WHY DIABETES IS BAD FOR YOUR FEET

Everyone knows that diabetes, otherwise known as high blood sugar, is bad for you.  What most people don’t realize, however, is just how many people in the US have diabetes and the impact diabetes has on their feet. In 2021 the CDC released the following info graphic:

 

As a vascular surgeon the primary issue I see in patients with diabetes is foot infection.  But how does diabetes specifically make it more likely for patients to develop foot infections?  My hope in writing this blog today is to give patients a complete understanding of what happens to the feet of people with diabetes.

High concentrations of sugar in the blood lead to what physicians call an inflammatory state in the arteries, or blood vessels that take blood from the heart to the rest of the body.  The inflammatory state results in scarring and narrowing in the arteries.  However, only smaller blood vessels such as the ones in the eyes, toes/feet, and kidneys are affected significantly.  In the feet, the scarring affects both arteries that supply the feet and toes themselves as well as the arteries that supply the nerves.

With a lack of blood flow to the nerves of the feet, patients lose sensation in their toes and feet.  Thus, when a patient has an accidental injury like a scratch or a bruise, no pain is registered, and the area continues to be traumatized and unable to heal.  In addition, the muscles of the foot lose their ability to contract, and they then relax into positions that create bony prominences that erode through the skin and cause ulcers.  Finally, the nerve damage also results in the loss of natural oils in the skin that then makes the skin dry and prone to cracking.  This cracking then increases the chance of ulceration and foot infection.

As you can see, diabetes is very bad for the foot!  If you are diabetic and see an ulcer on your foot or have either pain or numbness, do not hesitate to call our office at 408 376-3626 to schedule an appointment today! Visit our website at www.southbayvascular.com to learn more. We Can Help!

BLOOD CLOTS

Today, I want to give insight into one of the more common questions I receive as a vascular surgeon: How do I know if I have a blood clot?

Why is this important? Here are a few facts directly from the US Center for Disease Control and Prevention (CDC).

  • Anyone can develop a blood clot.
  • In the United States, as many as 900,000 people are affected by DVT’s each year and
  • About 100,000 people die of PE annually.

Many factors can put you at risk for a blood clot. These include:

  1. Major trauma
  2. Cancer
  3. Being 55 and older
  4. Having a personal or family history of blood clots
  5. Immobility (such as being on bed rest or difficulty with walking)
  6. Pregnancy, or using estrogen containing medications such as birth
    control pills, patches, and hormone replacement therapy
  7. Obesity
  8. Smoking

Almost half of all blood clots occur either during or soon after discharge from a hospital stay or following surgery. The more risk factors you have, the greater your risk of developing a blood clot will be.

The medical term for blood clot is Deep Vein Thrombosis. (DVT) Veins at their most fundamental level are blood vessels that return blood from the body (e.g. feet, hands, intestines, kidney, etc.) back to the heart.  In the legs, there are two main sets of veins: superficial and deep.  Deep veins are very close to the muscle and bones.  Superficial veins are very close to the skin, hence the name superficial.  The word thrombosis derives from the Greek word of the same spelling, thrombosis, which means curdling.  In contemporary medicine thrombosis refers to the blood’s transition from liquid to solid.  With all these words explained, we can see that a deep vein thrombosis refers to blood clots that are in the deep system of veins in the legs.  Though superficial veins can become clotted as well, the symptoms that result are usually not as severe as a deep vein thrombosis.

Once the deep veins of the legs are blocked, blood becomes trapped in the veins below and the blood pressure in the veins increases.  Consequently, the leg and foot will become swollen, blue, and tender.  Patients often complain of a “tension” or “pulling” sensation in the groin, thigh, and behind the knee.  These feelings of tension and pulling are often also considered as very painful.  Because of the swelling there may be severe difficulty with tasks as simple as walking to the bathroom or a few feet.

PE’s: A Silent Killer

Sometimes, a piece of clot can break off from the legs and travel to the lungs.  This is called pulmonary embolism or PE.  Pulmonary refers to lungs and embolism refers to something that breaks off from one place and travels to another.  When patients have a blood clot associated with a pulmonary embolism, they will experience:

  • Shortness of breath
  • Palpitations/fast heart rate, and
  • In very severe cases, dizziness associated with fainting.

Recognize The Signs and Symptoms of a Blood Clot

DVT (Arm or Leg) – if you experience any of these, call your doctor as soon as possible.

  • Swelling of your leg or arm
  • Pain or tenderness not caused by an injury
  • Skin that is warm to the touch, with swelling or pain
  • Redness of the skin, with swelling or pain

PE (Lung) – if you experience any of these, seek medical attention immediately.

  • Difficulty breathing
  • Chest pain that worsens with a deep breath
  • Coughing up blood
  • Faster than normal or irregular heartbeat

Blood Clots Can Be Prevented

  • Know your risks and recognize signs and symptoms.
  • Tell your doctor if you have risk factors for blood clots.
  • Before any surgery, talk with your doctor about blood clots.
  • See your doctor as soon as you can if you do have any symptoms.

    I hope this blog post can shed some light on blood clots.  If you or someone you know are experiencing these types of symptoms, please do not hesitate to visit our website at www.southbayvascular.com to call our office at 408 376 3626 to schedule an appointment today!

    FOOT PAIN AT NIGHT?

    As vascular surgeons, many of the consultations and questions we receive revolve around one issue: foot pain!  As people age there can be many sources of foot and leg pain and I want to shine some light onto a few of the most common causes that I see.  They include peripheral vascular disease, chronic venous insufficiency, diabetic foot disease, and sciatica.

    Peripheral Vascular Disease:

    In all people there are two main kinds of blood vessels, arteries, and veins.  Arteries bring blood from the heart to the feet.  Veins bring blood back from the feet to the heart.  In individuals who have a history of

    • High blood pressure,
    • High cholesterol,
    • Diabetes,
    • Obesity,
    • Smoking

    The arteries that lead to the feet can develop blockages, otherwise known as Peripheral Vascular Disease.  When too many blockages develop, the feet do not receive the amount of blood they need to stay alive, and they become very painful.  When this happens, patients tend to hang their feet in dependent positions off the side of the bed at night to allow gravity to help the blood travel through the blockages to the feet.  The pain tends to concentrate on the forefoot and toes where the blood vessels are the smallest.

    Chronic Venous Insufficiency

    With vein disease, patients tend to have swelling in the legs below the knee including the ankle and feet.  Normally, there are structures in the veins called valves that allow blood to go to the heart but not to go back down towards the feet.  In patients with vein disease, these valves leak and cause blood to pool in in the legs below the knees.  After patients are standing or sitting upright for extended periods of time, the pressure in the veins of the legs builds resulting in an aching pain as well as also causing varicose veins, dark discoloration of the skin, and, in the worst cases, ulcers on the leg.

    Diabetic foot disease

    Diabetic foot disease is one of the most common problems I see as a vascular surgeon.  These patients describe numbness much more often than pain.  This numbness is a result of the inflammatory damage that high sugar levels in the blood can inflict on the nerves of the foot.  Sometimes, even when these patients develop ulcers, they do not feel any pain because the nerve damage is so severe.  As such, patients with diabetic foot ulcers, though they can experience pain, often experience numbness as well.

    Sciatica

    Lastly, sciatica can also be a cause of leg and foot pain.  The nerves that detect sensation from the legs and foot originate from the spinal cord in the back of the pelvis and abdomen.  As such, when these nerves are pinched they tend to cause the patient to feel a pain radiating from the lower back or buttock down the leg and sometimes even to the foot.  This radiating pain can be easily distinguished from the pain of peripheral vascular disease and venous insufficiency which is concentrated in the legs and feet.

     

    If you or anyone you know suffers from leg pain at night and if any of these stories seem to fit the pain or discomfort that you may be having in your legs, please call one of our South Bay Vascular Offices in either Campbell or Gilroy CA at 408 376 3626 today to schedule an appointment! We Can Help!

    ARTERIES AND VEINS….WHAT’S THE DIFFERENCE?…AND HOW DO THEY WORK?

    As a vascular surgeon, one of the more common questions I receive from patients and from friends and family alike is what do I actually do?  I find the question interesting because before I went to medical school, I did not even know that the field of vascular surgery existed!  Vascular surgeons operate on the blood vessels all around the body including the chest, arms, neck, abdomen, and legs. One key thing to remember is that Vascular surgeons do NOT work on a person’s heart. Heart doctors are more commonly known as cardiologists and cardiac surgeons.

    There are two different types of blood vessels: arteries and veins.  Arteries are the tubes that bring blood from the heart to the rest of the body including arms, legs, head, abdomen, and legs.  Arteries allow blood to travel at high speed with the pressure provided by the contraction of the heart.  Common health problems like high blood pressure, high cholesterol, smoking, and diabetes can result in blockages of the arteries that lead to the foot.  Once the blockages are severe enough, a patient can have pain in the calves and feet as well as ulcers or gangrene of the toes and feet that do not heal.  In addition to the effects on the legs, patients can also develop narrowing in the carotid arteries that supply the brain, the arteries that lead to the arm, and the arteries that lead to organs in the abdomen.

    On the other hand, veins are the tubes that bring blood back to the heart from the body.  After dropping off oxygen and nutrients to the tissue, the blood returns to a low-pressure state and thus moves at a low speed in the veins back to the heart.  Because of the low pressure, specialized structures called valves exist in the veins to make sure that after blood goes back to the heart, the blood does not reflux back into the vein.  When reflux occurs, the venous pressure can increase and cause ulcers, swelling, and varicose veins in the legs.

    If you have ulcers on your feet that have not healed or varicose veins or swelling in your legs that are limiting your life, do not hesitate to call our office at 408-376-3626 to schedule a consultation. We can help!

    Visit our website at www.southbayvascular.com to learn more about who we are, what we can do, and how we can help restore your circulatory health.

    South Bay Vascular Center and Vein Institute

     25 years of compassionate vascular care for South Bay communities

     

    YOU HAVE A BLOOD CLOT. NOW WHAT?

    One of the most common consultations that we as vascular surgeons receive is for deep vein thrombosis, otherwise known as blood clots.  Deep veins refer to the location of the vein that has the problem.  In the legs we have two main sets of veins: Deep and superficial.  Deep veins are within the muscle and close to the bones whereas superficial veins are close to the skin; hence their names!

    Thrombosis refers to the process of the blood turning from a liquid into a solid form.  Normally, thrombosis occurs in response to an injury to stop bleeding from a wound.  However, when thrombosis occurs in the deep veins, it stops blood from being transported from the foot back to the heart.  The obstruction of flow results in swelling and pain below where the thrombus, or clot, has formed.

    There are many causes of blood clots, but the most common causes include:

    • Traveling for extended periods of time in a sitting or resting position.
    • Trauma, including accidents which cause broken bones or bruises.
    • Narrowing of the veins of the pelvis, and
    • Specific genetic mutations that increase the likelihood of the blood forming clots. 
    • In older patients, another potential cause of blood clots without any other cause is cancer.  Cancer, unfortunately, can result in the release of chemicals and hormones within the body that make clotting more likely.

    For patients who develop a blood clot in the context of traveling, narrowed pelvic veins, or having a traumatic injury to the affected leg, treatment involves a 3-month course of blood thinning medication followed by ultrasound tests to determine the stability of the clot.  If the symptoms improve and the clot remains stable, then the medication to thin the blood can be stopped at 3 months.

    For travelers who are forced to sit for extended periods without being able to move, making an effort to walk around intermittently throughout the traveling can be helpful.  For example, on the plane, every 30 minutes stand up and walk up and down the aisle 3-4 times.  For patients who have a traumatic injury to their leg, the best choice would be to avoid, if possible, situations that led to the particular accident.  Finally, in patients with narrowed pelvic veins, I as a vascular surgeon can help relieve the narrowing with a special minimally invasive procedure called a venogram.  In the procedure, I place a self-expanding tube called a stent into the compressed vein via a small 2 mm puncture site in the groin to make sure the compressed vein remains open.

    For those patients who did not have a traumatic accident, narrowed pelvic veins, recent travel, or a high suspicion of cancer, referral to a hematologist, or a doctor who specializes in disorders of the blood, can be helpful.  The hematologist can help order special genetic tests to determine if there is a genetic predisposition to forming clots.  In patients who do end up having genetic mutations, long-term placement on blood thinning medications can help prevent further events.

    If you are anyone that you know is suffering from a blood clot, please do not hesitate to call our office on 408-376-3626 to schedule an appointment!  The expertise that vascular surgeons have in this area of medicine is critical to ensure a good outcome!

    TRANSCAROTID ARTERY REVASCULARIZATION: THE FUTURE OF CAROTID SURGERY

    One of the most gratifying problems we help treat for patients is carotid artery disease.  The carotid arteries supply the brain with blood.  In patients with high blood pressure, high cholesterol, diabetes, and a history of smoking, the carotid arteries can become narrowed and form blood clots that then go into the brain and cause strokes.  Traditionally, vascular surgeons have fixed this carotid artery narrowing’s with a surgery called a carotid endarterectomy.  The carotid artery is dissected out and cut open.  The plaque is then removed, and the carotid artery is sewn back together.

    Over the past five years, however, I have had the opportunity to perform a new technique involving carotid stenting called trans carotid artery revascularization or TCAR.  Stents are self-expanding metal tubes that we can use in the carotid artery to stop clots from forming in narrowed areas.  TCAR uses a suction machine to reverse flow in the carotid artery during the placement of a stent to minimize the risk of inadvertent stroke during the procedure itself.  After having performed over 20 of these procedures in the past two years, I can say with confidence that the flow reversal and stenting that TCAR provides is a highly safe and successful way to treat carotid artery disease.  Furthermore, the length of the incision, postoperative pain, and risk of nerve damage and bleeding are all much less with TCAR than with CEA.

    I am so happy to be able to offer this revolutionary, safe, and effective therapy to all my patients at South Bay Vascular Center.  Should you or anyone you know have any problems with your carotid arteries or a stroke, please do not hesitate to call us today at 408-376-3626 to schedule a consultation.

    https://youtu.be/O32nDoovMPY]

    WHAT CAUSES VARICOSE VEINS; WHY DO MY LEGS SWELL WHEN I HAVE THEM AND WHAT CAN I DO ABOUT IT IF IT HAPPENS??

    Hello. Dr Lau here again. Today I wanted to share some information about Varicose Veins.  Almost daily, my patients ask me “Dr Lau, what causes varicose veins and associated swelling in the legs and what can I do about them?”

    Although every patient I meet is different, varicose veins are one of the most common conditions that I treat as a vascular surgeon and relate to a disruption of structures within the veins called valves.

    Normally, veins have valves that allow blood to go from the feet to the heart and prevent the blood from pooling in the legs. When these valves become damaged, patients can develop varicose veins because of the higher pressure in the veins within the legs. Damage to the valves can occur from standing for extended periods of time at work or otherwise which increases stress on the valves.

    Deep vein thrombosis otherwise known as a blood clot can also damage the valves irreversibly. Some patients do not stand for extended periods of time and/or have blood clots but still develop varicose veins and swelling. In these patients, genetic factors may play a role.

    Due to advancements in our understanding of how the veins work and, in the technology, we use to treat veinous disease, vascular surgeons have much to offer patients with varicose veins and swelling. We always try a period of compression stockings which are effective for reducing swelling and varicose veins in up to 50% of patients. If compression stockings do not work, we can perform a procedure that heat seals or glues the veins in the legs closed so they can no longer leak. Finally, we can also investigate obstructions in the connections between the heart and the legs in the abdomen with both ultrasound and specialized x-ray machines.

     

    A SPECIAL WORD OF CAUTION: Not all Varicose Veins are Cosmetic Problems. In fact, varicose veins can sometimes be the sign of a much more complex vascular condition and as such Vascular Surgeons are uniquely qualified to diagnose and evaluate the underlying causes for the formation of varicose veins.  Clinics focusing exclusively on the treatment of varicose vein often time underdiagnose the underlying causes of these varicose veins and physicians advertising as “Vein Specialists or Vein Doctors” should be carefully evaluated before being allowed to treat your veins. Medicare as well as most commercial insurance carriers have identified strict guidelines for treating varicose veins and your treating physician must carefully follow these guidelines before treatments will be reimbursed. Many cosmetic varicose vein clinics will encourage patients to pay for cosmetic procedures in cash to avoid the guidelines established by Medicare and most major commercial insurance companies so patients must make informed decisions prior to simply paying cash to have a cosmetic procedure done.

    As a vascular surgeon, I am well versed in the ways to diagnose and treat venous disease. Please do not hesitate to call to schedule an appointment if you have either varicose veins or swelling in your legs! If you or anyone you love is suffering from Varicose veins, please call our office to schedule an appointment at 408-376-3626.

    SOUTH BAY VASCULAR CENTER WELCOMES DR IGNATIUS H LAU

    My name is Ignatius Lau, and I just joined South Bay Vascular Center as a vascular surgeon.  I grew up in Portland, Oregon, and then went to the University of Washington in Seattle, Washington, for college.  Afterwards, I went to Stony Brook University in Long Island, New York, for medical school and finished my training at the Icahn School of Medicine at the Mount Sanai Hospital in New York City.

    Developing a passion for vascular surgery has been one of the most satisfying parts of my life.  I love the technical challenge of vascular surgery.  I love the ability to form long-term relationships with my patients and help lead them through challenging points in their journey to become stronger healthier people.

    The scope of therapeutic options is growing so rapidly with advancements in technology in vascular surgery.  As such, I look forward to sharing these ways in which we as vascular surgeons can help patients on this blog!

    WHY DON’T THE WOUNDS ON MY LEGS AND FEET HEAL ANYMORE?

    Hi! Dr. Lau here again with South Bay Vascular. Today, I wanted to shed some light on one of the most common issues that we see in vascular surgery, non-healing wounds of the feet and toes. My hope is that after reading this blog you will have a better understanding of what causes leg wounds and ulcers; why sometimes they won’t heal on their own, and what we in vascular surgery can do to help them heal.

    Ulcers, generally speaking, develop because of TWO main causes: nerve damage induced by diabetes and lack of blood flow. When patients have elevated levels of sugar in their blood with diabetes, the sugar forms toxic compounds that damage nerves in the foot. Consequently, the patient cannot feel injuries that would otherwise cause a normal patient to adjust position to stop the injury. With this loss of sensation ulcers form at the point of repeated injury that the patient cannot feel.

    The second cause, a lack of blood flow, develops over decades in patients who smoke and who have high blood pressure and high cholesterol. These medical problems cause hardening and narrowing of the blood vessels, otherwise known as atherosclerosis.

    In patients with diabetes, I coordinate carefully with my podiatrist colleagues who are experts in specialized footwear and surgical interventions that alleviate common areas of trauma. In patients with poor blood flow, I, as a vascular surgeon, can perform minimally invasive surgery to restore blood flow to the affected area. We use wires and specialized tubes to gain access to the blood vessels and then use balloons to break open the narrowing’s and self-expanding tubes called stents to keep the vessels open. Afterwards, we use a specialized x-ray machine called fluoroscopy to see that the narrowing’s have opened again to allow blood to flow back to the area. Patients usually leave to go home the same day with only a 2-millimeter puncture in their groin and are back to normal activity the day after surgery!

    If you or anyone you know has a wound on their leg, foot or toe that hasn’t healed in more than two weeks, please call our office at 408 376 3626 to schedule an appointment.

    ONE PATIENT, ONE DOCTOR, ONE NURSE; SOUTH BAY VASCULAR CENTER’S COMMITMENT TO PERSONALIZED CARE

    Unlike so many big box medical centers (Kaiser, Sutter, PAMF, Stanford) where patients are often “overwhelmed” as soon as they get to the parking lot, South Bay Vascular Center and Vein Institute offers world class, cutting edge vascular surgical care in a kinder, gentler environment.  Individualized patient care, although talked about and marketed heavily by these corporate health systems, more often than not falls far short of patient expectations as higher order operational efficiencies and profitability concerns impact the kind of care patients actually experience in these larger health care systems.

    ONE PATIENT; ONE DOCTOR; ONE NURSE. 

    Putting patients at the center of everything that a physician does is a philosophy that sounds obvious…but is that always the case? At South Bay Vascular Center we are honored by the chance to earn your trust and to serve as your physicians; BUT, we also know that we must EARN the trust of every patient that we see.  That’s why our CREDENTIALS are NOT Enough…That’s why our REPUTATION is NOT enough. That’s why unmatched patient care is at the center of everything that we do. That’s why when patients come to our facility for a procedure each patient has their own nurse from start to finish to ensure the greatest patient care experience from start to finish. 

    We know patients have options for their vascular care and that’s why we work hard to ensure that any patient referred to us by another doctor or that comes to us on their own has the confidence to know they’ve made the right choice of doctor to help them with their vascular related illnesses. ONE PATIENT; ONE DOCTOR; ONE NURSE is just one of the many ways that South Bay Vascular Center demonstrates our commitment to our patients in our efforts to provide the most advanced vascular care options offered anywhere in the world.

    OUR TEAM

    Together with her full time, highly skilled team of critical care and surgical nurses, radiological technicians, RVT certified Ultrasound Technologists and scrub assistants, Dr Kokinos provides unmatched peripheral vascular surgical care in her Nationally Accredited Surgical Facility. As diverse as Silicon Valley is, our staff reflects this same diversity as we have native speaking staff fluent in over 10 different languages. Be it Vietnamese, Mandarin, Korean, Russian, Tagalog, Hindi, Spanish, French, Greek or English, we have staff to make our patients comfortable in their native tongue.

    OUR FACILITY

    The South Bay Vascular Ambulatory Surgery facility is one dedicated entirely to the practice of Vascular Surgery and houses a specialized inventory of vascular medical devices and imaging equipment that surpasses the number of vascular medical devices and imaging equipment at Good Samaritan and O’Connor Hospitals combined. Together with her highly trained and specialized team, Dr Kokinos brings over 30 years of surgical experience and 7 years of specialized surgical experience operating in a specially built vascular surgery outpatient facility to her patients.  Other physicians may claim to have the kind of training and experience that Dr Kokinos has in the outpatient environment, but NO other Vascular Surgeon in Silicon Valley comes anywhere close to having the kind of experience and outcomes Dr Kokinos does when it comes to providing care to the patients who come to her for the treatments and care of their vascular disease.

    Put another way, for 25 years Dr Kokinos and her team at South Bay Vascular Center and Vein Institute have provided unmatched, compassionate and individualized vascular surgical care to South Bay communities. It is why more independent physicians refer their vascular patients to Dr Kokinos than to all the other Silicon Valley vascular surgeons combined. When it comes to your health, we know that it’s not just our credentials and our experience that count.  It’s not about just having an accredited facility or a staff of travelling specialists to help when needed…   It’s about the RIGHT KIND OF EXPERIENCE EVERY TIME YOU NEED IT.

    RESULTS matter when it comes to your health because sometimes you don’t get a second chance.

    South Bay Vascular Center and Vein Institute: We Offer Hope When Others Say there Is None.

    Call us at 408-376-3626. We Can Help