RosenVeinLecture 104,Pt2: Why Bad Veins Happen To Good People

RosenVeinLecture 104,Pt2: Why Bad Veins Happen To Good People

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Venous Pathophysiology, Part 2 The whole of the Chicagoland area…including Northbrook where Rosen Vein Care is located…was once burdened by a sheet of glacial ice that oppressively flowed southward from Wisconsin. But hey…that’s just a theory. It’s not as if there was a video camera catching the evidence as it happened over hundreds of thousands of years. And that’s science: making best guesses based on facts as best we can gather them. Gather enough repeatable facts and you have yourself a theory. If it holds up long enough to the nerditudinous scrutiny of your peers… they’ll call it a Law. The lamp of scientific inquiry has flickered its way into nearly every crevice of uncertainty regarding the workings of our world…our bodies included. Over the years, a few theories have surfaced regarding the progression of superficial venous insufficiency and its effects on the lower extremities. Here’s where the trail of our discussion regarding the pathophysiology of venous disease picks back up again. The Old Theories: 1. Venous Stasis Theory: Attributed to Dr Homans and formulated during the early-mid 20th century: Valve/vein wall failure→reflux→stagnant blood→increased pressure→prevents nutrients from getting to skin→skin changes 2. Diffusion Block Theory (Fibrin Cuff): Venous Hypertension→capillaries become “leaky” (any docs reading this would rather I state it thusly: a widening of the endothelial gap junctions occurs)→fibrinogen leaks out and forms “cuffs” around capillaries→creates a barrier to oxygen/nutrient diffusion to tissues→ epidermal cells die. However, recent evidence suggests that the cuff is made up of multiple different proteins (fibrin,collagen,laminin…) and seems to serve as the body’s way of maintaining vascular architecture in the face of an increase in mechanical load due to venous hypertension. So the cuff could have protective benefits. But, it’s out with the old theories and in with… The New Theory: Inflammatory Model of Venous Disease A beautiful and compelling case which wraps it all up in a nice package: Venous Hypertension→shear stress on endothelial cells that line the inside of vessels→increased permeability of the lining→White Blood Cells (especially macrophages for those still awake) & Red Blood Cells leak out→ WBC’s become activated and release […]

Rosen Vein 104:Pathophysiology or “Veins Gone Wild!”,Part 1

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Venous Pathophysiology, Part 1: The North Suburbs of Chicago seems an idyllic place. Great schools. Lovely parks. The beautiful state-of-the-art Rosen Vein Care office in The Professional Plaza at Northbrook Court. But despite all the local trappings and amenities, we live in an imperfect world. The second year of med school deals with learning about medical imperfection; what happens when things go wrong. Here’s a little taste of 2nd year med school for you…a discussion of venous pathophysiology. Pathophysiology is why doctors exist. Rosen Vein Care exists to fix the pathophysiology of the superficial venous system. I live and breathe the stuff. The concept is pretty easy to grasp: remember the major players of the venous system in the lower extremities: veins, valves, and pump…then realize that what can go wrong often does go wrong. The final common pathway of all the problems is an increase in the venous pressure in the extremities (venous hypertension). Let’s consider the players one-by-one: 1. Calf Muscle Pump Failure:  Think of this as “congestive heart failure” of the “peripheral heart”. Decreased pump function→decreased “ejection fraction”(the amount of blood pumped out of the legs and back to the heart)→increased volume of blood remaining in the lower extremities→ INCREASED VENOUS HYPERTENSION. This can be caused by: –Neuromuscular diseases (can’t move muscles in pump) –Muscle wasting (used to pump better, now not so much) [Please resist the urge for a “that’s what she said”] –Deep fasciotomies…or surgical incisions made deep into the muscles that render them unable to be used effectively 2. Plumbing Issues: Once you start talking about vascular problems what you are really talking about are plumbing issues. Plumbing issues can be boiled down to either blockage/narrowing or leaking. If we used such simplistic terms doctors would never be taken as seriously as they expect to be taken. Therefore we’ve come up with fancy-shmancy ways of saying the same thing. We call blockage “obstruction”. We call the leakage “incompetence”. [If the plumber told us our toilets are obstructed and our faucets are incompetent he’d likely charge us double, G-d forbid] a) Obstruction: The pump is fine but […]

Rosen Vein Lecture 103:Leg Vein Physiology(How veins work)

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Some people living in Chicago and the Chicagoland Suburbs who happen to suffer from varicose and spider veins take comfort in the fact that for 8-9 months out of the year it’s too cold to wear shorts…and therefore they can avoid wearing shorts along with everyone else around them.   This just illustrates one of the more significant effects of venous disease: lifestyle limitations. Not to discount the fact that untreated disease can lead to things like blood clots and skin ulcers…but sometimes the emotional discomfort of having unsightly legs can be just as limiting and profound as the physical discomfort. Why should a completely fixable problem keep people from engaging in activities that they would otherwise love to do?! I want you to feel happy about parading your legs around town! They’re literally like walking billboards for Rosen Vein Care…show ’em off! That’s why I am on a mission to educate. As the Greek philosopher Epictetus said, “Only the educated are free”. I want to help free people from such limitations. Therefore I’m using the first postings of my blog to get you up to speed on the current understanding of venous disease. Once you understand the underlying problem and the state-of-the-art treatment options we provide at Rosen Vein Care, you’ll be better equipped to make a decision, to make a significant change. Enough preamble…let’s get down to business: How and What Leg Veins Do Arteries carry blood Away from the heart. The heart’s job is to keep on pumping and get the nutrient-rich blood to all the areas of the body. Arteries get all the press. “Hypertension” this….”Coronary artery disease” that…yadda-yadda “aortic dissection”. Most people, physicians included, rarely stop to think about how the body returns the blood back to the heart through the veins. The blood from the head is easy to get a handle on…gravity just drains it downward toward the heart. Fair enough. What about the legs? It’s not as if there is another heart in your lower extremities that pushes the blood upward against gravity. Well, actually there is! When the muscles in your calf […]

Rosen Vein Lecture 102: Lower Extremity Vein Anatomy

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My goal for this blog is to provide patients suffering from varicose vein disease in the Chicagoland area with the tools they need to be the most informed patients they can be. Treating your varicose vein disease is a team effort and you are the most valuable player on the team! While it’s up to the experts at Rosen Vein Care to diagnose and treat your particular issues, the team needs your help in ensuring the best results possible for you. You need to be involved every step of the way. So the first step is to learn about what led you to seek help in the first place. Chronic venous disease is as fascinating to study as it is challenging to treat. So, fellow freezing Chicago and North Shore residents alike…nuke up a cup of tea in the microwave… grab a cozy blanket…and prepare to curl up with an informative lecture on veins and how they do what they do. Don’t be afraid…I won’t show any icky pictures. Not yet, anyway. But it is important for you to know where those painful bulges and spider veins ultimately came from. Diagnosing vein disease requires obtaining a road map via ultrasound of the unique features of your lower extremity veins. Like snowflakes, no two people’s leg veins are alike…but there are some pretty consistent “major players” that we can typically find. Over the past decade or two, great tumult existed in the world of Phlebology (the field devoted to treating venous disease) regarding how to name the veins in the lower extremities. You’d think that they would be a rather sedate crowd, but get Phlebologists started on vein nomenclature and…hoo-wee…watch the sparks fly! Are they “Great” or “Long” saphenous veins? Are they “Small” or “Short” or “Lesser”? Eventually it took a  Battle Royal Melee in The Octagon…ok, the equivalent of one in academic medicine…a meeting of international members of the American Venous Forum in 1994…who eventually settled upon the Great and Small saphenous veins. Great Saphenous Vein: These veins run from the inner side of your ankle up the leg and […]

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