Hand Rejuvenation

Here is another interesting article about hand rejuvenation.  http://www.nytimes.com/2012/03/15/fashion/Skin-Deep-Treating-Hands-for-Signs-of-Aging.html?_r=1

 Unfortunately as we age, our hands make us look older than we really are! We spend most of our time focusing on our face and body – with expensive creams and cosmetic treatments. Our hands usually do not get the same care. Hands are exposed to the weather and sun, and as we age, the skin on the back of the hand becomes thin, looses elasticity, wrinkles and reveals the underlying tendons and veins. Age spots and sun damage also develop. For total hand rejuvenation, three elements need to be addressed:

Prominent Veins:  Treat with Sclerotherapy

As we age, the veins of the hand become more prominent. Why does this happen? For some people, the veins enlarge. One method of improving the appearance is to perform sclerotherapy. Using a tiny needle an FDA approved drug is injected into the veins on the back of the hand. Asclera is the sclerosant of choice at NJ VeinCare for the injection of hand veins.  A compression glove is applied and the veins will reduce in size and ultimately disappear. Treatment is almost painless and results are typically obtained with one or two treatments.

Loss of Volume Under the Skin: Restore Volume with Radiesse

Another approach is aimed at increasing the amount of tissue under the skin to hide the unsightly veins and tendons. This is called injecting a “filler”.  Radiesse and other fillers have been FDA approved for use for adding volume to many locations on the body, and are considered safe and effective when properly used.

Skin Rejuvenation: Remove Pigment Spots with Light Therapy

We offer light treatments – photorejuvenation – to reduce age spots and sunspots. The same treatment may be used on the face– IPL PhotoFacials™ – can be used for the same conditions on the back of the hands. Using the most advanced laser technology – the Palomar Icon – the intense pulse light seeks out specific pigment colors in the deep layers of skin on the back of the hand. The laser penetrates deep to treat the “problems” deep at their source.

I had an article published on a well known blog: http://www.kevinmd.com/blog/2015/08/why-this-physician-still-loves-medicine.html

What I Still Love About Medicine?

From every direction, the practice of medicine in the U.S. is under attack. If one were to believe the headlines, the American healthcare system is populated by insensitive, selfie shooting, medicare-medicaid cheating, inefficient, and ineffective physicians grappling with an over regulating government, predatory insurance companies more concerned about profits than the health of their customers, and a legal system that more often confuses a bad medical outcome with actual malpractice.  Morale in medicine may never have been lower among physicians than it is currently. Studies have demonstrated that few physicians are positive about the future of their profession, and the majority do not recommend medicine as a career choice for young people or their children. 

I have always wanted to be a physician. It has always seemed that it was the “family business”.  With a Grandparent, uncles, cousins and a father in healthcare, did I exercise “free will” when I accepted admission to a 6-yr medical program at the age of 18?  One could argue, maybe not!  However, on the eve of starting medical school I affirmed for myself that it was what I wanted to pursue.  I have never looked back on that choice with regret despite the ups and downs of this noble profession.  To answer my self-imposed question, what I love about medicine are the unique opportunities it has given me. Caring for others, educating trainees, a collegial bond, and the intellectual challenges have sustained me through difficult times.

As a physician we have a unique responsibility and a privilege. It is called the “doctor-patient relationship.”   I have always viewed this privilege as earned through years of hard work. Inherent in our profession is the acknowledgment that those we care for are suffering. The Latin root “patiens,” from “patior,” is to suffer or bear. I can’t stand it when some try to use the term client in its place.  My automobile mechanic has clients. I have patients. We share an intimacy of information and emotion with patients that few other professions allow. Other than maybe members of the clergy, no one else is privy to the closely held secrets, pains and distress of our patients.  We often have the ability and need to heal not just the body but also the spirit of our patients.  At the end of the day, it is just one doctor-one patient linked together in a sacred relationship. I don’t think any other field would provide the same opportunity. The more we give, the more we get.

Sadly, the pressures on physicians are increasing while economic reimbursement is decreasing.  The amount of debt accrued by medical students is astounding. In as study by the AAMC, it was noted that the median educational debt of all students was $180,000. Including interest payments, the total repayment could approach half a million dollars. Considering the length of time in post graduate training as a resident or fellow varying from 3 to 7 yrs. earning a modest income while working long hours, the “opportunity cost” of not being able to earn a higher income and start saving for retirement is a real economic hardship.  Medicine has attracted the “best and the brightest” historically. Given falling reimbursements, increased debt and outside pressures, people contemplating a career in medicine may not make the equation that the personal rewards that a medical career can give balance against the decreased economic benefits.  That will be a regrettable day that is probably already here.  To “save” medicine, society will have to absorb the cost of medical education in some manner as it did the cost of postgraduate training with Medicare.  Those that choose the profession in the future may actually be more dedicated and value the non-monetary reimbursements more than the financial.  Hopefully they will be just as capable.

Gary B. Nackman, M.D.

Owner, NJ VeinCare, LLC

Clifton, NJ

Clinical Associate Professor

Dept. of Surgery

Rutgers-Robert Wood Johnson Medical School

New Brunswick, NJ

     Here is an interesting article discussing the interaction between the venous and the lymphatic system. Chronic venous insufficiency can lead to not only the pain, aching, heaviness and restless legs but also swelling.  The tissue fluid can overload the lymphatic system causing edema.

http://www.lymphedemablog.com/2013/07/03/chronic-venous-insufficiency-and-the-effects-on-the-lymphatic-system/

     This is a touching story about how doctors and patients can touch each other's lives in unanticipated ways. It is about the magic of the doctor-patient relationship.
http://www.kevinmd.com/blog/2015/08/doctors-arent-allowed-to-cry-but-maybe-they-should-be.html

Individuality in Medicine?

http://www.kevinmd.com/blog/2015/08/embracing-individuality-will-save-medicine-heres-how.html#comment-2173724348

    This is an interesting article by a physician early in their career. I have been out of residency and fellowship for close to 20 yrs and have a bit of a different take than the author. Sadly, the author's view reflects an element of being trapped in a field that the author would not recommend to others. I have always viewed being a physician as a privilege that was earned through years of hard work. I have spent most of my career as a full time academic surgeon/educator at a major university hospital until 6 yrs ago when I started a private practice. The author seems to feel that the subjective evaluation of his faculty is somehow unfairly inhibiting individuality and that the societal forces of medicine are pushing against the individuality of the physician practice. It is true that medical students and residents are evaluated by both subjective and objective methods, but education research has demonstrated the validity of the subjective observations of trained observers. The issue of when individual expression becomes a question of "professionalism" is a good one. The societal forces impacting medicine with increased regulation, governmental and corporate interference with the doctor patient relationship is a real issue. However, at the end of the day, the physician is granted a unique experience and responsibility in the doctor patient relationship, which is why medicine still offers exceptional opportunities to intervene in the suffering of others.

Phlebitis

     Many people have questions about a medical condition called phlebitis. Phlebitis means inflammation of a vein. Most of the time this is a "sterile" inflammation, which occurs in the absence of an actual infection (an exception might be after having an intravenous catheter that becomes infected).  The inflammation of the vein may be associated with a blood clot, a condition known as thrombophlebitis. The superficial veins, such as varicose veins of the leg or arm may be involved or even the deeper veins found near the muscles.   A blood clot of a deep vein, a DVT, can have life threatening consequences.

     Most episodes of superficial phlebitis respond to elevation of the extremity, warm soaks, anti-inflammatory medication such as non-steroidal anti-inflammatory dugs such as ibuprofen or aspirin.  Sometimes, a superficial clot can spread to a deep vein so it is very important to see a physician if you have a painful vein.

    For an excellent review, see this article on WebMD: http://www.webmd.com/a-to-z-guides/phlebitis

27 years ago I started my surgical internship at St. Luke's/Roosevelt Hospital Center at the St. Luke's site.  Hard to believe how time flys! There have been so many changes in technology, procedures, training and how health care is delivered.  In my specialty of Vascular Surgery, the greatest changes have been in the area of endovascular procedures which treats the abnormality of a blood vessel remotely using a catheter of some sort. In the world of vein care, the management of patients with varicose veins and chronic venous insufficiency has dramatically improved. There has been an increase in the understanding of the role of the venous valves of not only the deep veins of the leg but also the superficial and perforator veins in the causation of pain, swelling and even ulceration of the leg.   27 yrs ago, a patient was admitted the night before a painful stripping of the veins of the leg under general anesthesia through incisions from 1/4 of an inch to 3 inches and remained in the hospital overnight afterwards. People were often 6 weeks before they returned to normal function. Today, we achieve better results with an office based procedure in under 1 hr with local anesthesia and practically no pain. Patients return to work in a day or two. This procedure, known as the Venefit procedure has radically improved the quality of life of millions of patients around the world since its inception.

     Some people say that the appearance of one's hands tells a story of our lives! That is because of the environmental exposure our hands receive. Sun can cause significant skin damage and our hands are almost always exposed to the elements.  A good sunscreen can prevent cosmetic problems and even skin cancer.  Sun related aging once it has occurred, can be addressed by aesthetic procedures. Intense pulsed light therapy can reduce the appearance of years of damage.  Age related thinning of the skin over the back of the hand reveals prominent veins and tendons. There are injectables that can restore plumpness.  Call today and ask about our hand rejuvenation specials! 973-778-2222

Here is an interesting link with a lot of information about varicose veins. It is well written and answers many common questions! http://www.medicalnewstoday.com/articles/240129.php

If you suffer from varicose veins, you don't need to. Treatment is far better and less painful than in the past. Minimal discomfort with great cosmetic results are the norm!

 Here is an interesting article that one of my staff members found about varicose veins in young men: http://www.menshealth.com/health/varicose-veins-in-young-men

If you’re like most guys, you figure that varicose veins are:

a) a woman’s problem;

b) a punch line that includes "compression hose";

c) not a big deal.

Think again.

As many as 56 percent of men suffer from these ballooned veins, according to British research.

And varicose veins are not just a cosmetic concern—they can lead to discoloration, bleeding, skin ulcers, and a “heavy leg” sensation that may hinder daily activity.

The problem involves the veins in the lower extremities. When you are in an erect position, your blood pools in these veins, expanding the vein walls which over time stop returning to their previous, more taut condition. According to French researchers, people with a particular genetic variation have markedly weaker veins, and have almost twice the risk for developing varicose veins.

More from MensHealth.com: Your Skin Problems, Solved

“When the walls are weaker, it allows the veins to expand and eventually the valves [that regulate blood flow in the vein] don’t meet, which allows blood to reflux and flow in the opposite direction,” says Lowell Kabnick, M.D., director of the New York University Vein Center.

When that happens, the person develops the bulged, gnarly look of varicose veins—causing symptoms that include throbbing, swelling, and decreased mobility.

How can you avoid varicose veins. Take these precautions:

• Exercise: This is the easiest way to maintain healthy venous structure and keep your vein walls strong. It’s important to involve your calves, which play a crucial role in maintaining blood flow from your legs back to the heart.
• Reduce standing or sitting pressure: Sitting, which has been catching a lot of blame lately, takes another hit here. Why? Blood naturally pools in your legs when you’re not moving, and sitting for long periods exaggerates the problem. Your solution: simply tap a foot, raise your legs, or take a walk. If you’re standing still, sway from side to side if possible. Beyond that, try to raise your legs or lie horizontally twice a day for 15 minutes to remove all pressure on your veins.
• Compression hose: Dr. Kabnick recommends everyone wear knee-length compression stockings—even if they don’t have signs of varicose veins. Compression leggings’ tension pushes the blood up from the ankle (the greatest pressure point), and redistributes it more evenly up the leg. If you don’t need prescription-grade strength, aim for hose with 10 to 30 millimeters of mercury (measurement of pressure).
• Watch your diet: Stay away from foods high in sodium (especially restaurant, frozen, and packaged foods) since salt leads to fluid retention.

So, say you already have pain from raised bluish/brown veins. The good news is treatment of varicose veins has come a long way from the medieval-sounding “stripping” procedures of the not-so-distant past. 

Today, doctors use lasers to remove and seal shut varicose veins. It’s a quick, noninvasive, outpatient surgery—and pain-free, too. For minor cases, a doctor might suggest sclerotherapy, a chemical injection that destroys the damaged vein. 

More from MensHealth.com: 10 Questions Every Guy Should Ask His Doctor 

“Going to the dentist is worse than removing varicose veins,” says Ronald Sprofera, of Jersey City, N.J. His surgery, performed by Dr. Kabnick, was over in 30 minutes. He never so much as flinched. 

“I waited 10 years before I did anything,” said Sprofera, who had seen his mother suffer with varicose veins and the ensuing treatment years ago. “I shouldn’t have waited so long.”

I have posted below what became a landmark paper that I had the privilege of co-authoring in the laboratory of an old friend and mentor, Dave Tilson who was the Chief of Surgery at St. Lukes/Roosevelt Hospital and a Chaired Professor at Columbia University.  To summarize the findings of this study, we evaluated the amount of collagen and elastic tissue along with the enzymes that break down those proteins in the wall of abnormal varicose veins, normal veins in patients with varicose veins and  normal veins that were left over from heart bypass patients. We identified abnormalities of the amount of collagen with increased amounts in both the varicose veins and the seemingly normal veins in varicose vein patients as compared with the normal veins of heart bypass patients. This paper identified the presence of connective tissue abnormalities before valvular insufficiency developed.

 

 

 

Analysis of the connective tissue matrix and proteolytic activity of primary varicose veins.

J Vasc Surg.  1993; 18(5):814-20 (ISSN: 0741-5214)

Gandhi RH; Irizarry E; Nackman GB; Halpern VJ; Mulcare RJ; Tilson MD
Department of Surgery, St. Luke's-Roosevelt Hospital Center, Columbia University, New York, NY.

 

 

PURPOSE: Valvular incompetence and venous wall abnormalities have been suggested as primary etiologic factors responsible for the development of varicose veins. This study was conducted to evaluate the connective tissue constituents of greater saphenous varicosities. Proteolytic activity, a factor that can lead to matrix degradation and cause weakening and dilation of the venous wall, was also assessed.

METHODS: The collagen and elastin contents of 16 nonthrombophlebitic greater saphenous varicose veins (VV) and seven normal greater saphenous veins (NV) were quantified. In addition, four duplex scanning-confirmed competent segments of greater saphenous veins (i.e., potential varicose veins [PV]) affected by varicosis at alternate sites were analyzed. Proteolytic activity was determined by zymography and radiolabeled substrate assay.

RESULTS: The content of collagen was significantly increased in the VV and PV compared with NV (VV = 189 +/- 7 mg/gm, PV = 189 +/- 9 mg/gm vs NV = 144 +/- 10 mg/gm, p < 0.05). Conversely, the elastin content in the VV and PV was significantly reduced (VV = 53 +/- 3 mg/gm, PV = 50 +/- 4 mg/gm vs NV = 74 +/- 4 mg/gm, p < 0.05). The collagen to elastin ratio demonstrated an alteration in VV and PV compared with NV (VV = 3.7 +/- 0.3, PV = 3.9 +/- 0.4 vs NV = 2.0 +/- 0.2, p < 0.05). Casein and gelatin zymography did not demonstrate significant qualitative differences in the enzymatic activities among the three groups. Quantitative analysis of the elastase activity in the venous tissues was similarly not appreciably altered (VV = 5.1 +/- 0.2 U/gm, PV = 5.3 +/- 0.2 U/gm vs NV = 5.7 +/- 0.3 U/gm).

CONCLUSION: A significant increase in the collagen content and a significant reduction in the elastin content of VV were demonstrated. The net increase in the collagen/elastin ratio is indicative of an imbalance in the connective tissue matrix. The biochemical profile of PV was similar to VV and significantly different from NV. These preliminary data support the presence of connective tissue abnormalities before valvular insufficiency. In addition, the absence of an increase in the proteolytic activity excludes enzymatic matrix degradation as an essential component in the formation of venous varicosities.

Welcome to the blog of NJ VeinCare and Aesthetics Center!

 

 NJ VeinCare and Aesthetics Center was created by Gary B. Nackman, MD, FACS, to provide quality patient focused care to patients with both medical and aesthetic needs. We specialize in the treatment of both painful and unsightly varicose and spider veins of the hand, leg and face. Our main office is located at 1037 US Highway 46 East, suite 202 in Clifton, NJ with plenty of off street parking. For further information, please go to our webpage, www.njveincare.com. For an appointment please call 973-778-2222.