Nice Living with Dr. Kamran Season 2 Ep. 2
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Aimee: Hello, and welcome to another edition of Nice Living with Dr. Kamran. With me as always, of course, the star of the show, Dr. Kamran Goudarzi. Dr. Kamran, it’s so great to be with you here again.
Dr. Kamran: Wonderful to be here. Thank you
Aimee: Now, Dr. Kamran, you know, you are just, the pioneer in the industry when it comes to vein disease, venous insufficiency treatment.
And I know it’s been a huge passion of yours to not only educate patients about the signs and symptoms of vein disease but also your colleagues in the field.
Dedication to Primary Care Physicians & Introduction to Venous Insufficiency
Aimee: And today’s episode is dedicated to talking specifically to our friends that are primary care physicians. So tell us a little bit about what we have in store for our listeners today.
Dr. Kamran: [00:01:00] again. Thank you very much for, you know, having this, participate in this, in this dialogue.
Dr. Kamran’s Journey and the Evolution of Vein Treatment
Dr. Kamran: there are a lot of real pioneers in the field, of course. I think I’ve just contributed in a very small amount, but I can say that we’ve been doing it for very many years. And specifically, we have been concentrating on the non-invasive, technique.
of taking care of veins as an office procedure for about since 2002, I believe, so it’s been almost 20 to 23 years. And of course, being exposed to this condition for this many years does show you some trends and educate us about things that we hadn’t learned in medical school. So, that was, you know, I thought it was very important to, uh, You know, have this discussion so we can hopefully inform some of our primary care physicians about some of the symptoms that they might not think it is venous in origin.
Aimee: Absolutely. And that’s such an important topic again, as we’ve [00:02:00] primarily spoken with, different patients about the condition, For primary care physicians.
Addressing Common Misconceptions Among Physicians
Aimee: What are some of the misconceptions that you feel are most common among your colleagues there?
Dr. Kamran: Well, thank you for asking this question. So the primary care physician, I think got one of the toughest jobs because they have to know about every disease, about every condition, every patient that walks in, uh, their list of differential diagnoses is huge. You know, what could it be? What’s the most likely thing to be?
One of the things that I’ve noticed and I’ve finished medical school in 1978 but actually finished medical school in London, University of London, then I did two years of residency there, did another five years here. So I’ve been exposed to both countries and, you know, a lot Internal medicine, general surgery, vascular surgery.
One thing I noticed is, uh, the venous disease, unfortunately, and even I was taught this in medical school, that it was venous disease means varicose veins. And that is all we knew about it. [00:03:00] So, if the patient had Varicose veins, then it was venous insufficiency, and we didn’t have good ultrasounds, we didn’t have ultrasounds in the beginning, around 1978, it was still in the earlier stages, and as the resolution has gotten better, we are able to look under the skin, we’re finding out there’s a lot more going on than just having varicose veins.
In fact, varicose veins may or may not be present. And when you have venous insufficiency. So, uh, a lot of patients that I see who are seen by family practitioners, primary care physicians, even, you know, in different specialties like orthopedics, neurosurgery, et cetera, et cetera. Um, I noticed there’s a lot of times the diagnosis was venous insufficiency and it was overlooked.
So, again, I talked about this before, so I thought, you know, this would be an easy way of, um, producing a podcast and sending it to primary care physicians, um, hopefully, it’s just, you know, each episode is 20 minutes, and, uh, it’s free right now, so if they get [00:04:00] on the car and driving or taking a break, they could have a listen and see, does it help them understand venous insufficiencies?
Is it important for them to know what venous insufficiencies is. Is some of the conditions they are treating right now is venous insufficiencies they don’t even know about it?
Symptoms of Venous Insufficiency: Cramps, Restless Leg, and Swelling
Aimee: So, Dr. Kamran, what are, you know, some of these symptoms that patients may be coming in with that could be a red flag for venous insufficiency?
Dr. Kamran: So thank you for asking, that’s very important because I think one of the number one misconceptions is that patients come in and see me, and they’ve already seen the primary care physician, they’ve seen other doctors, is night cramps. They have cramps like charley horse, like they’re in a calf, or I’ve seen it having in their thigh, even in their feet and their toes, and these are very classically at night for some unknown reason, and it gets to when it initially is like once a month, then once a week, then every night, then he wakes them up, then he wakes [00:05:00] them up to go back to sleep, then he wakes them up, and so bad they have to get up and walk it off.
And that is pretty much classic for venous insufficiency. I wasn’t taught that in medical school. I had no idea that was, you know, what was going on until I started treating these patients. And the first thing they told me after they’ve taken their veins is, my God, my cramps are gone. So, um, Then, of course, the next question would be, well, have you complained about this before?
Well, yeah, I’ve seen my primary care physician, I’ve seen my internist, I saw so and so. And they told me, well, I’m dehydrated. Well, as we know, you don’t get dehydrated at two, three o’clock in the morning, in the morning, or at night when you’re sleeping. I mean, if you’re dehydrated during the daytime or you’re low on magnesium or you’re low on potassium or you’re low on calcium.
Well, you know, it’s very hard to get low on potassium unless you’ve got some medical condition causing it, or you’re on a large amount of diuretics, or you don’t get dehydrated unless you’re in the middle of, you know, heat, or you’ve got severe diarrhea, or nausea and vomiting, but an average person doesn’t go to bed and all of a sudden [00:06:00] gets dehydrated and gets cramps.
So, um, all we are doing is trying to give an explanation to the patient so that that’s the end of that conversation. And I think it’s very unfair there because the patient is telling you, I have venous insufficiency, and literally by taking care of their veins, even the, so usually the commonest cause of venous insufficiency is great saphenous vein.
And after that, the small saphenous vein. So the minute we treat the great saphenous vein, I find that the cramps are gone. I mean, it is amazing. It’s like two plus two is four. You take, you have cramps at night, it wakes them up. They have to walk it off. You treat the veins. Cramps are gone. Now there is one thing you could do, uh, is put them on compression stocking.
This is medical grade compression stocking and not any compression stocking that you can get. A lot of these compression stockings are doing more harm than good. These are thigh highs because the disease usually starts in the thigh and they should be, you know, one of the companies which has FDA [00:07:00] approval for proper compression stocking.
We put that in only the daytime, never at night. Although they’re wearing it during the daytime, they find that the cramps are so much better at night. And the minute you see some improvement, you’re like, okay, I think I’ve got a diagnosis. This is probably what it is. Then, of course, you have an option of, you know, continue with the stockings or have something done about it.
Which, you know, most people, especially in the South, it gets so hot here, they would rather have something done if it can be done safely and could be done painlessly. They would rather have it done, you know, and have those veins taken care of.
Aimee: Are there any other symptoms that are pretty prominent for folks when they’re going to the primary care physician?
Dr. Kamran: Sure, so the other misdiagnosis, if I may use that word, and by the way, Aimee about, depends what the studies you read, but anywhere from 35 to 45 percent of people, especially ladies, Um, have venous insufficiency. So it’s one of the commonest [00:08:00] conditions on the face of the earth. When you think about what percent of people have gallstones, it’s only ten percent.
What percent of patients have, you know, arthritis or fibromyalgia, um, or breast cancer, you know, it’s one in ten percent, ten people can get breast cancer. Some would say that’s one in ten. 40 percent is almost half. So this is a condition that you’re going to be very prone to it. And especially if one family member has it, uh, or certainly if two, it’s almost 90 percent chance you can have venous insufficiency.
So extremely common conditions. And, uh, there is a lot of breast cancer awareness, colon cancer awareness, heart disease awareness, but there’s no such thing as venous insufficiency awareness. Which is a condition which affects a lot of people and is easily treated and they don’t know about it. So, um, I noticed that cramps are missed very often when it comes to the symptoms.
Now we’re talking about symptoms, not signs [00:09:00] yet. The runner up there, uh, although not quite as common, But, uh, it is missed a lot of times is restless leg. These are people who tell me they’re running the marathon, especially at night, or the husband tells me, or the wife tells me that my husband is running the marathon every night, moving and legs constantly.
Those people, when they come to see me, they have already seen neurologists, have they seen a primary care physician. Sometimes, they come in with two, three different drugs. And these are some of these are anti-seizure medications. So they have to take it for life. And then it doesn’t get better then the primary care physician gives them another pill to add to it.
So now there are two pills, there are three pills. And then it’s very frustrating for the primary care physician as well. Oh my God, what to do with this person? You send a neurologist, they just give you the label, right? Restless leg. But what do I do with it? Take medication. And then they come in, we find out, you know, if they’ve got venous insufficiency and restless legs, you take care of the veins.
[00:10:00] In my opinion, in what I’ve seen in my practice, 70%, minimum of 70 percent of these patients, their restless leg is either better or is cured. So, they don’t have to take medications and the medicines are not safe. They are expensive, they can damage your liver, you can damage your kidney, uh, they can affect your mind, some of these seizure medications.
So, um, if it is something that can cure you, why would you want to take medication? So if you have restless leg and you have signs of venous insufficiency in your family history, then I think, um, those people are extremely thankful. And when you, when you treat them, they, you know, restlessly gets better. So that’s the number two symptom.
Aimee: Anything else that you see kind of as a recurring one that, uh, that folks are coming in the office asking about?
Dr. Kamran: Well, uh, this is a talk for primary care physicians. So I’m going to hit number three, which is probably be number one is swelling, swelling in their ankles. So the primary care physicians, the [00:11:00] patients, you know, who have swelling, well, you know, could it be? kidney function issues. Could it be heart failure?
But very rarely they think about venous insufficiency. I mean, I have patients that come and see me healthy, 30-year-olds, and they said they have swelling. So the doctor gave him some Lasix and said, take this every time you get swelling. And of course, the swelling is there every day. As soon as they stop taking it, they get, you know, more swelling or stop the salt or whatever.
That age group, particularly, venous insufficiency being the cause of the swelling, is probably should be number one in the list of things you should think about. Considering that it’s both legs and if it’s one leg, you always have to worry about deep vein thrombosis, which is very dangerous.
So, I’m not saying that that’s a diagnosis. You know, I’ve been in medicine, as I said, for close to 50 years. One lesson I learned, medicine is never just one thing. It’s a series of things, [00:12:00] and then you have to go through a list of differential diagnoses, come up with a list. that all the probabilities and then try to rule them out or rule them in and then decide which one is easily treatable or not.
Uh, you know, venous insufficiency, you know, is very easily treatable. Lasix medication, you have to be on it for a long time. So once the primary care physician has done a thorough evaluation and knows that this is not their heart, this is not a kidney, I think you should say, okay, could this, could this be venous insufficiency and they could send them to a, you know, main physician who has a very good vascular ultrasound thing because that’s what it comes down to.
Uh, all our techs and I believe all the techs who deal with vein disease should have, um, at least be certified in, in vascular ultrasound and have a fair amount of experience with venous disease because it can fool you very easily. Um, so yeah, swelling is, is extremely important. So now you could have venous [00:13:00] insufficiency and also have a little bit of salt retention.
Address both conditions. They’re not mutually exclusive. Take care of the vein, and also give them a diuretic to take care of the, you know, swelling.
Aimee: Yeah.
The Impact of Venous Insufficiency on Overall Health
Aimee: And, you know, so the swelling aspect, that’s also a visual sign there, but I imagine with the swelling patients are encountering some of those symptoms like heavy, tired, maybe even achy legs with all that swelling. Is that something you experienced too?
Dr. Kamran: That’s a very good point. swellings, there’s something kind of interesting, because sometimes patients, you know, have sock lines, and they don’t think they have swelling. I’ve noticed if you’ve got venous insufficiency when you’re on a plane ride, uh, because the, uh, the cavity is not always pressurized.
So they end up having, uh, they say when I’m on a long flight, four-hour flight, my ankles really swell up. That should make you very suspicious that it’s venous insufficiency. So now you’ve got all this fluid in your leg. What’s that going to do? Your legs are going to be heavy. They’re going to be [00:14:00] tired.
They’re achy. Even puts more pressure on your knees on your back. So if you have 10 pounds of, you know, weight per leg, when you’re trying to walk, you know, it’s going to put pressure on your knees, going to put pressure on your back. So you’re going to tire easily. And I’ve had patients with severe venous insufficiency that I’ve treated.
And they say, usually they used to have to, Put the hand behind their leg before they could put their leg out of the car. And now they can just lift their legs and get out of the car. They can go up and down the stairs easier. So, um, the achy, tired feeling, unfortunately, uh, we always try to find a reason what their symptoms are so you can forget about it.
Uh, Oh, I walk on cement floors all day long. That’s why my legs are sore and achy. Well, honestly, I don’t think what the floor would be, it wouldn’t make any difference. You have venous insufficiency. See, the problem is, if I could describe venous insufficiency, trying to, and I try to understand it myself, how could I explain it?
If somebody puts a tourniquet on your arm, So draw your [00:15:00] blood, you know, we usually blow it to about 40 millimeters of mercury and that the artery, the blood is still getting into an arm, but the veins are blocked so you can’t get out. So then you draw the blood. Now, if somebody forgot to take that, tourniquet off and send you home with it. As time goes by, your arm is going to get heavy. It’s gonna swell up. The fingers are gonna be bluish in discoloration. So that is an anatomical blockage. Here is a, is a valve issue, is a, is a physiological blockage because when you stand up, the valves don’t work well in the superficial vein so the blood, some of it tracks back down.
Right through those superficial veins. So it’s just like having a tourniquet in your arm. So when you have a tourniquet on the arm, I ask somebody, how does it feel like? Yeah, it’s a little achy, it’s a little bluish discoloration. It’s just heavy, it aches. That’s exactly what is happening to your legs when, when at the end of the day.
[00:16:00] So, uh, all these other symptoms obviously are going to get gotten better. I’ve had patients that really felt that they’re going to see an orthopod because their knee was hurting and they weren’t really talking with them I find that really it was venous insufficiency. Take care of the veins. Take care of the swelling. their knees don’t hurt as much.
They’re just, you know, they can walk a lot better.
Aimee: does that impact any other aspects of the body overall? if the blood’s pooling in the legs, is that impacting anything on the top half of the body?
Dr. Kamran: Again, very, very good point. So if the blood is not pooling in your leg, it’s not getting back to your heart. So, um, I have patients I’ve gone to face, we’ve got some gigantic veins, usually guys, especially. So a lot of these people in the warm day, they tell me they get lightheaded. They have to sit down.
Why do you get lightheaded? Because those veins get bigger and bigger with heat. So now you have a, probably a pint or two of blood is pooling in your leg, which means it’s not going to go to your brain. So, uh, obviously the heart tries to compensate. It beats a little faster, [00:17:00] it beats a little harder, uh, called the Starling’s curve, because, you know, it’s like a pump.
Not enough blood coming, except pump can’t correct itself, heart can. If you don’t have enough blood coming back to your right atrium, it pumps harder, a little faster to get the blood going. Eventually, it gets to a point where you just can’t keep up with it. And so they get lightheaded. The blood is not reaching to your brain, so then you have to sit down.
So, um, that is certainly,you know, a physiological problem. It is, really does improve your circulation. All these people that I take care of, you can see they, they get more hair on their, on their ankles, uh, than I’ve seen. And that tells me there’s improved circulation because we all know poor circulation causes, you know, hair loss.
So these are some of the symptoms and, uh, of course we haven’t even touched on the signs.
Aimee:
Closing Remarks and Teaser for Next Episode
Dr. Kamran: if you could like to join us in the next episode, we can talk about signs
So stay tuned for the next episode of Nice Living with Dr. Kamran, where we’ll continue this conversation all about vein [00:18:00] disease signs, symptoms, we’re going to dive into prevention as well and treatment options. So stay tuned. We’ll see you next time on Nice Living with Dr. Kamran.
Aimee: Thanks so much.
