Veins1: Welcome to the Veins1 vascular moderated chat. This is the second of four moderated chats on Veins1 in October. Each will be held Tuesday at 9:00 pm eastern standard time. We welcome your questions and your input.

Veins1: Today's guest is Gregory A. Spitz, M.D., F.A.C.S.. Dr. Spitz is a leading general surgeon, and the inventor of the surgical technique for varicose vein removal used with the TriVexÔ System. As a member of the Senior Attending and Teaching Staff at Rush-Copley Medical Center in Aurora, IL, Dr. Spitz specializes in minimally invasive vein surgery, advanced laparoscopy and minimally invasive hernia repair.

 Veins1: Dr. Spitz is a member of the American Medical Association and a Fellow of the American College of Surgeons. He is also a member of the Illinois State Medical Society, Kane County Medical Society (Secretary of Treasury, President-Elect, Board of Directors), Fox Valley Medicine (Board of Directors), the Warren Cole Surgical Society and the American College of Phlebology (member and speaker).

Veins1: He is a graduate of the University of Illinois, College of Medicine, Chicago, IL. His internship and residency were performed at the University of Illinois, Metropolitan Group Hospitals, Chicago, IL.

Veins1: We welcome your questions!

kas517: Dr. Spitz, can varicose veins of the foot be removed?
Dr. Spitz: Varicose veins on the top of the foot as well as the rest of the foot are from an incompetent (leaky) valve above that...these can both be treated as an outpatient. Proper diagnosis with duplex ultrasound will delineate the problem.

kas517: Are there any age constraints on varicose vein procedures? I'm 17 years old and am starting to notice varicose veins. Am I too young to have the procedure?
Dr. Spitz: The youngest TriVexÔ patient to date is 15 years old done last summer
  

uc99: Are there treatments for very blue, very noticeable veins near the skin's surface? They don't bulge and aren't painful, so they're not varicose veins, just unsightly.
Dr. Spitz: Again, diagnosis with ultrasound will help...but any vein that can be visualized can be removed...some of these are normal with certain people. Smaller non-bulging veins can be treated with sclerotherapy (injections).

sportgirl13: Does weight training really cause your veins to bulge? Can that be a cause of or aggravate varicose veins?
Dr. Spitz: Weight training will cause increased pressure on the veins...if you have a predisposition (heredity) for the problem it may aggravate it. However, staying fit is always a good choice.
 

daisy21: Is there a connection between oral contraceptives and spider veins? I know a few girls who have had spider veins develop after being on birth control for a year or so. Is that just coincidence?
Dr. Spitz: Yes, but a weakly proven connection...hormones and changes in hormone levels are a definite risk factor.
  

red rider: What is a doppler test? And why is it important? My Mother had to get one of these because of concerns about veins in her legs.
Dr. Spitz: Strictly speaking, doppler is just listening to the veins with a special device. It is often confused with ultrasound which will view the veins and vein valves.
  

hot babe: I am a flight attendant and spend a significant amount of time in pressurized cabins in the air. What can I do to minimize the occurrence of varicose veins?
Dr. Spitz: Walking while working and compression hose will help; over-the-counter should do for that.

John Rafael Grant: Dr. Spitz, is the TriVexÔ procedure applicable to anorectal varicose veins?
Dr. Spitz: No, those would technically be hemorrhoids.
  

ses330: My mother has to have a hip replacement on her right side and has varicose veins on her left side. Is there a certain order in which she should have these procedures scheduled?
Dr. Spitz: It depends on which is more symptomatic...if the veins are causing significant problems they should be done first. After hip surgery deep vein clots are a problem...so having the varicose veins taken care of first may be the right choice.
  

kellykel: I'm a 25 year-old healthy, active female. Varicose veins do not run in my family. Am I at risk for varicose veins? Is there a way for me to prevent getting them?
Dr. Spitz: Just staying fit in general, ie exercise and avoid being overweight
  

maybaby: I experience pain and tingling in my fingers and toes after being exposed to the cold. Sometimes this can last up to 3 or 4 days - is that Raynaud's disease?
Dr. Spitz: It may be Raynaud’s. Testing can be done by a vascular surgeon. Usually Raynaud’s causes blue discoloration also.

Jonathan Smith: After strenuous exercise, I like to use the Sauna and/or Hot Tub at my local YMCA. Will this aggravate or exaggerate the varicose veins in my lower leg?
Dr. Spitz: If you have varicose veins, using extremes of hot water for long periods can aggravate the problem.
  

Susie Q: Is it possible to get varicose veins in the wrist? I have a pulsing bulge in my wrist that at times is itchy. Is this possible? I thought varicose veins only occurred in the legs.
Dr. Spitz: A pulsing bulge at the wrist may involve the arteries of the wrist...there are no varicose veins of the wrist.
  

Veins1: Is there a correlation between heart problems and varicose veins?
Dr. Spitz: Heart problems are more related to peripheral vascular disease of the arteries. They usually will correlate in some way...not with the veins.
  

red rider: One other question on the spider veins-- a friend who unfortunately drinks a lot and he has red spider veins on his nose. I like to drink a glass now and then, but with the veins problems in my family, I want to know if I am risky getting a red nose covered with little veins, too.
Dr. Spitz: That is related to liver disease from drinking; the liver disease usually only comes with heavy drinking
  

JohnJ1956: I read online that perhaps varicose veins can lead to blood clots. Is this true? Is there anything I can do to avoid this aside from operation?
Dr. Spitz: Varicose veins have stagnant blood in them. They are a true medical problem and can lead to clots. Avoid being overweight and stay in general good health otherwise. Removal of the source (bad valve) and the veins is the best choice.
  

Veins1: What should people do if their jobs require long periods of standing?
Dr. Spitz: Keeping the calf muscle moving by flexing and extending the legs during standing helps the circulation.
  

Susie Q: How destructive is a collapsed vein? I've heard of that occurring when people give blood and am wondering how bad that is? How does that happen and does it cause permanent damage?

Dr. Spitz: Rarely giving blood or getting an IV can cause irritation of the vein wall. This can cause the vein to be blocked...usually there are hundreds of other veins to take up the slack.
  

dcs95: My left leg has varicose veins in the calf. I have a tingling, twitching feeling in the leg at times. I have been told the problem is in the main vein and the injections would not help. What are the risks of leaving them alone, and what are possible solutions for repair?
Dr. Spitz: Leaving can lead to phlebitis, clots or ulcers in the leg...find a doctor on Veins1.com. A valve procedure and TriVexÔ are a great solution after diagnosis with an ultrasound. Outpatients are a 40 minute procedure in most cases.
  

Brian Johnson: I've been reading a lot online about TriVexÔ. I also saw it featured back in July on the Today Show. Can you explain the benefits of TriVexÔ vs. other varicose vein removal procedures?

Dr. Spitz: TriVexÔ visualizes the veins and accurately removes only the "bad" veins from the leg. Easy recovery, only 3-4 tiny incisions and you are walking that day. Other procedures are blind, tedious and require long operative times with many incisions…as many as 30-40 was very common.
  

uc99: Are there any treatments for venous leg ulcers other than compression wraps?
Dr. Spitz: Ulcers are the end point of vein disease and need good diagnosis and treatment. This may involve a valve procedure, TriVexÔ and possibly a procedure that goes under the muscle SEPS to stop the leaky valve from causing back pressure.
  

red rider: Thanks, Doctor. Can you answer my question on my Mom's legs, too? About why they are doing Doppler Test on her legs and is she at risk of losing them?
Dr. Spitz: Without examining her, I couldn't guess about her prognosis...they could be checking veins or arteries with a Doppler.

maybaby: Can spider veins in diabetics be removed?
Dr. Spitz: Spider veins can be treated with laser or injections or both in the office (diabetics included)
  

boosted302: What about...I think it was called injection therapy? Is this procedure as safe as the others?
Dr. Spitz: Injections = Sclerotherapy...it is not recommended for varicose veins, only spider veins. It clots the veins and larger veins attached to leaky valves will open up again.
  

daisy21: Is there any way to make my veins bigger or more accessible? Nurses always have a hard time gaining access to my veins when it's time for them to do bloodwork. Is there anything I can do about that?
Dr. Spitz: No that is just an inherited trait.

dcs95: Does sitting for long periods of time have a negative effect on the veins?
Dr. Spitz: Just like standing for long periods, it can aggravate stagnant blood in the veins.
  

hot babe: Is there post-surgical follow-up with TriVexÔ? How long is the healing process to recover?
Dr. Spitz: We see our patients in 2 days to remove dressings and our patients receive therapeutic ultrasound treatments to make the recovery even easier. Most patients get back to work in 3-4 days and full impact exercise in 10 days. Walking is encouraged during the entire recovery.
  

Veins1: There are a few questions on what constitutes cosmetic surgery?

Dr. Spitz: Cosmetic would be a face lift, eyebrows or breast augmentation that only affects the look of something. Varicose veins are a medical condition and treated accordingly...but the cosmetic result of a vein operation is of course important and always considered.
  

Veins1: What can be done regarding discoloration of the leg after varicose vein surgery? Is time the main factor? What else can be done to regain normal coloration?
Dr. Spitz: Varicose veins themselves can cause discoloration. We use ultrasound treatments and special ointments to treat these areas.
 

Victoria M: Hi, I have more of a cosmetic problem. I have very noticeable blue veins throughout my body, especially in my chest, abdomen and legs. Is there any procedure to help these "normal" veins or anything whatsoever (i.e. lotions, etc) that can remedy this problem?
Dr. Spitz: None that I know of...this is likely the nature of your skin type.

boosted302: Are there any vitamins I can take to help promote my vein health? I am concerned about varicose veins in the future because it runs in my family...thanks.
Dr. Spitz: No specific vitamins, but general good health with exercise and avoiding obesity. Having a good diet should deliver all the vitamins you need for most people.
  

Henry: Can TriVexÔ heal leg ulcers?
Dr. Spitz: Leg ulcers are the end stage of vein ulcers.  If it is a venous ulcer, TriVexÔ can remove the veins under it causing the problem. This is combined with a valve procedure as an outpatient.

Veins1: There are a few questions regarding how best to evaluate leg stockings?
Dr. Spitz: If this is an ulcer from artery disease, other treatment is needed. We prescribe different stockings for patients depending on their problems. Quality of the make is like anything else...we have brands available to us that are time proven.

Shelly: What exactly are reticular veins, and what causes them to become more noticeable?
Dr. Spitz: Reticular veins are bigger than spider veins but smaller than varicose veins. They are 2-3 mm and can bulge a little. They can be attached to a leaky valve causing pressure to make them bulge.
  

Brian Johnson: What can I do to increase circulation in my hands? I typically work 8 hrs in front of a keyboard per day and when the day is over, my wrists hurt.
Dr. Spitz: That may not be circulation, but carpal tunnel syndrome is possible...this involves nerves being impinged.
  

iepnihs2 : Hi. When I work out, veins bulge on my forehead. They aren't there when I don't work out. I'm thinking about a hair replacement procedure where they put little plugs in your head. What if they hit a vein??
Dr. Spitz: Hitting a bulging vein anywhere can cause bleeding, especially the head. I know that reputable hair replacement surgeons take this into account and avoid them.

Veins1: Someone asked, what are incompetent veins?
Dr. Spitz: Incompetent means instead of driving the vein blood back up toward the lungs and heart like it is supposed to, the vein blood goes down. Small valves in the veins themselves lose their elasticity and don't stop the blood from pooling anymore...this leads to ulcer (open wound) and clotting.

Veins1: Dr. Spitz, we are getting close to wrapping up. Are there some areas of vascular health you want to address before we close?

Dr. Spitz: Just to reiterate...varicose veins are a medical problem and should be diagnosed by a vein specialist. There are a lot of people who just learn how to do things at weekend courses and I would avoid them…board certified general and vascular surgeons are well trained to treat these patients.

Veins1: Thank you Dr. Spitz for your insightful responses tonight. And thank you audience for your participation in the Veins1 moderated chat.  Remember, this was the second of four moderated chats on Veins1 in October.  Each will be held at 9:00 pm eastern standard time.  The next chat will be 10/15 at 9:00 pm eastern standard time.