Last week I attended the monthly local medical society meeting at the Benton Club in St. Joseph. The bartender gave me a tour, attempting to squeeze in every highlight of its 100+ year history, while all the other member physicians gathered and greeted each other in the reception hall. Soon we were watching a local cardiologist give a presentation on the use of a non-invasive CT Scan to compute in seconds the risk of a heart attack in patients.

As I watched the colorful pictures on the screen, I thought of my mother, who passed away at a fairly young age after living with “heartburn” for years, that was treated with medications for indigestion. Being a woman and a diabetic are both major factors that confound the symptoms of heart disease. A slightly higher index of suspicion could have saved her life and one of the newer diagnostic tools such as the Coronary Calcium Scan could have kept her health in check.

My thoughts shifted to one of my recent patients, a 93-year-old woman with advanced venous disease in her legs. She was brought to my clinic in a wheelchair by her two daughters. When I asked her what changes she hoped to accomplish, she promptly responded, “Can you help me get me out of this wheelchair?”. There was no hesitation in her voice as she expressed her desire to not only live longer but also enjoy her life along the way.

Life is a beautiful journeyI witness the daily hopes and aspirations of numerous patients like this amazing woman who is 93 years “young”. Some have the usual symptoms of heaviness in the legs, cramps, restlessness, and swelling. Many others have lived long enough with vein problems in their legs and present with clots or sores in their legs. Hope tends to be contagious. Earlier this week, while treating a patient who came with a clot in her leg, I found out that her husband was also on my schedule. He has lived with swelling and sores in his legs for many years. She indicated with pride that, “I diagnosed his problem myself and told him to come and see you”. I won’t be surprised if he will soon be able to enjoy the full use of his legs without the constant fear of ongoing pain, infection, or even risk of amputation.

My kids did not have an opportunity to spend time with my mother, their grandmother, and I never had a chance to be her doctor. I take consolation from knowing that my work allows many of my patients to enjoy a longer, healthier life. Life is much more beautiful when mothers and grandmothers are part of the journey.

Sam Gupta, M.D.

Veins, acting as “pipes,” have to frequently work against gravity to push blood back towards the heart especially when we sit or stand. These veins have valves that assist in the one-way flow back to the heart. Further, leg muscles especially calf muscles act like a pump much like a sump pump in our basement.

Click to view large image

Over time, compounded by factors such as genetic predisposition, pregnancies, hormonal changes, prolonged sitting or standing, lifting weights, and age, some veins fail. Unable to move forward, blood begins to backtrack and pool in the legs causing the familiar symptoms of heaviness, achiness, and tiredness in legs, particularly in the evenings. Increased pressure on the vein walls makes them “gnarly” or varicose. Some veins that are close to the surface of the skin can be seen from the outside as ropy veins or spider veins.

Venous hypertension (increased pressure of the blood in failed veins) predisposes you to profuse bleeding. Elevated pressure causes fluid from veins to leak out into surrounding space much like flooding in our basement when a pipe breaks.

Remember that the blood in veins is deoxygenated (has “low” oxygen content) and replete with waste products. This blood needs to be sent back to the heart where it can be enriched and put back in circulation. When there is an increased buildup of venous blood in the legs, patients may notice itching, burning, leg cramps (charley horses), and restlessness. Persistent stasis (pooling) causes hyperpigmentation (discoloration of the skin due to deposition of the hemosiderin pigment from the breakdown of red blood cells), cellulitis (skin infection), thrombosis (blood clots), and poorly healing ulcers (sores) in the legs. This is comparable to staining on the walls from leaky pipes, growth of mold, cracks in the walls, and eventually its breakdown.

These unhealthy veins in the legs are unnecessary. In the past, they were removed surgically. Modern treatment options are much easier, safer, and very effective with no downtime. Almost all insurance including Medicare offers coverage for symptomatic varicose veins. Contact Alsara Vein Clinic at 816-396-0245 to set up a Consultation today.

My 9-year-old daughter recently had a major change in her career plans, from wanting to be a mermaid to being a Physician. I am still trying to find similarities between the two professions to better understand what led to this “slight” change in the career path for her. Some rightly said that children are like mirrors; they reflect all that they see and hear. Perhaps she sees the difference that our work has made in the lives of many including her teachers who came seeking care. I am certain that the stories of numerous patients have impacted her. For instance, hearing that several of my patients have “charley horses”, it was only natural for her to request one… “Dad, I would like one (charley horse) too!”

Although charley horse is a commonly used term for cramps in the leg, typically in the calf muscles, I was curious to learn about the origin of the term. There is a debate about the origin of the nickname. According to one source, there was a lame horse named Charley whose work was to help move things around a baseball park. The picture of the limping horse was so deeply entrenched in memories of the ballplayers that they started referring to each other as “charley horse” if they pulled a leg muscle or developed any minor impairment in their legs. Since the 1880s, the slang word lingered and is now commonly used to describe a sudden tightening or contracting sensation that lasts a few seconds to several hours and can be painful as well as debilitating.

The dreaded charley horse is reported to affect up to 60 percent of adults who have reported the presence of nocturnal leg cramps in the form of a painful spasm, tightening of calf muscles, and twinges. Numerous causes of charley horses have been described in the medical literature including muscle fatigue, dehydration, mineral deficiency, and poor circulation (venous insufficiency).

During the initial stages, it is a good idea to gently massage the affected areas and use over-the-counter pain medication such as ibuprofen.

There are some easy ways to help prevent charley horses including staying hydrated, eating a balanced diet, avoiding excessive sugars and caffeine, and avoiding overexertion.

There are numerous old wives’ tales about home remedies from drinking pickle juice, using quinine, to the use of a bar of soap under the bedsheet to fend off charley horses. There is scarce scientific data to back these claims. One Harvard study described an ion channel called TRPV1 that activates the spinal column and inhibits the firing of nerves to dull the pain of cramps. It is possible that the protons in pickle juice use this mechanism to help alleviate the discomfort. Remember that a mere 2 ounce shot of the juice may contain a few hundred milligrams of sodium, so anyone with heart disease, hypertension, or renal insufficiency should exercise caution. Quinine has potential side effects such as severe bleeding and heart arrhythmias. There does not seem to be any harm from using a bar of nice smelling soap if you have a strong urge to try it under your bedsheet. If nothing else, it will help your bed smell nice!

Having a magnesium, potassium, or calcium deficiency can contribute to leg cramps, however, your medical history must be taken into account before you consider using any over-the-counter supplements. It is always better to discuss with your Primary Care Provider to avoid any adverse interactions.

Although infrequent incidences of muscle spasms may not be anything to worry about, they are signs that the spasms might be more than a run-of-the-mill charley horse. Studies have shown that leg cramps at night are a very common manifestation of venous disease in the legs. Our veins are responsible for collecting de-oxygenated blood from the tissues and returning it to the heart and lungs, where the blood is replenished with oxygen and nutrients. Veins in the legs tend to fail more easily due to risk factors such as genetic predisposition, prolonged sitting or standing, pregnancies, and age. When some veins fail, the blood cannot flow through them effectively and starts pooling in the legs. In face of compromised blood flow, calf muscles are not able to function appropriately and cause cramps (charley horses) and restlessness (Restless Leg Syndrome).

I cannot emphasize enough the seriousness of repetitive muscle cramps. One of our patients, Sandra Dyer, has graciously shared her story. She and her husband came to us looking for answers after three visits to the hospital for severe leg cramps.

Like most chronic conditions, left untreated, the diseased (varicose) veins continue to worsen and may cause other complications such as swelling, skin discoloration, blood clots, poorly healing sores, infection, or bleeding.

Using modern technology, we are now able to easily seal the diseased veins with help of endovenous laser ablation, allowing you to return to normal activities, without any downtime. Treatment of symptomatic venous disease is typically covered by most insurance companies including Medicare and Medicaid.

If “charley horses” are visiting you at night, call 816-396-0245 to get back in the saddle or schedule a Consultation today.

Click to view large image

Please describe your experience with us:

You know we are going to give you all high marks!!

Front Desk staff:

Excellence with a smile & helpful.

Ultrasound Technologist:

Excellence with a tinge of sarcasm (which we loved!).

Provider/Doctor/Nurse Practitioner:

Excellence with funny analogies.

Billing/Patient Account Services:

Medicaid/Medicare/Tricare insurance – didn't need to do anything.

Call Center/Patient Service Center:

Very good.

What made you choose us?

LaVerna Village nurse practitioner recommendation.

What symptoms were you experiencing?

Swelling in lower legs, wound that didn't heal.

How were you affected by your legs previously? What couldn't you do? How has that changed now?

Legs had been swollen for years, couldn't walk much; skin so tight couldn't move knees or ankles. [After treatment] swelling is gone, wounds healed, able to bend knees & flex ankles – walking better.

What improvements have you seen in your legs?

Swelling gone, able to flex ankles & bend knees, sores healed.

Additional Comments: What did you appreciate? What makes us different than other medical clinics? What could we have done better to exceed your expectations? What changes would you like to see?

Eveyone at Alsara Vein Clinic put us at ease from the start & very helpful. We loved the casual professionalism and witty banter because we knew/felt deep down you really wanted to help.

Infection / Venous Ulcer

Progression of Varicose Veins can lead to Venous Ulcers and Infection

• Consultation

• Contact Us

Varicose Vein Treatments are coved by insurance including Medicare and Medicaid

• VEIN DISEASE - OVERVIEW
• Varicose Veins
• Chronic Venous Insufficiency
• Blood Clots
• Spider Veins
• Restless Leg Syndrome
• Edema (swelling)
• Infection / Leg Ulcers
• Neuropathy

Please describe your experience with us:

Front Desk staff:

Very friendly. They know their stuff.

Ultrasound Technologist:

I only had one and she was the best – Kati.

Provider/Doctor/Nurse Practitioner:

My doctor [Dr. Gupta] was excellent, very friendly.

Billing/Patient Account Services:

Excellent service.

Call Center/Patient Service Center:

Fantastic lady, knows her stuff.

What made you choose us?

Dr. Randalls of M.C Northwest Health told us about your clinic. I'm so glad she did.

What symptoms were you experiencing?

Blisters turning to open sores. Legs red and covered in scabs.

How were you affected by your legs previously? What couldn't you do? How has that changed now?

I couldn't get my sores under control. They kept getting worse. With the right treatment, my legs finally start to heal. I can wear shorts and am not embarrassed to show my legs.

What improvements have you seen in your legs?

My blisters are gone. No more scabs; not 100% yet but getting closer.

Additional Comments: What did you appreciate? What makes us different than other medical clinics? What could we have done better to exceed your expectations? What changes would you like to see?

I appreciate the hard work Dr. Gupta & Kati did to make me better. I haven't been to another clinic so I can't compare. You could not do any better than you did for me. You don't need to change a thing, you're already doing it right. To all your future patients, this is where you want to be!

Signs and Symptoms

The initial signs and symptoms may include:

• Aching
• Burning or numbness
• Cramping or 'Charley horse'
• Heaviness
• Itching
• Leg pain
• Restlessness in legs
• Tiredness

• Swelling in feet ankles and calves

• Left untreated, may result in skin discoloration, bleeding veins, sores that heal poorly, and blood clots.

• Consultation

• Contact Us

Varicose Vein Treatments are coved by insurance including Medicare and Medicaid

• Signs & Symptoms
• Leg Cramps & Restless Legs

As living beings, we are part of the natural world and interdependent. As you rest and renew, you can also better meet the needs of those who depend on you. My sister passed away recently and unexpectedly at the young age of 56. Anyone who has lost a loved one knows the intense sense of loss and emotional pain that is involved in the grieving process. The absence of the person who contributed so much to your life is deeply felt while you bereave. In fact, the term bereavement means “to be deprived of someone through death”.

In pursuit of spiritual healing, my wife and I toured some small, quaint towns nestled in the Himalayan Mountains, also the home of many Buddhist monks. It was then that I realized if you befriend nature, it reciprocates with its timeless beauty and power of healing. From the radiant sun to the ice-cold water of the countless streams and the vibrant colored flowers to the succulent fruits native to the region, one must experience personally to fully appreciate it.

Due credit goes to our energetic and young tour guide, a native to the Himalayan region, who enjoyed narrating history, pausing only when he sensed that his audience in the back seat were napping. He shared stories of his childhood, growing up in a family where his father was a truck driver who had to quit working due to severe recurrent leg cramps and swelling in his legs. Having turned “black and brown”, his legs were set to be amputated by a local surgeon; however, a knowledgeable dermatologist recognized the features of chronic venous insufficiency and actually performed a phlebectomy (removal of veins). Although the legs were saved, his father continues to live with swelling and debilitating leg pain. Over the years, his condition took a toll on the family and his father resorted to alcohol abuse.

Since I was on a retreat to nurture my own spirituality far from the realms of modern medicine that I left behind in America, I maintained silence. Nevertheless, at the conclusion of my trip in the Himalayas, I shared with the tour guide how minimally invasive procedures such as EVLA (endovenous laser ablation) allow us to easily correct the circulatory problems caused by venous insufficiency in the legs. He appeared astonished to hear that a simple, 1-hour procedure could have potentially restored full function to his father’s leg.

When we are faced with loss, it is sometimes difficult to feel a sense of gratitude in our lives, yet I had another opportunity to recognize the blessings soon after. Upon conclusion of the 10-day trip, as we made our way through the airport security checkpoints, I crossed paths with a security officer who politely asked me to stretch out my arms while he whisked his “magic wand”, checking for any metal items. In doing so, I struck up a casual conversation with him about how busy the airport was and, out of habit, mumbled about the adverse effects of gravity on blood flow in legs. This astute officer was quick to recognize that I was a Physician and appeared eager to know my area of expertise. His eyes lit up when he learned that I specialized in the treatment of venous leg disorders. He shared that his father has severe swelling, tingling sensation, and numbness in his legs that had already caused numerous falls and injuries. I explained how swelling in the legs was the most specific sign of underlying, chronic venous insufficiency. The tingling and numbness experienced in the feet are often caused by the mechanical pressure of the fluid that builds up throughout the day in the legs. I offered him my business card so that he could contact my office for further guidance (and to avoid holding up the security line!). I had never imagined that a 30-second airport security screening could culminate in a varicose vein consultation.

The loss of my sister has brought my family closer together, all with a deeper sense of compassion and appreciation for the loved ones in our lives. Hence, even through loss and grief, the blessings continue. Without grief, there is little appreciation for joy. Although my sister leaves behind a void, her absence has propelled me to a spiritual path for a more meaningful existence. Life is still a beautiful journey after all!

If you are concerned about varicose veins, chronic venous insufficiency., leg pain, leg cramps, tingling, numbness, swelling, discoloration, or leg sores that are slow to heal, call Alsara Vein Clinic at 816-396-0245 to set up a Consultation today.

Please describe your experience with us:

Front Desk staff:

Friendly and informative.

Ultrasound Technologist:

Knowledgeable, willing to explain.

Provider/Doctor/Nurse Practitioner:

Very professional. Explained everything.

Billing/Patient Account Services:

Excellent.

Call Center/Patient Service Center:

Very helpful.

What made you choose us?

Doctor referral.

What symptoms were you experiencing?

Lower leg swelling.  Pain.

How were you affected by your legs previously? What couldn't you do? How has that changed now?

Leg felt heavy.  Swelling cause skin breakdown which lead to continuing infectons.

What improvements have you seen in your legs?

Less swelling and the pain has gone away.

Additional Comments: What did you appreciate? What makes us different than other medical clinics? What could we have done better to exceed your expectations? What changes would you like to see?

I appreciated the staff and how they make a patient feel comfortable.  Your facility is very clean and pleasant.  I also liked that the staff was not trying to push me through my appointment to get to the next patient.  Don't change a thing. "One can't fix what is not broken.".

Unhealthy veins are like weeds in a garden

Left untreated, they continue to worsen and turn into a serious problem.

Maybe you’ve seen the blue or purple squiggly veins on your legs that look like lines on a roadmap and wondered how to get rid of them. Maybe you are experiencing pain, cramps, restlessness, or have sores on your legs, and you were told by your Primary Care Provider that you have varicose veins. Perhaps you wondered “What the heck are varicose veins anyway” and “How do I get rid of them?”

What is a Varicose Vein (and CVI)?

In simplest terms, varicose veins are faulty blood vessels that have become overstretched and swollen with blood.

When your heart beats, it pumps blood through arteries to every part of your body carrying oxygen and essential nutrients. Since you have a limited amount of blood (about 5 liters in an adult), the deoxygenated blood returns to the heart via countless veins in your body. The veins in your legs are farthest from the heart and must work against gravity to push blood back to the heart. Compounded by other risk factors, some veins wear out over time and become “varicose”. The pooling of blood in varicose veins may cause symptoms such as heaviness, tiredness, itching, burning, cramping, restlessness and pain. Left untreated, the increased pressure of blood in the leg veins can leak out, causing problems such as edema, skin discoloration, sores in legs that heal poorly, and frequent skin infections. This condition is called Chronic Venous Insufficiency (CVI).

Who gets them?

Although varicose veins affect both men and women, they are slightly more common in women who tend to have them at an earlier age. This may also have to do with the fact that men are less inclined to seek timely medical care. Hence, it is not a surprise that men have more advanced stages of varicose veins and CVI by the time they see a vein specialist compared to women. People in general are more likely to get them as they get older.

Frequently there is a genetic predisposition to vein problems. That means that if your mom or your sister has them, you are more likely to also have them. Things that put pressure on your legs and feet — like being overweight or standing for a long time, every day, without exercise — can also cause varicose veins. Pregnancies also make veins worse due to increased pressure of the uterus and the extra blood volume.

Do I need these veins?  How do I get rid of them?

Once a vein is varicose, it is a diseased blood vessel much like a “weed” in your yard. Just like weeds compete for space and nutrients in your yard (and are formidable competitors!), varicose veins have weakened walls that facilitate easy entry of blood but instead of pushing the blood back in circulation, the blood tends to pool in them causing a wide variety of problems including life-threatening blood clots.

In the past, varicose veins were “stripped” much like pulling weeds from the yard. This was a painful, imprecise, and invasive surgery with significant downtime, scarring, and risk of complications. Even worse, many patients required additional treatment due to other veins rapidly becoming varicose.

In the last 15 to 20 years, our increased understanding of venous disease, modern tools available for accurate diagnosis, and minimally invasive treatments have revolutionized how we treat vein problems in legs. After your vein specialist has performed a detailed ultrasound scan of your legs, he/she will create a “road map”. Then, using tools such as Endovenous Laser Ablation (EVLA), your Vein Specialist can seal the underlying varicose veins at their source, much like closing the large root of weeds from the inside. Any smaller, persistent veins can then be treated using injection sclerotherapy that is analogous to using a weed killer in your yard. Some unsightly varicose veins are removed by microphlebectomy, the careful removal of unwanted veins through tiny openings using very fine instruments without the need for sutures or risk of scarring.

Current treatments are very safe, effective, and provide long-lasting relief without any downtime or painful recovery. Since varicose veins and CVI are serious problems, almost all health insurance companies, including Medicare and Medicaid, offer coverage for necessary scans and treatments.

Contact Alsara Vein Clinic at 816-396-0245 to set up a Consultation today.

– and bikini contests!

Where did summer go? It seems like only yesterday the snow had finally melted, after a prolonged winter, and here I am talking about fall. In fairness, this summer was an extraordinarily busy time for us at Alsara Vein Clinic. We saw more new patients in July than any other month in the past. Every one of my staff members worked extra, long hours to ensure each patient received top-notch care, even in the face of increased patient volume and the numerous urgent requests to see a patient the same day.

I am humbled by both the confidence that numerous referring providers have in our care and the trust of patients who refer family and friends. For example, Jim*, a 76-year-old gentleman, came to Alsara Vein Clinic after exhausting all options at hospitals and other clinics in the area. With a tracheostomy collar in place, he was unable to talk and breathe at the same time, yet he had much to discuss. After providing his medical history, he cleared his “airway trash”, drew a deep breath, and concluded by saying, “I am hanging by the last straw. My neighbor across the street advised me to come to you. You took care of him when he had no hope that anything could be done.” Since then, the topic of his conversation has been anything but medical. Taking swift breaks to inhale, he seemed more interested in talking about his friends, family and his many aspirations although, as he politely stated, “I realize that I won’t be able to participate in a bikini contest anytime soon!”

Later that week I saw Tom**, a 58-year-old, who had avoided seeking care as he was sure that leg amputation was going to be the only option available, given the advanced stage of chronic venous insufficiency in his leg. It seems that every clinic day has its fair share of patients with swelling, severe leg cramps, and restlessness. We also see many male patients with clots, bleeding, and poorly healing sores in their legs, all of which are features of advanced, chronic venous insufficiency.

A detailed duplex ultrasound scan (Mapping) provides us with a “road map” of all the key veins in the legs. The goal of every treatment modality is to get rid of the underlying varicose veins and restore proper blood flow by routing blood to the healthy veins. The new, modern, minimally invasive treatments allow us the opportunity to eliminate the diseased veins safely and effectively with very little downtime; these are also much safer than surgeries used in the past. Over the last 10 years, further advancements have occurred in our understanding of venous diseases and the options available to treat them. For instance, the latest 1470 nm laser used at Alsara Vein Clinic offers a 40-fold improvement in energy absorption, compared to older generation lasers, resulting in even less bruising and discomfort. All treatments including Endovenous Laser Ablation and Ultrasound Guided Sclerotherapy are performed in the comfort of the office setting and patients can resume normal activities immediately.

I feel very fortunate for the technology and scientific knowledge backed by the experience of successfully treating thousands of patients over the past decade. Although participating in a bikini contest is not completely ruled out for Jim*, I suspect that he will put his legs to much greater use in the years ahead!

Concerns about your legs? Call Alsara Vein Clinic at 816-396-0245 to set up a Consultation today.

Sam Gupta, MD, MPH

* Jim is an actual patient of Alsara Clinic and has graciously given permission to use his quotes, story and images.
** Tom – his name changed to protect confidentiality.