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

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.

THE “RIGHT” EXPERIENCE COUNTS WHEN IT COMES TO YOUR HEALTH

The “RIGHT” Experience Counts When It Comes to Your Health! South Bay Vascular Center and Vein Institute is the Bay Area’s Most Trusted Varicose Vein Clinic and Treatment Center.

Having performed over 20,000 vein procedures in the past 24 years, more independent doctors refer their vein patients to Dr. Polyxene (Polly) Kokinos than to any other vascular surgeon in the greater Silicon Valley region. Recognized as San Jose’s most experienced Vascular Surgeon and Varicose Vein Expert, Dr Kokinos offers cutting edge care to patients suffering from all forms of both arterial and venous disease.

Here’s why more local doctors refer to South Bay Vascular than to any other Vascular Surgery Center in the Valley:

  • The “RIGHT” Experience Counts When it Comes to your Health: South Bay Vascular center has been treating vein patients in a private practice setting for over 24 years.
  • Cutting edge vascular care in a fully accredited, state of the art, and private out-patient surgery center dedicated entirely to the practice of vascular surgery.
  • Access to the most Advanced Imaging and Device technologies found anywhere in the world.
  • On-site fully staffed IAC accredited Vascular Ultrasound Clinic that is operated full time by Registered Vascular Technologists (RVT).
  • Vascular Studies ready by RPVI certified Vascular Surgeons.
  • Same day availability for Hemodialysis Access de-clots.
  • “One-Doctor, One Patient, One Nurse” practice philosophy means we put the patients first.
  • Full time access to practice physicians
  • Easy access to care: No admissions departments.
  • RESULTS:   We are MORE than just a colorful website and a Google Adwords campaign. Remember, all that glitters is NOT Gold!  https://www.southbayvascular.com/blog/varicose-vein-doctors/

 Trust the doctor your physician does.

 Remember, Its Not Just Experience That Counts.

When It Comes to Your Health, It’s The “RIGHT” Experience that Matters!

Dr Polyxene Kokinos, Silicon Valley’s Vascular Surgeon.

Call us today at 408-376-3626 to schedule your vein consultation.

Click here to learn more about Dr Kokinos  NOT JUST VASCULAR CARE, EXCEPTIONAL VASCULAR CARE

VARICOSE VEIN DOCTORS

Type “Varicose Vein Doctor” into your Google search and in seconds, you’re overwhelmed by results.

Each link points to a different website.  Each site claims their “Vein Doctor” is the “best” and every practitioner claims to have the “bona-fides” to back-up these claims. Credentials span the continuum from Academic Institution Affiliations, (claiming to be X, Y or Z University Affiliated); to Chair-Personships (they “chaired’ this or that medical departments in the “Big Box” health care systems they came from (i.e. Kaiser, PAMF, or Sutter) to Medical Journal Publications…all this in an apparent attempt to equate administrative responsibilities with clinical excellence. Some of the bolder in the group even claim they trained at the best medical schools hoping to convince potential patients that by attending a great medical school they are the best physician for the procedure.

 

AN ESPECIALLY CONCERNING TREND IS A PHYSICIAN’S USE OF GOOGLE ADWORDS TO ADVANCE THEIR MESSAGE

 

If a vein doctor’s website shows up in your Google Search and you see that the listing starts with the word “AD” …be careful. It means that the owner of this practice is paying Google a special Advertising fee to get their name to the top of the search results. This is an attempt by this physician to “BUY LEGITIMACY”.  Businesses PAYING google to display their ads above the practitioners who have EARNED this privilege is a great way for Google to make money. Unfortunately, it can be deceiving to people who think that because a doctor’s website pops up at the top of the search results that they must be the best. (On a separate note…If a physician’s website DOES show up at the top of the search results and DOES NOT have the word “AD” in front of it, IT IS a sign that this physician has many website visitors and that they have been around for a long time…Especially if this listing is followed by a large number of Google Reviews.)  It also means that this physician has EARNED their reputation, and NOT purchased their website ranking. A word of warning to patients searching for an experienced vein care professionals. Anyone can pay to elevate their search rankings on Google; regardless of their experience.

 

IGNORE websites with paid “AD’s”, especially if they don’t have any verified Google reviews. 

 

To make things even more difficult, it can be very confusing just trying to figure out what kind of doctor actually does varicose vein procedures. Some doctors call themselves “Vein Specialists”. Others call themselves “Vein Experts”. You’ll also see the labels “Phlebologist” and “Vascular Expert”. Finally, there is the “Vascular Surgeon”. You ask yourself, do all of these physicians fix varicose veins? If so, what’s the difference? (Learn more by clicking on the following link). https://www.southbayvascular.com/blog/vascular-surgeon-vs-phlebologist-vs-vein-specialist/ Every one of these “Vein Doctors” promises to rid you of your ugly, painful veins, leg swelling and non-healing ulcers. Every one of them posts photos showing off their work to prove their point.

Let’s face it, it’s confusing. All you really want is to get your veins “fixed” so that next time you get invited to a pool party you can wear shorts or a skirt again without being “mortified” by how bad your legs look. So, what’s next?

Lost in this hype, finding the right doctor to treat your varicose veins might seem impossible. Choosing the best doctor for your specific vein condition is a difficult decision and not one that you should take lightly.  Only after serious consideration of the available options should this decision be made and in the best of all worlds, it should be made in consultation with your primary care physician…and this is the probably the most important message in this post.

LISTEN TO YOUR PRIMARY CARE DOCTOR

They’ve been in this community a long time and they know who is good and who is not. Their referral should be your number one reason to make an appointment with a Varicose Vein Doctor.

In the best of scenarios, patients should visit as many doctors as they can; interview them and question them about everything relating to their condition and their ability to help you…but remember, your primary care doctor has been doing this for a long time. They’ve got the benefit of having seen the results from different doctors and on the strength of their recommendation, you should have the confidence to know that you are making the right choice.

Here are a few things varicose vein patients should keep in mind:

  1. Remember, these are your legs. You deserve the best and you deserve to “Love Your Legs Again”.
  2. Don’t be frightened to ask your doctor tough questions.
    • Don’t just ask your vein doctor how long they have been in practice, ask them how long they have been doing these specific kinds of vein procedures. Ask them how many of these procedures they’ve done.
    • If your doctor is in private practice, ask them how long they have owned their own practice. This is important because getting things done right in a private practice is significantly more difficult than getting work done in a University Hospital or Big Box Medical System.
    • How many of these procedures have you done RECENTLY….if they do less than 25-30/ month, you might want to seriously consider finding another option
    • What kind of complications might you expect…every person is different and if your doctor says your legs will look as good as they did when you were 20, you might want to consider seeing someone else.
    • Who does your ultrasounds…are your ultrasound techs RVT’s (Registered Vascular Technologists?) Are they done “in-house” by full time Vascular ultrasonographers or are they done by “travelling” ultrasonographers who just work in their office a few times a week and who are not full time employees of the medical office.
    • Most importantly, is your Vascular lab IAC Accredited? This is especially important as your doctor will make their diagnosis on the basis of your ultrasound report and an IAC accreditation guarantees the best of the best studies are being done at that particular lab.
    • Who reads the ultrasounds….is it an RPVI registered physician, not simply a radiologist… as the two physicians will look for vastly different signs relating to vascular disease and health. Keep in mind if the study isn’t read correctly, the procedure can go poorly.
  3. Finally, ask your “Vein Specialist” about what happens if you have a complication Ask your provider if they have “Admitting privileges” at the local hospital in the event something goes wrong during the procedure and what their plan is if their procedure fails.

 

EXPERIENCE COUNTS WHEN IT COMES TO YOUR HEALTH!

 

South Bay Vascular Center and Vein Institute brings 24 years and 20,000 vein procedures to you as our patients. As the leading independent Vascular Surgery practice in the San Francisco Bay Area, more local independent physicians refer their vein patients to Dr Kokinos than to any other vascular surgeon in the greater Silicon Valley Region.

WE OFFER HOPE WHEN OTHER SAYS THERE IS NONE!

Call us today at 408-376-3626 to schedule your vein consultation

VEINS, VEINS, VEINS…VARICOSE VEIN TREATMENT IN SAN JOSE

South Bay Vascular Center and Vein Institute is Northern California’s #1 varicose vein treatment center and vein repair clinic. Our ABMS board certified vascular surgeons have performed more successful varicose vein procedures than any other physicians in the region and are the best trained vein specialists in the area. Every vascular surgeon at South Bay Vascular Center and Vein Institute has completed a board eligible fellowship training program in both general as well as vascular surgery and has been trained to both identify and to treat any level of venous disease.

Unlike interventional radiologists, interventional cardiologists, phlebologist’s and dermatologists who perform varicose vein procedures to supplement the income from their primary speciality, VASCULAR SURGEONS have spent their entire careers treating diseases of the circulatory system. They spend all their time diagnosing and treating any venous and/or arterial abnormalities. More importantly, when the problem is more than a simple cosmetic issue (most commonly experienced as leg swelling or aching) the vascular surgeons of South Bay Vascular Center are the ones to take care of it. They have the most advanced ultrasound testing facility, angiography suite and screening protocols in the entire region to help diagnose deeper systemic circulatory diseases such as DVT’s (blood clots) and iliac vein compression.

Many of the patients who visit our clinic find us after their vein treatments at other “Vein Speciality” clinics fail to help them achieve their desired outcomes. Unfortunately, many of these same patients tell us they were led to believe that varicose vein surgery is a relatively easy procedure and can be performed by any level of licensed physician after a basic course in cosmetic vein treatment modalities.

Having served the South Bay for over 20 years, Dr. Kokinos and the staff of South Bay Vascular Center and Vein Institute have performed over 20,000 successful Varicose vein procedures. In addition to her clinical practice, Dr. Kokinos is recognized nationally as an expert in the treatment of varicose veins, peripheral arterial disease, chronic limb ischemia and iliac vein compression. Together with her partner, Dr. Carlos E Pineda, Dr. Kokinos is proud to bring this level of care and experience to every one of her patients and is honored to be entrusted with the care and treatment of them.

Understand your treatment options. Ask your “Vein Specialist” about what happens if you have a complication with your procedure. Ask your provider if they have “Admitting privileges” at the local hospital in the event something goes wrong during the procedure and what their plan is if their procedure fails. Most importantly, check the primary board speciality of your varicose vein “specialist”. If it isn’t vascular surgery, there is someone more qualified and better trained to perform the procedure.

Remember, these are your legs. You deserve the best..and you deserve to “Love Your Legs Again”.

CALL US AT SOUTH BAY VASCULAR CENTER AND VEIN INSTITUTE.

408-376-3626

TEN MISCONCEPTIONS ABOUT VARICOSE VEINS

Last weekend, during my daughter’s water polo game, I noticed the coach for the opposing team was limping and had a very swollen left leg. With a closer look I realized he had the hyperpigmentation (skin darkening) of chronic venous disease and ugly bulging varicose veins easily the size of my thumb all over the inside of his calves. I decided to go ask him about them, as they looked awful, the man was clearly in pain, and I was concerned. After a brief conversation with the coach, where he told me various “old wives’ tales” it dawned on me that he probably wasn’t alone thinking the way he did so I thought I should post this blog in an attempt to clear up these ten common misconceptions about varicose veins. Here goes:

“Varicose veins are simply a cosmetic problem”

About half of the patients we see in our practice for varicose veins complain about the pain they experience because of their veins. Because these patients are experiencing pain and suffering, many times varicose veins are categorized as a Medical condition and not just a cosmetic issue. This is especially true if they are accompanied by leg aching, throbbing, swelling, or discoloration. Venous disease affects about 40 million people in the United States and about 1 million end up with ulcers that are painful and difficult to heal. As a medical condition, depending on the severity of a patients condition, insurance often covers for the procedure to be done. That way, patients are not forced to pay out of pocket to rid themselves of their painful and ugly veins.

“Varicose veins can cause strokes, heart attacks, or gangrene”

Although varicose veins are a circulatory problem, the blood vessels causing strokes, heart attacks, and gangrene are arteries not veins. The patient profile of patients suffering from vein issues (women, multiple pregnancies, family history, standing occupation) is very different from those that get arterial problems (smokers, diabetics, patients with high blood pressure or cholesterol). Because of this, patients suffering from varicose veins should consult with their physicians to determine if this problem is accompanied by any underlying,and potentially more serious, circulatory issues

“Only women get varicose veins”

Although venous disease is more common in women, about 40% of our patients are men. Unfortunately, men tend to present with more advanced disease or longer standing symptoms.

“I have had my veins just like this for twenty years”

Venous disease does progress if not treated and currently there are several outpatient office procedures that can be done with excellent results and low risks

“It is not worth treating varicose veins because they just come back”

The treatment of venous insufficiency is one of the more successful treatments in medicine, as long as the underlying cause is treated- ie. the underlying veins that have the leaky valves. In the old days, patients were treated simply with removal of the bulgy veins. Because the underlying saphenous veins that had leaky valves were not treated, the bulgy veins come back. Now that we do ultrasound to “map out” the diseased veins, the recurrence rate should only be about 10% at 10 years.

“Insurance will not cover any varicose vein treatment”

Although insurance companies have absolutely made the criteria for coverage for venous disease much more difficult over the last ten years, most patients who do have leaky valves in their underlying valves are covered. Sclerotherapy for spider veins and the simple removal of bulgy veins for appearance are almost never covered today.

“Varicose veins are “surplus parts” that I might need someday”

They are abnormal blood vessels that develop usually because there is an underlying medical problem- vein valve failure or “leakiness”. The underlying greater saphenous vein, that usually is the one that has the leaky valves, is sometimes used in open-heart surgery or arterial vascular bypass surgery. However, today, it is not commonly used as those operations have been replaced to a large extent by less invasive procedures using balloons and stents.

“ Varicose veins are just part of getting old as is my leg pain”

Although it is true that there is an increase in the incidence of varicose veins as one gets older (one study found that 75% of women over the age of 65 had venous issues), it is NOT a normal part of aging to feel heaviness, aching, or throbbing in the legs. It is important to go have those symptoms evaluated by a vascular surgeon as often it can be easily treated.

“Treatment of my varicose veins will lay me up for weeks”

Until about 15 years ago, the main treatment for varicose veins was a difficult procedure called vein stripping. This was generally done under general anesthesia, in a hospital where one was admitted, with two moderate sized incisions in the groin and at the ankle. It generally took patients several weeks to recover. The field was revolutionized by the introduction of endovenous ablation, which currently is an office procedure, done under local anesthesia where the patient usually has NO post-operative pain. Most patients return to all of their normal activities with 24-48 hours.

“You have to have bulging veins to have a vein problem”

Many patients who present with heavy, aching or swollen legs actually do not have bulging varicose veins but are found to have a problem on evaluation. In order to diagnose venous disease, it is important to have a VENOUS REFLUX ULTRASOUND. This is not the same as a vein ultrasound to look for blood clots that primary care doctors often order at hospitals. It is critical to have this test done at an ICAVL accredited laboratory as it is extremely technologist dependent. A good exam will take about 30 minutes per leg and will examine veins with the patient in a standing or head slanted up position from the groin to the ankle.

TREATMENT OF VARICOSE VEINS IN LOS GATOS

WE CAN TREAT YOUR VARICOSE VEINS, SWOLLEN, ACHING LEGS, NON HEALING LEG WOUNDS, AND PERIPHERAL ARTERIAL DISEASE

For 20 years, the physicians and staff of South Bay Vascular Center and Vein Institute have successfully treated tens of thousands of patients in the Silicon Valley communities of Los Gatos, San Jose, Campbell, Los Altos, Palo Alto, Morgan Hill, Gilroy and the greater South Bay. Our ABMS Boarded Vascular Surgeons are experts in the treatment of varicose veins and swollen legs and can help patients get their lives back by successfully treating these conditions.

Spider and varicose veins are a common problem that many men and women have to confront. Spider veins are small, reddish veins that appear on the surface on the skin, while varicose veins are blue, tangled, bulging, knotted vessels that are much larger. Women are more likely to experience varicose veins than men, but they are common among both genders.

Aside from their unsightly appearance, varicose veins can cause a feeling of heaviness or tiredness in the leg, swelling, tenderness or pain when touched, and a general sense of restlessness. Age and family history are two major factors in a person’s risk of varicose or spider veins, but lifestyle also has a role to play. People who do not exercise regularly, are overweight or obese, or who sit or stand for long periods of time have a higher risk of varicose veins and venous insufficiency. Women who are pregnant also have a higher chance of these issues.

Varicose and spider veins are most common among people who are middle­aged, but even those in their teens and twenties can have this problem. No matter what a person’s age, there is no reason to wait to have these issues examined.

Vein issues can occur if a vein becomes weakened. Elastic vein walls and tiny one­way valves help send blood back to the heart, but if they lose their strength blood can start to pool backwards into the vein. Varicose veins may not be symptomatic at first, but many patients eventually report achiness and a sense of heaviness in their legs. Often accompanying these symptoms are ankle and lower leg swelling, cramps, a sense of restlessness, and an irritated or itchy rash around the ankles. The area around the vein may become numb or tender to the touch.

Varicose vein symptoms can also be aesthetic. Bulging, twisted, or knotted veins can form over the ankle and foot while the skin around them becomes discolored, leathery, and thick. In advanced stages this skin may begin to break down, leading to ulceration.

Spider veins are similar to varicosities, but they are smaller and appear closer to the skin’s surface. As their name suggest, they often form in patterns similar to spider webs. They are often red in color and may be a sign of more serious ​vein disease​ under the skin

Varicose veins can lead to more serious conditions, including:
● Thromboses – blood clots that form in an enlarged vein
● Phlebitis – vein inflammation
● Venous Stasis Ulcers – Ulcers that form due to a lack of proper drainage in an enlarged vein

Lots of centers treat the complications of poor flow through the venous system when it shows up as spider veins, varicose veins, and other cosmetic issues. Fast cosmetic fixes, however, can often mask more serious underlying circulation issues that only a vascular surgeon is trained to address. At South Bay Vascular Center and Vein Institute our goal is simple: to ensure the best possible outcomes in the safest and most comfortable environment possible.

If you suffer from varicose veins, leg swelling, especially Left Leg Swelling, after cosmetic vein treatments, please call our office at 408-376-3626 to discuss how we can treat your varicose vein and other circulatory issues. We Can Help!

WHAT IS ENDOVENOUS LASER THERAPY?

Endovenous Laser Ablation (EVLT), a treatment for varicose veins, is an advanced, highly effective treatment for varicose veins. EVLT works by using targeted laser energy to close off problem veins, thus relieving the symptoms and appearance of varicose veins and restoring healthy, attractive legs. This treatment is ideal for large varicose veins, including the greater saphenous veins.

The EVLT™ Procedure is minimally-invasive and virtually pain-free. While surgical vein treatment methods can cause scarring and other side effects, the laser energy used in EVLT minimizes risks and complications. Laser energy is delivered directly to the target vein to shrink the walls, which eventually causes the vein to close. Blood flow is diverted to other, healthy veins, eliminating the varicose vein bulging, discoloration, and pain.

EVLT is performed as an outpatient procedure, usually in less than an hour, with only local anesthesia. This means that recovery time is dramatically reduced. Most patients can resume normal activities immediately following treatment, while enjoying superior clinical and aesthetic results.

WHAT IS VASCULAR ULTRASOUND*

The medical specialty of vascular technology utilizes diagnostic ultrasound to generate images of blood flow within the veins and arteries. Ultrasound uses high frequency sound waves, similar to the sonar that a ship uses to detect structures beneath the surface of the water. Vascular ultrasound can also be known as a Doppler or duplex study. For example, if your physician wants to make sure that you do not have a blood clot in your leg, he or she might order a venous duplex or venous Doppler examination.

Vascular ultrasound procedures are noninvasive, meaning they do not require the use of needles, dyes, radiation or anesthesia and are, therefore, relatively painless and harmless.

The information obtained through vascular ultrasound examinations is extremely helpful to physicians in diagnosing a variety of conditions related to cardiovascular disease, disorders of the heart and blood vessels. Early detection of life-threatening vascular diseases is possible through the use of noninvasive vascular testing techniques performed within vascular facilities.

Vascular ultrasound’s reliability in diagnosing conditions related to heart disease and stroke is encouraging as we strive for ways to reduce the more than 500,000 lives lost in the United States each year to these disorders. However, it is critical that the public realizes there are many facets that contribute to an accurate diagnosis based on vascular ultrasound examinations. These factors include the skill of the technologist/sonographer performing the examination, the type of equipment used, the background and knowledge of the interpreting physician and quality assurance measures. In fact, poor ultrasound examinations often lead to inconvenient, redundant studies, misdiagnosis and even unnecessary tests or surgery.

*Taken from the Intersocietal Accreditation Commission Website