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2018 LEEF iGala

We are proud to support the Longmeadow Educational Excellence Foundation and hope to see you at their 2018 LEEF iGala on November 3!

Learn more and buy tickets.

By |October 31st, 2018|What's New from Dr. Lee|

Dr. Lee Discusses DVT on Western Mass News

Dr. K. Francis Lee appeared on the “Better Western Mass” show yesterday on Western Mass News, WGGB-40 to discuss the prevalence and dangers of deep vein thrombosis in recognition of March as DVT Awareness Month.

Watch it here.

By AVCC | March 20th, 2018

By |March 20th, 2018|What's New from Dr. Lee|

Choosing the vein care center that’s right for you

Asking the right questions is key

Whether you are simply seeking treatment for unsightly spider veins, or have more serious conditions like venous insufficiency, varicose veins, blood clots in your legs or venous stasis ulcers, it’s important to ask the right questions when deciding where to go for treatment.

Insist on accreditation. Vein procedures should be performed by board certified surgeons and physicians with appropriate accreditation from the Intersocietal Accreditation Commission.

Experience counts. Effectively treating venous insufficiency, varicose veins and spider veins requires thorough knowledge of the vascular system and the skill to perform intricate procedures. Many of the veins we treat are very complex, and some procedures are extremely advanced. Precision is key to success. You should ask how much experience the surgeon has performing your procedure.

Don’t fall for false promises. Ask the surgeon about the expected outcome of your procedure, and how many treatments you may need. In our practice, we work with you to set realistic expectations and not promise more than what it is physiologically possible so you are not disappointed with the results.

Diagnosis determines treatment. Ask how the surgeon will confirm your specific condition before recommending treatment. Proper diagnosis should include an initial consultation to identify cosmetic (spider veins) versus medically necessary conditions (varicose veins and/or venous insufficiency).

If there is a medical concern, the initial evaluation is generally followed by a venous physiology ultrasound study, which should be performed by a sonographer or clinician credentialed as a registered vascular technologist. This determines how severe your condition is, what your diagnosis entails, and what treatment options are available. Following these steps will help you meet your care goals efficiently and effectively.

Technology drives results. A key component in effectively diagnosing and treating vein conditions is the technology we use. We can now detect the root cause of your venous problem more accurately thanks to duplex ultrasound.

Advances in laser technology also drive success during endovenous laser treatments, a procedure used to treat venous insufficiency. A skilled surgical team can safely perform even complex procedures on an outpatient basis. Most patients feel better and resume their daily activities within a very short period of time. Excellent technology used by highly trained specialists offers you the best possible results, with the least amount of discomfort and recovery time.

We are truly committed to performing with excellence and aim to reach the best results for patients who visit our state-of-the-art vein center. If you have any questions, give our office a call at 413.732.4242.

By |September 25th, 2017|What's New from Dr. Lee|

Love Your Legs This February!

Are you experiencing tired, aching, restless legs? We’ve added additional New Patient Appointments during February to meet with Dr. Lee and our team of providers for people experiencing medical problems related to venous insufficiency. 

We are also offering free consultations in the month of February to meet with our Physician Assistant to discuss cosmetic treatment options for spider veins!

Call us at 413-732-4242 to schedule your consultation today!

 

By |February 8th, 2017|Other|

Need an Urgent Appointment?

If you need an urgent appointment, please call out receptionist at 413-732-4242. We will make every effort to you an appointment as quickly as possible.

To request a consultation, please fill out the form below:







By |June 9th, 2016|Other|

The Harm of Sitting

For some, a livelihood can be made from the strength of their bodies. Serena Williams. Michael Phelps. Usain Bolt. They worship their bodies with exercise, high-quality food, massages, and sleep. These athletes forge their bodies and skillsets into art; and we, the awe-inspired, wonder at them.

Yet for most of us, the body is not beauty, but utility.

We may pay homage to our bodies occasionally—a light jog, a weekend morning raking leaves, a walk along the beach—but these relished moments are pittances, when predominantly, we abuse our body to make ends meet.

Consider, it is Sunday night—10:30 p.m. You have indulged in apple pie à la mode, and are filing taxes. While your liver works industriously to convert excess sugar into long-term storage (fat and glycogen), the pineal gland in your brain begins to release melatonin (sleep-inducing hormone). Eyelids droop. You turn the intensity of lights up, thereby activating cells in the retina that inhibit melatonin secretion. Your body interprets that there is a reason to be awake, some danger to overcome. Cortisol (stress response hormone) is secreted, allowing you to nibble the crust of the apple pie and persevere.

Indeed, there is a certain beauty to the body’s industry, but also there are certain limits. Each day, we push these limits until the body pushes back. While prolonged standing can lead to venous dysfunctions as I’ve discussed previously, there is a danger at the other end of the spectrum: prolonged sitting.

“We have created for ourselves a modern way of living that clashes with the way we’re meant to be,” wrote Dr. James Levine,[i] the Director of the Mayo Clinic-Arizona State University Obesity Solutions Initiative, and author of “Get Up!”

The phrase has taken hold: “Sitting is the new smoking.” The National Institute of Health has launched an initiative aimed to address this problem, cities have increased the number of bike share options, and companies have even begun to install treadmill desks and promote active work environments. Why? Because even when defined by utility, the body is most productive when healthy, i.e. active.

Studies validate the need to be active, showing that sedentary lifestyle is a risk factor for obesity, diabetes, hypertension, cardiovascular disease, age-related frailty and cancer.[ii] Unfortunately, I also treat the effects of inactive lifestyle each day in my practice, since sedentary lifestyle puts people at risk for chronic venous insufficiency (CVI)[iii] [iv], peripheral vascular disease[v] [vi], vascular blot clots[vii] [viii], and other diseases. While inactivity puts individuals at risk, exercise can help in the treatment of these same venous disorders.[ix] [x]

Physical activity is crucial because the muscular and circulatory systems work cooperatively. Case in point: the calf-muscle pump. Did you know, that while arteries pump oxygenated blood away from the heart at relatively high pressures (120/80 mmHg), veins collect and transport de-oxygenated blood back to the heart at relatively low pressure (5-15 mmHg)—and as such, the calf muscle plays a crucial role in pumping the blood from our feet and legs at ground-level upwards to the heart some four feet above.

How? As the calf muscle flexes, it forces blood against gravity up along the course of the veins, which are lined with one-way valves that catch the blood as it travels, preventing it from flowing backwards. A normal, efficient calf muscle will force 70% of blood out of the calf as we walk.[xi]

The relationship is evident: the more efficient the muscles, the more efficient the blood flow, and vice versa. For people with venous insufficiency, healthy musculature is crucial, and physical activity can help without the need to start any onerous workout regime. As the ice and early dusk of winter settles into the Pioneer Valley, I encourage readers to incorporate simple movement into their daily habits.

The simple act of getting up to walk to the water cooler can engage your leg muscles, loosen back muscles, as well as promote blood flow that increases concentration and work productivity. In-chair exercises can also be helpful. One study investigated ten in-chair exercises most commonly recommended by airlines, and found that exercises requiring the heel to be raised caused the greatest calf-muscle pump activation (see below images).[xii] In the end, while scientific studies can validate, individuals must motivate themselves to be proactive, beginning with understanding the harm of inactivity, and the preventative and therapeutic benefits of physical activity.

        AVCC Blog PIc

Figure (taken from O’Donovan, et al., 2006) showing that heel raising exercises 1, 4, 6, 7, and 8 significantly activated the calf-muscle pump.

 

References:

[i] As quoted in Los Angeles Times: http://www.latimes.com/science/sciencenow/la-sci-sn-get-up-20140731-story.html

[ii] Bouchard C, Blair SN, Katzmarzyk PT. Less Sitting, More Physical Activity, or Higher Fitness? Mayo Clin Proc. 2015 Nov;90(11):1533-40. doi: 10.1016/j.mayocp.2015.08.005. Epub 2015 Oct 5. Review. PubMed PMID: 26422244.

[iii] Medline Plus website: https://www.nlm.nih.gov/medlineplus/ency/article/000203.htm

[iv] New York Presbyterian website: http://nyp.org/services/venous-insufficiency-ulcers.html

[v] MD Guidelines website: http://www.mdguidelines.com/peripheral-vascular-disease

[vi] Cleveland Clinic website: http://my.clevelandclinic.org/services/heart/disorders/pad

[vii] Healy B, Levin E, Perrin K, Weatherall M, Beasley R. Prolonged work- and computer-related seated immobility and risk of venous thromboembolism. J R Soc Med. 2010 Nov;103(11):447-54. doi: 10.1258/jrsm.2010.100155. PubMed PMID: 21037335; PubMed Central PMCID: PMC2966881.

[viii] Suadicani P, Hannerz H, Bach E, Gyntelberg F. Jobs encompassing prolonged sitting in cramped positions and risk of venous thromboembolism: cohort study. JRSM Short Rep. 2012 Feb;3(2):8. doi: 10.1258/shorts.2011.011121. Epub 2012 Feb 14. PubMed PMID: 22393469; PubMed Central PMCID: PMC3291423.

[ix] Klyscz T, Jünger M, Jünger I, Hahn M, Steins A, Zuder D, Rassner G. [Vascular sports in ambulatory therapy of venous circulatory disorders of the legs. Diagnostic, therapeutic and prognostic aspects]. Hautarzt. 1997 Jun;48(6):384-90. German. PubMed PMID: 9333613.

[x] Partsch H, Blättler W. Compression and walking versus bed rest in the treatment of proximal deep venous thrombosis with low molecular weight heparin. J Vasc Surg. 2000 Nov;32(5):861-9. PubMed PMID: 11054217.

[xi] Chapter 11 of Physiology of Venous Insufficiency, by Kevin G. Burnand and Ashar Wadoodi, Abstracted by Teresa L. Carman

[xii] K.J. O’Donovan, T. Bajd, P.A. Grace, D.T. O’Keeffe, G.M. Lyons, Preliminary Evaluation of Recommended Airline Exercises for Optimal Calf Muscle Pump Activity, EJVES Extra, Volume 12, Issue 1, July 2006, Pages 1-5

 

By |December 11th, 2015|What's New from Dr. Lee|

The Nightmare of Leg Cramps—Chronic Pain Awareness Month

Have you ever woken at night to the debilitating, piercing pain of a leg cramp? If so, you are not alone. It’s been shown that 33.6% of the general public experience night-time muscle cramps, and as high as 50% among those with chronic venous insufficiency.1

Across the nation, the same scenario occurs each night. A calf muscle suddenly seizes. The stricken individual jolts awake and screams aloud. The disoriented spouse frantically begins to massage the muscle, as the pained individual finds a way to get up and walk around, begging the cramp to subside. Sometimes they find themselves standing on the cold tile of the bathroom as the cold sensation on the feet can sometimes coax the pain away. This nightmare occurs more than 3 times a week for 40% of vascular patients (occurring every night for 6%), according to one study.2

Night-time muscle cramps are not only common; they are complicated. There are several different causes: such as vascular diseases, over-excitable neurons, irregular endocrine or metabolic function, genetic disorders, and nutrition deficiencies. For this reason, a myriad of treatments exist, ranging from the robustly-studied neuron-stabilizing quinone, to the more holistic “spoonful of mustard” before bedtime. This complexity unfortunately means that sleep-deprived individuals with muscle cramps do not know where to turn.

One fact is clear. If you experience leg cramps and also have varicose veins, spider veins or other signs of venous insufficiency, your first step should be to seek consultation from a vein specialist.

In the past ten years, I have performed over 10,000 venous procedures for patients with a diagnosis of venous insufficiency.” My patients are often afflicted with night-time leg cramps, which reflects the established knowledge that venous disease places individuals at risk for night-time leg cramps.3 While very few diseases in the field of medicine can be fully “cured,” the occurrence of leg cramps almost always improves significantly, or goes away entirely when the underlying venous insufficiency is treated.

In fact, the reduction of nocturnal leg cramps following treatment is so reliable in my experience that it can be used as a measure for post-operative evaluation. For instance, a patient may come to me with both joint pain and venous pain. They will describe symptoms of a whole array of leg and joint symptoms. If after the venous treatment, their leg cramps have disappeared while the other less obvious pain symptoms remain, it becomes clear that the treatments have effectively addressed the venous condition and what remain are symptoms associated with other causes, such as arthritis, fibromyalgia, or neuropathy.

As we become increasingly aware of the roll chronic pain can play in our lives, it is important to be aware of the relationship between leg cramps at night and chronic venous insuffiency. If you have ever experienced leg cramps at night, ask yourself a simple question: do you have any varicose veins, spider veins or other venous problems? If so, your leg cramps may be treatable, even curable. It is among the most satisfying things in my daily life – to hear my patients say afterward, “I haven’t had any cramps since I last saw you.” Sometimes, it’s the spouse who thanks me more. They’re not awoken by their loved one’s scream at night.


References:

[1] Ruckley CV, Evans CJ, Allan PL, Lee AJ, Fowkes FG. Chronic venous insufficiency: clinical and duplex correlations. The Edinburgh Vein Study of venous disorders in the general population. J Vasc Surg. 2002 Sep;36(3):520-5. PubMed PMID: 12218976.

[2] Monderer RS, Wu WP, Thorpy MJ. Nocturnal leg cramps. Curr Neurol Neurosci Rep. 2010 Jan;10(1):53-9. doi: 10.1007/s11910-009-0079-5. Review. PubMed PMID: 20425227.

[3] Hirai M. Prevalence and characteristics of muscle cramps in patients with varicose veins. Vasa. 2000 Nov;29(4):269-73. PubMed PMID: 11141650.

By |October 7th, 2015|What's New from Dr. Lee|

IAC Accreditation – What We Are

Feedback comes in many forms—from the mother’s lips to a child, or from a restaurant reviewer’s keyboard to a chef—but there is one thing that remains constant. Everyone needs feedback.

The more paperwork-intensive, the more people avoid it. But no matter how uncomfortable receiving feedback may be, the complete lack of it is also unnerving—we succumb to easy complacency, or worse, we doubt our work and worry: “How are we doing?”

We at Advanced Vein Care Center are proud of the work we do. Since the beginning, we’ve been committed to the highest standards of patient interaction, surgical techniques, medical equipment, complication prevention, and objective self-monitoring. But, how well are we really doing? And, how valid is our self-assessment? There was no way to answer these questions objectively by ourselves.

Hence, over a year ago, we took action to answering these questions by subjecting our quality of care to external standards. We looked for the most current and strictest standards. We began to ready ourselves for submission of application to the Intersocietal Accreditation Commission (IAC) which evaluates medical practices based on personnel, facilities, process, and monitoring of quality improvement. We initiated this process all on our own, self-motivated by quality assurance and true excellence.

Then, last January, the earth shifted under the feet of vein care specialists in the state of Massachusetts. A major healthcare insurance company, the Blue Cross/Blue Shield of Massachusetts sent out a letter requiring that within nine months all vein care centers must be accredited by the IAC to be able to treat their patients and be reimbursed. While the rest of the world were shocked, we were elated by the news since we were well on our way to full compliance and meeting their highest standards.

As of February this year, the IAC Vein Center division had accredited only one practice in New England (in Rhode Island).   In March, within a month of submitting our application, we were granted a 1-year accreditation, pending a 3-year accreditation following a successful site-visit. We became the first practice in the state with that distinction.

In June, three IAC reviewers visited our office—combing through our policies & protocols, complications lists, and performing random-checks of patient records in our electronic medical records. They watched and evaluated how we performed our vein procedures, lasers, excisions, and ultrasound, and how we maintained patient confidentiality. It was a nerve-wrecking day, to say the least.

By the end of the day, however, our staff were smiling from ear to ear, as we received wonderful feedback from the reviewers. They confirmed what we had suspected all along—that the way we have been caring for our patients was a “model” for excellence, and that we should continue going “above and beyond” just what was required to pass as a vein center. Case in point: In our office there are four fully trained ultrasound sonographers to diagnose and help treat various vein conditions. This demonstrates our commitment to clinical excellence, as many vein specialists in the field have none to just one or two sonographers working full-time in their office.

In the end we received full accreditation for 3-years—becoming the second practice in New England and the first in Massachusetts to do so. Considering the high number of teaching hospitals and academic institutions in New England, this was a great honor. This also showed that Western Massachusetts does lead the region in some aspects of healthcare.

With pride and satisfaction aside as we move forward, the IAC accreditation does not change what we are. We have always been and still are a group of clinicians and administrative staff who care deeply about what we do. We strive to treat everyone like how we would like ourselves and our families and friends to be treated. We do want everyone to feel better and look better. This is what we are. IAC Accreditation was merely a validation.

My thanks to everyone at Advanced Vein Care Center. Patients and staff and all. Thank you.

By |September 17th, 2015|What's New from Dr. Lee|

Why Do Your Legs Hurt More in the Summer?

Many people ask why their legs ache more in the summer than at other times of the year. The answer involves many different factors – some apparent, some beneath the surface, just like your veins.

The first reason, I tell my patients, is daylight. The longest days in the summer (in 2015) have 15 hours and 15 minutes of sunlight. In contrast the shortest days in the winter have only 9 hours and 6 minutes of sun.1   In combination with peoples’ more active summer lifestyles—think gardening, lawnmowing, cooking, socializing at barbecue—people are simply on their feet for longer amounts of time before the sun sets. To be exact, 60% more time is spent on their feet during the summer. By the time those glorious 8pm summer sunsets arrive, gravity has caused blood to pool in the lower limbs, the sensation of achiness following.

The more overlooked reason, I tell my patients, is a fascinating phenomenon that takes place just beneath the surface, a process called vasodilation (“vaso” referring to blood vessels, and “dilation” meaning to enlarge). Vasodilation is when the size of blood vessels will increase in response to certain environmental situations, such as the hot temperature of the summer. You can see vasodilation when someone returns from summer yard work with flushed cheeks and skin.

The veins enlarge, which helps the body quite ingeniously cool itself by increasing blood flow towards the skin. Unfortunately, it may also worsen symptoms of venous insufficiency by increasing the volume of blood held in the vein—a process not fully understood by most people who are unaware of the changes their body undergoes in adapting to heat.

To fully understand vasodilation, consider the veins themselves. Veins have a thin smooth muscle layer that facilitates change of its diameter constantly. They can either relax/widen or constrict/narrow. Consider also the surprising expansiveness of the circulatory system, which is an estimated 60,000 miles long if every vein, artery and capillary were measured end-to-end.2  Both elastic and expansive, our veins have an incredible ability to change. Case in point: in normal temperatures, the amount of blood flow to the skin is roughly 0.25 Liters/minute, whereas in high temperatures, the blood flow increases up to 8 Liters/minute—meaning over 30 times more blood flow.3

Consider this capacity for blood volume expansion with another interesting fact. What is the largest “organ” in the body? Not the lungs, not liver, not even the bones. The largest organ in the body is the skin. The skin on our body and all its associated structures like the hair follicles, sweat glands, nails, etc., are called “the Integument”. The integumentary system in our body is the largest “organ” in our body. The medical student learns this in their introductory course in their first year. It’s a good thing. It’s because living organisms have learned to use their “skin” as an important means to regulate their body temperature.

So, after lying on the beach, we become red, and flushed. Our bodies circulate much more blood toward the skin. How does this change help our bodies cool off?

Much like a convection oven, there is a flow of heat within the body. In a convection oven, hot air circulates from the outside inwards—from hot metal coils of the oven inwards, towards the pasta casserole or glazed salmon. In the body, there is a similar flow of heat, only in the opposite direction.  The body circulates heat away from the central organs outwards towards the skin, where sweat and a summer’s breeze allow heat to dissipate off of the body. The heart works as the fan propelling this convection current that circulates heat away from the inside of our body.

This process is significant. In hot temperatures, the body increases the amount of blood being pumped (the heart pumps more) and directs more of its blood outwards towards the skin.  In fact, roughly 60% of the circulating blood travels to the skin—meaning, 60% of the heart’s work is devoted to cooling the body.4 Interestingly, the U.S. Department of Energy reports that heating and cooling – think air conditioner in the summer – accounts for more than half of the electric bill in the typical home. So whether for your home or your body, temperature regulation proves a priority.

While the body is built to balance, and will adapt itself to maintain a perfect internal temperature, vasodilation presents problems for individuals with Venous Insufficiency. The body already has trouble sending blood back from the legs upwards to the heart because of inefficient ‘one-way check valves’ inside the veins. When the heart begins to pump faster to circulate 30 times more blood towards the skin, more and more blood tends to accumulate in the legs, producing mild, sometimes intense discomfort and swelling.

For this reason, it is best for individuals with Venous Insufficiency to be mindful of the effect heat has on their body. Keep cool. Avoid just standing or sitting around for long periods. Wear compression stockings (I know, neither fun nor feasible in hot weather). Exercise. Elevate the legs and allow the legs to rest at points throughout the day.

One more thing: Don’t forget the sunscreen as you enjoy the sun and enjoy those beach moments free from leg pain.

 

Sources:

[1] http://www.sunrisesunset.com/calendar.asp

[2] http://www.livescience.com/39925-circulatory-system-facts-surprising.html

[3 & 4] Nisha Charkoudian MD. Skin Blood Flow in Adult Human Thermoregulation:

How It Works, When It Does Not, and Why. Mayo Clinic Proceedings. 2003;78:603-612.

[5] http://energy.gov/public-services/homes/heating-cooling

By |September 1st, 2015|What's New from Dr. Lee|

Call to Book Appointment for Upcoming Vein Screening!

Our next Vein Screening will be held Tuesday, September 15th.  Call now to book your appointment!

(413) 732-4242

By |October 15th, 2014|Other|

Contact Us

Advanced Vein Care is happy to provide more information. Call our Springfield, MA office at (413) 732-4242 or fill out the form below.



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2018 LEEF iGala

  • October 31st, 2018

We are proud to support the Longmeadow Educational Excellence Foundation and hope to see you at their 2018 LEEF iGala on November 3!

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Suzanne from Middlefield, MA   

I can wear skirts now, and I am pain free. More attention should be paid to making sure the patient has the correct stockings. Also, I feel that more medication should be suggested for phlebectomy.

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