pain. And so one thing is we can't always tell what pain comes from, meaning it's like a little red indicator. Pain tells us there's something wrong, but it doesn't tell us what's the cause of it. And I remember we had one gentleman orthopedic surgeon had referred him to me to treat his leg before they did a total knee replacement. And we took care of the veins and took care of the giant varus coast veins that were on his knee, and his knee pain went away. So even though he had no cartilage, MRI showed that there was no cartilage. Treating his venous reflux disorder actually alleviated his symptoms. So sometimes we don't know we have symptoms, and some people just have really good, let me just start speaking of that.
[00:09:45] Speaker B: What are the symptoms?
[00:09:46] Speaker C: Well, the most common symptom is swelling.
[00:09:48] Speaker A: Okay.
[00:09:48] Speaker C: Swelling. Leg pain. And leg pain, it can be sort of and again, it's hard to determine it, but people feel like they have cramps. Their legs feel heavy at the end of the day. So one of the things is and this was amazing. It was when early in my career, I treated a lady with reflux disorder, and her swelling went away. She lost 20 pounds of water out of each leg. And I'm not kidding, it was amazing. And the amazing thing, too, is then her legs were lighter and she could walk again. And I'm heart surgeons or like General Patton, I don't want to hear excuses. Get up and move.
[00:10:18] Speaker A: Yeah.
[00:10:18] Speaker C: And so I was thinking she was not being sincere. And actually, I taught me a lesson because she could walk again. And a year later, she lost 100 pounds. Wow. But think about this. If I strap 20 pounds of water onto each of your legs, at the end of the day, you're tired, you're exhausted, they hurt, they ache. And so what we notice is after the procedures, people's legs feel lighter. They don't have leg cramps. Now, there's multiple reasons for, like, leg cramps, but the majority of the time when we treat venous reflux disorder, their leg cramps go away.
And that's the thing. They don't go away all the time. There's other causes, but it's pretty amazing. It will help people. And in some indications, there's another thing that this is just my observation, but there's something called restless leg syndrome.
[00:11:01] Speaker B: Yes, of course.
[00:11:02] Speaker C: There's two types. There's a type that I call the real type, or you're complete, like, will sedate a patient, and you've got to hang onto their leg because it's wiggling everywhere. And about a third of the time, that gets better. So people say, well, why didn't it work the other two thirds of the time? Well, sleep apnea and other reasons can cause restless legs as well. Then there's the other type that I think most of us that have venous reflux disease have. And that's where you're constantly moving, because moving causes the calves to pump the blood out of your legs, like jettisons it out, and so it alleviates your pain.
[00:11:33] Speaker B: So the person is intentionally moving a lot.
[00:11:35] Speaker C: Yeah, but they don't recognize they're moving because just by moving alleviates the pain. So subconsciously, they start moving more.
[00:11:41] Speaker A: Okay.
[00:11:42] Speaker C: And I noticed people move, and they constantly move. And then when you fix their legs, it's like, I don't have to move anymore. So that's another reason.
[00:11:51] Speaker B: So what happens?
What are the consequences if it's untreated?
[00:11:57] Speaker C: Well, untreated, the number one thing is it can damage your lymphatics. You have persistent swelling. Two, like I was saying, the leg will swell to the point where the arterial blood flow is compromised. In other words, if the pressure actually gets so great in the leg, all flow goes through our body based on pressure.
[00:12:15] Speaker A: Okay?
[00:12:16] Speaker C: So if the pressure gets so great that the blood can't flow from the deep system or the arteries to the superficial system, the skin, you don't have blood flow to the skin. So the skin dies. And the term for it, medical term for it, is called lipotomatosclerosis, okay? Which just means hardening of the skin. And it almost looks like the leg will almost take on the shape of a champagne bottle. I hear a lot of women say, why is my calf bigger than my ankle? It looks abnormal. And it's not that your calf is bigger, but all the skin has died. So it withers away into this almost like a champagne bottle. So that's one of the consequences. And another one that I learned was that varicose veins, we think of them as cosmetic, but untreated varicose veins. Now, I can never predict if you're going to get a blood clot, but once you get a blood clot in a varicose vein, it's been my experience 40% of the time, there is the risk that it can propagate or grow into the deep system. Now you've got what's called you go from superficial thrombophabitis to deep vein thrombosis. And as a consequence, that clot can then mobilize and can go to your lungs. And if it's big enough, it can obstruct the blood flow from the right to the left heart. It's called a pulmonary embolus, and it can be fatal.
[00:13:25] Speaker A: Okay?
[00:13:26] Speaker C: And as a patient, that's my biggest fear as a patient in a hospital, is a pulmonary embolus because they can be fatal quickly.
[00:13:35] Speaker B: And I'm sorry, you said that started with a varicose vein.
[00:13:39] Speaker C: Yeah. If you get a clot in a varicose vein, now, I can't tell you if you're ever going to clot in a varicose vein, but once you get a clot in a varicose, okay, 40% of the time, the literature kind of varies. I've seen 20 to 60, but I'm going to go with about 40. And now I've seen that. So what happens is the clot can grow.
I try to explain it like a skydivers when they jump out of the plane and they keep grabbing each other and they form this huge mass, and then it grows into the deep system. So now you have what's called a deep vein thrombosis, which is really serious because here's why. If you damage the deep system and you damage the deep valves, you may always have persistent swelling. And there's something called post phlebitic syndrome, which is almost like lipidomatosclerosis. So I say if you get a clot in a varicose vein, you need to see somebody quickly.
[00:14:23] Speaker B: I don't know this probably dumb question, but I assume if you get a clot in a varicose vein, you can see the clot.
[00:14:29] Speaker C: Yeah, you feel it. And that's actually a good question because a lot of people, they dismiss it. And I'll go back, one thing is people always assume clot one of the signs of pain. And a lot of people, we all do, we dismiss pain. We kind of make in our own mind of what it is. But really, if you look only for pain, like with dorsiflexion of the foot, where you move your foot, that only occurs about 33% of the time, so you're going to miss it a lot. So with superficial thrombophabitis, you can actually fill the varicose vein. It becomes hard, and the word is indirated. Then it becomes erythematus, meaning red, and it can have focal heat in it. Not your whole body didn't have a feet. Right. Locally hot.
[00:15:06] Speaker B: So the person is going to have an idea. They're going to know something's wrong.
[00:15:09] Speaker C: Yes, there's a lot of people even in the medical and again, I'm a former heart surgeon, right. And I didn't realize how much I did know about venous disease. And start treating people, and you quickly start learning all this stuff. And one of the things is you dismiss a varicose vein as being just a trivial cosmetic thing. And I can't tell you the number of people I've seen it propagate into the deep system. So even with superficial thrombophobitis, okay, it's now my practice. We put you on blood thinners, some form of anticoagulant for a period of at least three to six months to make sure that resolves so that you don't have this complication.
[00:15:46] Speaker B: Okay.
Getting back on the.
[00:15:51] Speaker A: Well, I think.
[00:15:52] Speaker B: You really just answered my question.
I was going to ask you.
[00:15:56] Speaker C: I guess there's a couple of other things I should point out, too.
[00:15:58] Speaker A: Go ahead.
[00:15:58] Speaker C: One of the things is now people look at spider veins and we just kind of think, well, that's an end stage thing. And people think it's cosmetic. And the majority of time it is cosmetic. There are situations where it will spontaneously rupture and bleed on a person, and they can lose a significant amount of blood.
[00:16:15] Speaker A: Okay.
[00:16:16] Speaker C: And so that's one thing. Another thing, you were talking about complications or adverse outcomes without treating your spider veins. Now, not all of them, but some of them, you can just really tell they're going to bleed. And so when you think about it this way, it's sort of like this glass right here. If this glass breaks, what's keeping all the cold air? Nothing. And so it all goes out. So as a consequence, there's no tissue around it to term tampon on it. So what happens is people can bleed and bleed and bleed.
[00:16:40] Speaker A: Oh, man.
[00:16:41] Speaker C: So the blood yeah, so we've seen it. And I heard a lady one time, she said it was shooting across the room, and I was like, It's not arterial. Then I started thinking about it. Now, remember I said the valves don't work. So as a consequence, you have a column of pressure, sort of like a submarine. At the surface. There's no pressure, and it dives. The pressure on the submarine keeps getting bigger. So if you can imagine at the top of your groin where the saffronus vein enters into the deep system, there's not as much pressure, but you start going down to your ankle. Now, even though it's a venous system, which only should be eight to 12 mercury, now you have 120 mercury in your vein, so there's 120 mercury on those veins, and so really, it can't shoot across the room.
[00:17:22] Speaker A: Okay.
[00:17:22] Speaker C: And my very first patient I ever treated, ever as a vein specialist, was a young man that couldn't they kicked him out of the pool because he bumped his leg and bled and bled.
It's one of those things where I've heard through the grapevine somebody actually passed away from bumping one.
[00:17:41] Speaker B: I'm sorry. So they were bumping a varicose vein?
[00:17:43] Speaker C: No, a spider vein.
[00:17:44] Speaker A: Oh, a spider vein.
[00:17:45] Speaker C: I'm sorry. I guess what a spider vein is. They're usually little purple or blue veins on our legs.
[00:17:49] Speaker A: Okay.
[00:17:49] Speaker C: And most people don't like them because it makes their leg looks bad. But what can happen is subset, the vein gets very elongated and torturous and very big and you may only have, like, one. I mean, you can actually see through well, when I did heart surgery, the vena cava, which is the largest vein in the body, we used to run a special catheter through it, and you can actually see through the venous system, and you can actually read the name of the catheter because that's how thin it is.
[00:18:14] Speaker A: Okay.
[00:18:14] Speaker C: So if you can imagine now you've got a spider vein on the skin that is very thin, and you bump it.
[00:18:20] Speaker B: So those things are I'm sorry, just really fragile. I mean, if all you got to.
[00:18:25] Speaker C: Do is bump it yeah, it can what happens is the best thing is just to treat it with medicine, make it go away quickly. We inject a little chemical, it scars it down. But then if you get to a situation where somebody doesn't have to do that, there's been consequences.
[00:18:39] Speaker B: Let me ask, you mentioned so you treat spider veins, you inject a chemical. What about when somebody comes to you they've had a blood clot in a varicose vein. What do you do with that?
[00:18:51] Speaker C: Well, it depends if it's acute and fresh. What we may do at the time of an operation is do what we call we drain it, we excise the vein and take the clot out. If it's been there for a while or there's various reasons. What I'll do is I'll put them on blood thinner and let the clot resolve.
[00:19:07] Speaker A: Okay.
[00:19:07] Speaker C: And the blood thinner doesn't dissolve the clot, but your body does. But what it does is it prevents a clot from getting bigger. We have a fibrinolytic system that actually degrade the clot. So I guess the classic one, if people are wondering, you ever heard of a transient ischemic attack where you have a stroke but it's not complete and it goes away quickly?
[00:19:24] Speaker A: Okay.
[00:19:24] Speaker C: Because the fibromyalytic system in our brain kicked in and dissolved the clot and allowed us to get reperfusion to the brain.
[00:19:29] Speaker A: Okay.
[00:19:30] Speaker C: So what we do is we use anticoagulant to prevent the clot from getting bigger. Then your body dissolves the clot usually, and it depends if it's a small one, I may take them to the operating room more rapidly, but if there's a lot of clots, I let it dissolve and declare what they're going to do before we operate.
[00:19:45] Speaker B: And I think you said that in terms of going in to operate, that's if it's fairly fresh, I would you said and how long would that operation take?
[00:19:53] Speaker C: Well, I guess that we do it at the same time we do the operation. So for me, it takes about 45 minutes to an hour and 1520 minutes.
[00:20:02] Speaker B: Is the patient completely sedated, or is it just like yes, we sedate patients.
[00:20:09] Speaker A: Okay.
[00:20:09] Speaker C: So it's the same stuff they use with colonoscopy. They call it twilight medication. My mentor used to say it's just like having a couple of margaritas. You fall asleep, you wake up and the operation's over in our office. And typically, it's about 2 hours you're there from the time you check into the time we leave. Okay.
[00:20:26] Speaker B: Rip Jimmy Buffett with the margaritas.
[00:20:30] Speaker C: But the operation itself, we don't make incisions. So what we do is make a little stab incision.
[00:20:35] Speaker A: Okay.
[00:20:36] Speaker C: We have special little devices, and we can extract the clot through nothing bigger than an 18 gauge puncture.
That's interesting. You get a good cosmetic result as well.
[00:20:44] Speaker B: Okay, so it's just a puncture.
[00:20:46] Speaker C: Yeah. So everything that we do is through a puncture.
[00:20:49] Speaker B: Now, what about all right, after any of those procedures, how long does somebody need to wait before they can start doing serious exercise?
[00:21:00] Speaker C: So the standard thing is, what we do is we make you wait two weeks after the final operation before you go back. So we typically will do a staged operation every two weeks. We give you a break for about two weeks, then we come back. And so, say, for example, we treat your right leg first, okay? You got two weeks, and then we come back and treat the left.
[00:21:17] Speaker B: So postopular I'm sorry. Now we're talking about an operation for venous reflux. Okay, let's make sure I don't want people to think we're talking about the varicose vein.
[00:21:28] Speaker C: Varicose, yeah. No, it's part of an operation. So if I do it, I'm going to do everything at one time.
[00:21:32] Speaker A: Sure.
[00:21:32] Speaker C: So that way you don't have to keep coming back to the office. So typically what we do to treat the saffinous vein is called endovenous laser ablation.
[00:21:39] Speaker A: Okay?
[00:21:40] Speaker C: Some people, it's a thermal so it's thermal ablation. So there's thermal and chemical ablation.
[00:21:45] Speaker A: Okay.
[00:21:45] Speaker C: So some people inject chemicals, some people use heat. I kind of use a combination depending on it's, like playing golf. You got to have more than a putter to win. You got to have everything. And so I do all sorts of things. So say you come in and you have varicose veins, and some of them have got clots in them and some don't.
And I will operate on people on anticoagulant as well, because I'll come back to that. But there are certain groups of people who are genetically programmed to form clots, okay? And my staff, we look for them all the time.
What we do is you go to the operating room, so we sedate you under sterile technique, just like a real big operation. Sure. We do everything under sterile technique. I use an ultrasound. I cannulate the vein. We put the laser fiber in, and then we use a numbing medicine, a solution called temescence around the vein so that you don't feel anything. And then we just Carterize the vein. And what's interesting was it took 1700 years ago, but Marcus Aurelius was the last great Roman emperor, I remember, and he had a physician named Galen, and Galen Postulated, that if you could get a wire hard enough and insert inside the SAFF in his vein. You could treat venous disease, but it took technology. One, being sterile. Two, pain medicine, because nobody's going to let you put a 700 degree wire inside your leg. And then the ultrasound has really changed. That's how we diagnose the disease. We use an ultrasound. And in addition to what I do, I can actually do ultrasound. So we kind of look so then we ablate the vein through heat.
[00:23:04] Speaker A: Okay.
[00:23:05] Speaker C: And then the varicose veins, you can actually see them. They'll like bulge. Those are the big veins. We mark them. You take a little blade or a little 18 thing, and we puncture them. And we have a device that looks like a crochet hook and sounds graphic, but we hook the vein, and then you sort of pull it out like an earthworm. Out of the out of the leg.
[00:23:21] Speaker A: Okay.
[00:23:22] Speaker C: That vein is gone. It will never come back.
[00:23:24] Speaker B: Oh, my God.
[00:23:24] Speaker C: So the laser is 99% effective.
[00:23:27] Speaker A: Okay.
[00:23:27] Speaker C: So, I mean, when we ablate that saffronous vein, that vein is gone 99% of the time.
[00:23:31] Speaker B: I didn't realize that the vein is actually gone.
[00:23:34] Speaker C: Yeah, it's gone.
That brings up a question people always want to say, well, how does the blood get back to my heart? And that's something. And what you have to realize is the deep system, which normally does about 90% of the work, it drains the muscles, the tissues, now has to do all the work. It's draining all the blood back to the heart. It's taking all the blood back because the saffronus vein is stealing it and taking it the wrong direction. It's almost like you really need a picture. So if you can imagine you're pushing the deep system, taking the blood back, the shallow vein is stealing it and taking it back down. So it's like you having to work harder. So when we ablate that vein, it just allows all the blood to get out of your leg. And really what the procedure does, if you look at the end result, it decompresses the leg. So what we have is excessive pressure in the leg secondary to the reflux disorder. When we get better, the bad vein, it decompresses your leg. Okay?
So the fullbactomy is we just hook them and you take them out. And then we do chemical sclerotherapy. There's various forms of doing sclerotherapy.
[00:24:31] Speaker A: Okay.
[00:24:32] Speaker C: And we just inject the spider veins, and it takes maybe three or four rounds over a period of time to get the spider veins to go away, just because that's the limitations we have in this time. But the veins will go away.
[00:24:42] Speaker A: Okay.
[00:24:42] Speaker C: And then people are back to so afterwards, you wear compression hose for two week, and then after the final operation, two weeks later, you're back to doing whatever you want to do. And I will say, the day of the operation, I do what's called necessary activity. You can go to the bathroom, get somebody to. Move around the house the next day, you can do whatever you want.
[00:24:59] Speaker B: So pretty quick.
[00:25:00] Speaker C: Yeah, so it's a quick. And so most people are back to work the next day.
[00:25:03] Speaker B: Oh, wow.
[00:25:05] Speaker C: And they're doing what they want to do.
[00:25:07] Speaker B: Now, will treatment for a venous reflux disorder promote healing of a venous ulcer?
[00:25:14] Speaker C: Yes, exactly. Okay, so what happens, again is the skin is and it's amazing, because what happens is if you look at the skin, it's unhealthy, and so it can't heal. And so as a consequence, it's because that venous congestion and pressure. So when you treat the saffronous vein, it will start to heal it pretty quickly. And I've seen there was a gentleman who had been being treated for venous ulcers bilaterally for ten years, came to see me. We treated them, and they healed within a month.
[00:25:40] Speaker B: Oh, man.
[00:25:40] Speaker C: Okay. And so that's part of it.
Yes, it will heal that, and it actually also improves the integrity of the skin. And so what we've noticed is men will start actually growing hair back on their legs where they lose it. So when I was a resident, we were always trained hair loss was arterial.
And so what we started noticing, after you start treating saffronous veins, the hair comes back on the leg. What that really represents know, I'm an Indiana boy. You can't grow corn in a bad field, and hair won't grow in an unhealthy environment. And so the hair starts growing back, which actually tells me that the health of the skin is returning. I think one of the things we got to look at, too, is people don't realize there's conditions like a hyperquagable state, and that's where people can spontaneously form clots. So one of the things we do at our office is we evaluate everybody, and we look for a history. So history of maternal or paternal or brother or sister who have blood clots, history of pulmonary embolisms, history of miscarriages. The placenta is basically like a vascular space suit. So if the baby develops a clot in that placenta, the baby could die. You could have a miscarriage. And I remember in med school, there was a young lady, she had nine miscarriages, and she kept having strokes, and she had what's called not a protein CNS deficiency, lupus anticoagulant factor. And I was reading over, and I figured that out. It was one of those shining moments as a med student, but far and few between. But the point being is so we evaluate people for that, and we come across a lot of people that actually have a hypercoagulable state. And the beauty is, not only do you protect the patient, but you can actually help identify family members and protect them as well because it is hereditary genetic.
[00:27:20] Speaker A: Okay.
[00:27:21] Speaker C: Yeah. So it's called thrombophilia, which we all know. Hemophilia. These people like to spontaneously bleed. So you have thrombophilia, and those are people who spontaneous clot.
[00:27:29] Speaker A: Okay.
[00:27:30] Speaker C: And so we work up a fair number of them to make sure these people are safe. We take that when we do the operation, before we operate.
[00:27:36] Speaker B: People like that, that you just said, they spontaneously clot.
How do you know? So you have a patient who comes to you.
[00:27:46] Speaker C: So we'll do the history and we'll kind of look and talk to them and we'll refer them to A oncologist hematologist who does the blood work and then we converse with them and make sure and that's why sometimes we will operate on anticoagulants.
I had a lady come up from the Caribbean because she had a protein CNS deficiency and we operated on blood thinner and she did okay.
[00:28:08] Speaker A: Okay.
[00:28:10] Speaker C: I guess another thing that I think is significance. Know, when I was a heart surgeon, it was amazing because I thought I was curing people. And you do to a point, but you don't really prevent anything. And some of the stuff we do as heart surgeon was tragic and sad. We're operating on people that are going to die. But with venous disease, not only do I cure you, but I prevent the progression of the disease. And going back to the natural history is what happens if a physician doesn't intervene. So by intervening we can actually prevent the skin damage. You can prevent people from getting ulcers and you can prevent all that stuff. So that's the beauty. So if you find it early, it will eliminate these skin damage issues.
[00:28:56] Speaker B: And by the way, does insurance pay for any of these three venous reflux varicose veins and or spider veins?
[00:29:04] Speaker C: So they'll pay for the chemical or thermal ablation and they'll pay for the sedation and they'll pay for the microflubectomies. That's the term we use to remove the varicose veins. And I want to step back. There's something too. Yes, but they did. Now the only thing they want copays compression hose and spider veins, they will not treat, they will not pay for.
[00:29:28] Speaker B: But it does cover yes, venous, right?
[00:29:30] Speaker C: Yeah, it covers that. So the really only thing it doesn't cover is spider veins.
[00:29:34] Speaker A: Okay.
[00:29:34] Speaker C: And I try to charge a fair price because we want people to do it and try to protect them. So that's about the only thing it doesn't really cover the cosmetic spider veins.
[00:29:45] Speaker B: I see.
Those are, I guess the three that you spend the most time with, I assume. Is that right? Yes, venous.
[00:29:56] Speaker C: Venous reflux spider veins and microphobacteries. That's the majority of the practice, yes.
[00:30:01] Speaker A: Okay.
[00:30:02] Speaker C: And then the other thing is we deal help with Lymphatics. So what happens is there is Lymphatic disease as well.
[00:30:08] Speaker A: Okay.
[00:30:08] Speaker C: So some people will show up and they have Lymphatic disease and not the venous disease. So treating their veins isn't going to benefit them. We still take care of them.
[00:30:18] Speaker B: Are these people who think they think it's venous reflux?
[00:30:22] Speaker C: Well, they're not sure. So they come to us and we evaluate them and we kind of look it over. So there's a subset of people, and you can actually have lymphatic disease and venous disease, but some people just have their veins are completely normal, but they have leg swelling, and that's lymphatic damage, and there's various reasons to cause it. The most prominent, again, is venous reflux disease in our country. And then the other is we see a fair amount of when a young lady has her first period, her menarch, an estrogen actually causes sclerosis of the lymphatics in some young ladies, and that will cause their legs to swell. And they had tiny legs before. Now their legs are very swollen and edematus. So what we do is we get them into compression therapy, where they actually do manual compression, and they massage their legs. Okay.
And I was really amazed the first time I saw somebody do it. I was impressed with how dedicated these ladies and gentlemen are at squeezing. What they do is it really massages. They push the into your abdomen, and they sort of force it, and they bring it back up to the left subclavian vein, which empties into the I mean, to the left subclavian vein, and that's where it empties. Then what we can do is we can get them into compression host therapy. And then there's pneumatic compression that you do at night. Say you get home from work or whatever you're doing. You can put your legs in a device that the insurance will cover most of the time, and you put your leg in this, then through sequential compression, it squeezes the fluid back out of your leg and help decompresses it.
[00:31:45] Speaker B: One last thing I thought about as we were talking, how prevalent is venous reflux?
[00:31:53] Speaker C: I think most people have it. I think the majority of our society actually has it.
[00:31:57] Speaker A: Okay.
[00:31:57] Speaker B: Because I guess we're so much so many of us are sitting well, but.
[00:32:02] Speaker C: See, sitting or standing, it's the same thing. It's immobilization. There was a study, and so the only people that really the people who are less likely to have venous disease are somebody that's always on the go. And so whether you're sitting at a desk or you're standing doing something like a heart surgeon or a computer specialist, you're immobile. Right. When you operate, sometimes you're standing the same spot for six, 7 hours in a case.
[00:32:24] Speaker A: Yeah.
[00:32:24] Speaker B: You mentioned before we went on that you had stood for 37 straight hours in surgery.
[00:32:28] Speaker C: Yeah, when I was a resident, I couldn't do that again, but really, when I came action, it was interesting because probably then I diagnosed myself, and I wasn't even aware that I had reflux myself at that. Oh, you did? Yeah. Well, I didn't realize it. So what happened was, when I finally got to go home, at the end of the second or third day, my legs were hurting, and they were heavy, and we were sitting there, and I think two in the top. We had done a transplant on a young lady in my attending, kept wiggling his feet.
[00:32:54] Speaker B: Oh, man.
[00:32:55] Speaker C: And he probably had venous reflux looking back on it because he was moving his legs trying to without even thinking about it, he was using the calf reflux to sort of pump it out. So I went home and put my legs up. Like, I literally rested my legs up against the wall, and it made him feel better.
So we all have reflux. I think it's very prominent. Okay. I think on any given day, I can't tell you the exact number, but there's a significant number of us that have it. I mean, I'm surprised everybody probably has it.
[00:33:25] Speaker B: That's incredible. I would have never guessed. But it makes sense because in this day and time I know you said standing, too, but so many of us are sitting. I mean, I'm pretty darn immobile all day.
[00:33:36] Speaker C: Yeah. The other thing, too is it doesn't cause it, but it sort of promotes it, I will say. Because, again, the two biggest things are genetic predilection to forming clots or no, to forming veno dilation.
[00:33:50] Speaker A: Okay.
[00:33:50] Speaker C: So what happens? Our vein will double or triple in size, and these one way valves, which originate on the inside of the wall and touch, are now distracted backwards, so they can't touch. So what happens is the blood flows up and then closes like a drawbridge. Now you pull the drawbridge back so it can't touch, and the blood just flows downward. So we have a genetic correction for veno dilation. And then when we stand all day long, it just keeps putting pressure on all those veins, and we rupture and so that and gravity. So we can't change genetics or gravity.
[00:34:17] Speaker A: Right.
[00:34:17] Speaker C: So neither one of those we can change. And so that's just what we have to deal with. Okay, but pregnancy, I was going to say.
So when women get pregnant oh, yes. And so what happens is typically your first child, about 20% to 25% of women will get it. And then about the second child, it jumps up to 40, and then it gets about after the third child, you're about 70%. Wow. And so what happens is they get the disease, and people think it's better to wait until you're done having children, and that's actually not true. It's better to get like if you know you're going to have more children and you recognize venous disease, it's better to get your legs fixed. Because number one, when a woman gets pregnant, about 60% of the weight she gains is pure water. So now you've got more water in your body, and it's putting pressure on those legs. Two, if we take care of the varicose veins, it reduces your risk of getting a clot in that varicose vein during pregnancy, because then if you're pregnant with a clot, they can't put you on oral anticoagulant, and then you have to get injections in your belly. So there's a lot of reasons to get your veins fixed. Know if you know you have venous disease before you have another child.
[00:35:23] Speaker B: So bottom it's and I'm really surprised. It's really common, obviously. Really know obviously. I know your practice is in Birmingham, but what part of town?
[00:35:34] Speaker C: Yeah, we used to be in Vestavia. Dr. Kingsley was my mentor who trained me to do it. And then we've moved to Hoover near the galleria.
[00:35:44] Speaker B: Okay, well, in closing, any final thoughts on venous reflux or any of the.
[00:35:51] Speaker C: Other well, I think that if you suspect it, one of the things is you don't have to have a referral. You can just call the office.
So that's one thing. And I think, too, the majority of people really do. There's a lot of people that have it benefit from it and from all the I remember in my time at Caraway, that's where I trained to do my general surgery.
And I think Caraway was one of the first to have a wound care center. And what I found interesting was when we first started doing it, it was diabetics vascular disease, and the majority of the wounds were vascular disease. And the things that shocked me was the people that did have venous disease, their wounds are so painful because with diabetic disease, you get neuropathies and so you don't feel the wound on your leg. I mean, somebody can debrief it and you won't feel it with a venous disease. It's a highly sensitive wound.
[00:36:51] Speaker A: Okay.
[00:36:51] Speaker C: And so then it's interesting over the transition from that, we've seen more and more now it's becoming almost venous wounds.
[00:37:00] Speaker B: Mostly.
[00:37:00] Speaker C: Yeah, it's mostly venous wounds. And so the benefit is by getting your leg treated, it'll really protect you from that. And to me, it's just it's amazing. And I couldn't how I thought I knew a little about venous disease. And then after spending my time with Kingsley and then practicing all the years I have, I was really amazed at the significance of Venus disease and how much of an impact it has on people.
[00:37:25] Speaker B: Well, great.
Definitely want to thank you a lot for time and all the information and want to thank Russ Dorsey here with KASU for basically doing all the engineering and putting it all together for us. And we'll just look forward to seeing you again.
