Cyndi   (00:00)

During my shift, would feel like from my knee down on my right leg, that my calf was swelling, it felt tighter, my scrubs felt tighter, my shoe felt tighter. In the past two years, I felt that if I was on my feet for the shift, I couldn’t really wear a sock the entire time on my right foot.

I think moving it to a more warmer climate where your legs are more exposed more often. Having the confidence to do and the uncomfortable feeling of wearing anything around my foot pushed me to really get a full pathway to feeling better.

Dr. Kamran   (01:03)

Once again, thank you very much for joining us for this episode of The Nice Legs by Dr. Kamran Today, I’m very honored and very thankful having as my guest Cyndi who is one of our ER nurses to talk about venous disease and venous insufficiency. The reason why I thought Cyndi would be such a great candidate is being a clinician, being a nurse for so many years, and also having a very active life when she came to the office, she pretty much had made her diagnosis. She already knew what the treatment essentially was going to be. And she could also describe how she felt afterwards.

Once again, Cyndi, Thank you very much for joining us. I’m very thankful to you.

Cyndi   (01:43)

Thank you.

Dr. Kamran   (01:44)

So if you would be so kind to tell me just a little bit about your background so people understand what you do for a living, what your job is.

Cyndi   (01:53)

Sure. My name is Cyndi. Recently relocated in the last three and a half years to Wilmington here from New York. Been a nurse going on 18 years, started an ICU, worked an orthopedic unit as a manager, ended up in the emergency room in New York. Worked the full 12 and a half hours, sometimes 16 hour shifts. Worked through COVID in our COVID emergency rooms in New York. Moved down here, started in the ER, I work in our transfer center here.

To say that days are grueling would be an understatement. Being on your feet for that long, knowing that there’s really no respite and no relief, especially working through COVID all that time. There was no sitting, there was no breaks. So yeah, that’s my experience in a nutshell, maybe a one minute nutshell.

Dr. Kamran   (02:42)

First of thank you very much for putting all the hours that you have. And most people don’t realize they give a lot of credit to the doctors, and I think all the credit should go to the nurses, because you guys are the manpower. You’re the ones who are doing everything, and we just enjoy ⁓ all the efforts that you’re doing and try to get credit for a lot of it. But really, without nurses, I’m married to one. My sisters are nurses. You guys are the ones who actually make it all happen.

And the minute you mentioned COVID, it really worries me as well because if you have venous insufficiency, you have very high risk of getting clots in the legs. A lot of people don’t realize even a lot of the lung issues that people had was not because the COVID was affecting their lungs, they were trying clots in their lungs from deep vein thrombosis. And if you have venous insufficiency, you probably at the time didn’t really know that and you’re working in an emergency room, you’re already prone to getting clots because of your venous insufficiency.

And now you’re working around COVID patients, which are what are the odds of not getting COVID. So, but the long hours, my God, yeah, the longer you’re on your feet, the more congestion you get in your feet, and the worse it gets. having said all that, could kindly tell me about your, made you think that maybe I have a problem in my veins, I have venous insufficiency, how did you come to that diagnosis? And then when you came to see us here, really, what did it take for you to get that confirmation, yes, indeed, you did have venous insufficiency and then the treatment plan.

What was your recovery like? And where are you now?

Cyndi   (04:19)

I would say like 10 years ago, easily, I started noticing my right leg and foot feeling heavier, especially after working more after working out as well. it felt heavier through the course of that time. Definitely noticed swelling had a lot of what looked like very like deep out pocketing almost. I wouldn’t even call it felt more like a more intense varicose vein, especially my right leg.

 

in during my shift, would feel like my, from my knee down on my right leg, that my calf was swelling, it felt tighter, my scrubs felt tighter, my shoe felt tighter. In the past two years, I felt that if I was on my feet for the shift, I couldn’t really wear a sock the entire time on my right foot. My left leg was also swollen, but not to the intensity of my right leg. And…

 

I think moving it to a more warmer climate where your legs are more exposed more often. Having the confidence to do and the uncomfortable feeling of wearing anything around my foot pushed me to really get a full pathway to feeling better. to the office first for the initial consultation and speaking about whether the insurance company, what or wouldn’t cover it.

 

I had a conversation with my husband and we decided that even if the insurance company wasn’t going to cover it fully, that it was something that we needed to do for the longevity of what would be an inevitable emergency if I didn’t have it done. To what you said, having throwing clots, God forbid, and or, you know, just the swelling of my leg. And then we have three large animals who love to jump off of us having these very large varicose veins. I could just see it being an emergency at some point.

 

Cyndi   (06:06)

After having my initial mapping and I think the ultrasound technician said, ⁓ wow, that’s very big. When she was scanning my right leg and she kept saying, ⁓ wow, ⁓ okay, wow. And I kept saying, okay, well this was the right decision then. So, and then of course after speaking with you, think the anxiety of having the first one was not as bad I think for me. I was really intrigued as to how the whole

 

(06:35)

process worked. I had it done during the summer season and wore to what your recommendations were. And I can’t thank you enough for the full compression stockings because having just one on, if anybody at all wears compression stockings, they know wearing them throughout the course of the day, they roll down. And knowing that I needed this to be a full recovery plan, I wasn’t really willing to have it not work.

 

I did wear them through July and August and had six veins done. We’re now doing like the cleanup or going in and finishing areas that are kind of just lingering I’m so pleased with what has already transpired. I thought it was a joke when the initial technician said, don’t buy any shoes from here on out because your shoe size will shrink. And it’s the absolute truth. I just wasn’t know one.

 

went to a wedding in New York and did not buy new shoes and my right shoe, my right foot was actually smaller than it’s ever been. I had to do like another notch, kind of like on the ankle loop. So absolute truth.

 

Dr. Kamran   (07:39)

you getting any Charlie horse or night cramps at night which would wake you up your procedure?

 

Cyndi   (07:43)

Yeah,

 

in my right leg more. I had a lot of cramping. I felt like I had to do the toe with the dorsiflexion, plantar flexion more often, especially through the shift. A lot of feeling like it was just tired and pins and needles couldn’t cross my legs, even though I know that’s not doctor recommended anyway. it just wasn’t something that I could do at all comfortably at any point in the day that

 

I was starting to feel the really like, the real pressure of it building.

 

Dr. Kamran   (08:14)

And as the day goes by, especially when you’re on your feet, the veins get bigger and bigger and they get to a point where they are almost like about to explode. The way I like to compare it, I think you probably as a nurse would appreciate that is when you’re having your blood drawn, the first thing to do is put the tourniquet on your arm. And I think most people do realize, I hope they do, that that tourniquet is not so tight to cut both your arteries and the vein. The whole idea is don’t put it tight enough so it blocks the veins but not the arteries.

 

So then that way the blood can’t drain from the arm and the veins really swell up. So it makes it easier for you to hit it with a needle and draw the blood. So just imagine if somebody put that tourniquet and forgot to take it off. After a while the hand starts getting bluish, discoloration, gets heavy, achy, tired feeling. So when you have venous insufficiency in your legs, because of the valve, it is not a…

 

Anatomical blockage is a functional blockage because your valves don’t work. So it’s like having a tourniquet. The minute you get out of bed, somebody put that tourniquet on and they don’t take it off till you get home. Now imagine 12, 14 hours on your feet. By that time, you feel your feet are about to explode. Now you come home, I promise you, the first thing you did, you lay down and kept your leg up. Because that’s the way at least the blood can drain. Because now with gravity, some of that blood drains from your leg.

 

Cyndi   (09:30)

Mm-hmm.

 

Mm-hmm.

 

Dr. Kamran   (09:41)

And then, you know, it feels better. remember one of my patients had several children and she said, Doc, when I got home, the first thing I did, I had to lay down on the bed, put my foot on the back of the chair, sofa, and then for a good 20 minutes to half an hour, then I was able to get up and cook dinner for everybody. So, and that’s using gravity. When you put the compression in stocking, you put them first thing in the morning before you get out of bed, but really, it doesn’t do it.

 

good job of collapsing every bad thing in your leg. It maybe takes care of at best maybe 50%. So even then when the weather is hot, you can’t, you have to wear them. It’s hard to wear them. You were so kind and so strong to wear it through July and August when the weather is hot. We are in North Carolina, the weather is very warm. And to be forced to wear those compression stocking, you know, because there is a three month requirement. Some insurance companies says you have to wear it for three months. And some say, you know, six weeks.

 

But unfortunately, although I’ve seen some improvement, I haven’t seen any cure. So stocking to me, personally, is just like a band-aid, but unfortunately, a lot of insurance companies still require you to wear their stocking. ⁓ the chronic congestion, so let’s think about this tourniquet on your arm.

 

If you left it for several months or several years, you find out the skin cannot take that much pressure. So the skin of your hands, in your case the skin around the ankle, starts getting scarred. The skin gets thickened. We call it lipodermosclerosis, which essentially means the scarring of the underlying fat in the skin. And then you get hyperpigmentation. The skin starts getting darker. ⁓ so it loses its youthfulness.

 

of course as time goes by, know, it does get some redness and then you can get dermatitis. fortunately, it is reversible. It slowly recovers, but I know right now it’s still quite early because you’re still going through treatment. And the one thing I think people need to realize is not one and done. To do a thorough job, you really got to go after those veins almost systematically. Don’t try to close all the veins at once.

 

Remember, when you close a vein, the blood has to go back to the deep system, and the deep system hasn’t seen that much blood for a while, so you’ve got to allow it to expand and to accommodate all this extra blood you’re getting. But we are seeing improvement in we’re talking about several things at the same time. The discoloration around the ankle, did you notice they were getting darker over the years? Or not too bad?

 

Cyndi   (12:21)

I wouldn’t say

 

terribly, no. I definitely had itchiness to my right leg towards the end, which definitely pushed me to need to know. mean, was just, it was just an itch you can’t scratch. It was so deep because it was just, and I could tell it was that my legs were kind of tired and done and I needed to really do something to help that and to try to stay pretty active.

 

Dr. Kamran   (12:26)

you did which is…

 

Cyndi   (12:48)

My husband and I bike several miles a day legs were really tired and really achy and as well as just being heavy. And to have that, to try to get on the treadmill, you really have to have the motivation to do it, to move, which you know helps, but then it ends up you’re swollen afterwards.

 

It is not a quick one visit fix. It is definitely a commitment and it’s worth it in the end. mean, for me, it has been worth it. I look forward to seeing what the next few weeks will be after finishing treatment. But I know in six months, a year, a year and a half, it will take commitment to know if I feel something, I need to come back and just get it checked because letting it go on for as long as I did is the nurse patient in me. But it needed to be done.

 

Dr. Kamran   (13:35)

Well, you’re raising some very good points. know, number one, yes, it is a process. I like to explain to the patients sometimes about things that they understand. Now, of course, you’re a nurse, you understand, but the average person, talk about cooking. You don’t just throw everything in there and you’ve got the stew, you know. Sometimes you’ve got to give it a little time to simmer. So you do the lasers, give it a little bit of time, let some of those veins shrink, then you go after them. There’s skin discoloration. Some people get it, some ⁓ takes time to get it. Fortunately, yours hasn’t developed so there’s an excellent chance of recovery. The itching is called venous dermatitis, that’s when it starts getting quite advanced. One of the things you’re doing, you and your husband, which is great in that is ideal to me is biking, because 90 % of the blood which gets out of your leg is through your calf muscles. So biking, really, you’re using calf muscles.

 

Running and jogging is good, but I think biking is great and I think one of the reasons your legs hadn’t could have felt a lot worse is Because you are so active and use your calf muscles I try to explain to people when a pump during the valve goes in a pump then the pump really doesn’t work anymore You need a new pump, but not all the valves are gone in the beginning So even a bad pump if you want to pump your bicycle and you have an old pump

 

You still, if you move it fast enough, you can get some air into your tire. So even with venous insufficiency, although the valves are gone, if you really use your calf muscles twice, three, four times as much as normal, you’ll find that the blood does drain from your legs. In fact, I think it was one study that showed, I think it was like 20 or 25 times, I’ve forgotten how many times the calf muscles have to contract before all the blood is drained from your leg.

 

But of course, that varies from person to person. So the fact that you were active, I think it really helped. Another thing I think was the cramps were once you had the procedure, you’re not getting any charred horse cramps at night, correct? And are you getting more, I call it miles per gallon out of your leg. Do you find you can walk further, you can do more?