Archive for the ‘Dr. Gould’ category

Compression Stockings

March 7th, 2014

Compression Hoes

Compression stockings, while generally unpopular, provide many benefits for patients with various venous disorders ranging from spider veins to venus ulcers. The Society for Venous and Lymphatic Medicine (formally the American Phlebologist Society) and the American Venous Forum stress three conditions for which there is evidence-based medical data to show clear benefits of compression stockings: to help heal active venous ulcerations, to prevent developing an ulcer after having had a Deep Vein Thrombosis (DVT), and to prevent deep clots from forming after surgery and therefore reducing the risk of a pulmonary embolism (clot in the lungs that can be fatal).

Compression stockings are beneficial for everyday use as well, particularly for those whose occupation require standing for long periods: teachers, hair stylists, and nurses to name a few. The Roman army learned this lesson during long marches that by wrapping their legs with strong leather straps, their legs were much less swollen and much stronger in battle.

TED hoes (the thin, white stockings that patients routinely get in the hospital while at bed rest) are NOT appropriate for the management of venous disease and should not be prescribed for ambulatory patients.

Compression stockings work by decreasing the diameter of dilated and enlarged veins in the legs, thereby increasing the blood flow velocity and promoting blood return to the heart. Compression reduces the filtration of fluid out of the veins and therefore reduces leg edema (swelling) when standing. Compression decreases inflammation in the legs and helps heal venous skin disorders and ulcers. Post-operatively it reduces the risk of developing a deep vein clot by promoting venous flow out of the leg.

Various classes of graduated compression stockings exist and newer, lighter fabrics are available. Many stockings are made of sheer microfibers that are comfortable, attractive, and lightweight while providing the adequate compression needed. In clinical practice, the worse the disease, the higher the compression required to get results. Jobs that require long periods of sitting or standing in one place are particularly prone to cause leg aching, swelling, and lead to varicose veins. Compression stockings, even though they are tight, hot, or just “hard to put on” are helpful for this group. Remember, the next time you struggle to put on your stockings, all the physiologic good they are doing for your leg. Assist devices are also available to aid putting the stockings on. All local pharmacies that sell compression stockings carry these devices or can order them.

In addition to stockings, more helpful tips for healthy legs include:

  • Regular Exercise
  • Elevate Legs
  • Move Your Legs Frequently
  • Avoid Wearing High Heels
  • Maintain Proper Weight
  • Wear Proper Support Hose

I am often asked if crossing one’s legs cause varicose veins. After a through review of the literature I found that it is very unlikely. Varicose veins are caused from defective valves inside the veins and not from external compression such as crossing your legs. Several well identified risk factors however are strongly associated with the development of varicose veins: family history, pregnancy, standing professions and aging.

Your doctor can prescribe many health items to aid in your care, known as durable medical equipment (DME). Compression stockings are considered to be “DME,” since they are required as part of your treatment plan. We provide these stockings for our patients since they are necessary for the procedures that we do at the Richmond Vein Center.

Some insurance companies will reimburse you for a portion of your costs (this varies between plans and insurance companies). The Richmond Vein Center does not have the required license to file on your behalf for durable medical equipment. Upon request, we can help you with the paperwork (receipt, CPT and diagnosis codes) so you can file for a refund if this is a covered cost with your insurance. We also give a surgical discount to our patients for their stockings in an effort to keep their procedure cost to a minimum.

Seeking Medical Vein Treatment

March 2nd, 2013

Woman Researching On Web

In general, there are two reasons why people seek treatment for venous disorders of the lower extremities. Some people have only cosmetic concerns and are unhappy with the appearance of their legs or worse are frankly embarrassed of the presence of their spider and varicose veins. Others seek treatment because of health concerns from symptoms ranging from annoying to incapacitating spider veins, varicose veins, edema, ulcers, bleeding and generalized leg pain. Typical pain includes a heavy, aching fatiguing discomfort alleviated by elevation, usually ambulation (walking) and sometimes by compression stockings. I remember several years ago a 35 year old patient who after his legs were treated stated post operatively that the “cinder blocks that he had been caring around for so many years were gone!” The common theme of venous disease of the legs is one of an annoying, heavy, aching feeling which almost always is relieved by correcting the venous abnormality.

The leg veins rely on a coordinated and complex system of valves and pumps to move blood out of the leg “uphill against gravity” and return it to the heart. When this process fails, either by weakened and incompetent valves located in the veins or by the vein walls themselves becoming tired (aging), weak and dilated, the leg veins especially in the calf muscles “fill-up” with venous blood which pools in the leg causing it to feel heavy and ache and ultimately fatigue. This is called chronic venous hypertension or insufficiency (CVI). As pressure builds up in the deeper leg veins, stress is placed on the surface veins and they become enlarged and result in varicose veins or spider veins.

Treatments of venous disorders until relatively recently (past 15 years) has been for the most part sketchy and poorly organized. Spider veins have been treated by dermatologist, plastic surgeons, general and vascular surgeons, and even primary care physicians with various areas of expertise and training.

The treatment of varicose veins has been historically the “stripping procedure” where a wire is passed along the abnormal vein from the groin to the ankle. A barb was then placed on the distal end (near the ankle) and the vein was then “pulled out” of the leg from the groin until the entire superficial vein was removed. This required general anesthesia, several nights stay in the hospital and weeks of recovery.

In 2000, a paradigm shift occurred when a vascular surgeon in California suggested that by using a thermal ablation catheter it might be possible to cauterize (collapse) from within the vein and close it off eliminating the need to perform the major stripping procedure. The procedure (VNUS Closure) was successful and an entirely new industry was born: The Out Patient Vein Clinic. The idea of treating venous leg pathology exclusively in an outpatient setting (physician’s office), revolutionized vein treatment and provided access to thousands of patients who otherwise would not have been candidates for treatment. Consequently, hundreds if not thousands of Vein Clinics have sprung up worldwide and it is as if “Cinderella finally has arrived at the ball”.

Treatment, never imagined before, can now be performed with local anesthesia, minimal risk and pain and essentially little to no loss from work. To keep pace with the ever growing number of Vein Clinics, two Venous Societies (American College of Phlebology, American Venous Forum) have led the way to establish standards of excellence in promoting advanced vein care.

Many vascular surgeons have changed direction from hospital work and responsibilities to perform office vein surgery. Other physician specialities have also begun treating venous disorders i.e. plastic surgeons, dermatologist, radiologist, cardiologists, general surgeons and primary care physicians.

As with any medical treatment finding a qualified specialist is important to obtain the best result. Vein specialist are called “phlebologists” and have had advanced training in ultrasound, sclerotherapy of spider veins, surgical removal of small vein and catheter ablation techniques for longer, larger and straight veins.

In general, it is a good idea to find a phlebologist who spends the majority of his time treating patients with venous diseases, who has had advanced training and who is a member of the major vein societies such as the American College of Phlegology and the American Venous Forum.

According to the American College of Phlebology Patient’s Guide to Phlebology
Handbook “Healthy Veins…Healthy Legs” there are ten important questions to ask your phlebologist (found in chapter 22):

  1. What training do you have in phlebology and where did you receive it?
  2. What is your primary specialty and are you board certified in it?
  3. What percentage of your practice do you devote to phlebology?
  4. Are you a Diplomate of the American Board of Phlebology?
  5. Are you a member of a professional phlebology society?
  6. Are you trained in ultrasound?
  7. What procedures do you perform, how many have you done, and who actually performs the treatments?
  8. Will I need more than one procedure? Why or why not?
  9. What complications have you seen with these procedures?
  10. What kind of follow-up will I need, and what should I do after the treatment to decrease recurrence of my varicose and spider veins?

My Journey

January 14th, 2013

Dr Gould Headshot  Labcoat

Early on, I came to the realization that I wanted to be a “helper” and “giver” along the journey of my own life. This feeling may have come from my days as an ocean guard, rescuing people from the surf, or from my mother who was a nurse and who helped all the sick “old people” in our neighborhood when I was growing up. That strong sense of purpose led me towards Medicine as a career. I have been fortunate to have had the opportunity to be a surgeon and contribute to many lives in a powerful and meaningful way.

For years I had dreamed of developing my own Clinic where I could help people in need no matter how big or small the problem, no matter how rich or how poor. In more than twenty-five years of practicing general and vascular surgery, I have learned that there is no better feeling than to help someone who is hurting or is in need.

As a result, I have been fortunate to have made so many friends along my private professional journey. Complete strangers, who I first met at night in an emergency room, who put their trust in me have later become my friends. Memories of surgical successes and, yes, of disappointments as well, have shaped who I am and have greatly influenced how I practice medicine. I have learned to listen to my patients for frequently they will correctly tell you what is wrong with them. I have learned the important principle of first “do no harm” and only perform surgery when necessary. I have learned that being kind and compassionate goes a long way in helping someone get well.

I feel very privileged to be a physician and have the opportunity each day to contribute to peoples’ lives. Having developed my own Clinic and establishing a philosophy of helping whoever calls on us is a very special opportunity to help those in need.

One evening, when I was a younger surgeon performing serious procedures in the operating room my son, who was mature well beyond his young age, asked me why I was so sad. I replied that I was very concerned about patients that were not doing well in the hospital. My son’s response was for me to visualize being in a large white room and imagine that all of the patients that I had helped along the way were smiling and thanking me for caring about them.

This image profoundly affects how I approach each day’s challenges and will forever affect how I treat patients, no matter how big or small the problem.

In conclusion, the Vein Center has provided me with a supportive and caring environment, without the distractions that are so frequent in hospitals today, to take advantage of the lessons that I have learned along the way to be a better person and surgeon. Lastly, I would like to thank my devoted wife who helped develop the Clinic and has been with me every step of this journey.

-Dr. Charles F. Gould M.D.