Tag: Amputation prevention

THROBBING LEG PAIN AT NIGHT: WHAT CARETAKERS NEED TO KNOW ABOUT PAD IN LOVED ONES

Posted on by Michael Kokinos

Understanding Your Role as a Primary Caregiver

For many women, caring for aging parents or partners is not just an act of love—it’s a full-time responsibility. As the backbone of countless households, women often serve as the primary decision-makers when it comes to healthcare for their families. If someone you love has been experiencing throbbing leg pain at night, struggles to walk long distances, or has wounds that won’t heal, this may be more than aging or tiredness—it could be a warning sign of Peripheral Arterial Disease (PAD).

PAD is a serious condition that impacts blood flow to the legs, and it can lead to severe disability or limb loss if left untreated. This article is designed to help women caregivers understand how to recognize PAD, why it’s especially dangerous when symptoms are dismissed, and how early diagnosis and treatment can make all the difference.

What is PAD—and Why Should You Be Concerned?

PAD is caused by plaque buildup in the arteries that carry blood to the limbs. Over time, this buildup narrows or blocks blood flow, depriving the legs and feet of oxygen-rich blood. The result? Pain, numbness, and poor healing—especially noticeable at night when circulation slows.

As a caregiver, you may be the first to notice these symptoms in your partner, parent, or loved one:

  • Complaints of leg pain at night, especially in the feet or calves
  • Needing to dangle their legs off the bed for relief
  • Difficulty walking long distances due to pain or fatigue
  • Sores or wounds on feet or legs that won’t heal
  • Cold, discolored, or numb feet

Why Nocturnal Leg Pain Is a Red Flag

Leg pain that disrupts sleep is often one of the earliest signs of severe PAD. This pain happens because the legs aren’t getting enough blood while the person is lying down. Many caregivers mistake this for arthritis or poor circulation from diabetes, but ignoring this symptom can lead to critical limb ischemia, a dangerous condition that can result in amputation if not treated promptly.

Why PAD Disproportionately Affects the Ones You Care For

If your loved one has any of the following risk factors, their chances of having PAD are significantly higher:

  • Diabetes
  • High blood pressure
  • High cholesterol
  • Smoking history
  • Chronic kidney disease
  • Age 60+

Many of these conditions are common in aging men and parents, especially those with a history of cardiovascular disease. As a caregiver, being aware of these overlapping conditions is crucial.

How Women Caregivers Make a Difference in Outcomes

Research shows that patients with involved, informed caregivers are more likely to seek early care and follow through with treatment. As a woman making medical decisions for your family, your role is pivotal in catching PAD before it becomes limb- or life-threatening.

Steps you can take:

  1. Start the conversation – Ask about leg discomfort, cramping, or nighttime pain.
  2. Encourage screening – A simple test called an Ankle-Brachial Index (ABI) can detect PAD early.
  3. Seek expert care – Choose a specialist with extensive experience in PAD and limb salvage.
  4. Support follow-through – Ensure your loved one takes prescribed medications, attends follow-ups, and adopts lifestyle changes.

Why Choose South Bay Vascular and Dr. Polly Kokinos

Dr. Polly Kokinos at South Bay Vascular Center has over 30 years of experience treating patients with PAD. As one of the few independent vascular surgeons in Santa Clara County, she offers a level of personalized, patient-first care that many large systems simply cannot match. Her team works closely with caregivers to:

  • Explain complex diagnoses in easy-to-understand language
  • Involve families in every step of the treatment process
  • Provide compassionate care that respects cultural and emotional dynamics

Dr. Kokinos is especially known for her work in limb salvage and amputation prevention, helping families avoid devastating outcomes. With her background in both community-based practice and international mission work, she brings deep empathy and unmatched skill to every patient interaction.

Treatments That Can Help Your Loved One

The good news? PAD is treatable—especially when caught early. Treatment plans may include:

  • Lifestyle changes: Quitting smoking, eating healthier, and walking
  • Medication: To improve blood flow and control underlying conditions
  • Minimally invasive procedures: Like angioplasty or stenting to open blocked arteries
  • Surgical options: For advanced cases where blood flow must be rerouted

At South Bay Vascular, treatment plans are tailored to each patient’s specific needs, and you—as the caregiver—are never left out of the loop.

Conclusion: Your Leadership Saves Lives

As the primary caregiver, you are not just supporting a loved one—you are advocating for their future. By learning the signs of PAD, understanding its risks, and connecting with experts like Dr. Kokinos, you can help ensure your loved one receives the best care possible before the disease progresses.

Don’t ignore nighttime leg pain. If your partner, parent, or family member is struggling with any of the symptoms mentioned above, reach out today. If you or our loved ones suffers from any of the conditions outlined above, ask your primary care physicians for a referral to Dr Kokinos at South Bay Vascular Center or if you think you need a second opinion, please call our office at 408-376-3626 to schedule an appointment.

We offer hope when others say there is none

PAD IN THE AFRICAN AMERICAN COMMUNITY; BREAKING BARRIERS TO EARLY DIAGNOSIS AND TREATMENT

Posted on by Michael Kokinos

Understanding the Unique Risk Factors for PAD in African Americans

Peripheral Arterial Disease (PAD) is a silent but deadly condition that disproportionately affects African Americans. Research shows that Black Americans are up to three times more likely to develop PAD than their white counterparts. This stark disparity arises due to a combination of genetics, higher rates of diabetes and hypertension, and limited access to healthcare. However, beyond the medical risk factors, there are also deep-rooted cultural and societal barriers that make early diagnosis and treatment of PAD particularly challenging for this community.

Dr. Polly Kokinos, a highly respected vascular surgeon with over 30 years of experience, understands these challenges. Having served underserved communities both locally and globally—including her missionary work at Tenwek Hospital in Kenya—she is uniquely positioned to provide compassionate, culturally competent care to African American patients facing PAD.

This article will explore the barriers preventing early PAD diagnosis in the African American community and how Dr. Kokinos and her team at South Bay Vascular are working to break down these obstacles.

Cultural Barriers to Seeking Early PAD Diagnosis

For many African Americans, historical distrust of the medical system remains a significant barrier to seeking medical attention for conditions like PAD. Generations of systemic healthcare disparities and unethical medical experiments—such as the Tuskegee Syphilis Study—have left lasting skepticism in many Black communities. This hesitancy often leads to delayed diagnosis and treatment, allowing PAD to progress to Critical Limb Ischemia (CLI), a severe form of PAD that increases the risk of limb amputation.

Additionally, the concept of self-reliance and resilience within Black culture often discourages individuals from seeking help for health issues until they become severe. Many African Americans feel a sense of duty to “tough it out,” prioritizing work and family obligations over personal health concerns. This reluctance can be particularly dangerous for PAD, a disease that advances silently, often without pain in its early stages.

The Role of Extended Families and Community Support

Unlike in some other cultural groups where medical decisions are highly individualized, many African American families rely on extended family networks and community institutions, such as churches, for guidance. When a loved one is diagnosed with a serious illness like PAD, the decision-making process often involves multiple family members. This means that healthcare providers must do more than just educate the patient—they must engage the entire family unit.

Dr. Kokinos recognizes this dynamic and works closely with families to ensure they understand the severity of PAD and the need for early intervention. Her patient-centered approach is based on relational medicine, rather than the transactional care often seen in large hospital systems. She takes the time to build trust, answer questions, and provide families with the resources they need to make informed decisions.

Financial Concerns and Healthcare Access

Another major barrier to PAD treatment in the Black community is the issue of affordability and access to healthcare. Many African Americans face challenges with health insurance coverage, making it difficult to seek preventative care. Even when insured, high co-pays, deductibles, and medication costs can discourage individuals from following through with necessary treatments.

Unlike many physicians who are constrained by large healthcare systems and administrative bureaucracy, Dr. Kokinos operates as an independent vascular surgeon, meaning she has the flexibility to offer tailored treatment plans that fit each patient’s financial situation. Her team at South Bay Vascular assists patients in navigating their insurance plans and finding cost-effective solutions for care.

The Stigma Surrounding PAD and Amputation

Many African Americans associate vascular disease with amputation, often believing that a PAD diagnosis is a precursor to limb loss. While it is true that untreated PAD can lead to amputation, early intervention can prevent severe complications. However, because of the deep-seated fear of limb loss, many Black patients avoid seeking medical attention until the disease has progressed to a critical stage.

Dr. Kokinos and her team emphasize the importance of early screening and non-invasive treatments that can save limbs and lives. She ensures that her patients understand that PAD is manageable when caught early, and that proactive care is the best way to avoid amputation.

Why African American Patients Trust Dr. Kokinos

Dr. Polly Kokinos is not just another vascular surgeon—she is a physician who has dedicated her life to serving communities in need. Her work at Tenwek Mission Hospital in Kenya has given her firsthand experience treating patients in underserved areas, reinforcing her commitment to providing equitable care. In Santa Clara County, she applies these same principles to help African American patients overcome healthcare barriers.

Unlike other vascular surgeons in the area who may rely on their hospital affiliations for credibility, Dr. Kokinos has built her reputation through skill, experience, and patient trust. She holds hospital admitting privileges, ensuring that her patients receive continuity of care, but she is not bound by the financial interests of a hospital system. This independence allows her to always prioritize what is best for her patients.

Conclusion: Taking the First Step

PAD is a life-threatening condition that disproportionately impacts the African American community. However, the barriers to care—ranging from cultural hesitancy to financial limitations—make early diagnosis and treatment difficult. The key to preventing amputations and saving lives lies in trust, education, and proactive healthcare decisions.

Dr. Polly Kokinos and her team at South Bay Vascular are committed to breaking down these barriers by providing compassionate, relationship-based care that empowers African American patients to take control of their health. If you or a loved one are experiencing symptoms of PAD—such as leg pain, numbness, or wounds that won’t heal—it is critical to seek medical attention before it’s too late.

If you or a loved one may be struggling to find answers to difficult medical questions and or a lack of compassionate care, please call our office to schedule an appointment with Dr Kokinos @ 408-858-3586. 

We offer hope when others say there is none. 

BLOOD THINNING MEDICATION’S PART 3: STATINS: WHAT ARE THEY AND HOW ARE THEY USED?

Posted on by Michael Kokinos

Over the past two weeks, I have described the blood thinning medications that vascular surgeons use to treat patients: Anticoagulant and Antiplatelet medications. This week, I want to spend time talking about another important medication that primary care physicians and vascular surgeons both agree helps to improve patient outcomes: Statins.

Statins refer to a general class of drugs that inhibit a special enzyme involved in the production of cholesterol within the body: 3-hydroxy-3-methylglutaryl-Coenzyme A, otherwise known as HMG-CoA.  HMG-CoA catalyzes the first reaction in a series of almost 30 individual reactions to create molecules of cholesterol!  As a vascular surgeon I sometimes prescribe Statins to my patients with high cholesterol to help my patients manage their cholesterol levels.

Cholesterol:

A high cholesterol level is one of the most common medical problems that patients I see have.  As a vascular surgeon it is important for me to understand when a patient has high cholesterol because of the following fact:

A high cholesterol level in the blood may result in a narrowing within the blood vessels of the heart, legs, and neck.  When these narrowing’s form they can cause heart attacks, ulcers and pain in the feet, and strokes, respectively.

In numerous clinical trials, the administration of statins has been shown to decrease the rate of death, heart attack, and stroke in patients at elevated risk of these medical problems due to high blood pressure, history of smoking, and diabetes.  The general group of statins includes medications like atorvastatin, simvastatin, and rosuvastatin.

At every office visit, I check my patients’ medical history to make sure that their cholesterol levels are being properly managed to ensure the best possible outcomes. Typically, when a patient presents in my office with a history of the following medical conditions, I will often prescribe statins as part of a larger approach to managing their cardiovascular disease:

  • History of heart attack, peripheral vascular disease, or stroke
  • History of diabetes mellitus over the age of 45

Vascular disease is both complex and difficult to manage. At South Bay Vascular Center and Vein Institute our physicians have been specially trained to understand “WHY” a problem exists so that our patients have real solutions to living a healthy life. Proper medical and surgical management of our patient involves a deep understanding of our patient’s medical history of which statins may play an important part. If you are currently on a statin or your referring physician believes a statin may be part of a larger approach to your circulatory health, please feel free to schedule an appointment with our office so that we can help you to evaluate this important decision with the context of your overall vascular health. Moreover, if you have a history of ulcers or pain in your feet or stroke, please do not hesitate to call my office today to schedule a consultation to determine if statins can be prescribed as part of your overall care and treatment!

Dr. Ignatius H. Lau: Vascular Surgeon

Dr. Ignatius Lau grew up in Portland, Oregon. He attended the University of Washington in Seattle for college and Stony Brook University in Long Island for medical school. He then went on to train in vascular surgery at Mount Sinai Hospital in New York City. During his time in New York, he performed over 1600 cases involving aortic, peripheral, venous, and carotid surgery. He has a special interest in limb salvage and treating patients with peripheral arterial disease and has extensive training and experience in treating the full spectrum of vascular diseases. Dr Lau was also very active in medical research during his training, ultimately finishing with twelve peer reviewed manuscripts. During his training in New York he met his wife, Lisa, who is a practicing endodontist. Together they love to hike, try new restaurants, and travel.

To see what our patients are saying about us, follow the link below to read our reviews.

https://www.google.com/search?q=south+bay+vasculr&rlz=1C1CHBD_enUS878US878&oq=&aqs=chrome.0.69i59i450l8.2997409j0j7&sourceid=chrome&ie=UTF-8#lrd=0x808e34eecfbc0653:0xb9aa2de7f50ba6a5,1,,,

South Bay Vascular Center and Vein Institute is Silicon Valley’s largest and most trusted Vascular Surgery practice.  Serving South Bay communities for over 26 years, Dr Kokinos and her Colleague, Dr Ignatius Lau are the region’s foremost experts in advanced vascular care and provide innovative care for patients suffering from circulation relation problems. At South Bay Vascular Center and Vein Institute our job is to understand the “Why” so that you have real solutions to living a healthy life. Call us today at 408-376-3626 or visit our website at www.southbayvascular.com to learn about what makes us the most referred to vascular surgery clinic in Silicon Valley.

BLOOD THINNING MEDICATIONS PART 1: ANTICOAGULANTS: WHAT ARE THEY AND HOW ARE THEY USED?

Posted on by Michael Kokinos

Over the next few weeks, I want to discuss the medications that vascular surgeons may prescribe.  These medications include anticoagulants, antiplatelets, statins, and other miscellaneous agents.  This week I will discuss anticoagulants!

Anticoagulation refers to agents that STOP the clotting of blood.  The clotting of blood starts with what is known as the coagulation cascade.  The cascade refers to a series of consecutive events each involving special proteins that are needed to occur for blood to form a clot.  Different anticoagulants block specific parts of the cascade.  The main reason we usually see patients with anticoagulants are for hypercoagulable states, certain heart arrhythmias like atrial fibrillation, and deep vein thromboses otherwise known as blood clots.  Hypercoagulable states are specific genetically inherited disorders that result in the blood being more likely to clot.  Atrial fibrillation and other arrhythmias can cause blood clots to form in the heart.

 

Anticoagulant agents are given to prevent the formation of clots in the heart that can then break off and go to the brain, hands, feet, kidneys, or any other part of the body and cause problems. 

 

Deep vein thrombosis or blood clots mandate the prescription of anticoagulant therapy to ensure that more blood clot does not form.

 

Anticoagulants can be broken up by many different classification schemes.  For the purposes of this blog, I will limit our discussion here to agents that are appropriate for the OUTPATIENT (Outside of the hospital) setting.  Please speak with you private physician to answer any additional questions you may have regarding Anticoagulation medication of feel free to reach out to me directions for more information on how anticoagulation is used. Anticoagulation agents that are used during hospitalization or in the IN-PATIENT setting in patients are outside the scope of this article.

 

Up until the 2010’s the mainstay of anticoagulation therapy was with a drug called warfarin (Trade name: Coumadin).  Warfarin, though effective, requires the weekly or biweekly measurement of a specific lab for the blood called the prothrombin time.  The active monitoring of the prothrombin time facilitates modulation of dosing to always allow for safe levels of effective therapeutic anticoagulation.  Since the beginning of the 21st century new agents have come to market that require only taking one or two pills a day.  They include Xarelto or Rivaroxaban and Eliquis or apixaban.

If you have a question about how your medications may be affecting your vascular disease, please do not hesitate to call and schedule an appointment today!

South Bay Vascular Center and Vein Institute is Silicon Valley’s largest and most trusted Vascular Surgery practice.  Serving South Bay communities for over 26 years, Dr Kokinos and her Colleague, Dr Ignatius Lau are the region’s foremost experts in advanced vascular care and provide innovative care for patients suffering from circulation relation problems. At South Bay Vascular Center and Vein Institute our job is to understand the “Why” so that you have real solutions to living a healthy life. Call us today at 408-376-3626 or visit our website at www.southbayvascular.com to learn about what makes us the most referred to vascular surgery clinic in Silicon Valley.

PART 4: WHY DO MY TOES, ANKLES AND FEET HURT AT NIGHT? DIABETIC FOOT DISEASE

Posted on by Michael Kokinos

Over the past month, I have discussed why venous and arterial disease as well as Raynaud’s Syndrome may cause pain in the feet and toes at night. Today, I want to discuss another one of the most common causes I see in my clinic for pain in the feet at night: Diabetic foot disease.

Interestingly, diabetes mellitus has Greek etiology and literally means sweet (mellitus) urine (diabetes).  Diabetes is a condition in which the body loses its ability to limit the amount of sugar in the blood.  The high concentrations of sugar result in the formation of harmful chemicals that can hurt the eyes, kidneys, and nerves all around the body, especially in the feet.  Once the sugar levels become high enough, they overload the kidneys—the organ that creates urine—and sugar overflows into the urine, hence the Greek etiology of diabetes mellitus.

Diabetes causes pain in the feet via two main pathways: Neuropathic pain and pain from ulcers. 

Neuropathic Pain:

For neuropathic pain, the high blood sugar levels damage the small nerves in the feet responsible for sensation.  As a result, patients often complain of burning, cramping, tingling, and at the very worst end of the spectrum, numbness.  Sometimes only the toes have these symptoms, but often times the symptoms can encompass the entire foot!

Ulcerative Pain:

The way diabetes results in the formation of ulcers is multifactorial.

  • First, the damage to the nerves can result in numbness or lack of sensation.  Thus, when a person injures their foot, that person does not feel it and protects it from further injury.
  • Second, in addition to damaging the nerves responsible for sensation, diabetes also damages the nerves that innervate muscles responsible for moving.  The damage to the muscle nerves occurs in such a way that irregular contractions of muscles within the foot push the bones of the foot outward creating pressure points that ulcerate easily.  Once the ulcer is formed, infection of the ulcer or exposure of the raw tissues beneath the skin can cause pain.  In patients who otherwise have numb feet, an infection can spread to an area that does have sensation and cause pain there.

Given that diabetes is so common, patient education is vitally important to those impacted by this disease.  If you or anyone you love suffers from diabetes, my hope is that this blog will help you to better understand some of the underlying factors that may be contributing to your foot pain at night.  As a rule of thumb, always remember to share with your primary care physicians all symptoms of pain that you experience during your regularly scheduled appointments and if you think your condition may be getting worse, please do not hesitate to call my office to schedule an appointment for a second opinion! We can help.

408-376-3626

Dr. Ignatius H. Lau

Vascular Surgeon

Dr. Ignatius Lau grew up in Portland, Oregon. He attended the University of Washington in Seattle for college and Stony Brook University in Long Island for medical school. He then went on to train in vascular surgery at Mount Sinai Hospital in New York City. During his time in New York, he performed over 1600 cases involving aortic, peripheral, venous, and carotid surgery. He has a special interest in limb salvage and treating patients with peripheral arterial disease and has extensive training and experience in treating the full spectrum of vascular diseases. Dr Lau was also very active in medical research during his training, ultimately finishing with twelve peer reviewed manuscripts. During his training in New York he met his wife, Lisa, who is a practicing endodontist. Together they love to hike, try new restaurants, and travel.

To see what our patients are saying about us, follow the link below to read our reviews.

https://www.google.com/search?q=south+bay+vasculr&rlz=1C1CHBD_enUS878US878&oq=&aqs=chrome.0.69i59i450l8.2997409j0j7&sourceid=chrome&ie=UTF-8#lrd=0x808e34eecfbc0653:0xb9aa2de7f50ba6a5,1,,,

 

PART 2: WHY DO MY TOES, ANKLES, AND FEET HURT AT NIGHT? RAYNAUD’S SYNDROME

Posted on by Michael Kokinos

Last week I wrote the first part of a four-part series about foot pain at night.  Specifically, I talked about venous disease as a cause of foot pain.

Today, I want to talk about another common cause of foot pain at night: Raynaud’s Syndrome. 

As a quick review, last week we talked about the two main types of blood vessels in our bodies: arteries and veins.  Arteries bring blood from the heart to the feet under high pressure.  Veins bring blood back from the foot to the heart under low pressure.

Raynaud’s Syndrome is a disease of the arteries, particularly the small arteries, in the feet.

(Though Raynaud’s can also affect the hands as well). 

Before we dive into Raynaud’s Syndrome though, I need to briefly review another anatomical system in our bodies that is involved in Raynaud’s Syndrome: The nervous system.

In general, we have two broad types of nerves.

  1. There are nerves that are responsible for sensation and for moving muscle and
  2. There are nerves that are responsible for regulation of bodily function.

Diving a little bit deeper into the kinds of nerves that regulate bodily function, there are the

  • Sympathetic nervous system: The sympathetic nervous system, amongst other things, is responsible for opening blood vessels in the legs and arms and increasing blood flow when exercise is necessary
  • Parasympathetic nervous system: The parasympathetic nervous system in similar fashion opens the blood vessels leading to the intestines to allow for the digestion of food.

In patients with Raynaud’s Syndrome, sometimes their sympathetic nervous system does not function properly resulting in the constriction of blood vessels that lead to the hands, fingers, feet, and toes.  When it happens, blood vessels in the fingers and toes typically first turn blue because of the lack of oxygen; then white because of the lack of blood flow; and finally red, once the constriction ends and the blood flow returns to the fingers and toes.  During this constriction of the blood vessels, patients can have significant pain, numbness, tingling, and, in very severe cases, ulcers (defects in the skin with exposure of underlying fat and muscle) and gangrene (black and dead tissue).

Interestingly, environmental and social triggers play a significant role in Raynaud’s Syndrome episodes of vessel constriction.  Factors including stress, caffeine, alcohol or other drugs, and cold temperature can all induce a painful episode with lack of blood flow to the hands and feet.

Not much is known about the cause of Raynaud’s Syndrome or specifically why it happens.  Sometimes, Raynaud’s Syndrome can occur on its own without any other related disease.  In other cases, the patient has another inflammatory disorder like lupus or Sjogren’s Syndrome that is known to be highly associated with Raynaud’s Syndrome.

Though we do not fully understand the causes of Raynaud’s Syndrome there are many treatment strategies that can help.  Starting with behavioral modifications and certain blood pressure medications that can reduce spasm to specific procedures aimed to reduce the spasm of the vessels induced by the sympathetic nervous system, there is so much that I as a vascular surgeon can do to help patients with Raynaud’s Syndrome.  If you think that you might suffer from Raynaud’s Syndrome, please do not hesitate to call our office on 408-376-3626 to schedule an appointment. We Can Help!

Dr. Ignatius H. Lau

Vascular Surgeon

Dr. Ignatius Lau grew up in Portland, Oregon. He attended the University of Washington in Seattle for college and Stony Brook University in Long Island for medical school. He then went on to train in vascular surgery at Mount Sinai Hospital in New York City. During his time in New York, he performed over 1600 cases involving aortic, peripheral, venous, and carotid surgery. He has a special interest in limb salvage and treating patients with peripheral arterial disease and has extensive training and experience in treating the full spectrum of vascular diseases. Dr Lau was also very active in medical research during his training, ultimately finishing with twelve peer reviewed manuscripts. During his training in New York, he met his wife, Lisa, who is a practicing endodontist. Together they love to hike, try new restaurants, and travel.

PART 1: WHY DO MY TOES, ANKLE, AND FEET HURT AT NIGHT? VENOUS DISEASE

Posted on by Michael Kokinos

One of the many questions I receive as a vascular surgeon is why do my feet hurt at night?  Though this question may seem simple, every person is different. Before I can provide you with “real” solutions to what’s causing this pain and what can be done to stop it, I need to evaluate multiple factors to understand “Why” this pain exists.  Over the next few weeks, I am going to explore the most common reasons for foot pain at night and why people can have pain in their feet at night caused by venous disease.

For the majority of patients Raynaud’s syndrome, Arterial disease, and Diabetic foot disease explain most of the reasons why people experience pain in their feet at night.  Though pain from problems with bones and muscle can play a role, pain due to these causes usually worsens during the day and with use, not when a patient is resting or lying flat.

In part one of this four-part series, I am going to discuss pain at night caused by VENOUS DISEASE.

Let’s start with a refresher on our bodies “plumbing” (Specifically, how does blood circulate around my body.)

  • Veins are blood vessels that bring blood BACK from the feet to the heart.
  • Arteries on the other hand are the blood vessels that bring blood FROM the heart to the feet.

Veins have specialized structures called one-way valves that allow blood to go up towards the heart but not back down towards the feet.  As we age, veins become dilated (start to leak) because the valves no longer seal properly. These leaky valves allow blood to fall back towards one’s feet which results in an increase in pressure within the veins at the ankle and just above the legs. Gravity tugs on the blood in our veins bringing it down to our feet which causes this increase in pressure

Interestingly, because of the curve that the veins take at the level of the ankle to enter the foot, the increase in pressure is not transmitted directly to the foot and toes.  The increase in venous pressure at the ankle typically results in

  • Varicose veins,
  • Swelling,
  • Dark skin discoloration from the leaking of red blood cells into the skin, and, in the worst cases
  • Ulceration.

Even without ulceration, however, the pain related to swelling and discoloration can be very severe.

People during their normal daily lives spend most of their days either standing or sitting.  Because of this, during the day gravity works in both positions to facilitate the pooling of blood around one’s ankles.  When patients come to me with pain in their feet, I always ask specifically if the pain is localized in the calves and ankles.  When pain is localized to the calves and ankles, I confirm a venous etiology by performing a physical exam and finding varicose veins, swelling, dark skin discoloration and/or ulcers between the ankle and the knee.

Pain that is reported in the foot and/or toes without the physical exam findings of varicose veins, swelling, dark skin discoloration, and/or ulcers between the ankle and the knee is NOT likely to be from a venous cause!  Though vein problems may sound or seem like a rare disease for those who have never had venous disease, patients with vein problems are one of the most common consults I see as a vascular surgeon.  Does foot pain wake you up at night? If you have any of the symptoms or appearance of the leg that I described above, please do not hesitate to call our office on 408-376-3626 to schedule an appointment.

One Final Note:

Though causes from the bones and muscles can play a role, foot pain that worsens at night is rarely due to these causes.  Often pain related to problems with bones and muscles worsen during the day and with use, not when any given patient is resting or lying flat.

Clues that can guide me as a vascular surgeon to the cause include throbbing and aching pain versus numbness and tingling associated with tenderness or pain located in the toes versus pain located in the ankle or just above the ankle in the leg.

 

Dr. Ignatius H. Lau

Vascular Surgeon

Dr. Ignatius Lau grew up in Portland, Oregon. He attended the University of Washington in Seattle for college and Stony Brook University in Long Island for medical school. He then went on to train in vascular surgery at Mount Sinai Hospital in New York City. During his time in New York, he performed over 1600 cases involving aortic, peripheral, venous, and carotid surgery. He has a special interest in limb salvage and treating patients with peripheral arterial disease and has extensive training and experience in treating the full spectrum of vascular diseases. Dr Lau was also very active in medical research during his training, ultimately finishing with twelve peer reviewed manuscripts. During his training in New York he met his wife, Lisa, who is a practicing endodontist. Together they love to hike, try new restaurants, and travel.

FIXING BLOCKED ARTERIES

Posted on by Michael Kokinos

The most common disease that I treat as a vascular surgeon is a medical problem called peripheral vascular disease.  Specifically, peripheral refers to the legs, and vascular disease refers to blockages of the arteries.

Because peripheral vascular disease is the most common disease that I treat, I want to talk today about what I can do as a vascular surgeon to fix these kinds of blockages in the arteries!

First though, let me explain why blockages to the arteries of the legs are bad.  When not enough blood flow reaches the legs, patients can have pain in their calves or buttocks that limits their ability to walk longer than a city block.  When the blockages are very severe, they can also have pain in their feet and toes even when they are not moving or develop non-healing ulcers and gangrene.  When I open blockages in patients’ legs, I allow them to walk again, or I give them the ability to heal their ulcers and gangrene pain free.  The improvement in patient lives is the most exciting aspect of my job!

There are two main approaches to performing what we call revascularization. Revascularization refers to the opening of old passageways or creation of new passageways to bring blood directly from the heart to the foot without any obstruction.

  • Open Surgery: In the early decades of vascular surgery, namely the 1980s and 1990s the primary way to treat peripheral vascular disease was to perform an open surgical bypass.  If there was a blockage in the thigh, I would surgically expose above and below the blockage and take a synthetic tube or the patient’s own vein and then sew it above and below the blockage.  This would allow the flow of blood to bypass the blocked segment, hence, the reason we call this surgery a bypass!  Though this procedure does produce robust flow, it necessitates large surgical incisions that cause significant pain and are susceptible to poor wound healing and/or infection.

 

  • Endovascular Surgery: In the 2000s, an innovative approach called endovascular surgery started to become more widely used and is now actually standard of care today.  Indeed, I prefer to treat patients with peripheral vascular disease with endovascular surgery whenever possible.  We access the arterial system of the leg with a needle in the groin.  Through that needle we put in a strong wire and over that wire we can then advance several different instruments over catheters.  In general, there are three different techniques I can employ in my efforts to re-establish blood flow to an area that is no longer receiving blood due to some type of arterial blockage.
    • Balloons: The most basic instrument is a balloon that expands and breaks up the narrowing or blockage.
    • Stents: If the balloon does not work, we can use a self-expanding tube called a stent.
    • Atherectomy: If the stent does not work, we can use a special device called atherectomy.  Atherectomy involves the use of a device that can literally cut the plaque out of the artery and aspirate all the debris.

 

These three technologies allow the reopening of arteries from the toes to the pelvis and only necessitate a 2 mm puncture site in the skin of the groin to be used.  There is little to no risk of infection and the procedure can be performed several times over the course of the patient’s life.  On the other hand, surgical bypass can only be performed twice—three times—during the patient’s life due to the development of dense scar tissue after each operation.

 

If you have trouble walking because of pain in your buttocks or calves or have pain in your feet and toes or ulcers that will not heal, please do not hesitate to call my office today at 408-376-3626 to schedule an appointment.  The chances are that I will be able to help take your pain and ulcers away! We Can Help

www.southbayvascular.com

WHAT IS “ENDOVASCULAR” SURGERY?

Posted on by Michael Kokinos

As a vascular surgeon, I perform two very different types of surgery: Open Surgery and Endovascular Surgery.

  • Open surgery is just as you might think!  It involves making an incision with a scalpel and using various tools like forceps, scissors, electrocautery, and needle drivers to expose and then repair specific structures.  Since the beginning of surgery itself, all surgeons, not just vascular surgeons, have been practicing open surgery.
  • Endovascular surgery is a recent development that only began in the 1990s.  Motivated by the desire to perform minimally invasive and less harmful interventions on the most sick and highest risk patients, pioneers in vascular surgery developed endovascular techniques.

Though the concept is simple, endovascular surgery now allows vascular surgeons to solve a multitude of problems with blood vessels very differently than they have in the past. Using advanced minimally invasive surgical techniques, vascular surgeons can treat many forms of vascular disease without the need to “cut-open” their patients to treat extraordinarily complex and in some cases life threatening diseases.

Endovascular surgical techniques utilize ultrasound (sound waves) to place the tip of a hollow needle into a blood vessel.  Once these hollow needles have been placed through the needle, we place a very stiff wire that allows us to advance large tubes called catheters into the vessel.  Catheters have many different functions depending on the situation and are used to re-establish blood flow in vessels that are diseased and or blocked.

For peripheral vascular disease, there are blockages in the legs of a patient that prevent blood flow from reaching the foot.  For peripheral vascular disease we can use balloons on the end of the catheter that are inflated to open a blockage.  If balloons do not work, then we can put a self-expanding metal mesh tube on the end of a catheter and then deploy it inside the blockage, thereby keeping it open.  There is also a technology called atherectomy which literally means cutting out plaque.  The atherectomy device has a cutting edge that sands down the plaque and then a suction function that removes all the debris.

For aneurysms, which are dilations of a blood vessel that can rupture, we use stent grafts, which are self-expanding metal mesh tubes that are lined with an impermeable fabric.  We place the stent graft above and below the aneurysm, thereby sealing it from the pressure created by the heart and preventing rupture.

At the end of these endovascular cases, the patient only has one or two 1 mm in size punctures over the arteries that were accessed.  Contrast this to the classic open surgeries where patients could have incisions up to 10 to 20 cm!  As a contemporary vascular surgeon, I take pride and joy in being able to offer both types of surgical interventions to my patients.  If you or your loved one may be suffering from vascular disease, please do not hesitate to call our office at 408-376-3626 to schedule an appointment today!

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

Posted on by Michael Kokinos

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