Thursday, July 30, 2015

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.

Wednesday, July 29, 2015

     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

Monday, July 27, 2015

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!

Monday, July 20, 2015

 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.”

Friday, July 17, 2015

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.

Thursday, July 16, 2015

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.