Dr. Kamran (00:00)
I’m not judging another surgeon. I wasn’t there. I can’t judge that. All I can tell you is it is very unusual. But yes, we’ve had patients who were so scared of having any other
treatment, they come here and we’ve taken care of them. They’ve been very happy.
Aimee Bowen (00:16)
Hello and welcome to another episode of Nice Legs with Dr. Kamran. We’re excited today to share with you some listener submitted questions and also some questions that have come from Dr. Kamran’s Facebook page at Scarless Vein Care. If you’re not following the page, make sure you follow it at Scarless Vein Care on Facebook. And of course with me as always is Dr. Kamran Goudarzi
Dr. Kamran, thank you so much for your time today and excited to dig into these questions with you.
Dr. Kamran (00:45)
Thank you very much. Again,
Aimee Bowen (00:47)
One of the things that we did want to let our listeners know is while we can’t answer specific
questions when it comes to the specific medical care that these patients may have received elsewhere, we can give some context around what is typical of what you see in your practice in Wilmington, North Carolina. Can you give a little bit more of insight on just how we’re going to be approaching these questions today?
Dr. Kamran (01:12)
Great, so there’s obviously a lot of questions coming So we thought we’d obviously read all your questions and…
We like to use this opportunity on our podcast to answer your questions. They might not be your very specific questions, but they’ll be in the same line of questioning that you We’re going to be doing this periodically. So…
send us a message on our podcast about what kind of questions you So, Aimee,
they approach with their questions or suggestions?
Aimee Bowen (01:47)
Sure. can head to Scarless Vein Care on Facebook, or if you go to scarlessveincare.com forward slash podcast, you can find a space to submit those questions there too.
Dr. Kamran (01:58)
if they want to, what kind of guests would they like to
we are here for our audience to bring what you request us to bring.
Aimee Bowen (02:05)
Dr. Kamran, shall we dig into our first set of questions? All right. So first off,
Dr. Kamran (02:08)
Absolutely. Go ahead.
Aimee Bowen (02:11)
They say they’ve noticed some veins all over their ankles, but they don’t hurt. Is this a sign of an underlying issue or a cause for worry?
Dr. Kamran (02:22)
That’s a very good question because a lot of people think that veins around the ankle, especially on the inside of the ankle, are just spider veins. They’re what we call ankle flares. And usually this suggests that there is relatively advanced venous insufficiency of vein disease. So if you have any ⁓ ankle flares,
and you can actually Google them, you can look them, you can go on our website, we’ve got quite a few pictures of ankle flares, if that’s what you have, the chances are you’ve had venous insufficiency or what we call chronic venous insufficiency for a long time and this is the end result of that. ⁓
So we can at least evaluate it. We can tell you if that is indeed what it is. Then it comes to the question, does it bother you or does it not bother you? And ⁓ some of those things actually end up having little, what are called micro aneurysms. And these are veins coming through the skin. And I’ve seen those rupture and bleed quite often.
So if that’s the case, you want to be ahead of it, you want to take care of it so it doesn’t bleed. ⁓ Insurance companies, if you have symptoms, they take care of it. Medicare, if you have blebs, if they bleed, pretty much all insurance companies cover it. And I believe with Medicare, for example, if you have blebs at the risk of bleeding, they allow us to take care of them because Medicare knows that if they bleed, it’s a problem.
You know, the last patient I had, it was actually a young guy, one of those ruptured patients ended up going to an urgent care. They put a wrapping on it, comes home, bleeds again, goes to the emergency room. In the end, they ended up stitching that thing. It was still bleeding. So after two, three visits, spending several thousand dollars, ended up coming to the office and we had to go back and do what we should have been doing in the beginning, which is close the feeding veins and then…
take care of it. So then we also had the infection which was associated with it because of the stitching. It actually caused a wound infection. So it got very complicated and became ⁓ quite painful both for myself and the patient. Now this is what I do. ⁓ To me the pain that I say painful for me is the frustration. This could have been taken care of so easily if you were a little proactive.
And that’s one of the reasons why we’re doing this podcast, for patient education. Just because it looks okay doesn’t mean it is okay. And you can always come and see us, we can evaluate you, tell you if there’s something to worry about or not worry about. Now it’s just cosmetic, we could also tell you, you know, what can we do to help it out.
Aimee Bowen (04:55)
term you used, bleb, What’s a sign, a visual sign or a symptom of that?
Dr. Kamran (04:59)
Very good question. So, blebs are really a medical term. I call them microaneurysms. That doesn’t really make a lot of sense to the public. So, these are veins which have come to the surface. You can almost feel them. You can touch them. Look, they’re almost the size of a tip of a pin. You know the pin has got two ends? You know that the top part, which is not the sharp part? That’s how they almost look like. There are several right under the skin.
They don’t necessarily have to be in the ankle. They could be anywhere in the leg. ⁓ What is happening over time, the vein is eroding through the skin. And it will get to the point it’s already eroded through the skin. Now what you’re really seeing is a vein wall. And then vein walls are not designed to tolerate dry air. So the minute it gets exposed to air, it gets crusty.
and they get a little scab and they just try to find what the scab is as soon as they touch it. Now you’ve taken the vein wall off. And inside the vein is blood. So it starts bleeding pretty badly. if…
If you’re not sure, just let us check it out for you or get your medical doctor to take care of it. But we see a lot of these things and unfortunately, there’s a lot of cases that I think should have been obvious to the primary care physician or to the doctors. Doesn’t seem to be that obvious and they overlooked it. So if.
probably the easiest way is to come and see us or see somebody who specializes in vein so they can look at it and say, yeah, that’s a bleb and there’s all the risks associated with that.
Aimee Bowen (06:45)
so we’ve got another question. A person says they have too many veins to even attempt treatment seems to think that they might be a lost cause. So when it comes to someone who might have a significant number of varicose veins or spider veins or maybe a mix. What’s the best next step for them? also…
Dr. Kamran (06:54)
Yeah.
Aimee Bowen (07:04)
How far is it before maybe nothing could be done or is that even something someone should worry about?
Dr. Kamran (07:10)
never too far that nothing can be done because I promise you the same people who have a lot of veins now, when they were 15, 16, 17 years old, they probably didn’t have any veins. So over time it got worse. It is like a dam breaking. They are blood vessels. So when one breaks, then it feeds the other one and then it opens more and more.
streams and rivers and then there’s flooding if you like to think of it that way. So the longer you wait the worse it gets. So at some stage you’re going to throw the towel in and say I’ve got to get ahead of this. I don’t think I’ve ever had a patient that I felt was a challenge. Most insurance companies pay for them so you can take care of them as long as they are symptomatic.
Then you might get to a point where it doesn’t bother the patient anymore, now they don’t like the looks of it. And believe me, I believe that they pretty much got every tool available to get rid of your veins. All the way from, you have an esthetician who’s got a topical laser for really, really, really tiny veins, so it’s more to inject them all the way down to injecting them, and then for the real gigantic veins, we have lasers which would inside the vein, it takes care of them.
So when you’re pruning your yard, I hate to put it that way, if you’ve got a huge gigantic tree, you obviously don’t want to use chainsaw, main chainsaw doing it, but if you’ve got too few twigs, you just get a pruner and you prune them. And veins are kind of very similar in a some patients get worried. say, where is the blood going to go? These are bad veins. The blood flows usually backwards. It doesn’t return towards your heart. So.
you’re stopping your main system of blood leaking out and instead of returning back to your the job of a vein is to, is a pipe trying to return your blood back to your heart, not to leak backwards and away from your heart. So, ⁓ you want to be ahead of it.
Aimee Bowen (09:07)
that’s great news for any patient who has been thinking that this might not be a possibility for sure. So this is now our next question, can you tell me how painful each treatment method is? You mentioned a couple of those different treatment methods. So from the injections versus laser versus full vein stripping surgery.
Dr. Kamran (09:26)
That’s a very good question, also not a very good question, because the question was how painful are these, but what is is that you’re talking about? Are you injecting a vein, or are you putting a laser inside the vein, or are you doing ultrasound kind of foam sclerotherapy? So they all have different degree of discomfort. I have been lucky enough to have been through pretty much all of them, and I also get my nurses and my
to practice on me before I let them practice on my patients. And I can tell you, most men, we are not as tough as ladies. And to me, it was uncomfortable but not painful, and depends what you’re talking about. So when you’re doing a sclerotherapy when you’re injecting a vein, the needle is tiny, extremely tiny, you barely feel it. I have patients who don’t even know I’m doing this. It’s like a horse fly biting basically some patients don’t even know that we are injecting them. I would probably say with injections, it’s a little bit like getting Sometimes you can’t even feel it because the needle is extremely small, extremely, extremely small.
In fact, we use this smallest needle that I know exists for those. Now, actual medication that you put in, causes pain. For example, hypertonic saline is quite painful, so that’s why I don’t use it. Polidocanol is not bad at all. You can barely feel it. So the medication you use, the size of a needle you use, the person who’s doing it, that’s very important.
If somebody hasn’t done this ⁓ very often or just too rough, it’s probably going to hurt you more than the other guy. I some of my nurses, the patients don’t even feel anything.
Laser ablation, that is when we actually, for really large veins, we do the ablation. That’s when we put the laser inside the vein. Those are just uncomfortable. I really, I’ve been through it, and 99 % of my patients don’t think it’s uncomfortable, because really what you’re feeling is a numbing medicine before you fire the laser. And the numbing medicine, quite frankly, doesn’t hurt as much as you go to the dentist, because they are really putting a…
a needle in your nerves, in your face trying to numb it, whereas we just put some fluid around the vein. So the laser you will not feel, you just feel the numbing medicine So it is uncomfortable, but we used to give patients painkillers. Now nobody wants painkillers beforehand, and there’s no painkillers afterwards. it depends, again, the answer to your question, it depends what treatment you’re having, and each have their own degree of tolerance. I have patients who have extremely small veins.
to the point that you could either use an injection or topical laser, as we literally put a laser through the skin and zap them. Some people think the topical laser is more painful. Some people think the needle is more painful. Obviously, if the topical laser is less painful, we use that. I get my esthetician to do that. If they think they know that’s too painful, then I just inject them. So we are all different. God has made us differently. And we all know our degree of tolerance to
pain. But the most important thing is what is it that you really need? Is it the sclerotherapy? Is it form of sclerotherapy? Is it laser? That becomes very important.
Aimee Bowen (12:52)
And then just in comparison to the treatments that previously existed, there’s a huge evolution that’s taken place in the non-invasive treatments for veins versus what was initial standard for vein treatment as well.
Dr. Kamran (13:06)
Absolutely, when we did venous stripping and I’m guilty of that before lasers came out before 2002. did, you know, we did venous stripping. Venous stripping is so painful, it has to be done in the operating room. You have to put on the general anesthesia. These procedures now we do it right in the office. It is really revolutionized what we can do with just a little bit of
So please do not blame the procedure, blame the surgeon. Because the procedure is not what hurts.
is the guy behind it. And they should have some certain amount of compassion, how you touch the patient, how you perform the procedure, and the degree of anxiety the patient has, you’ve got to alleviate that before you do a procedure. When you are all stressed and anxious and the doctor walks in and just throws you in the bed and starts injecting you, that’s going to be uncomfortable.
Aimee Bowen (13:59)
so dr kamran we had a facebook
of yours.
not one of your patients, but someone who has been a patient of someone else.
They said that they had vein treatment years ago and now their legs have huge permanent scars, lots of numbness and tingling as well and they want to know what could be causing this.
Dr. Kamran (14:19)
That is extremely unusual. We certainly in our practice we haven’t experienced anything like this, but about patients who come in,
clearly remember one patient who actually was from New York and ⁓ he was a kickboxer, so maybe the surgeon decided he was so tough he was going to do that to him. His leg literally looked mutilated. And what they done, they just made about 20, 30 incisions and taken the vein out. His leg was definitely numb. His scars were horrific. He had so much bruising afterwards. ⁓
I wasn’t there, I don’t know what the thinking was, you what happened there, but we’ve had those patients that come to our office and ⁓ we’ve evaluated and see what happened and ⁓ we’ve been able to. ⁓
improve that. One of the most satisfying things for me is when they’ve had the experience like that and they come in and they realize we’re not taking them to the operating room, we are doing it right in the office with many more local and they see the contrast how we, you know, how the experience was before and what it is in here. I’m not, again, I’m not judging another surgeon. I wasn’t there. I can’t judge that. All I can tell you is it is very unusual. But yes, we’ve had patients who were so scared of having any other
treatment, they come here and we’ve taken care of them. They’ve been very happy.
When you have a bad experience, end up not trusting anybody and sometimes, you know, just get a second opinion go to another practice or certainly come and see us. And hopefully I’ve been doing this for past 25 years in the form of ⁓ non-invasive treatment and then…
very many years in very invasive way when we used to strip veins. So I’ve got some fair amount of experience. Hopefully I can tell you what happened and what can be done so you don’t have the same experience again and reassure you.
Aimee Bowen (16:13)
That’s
Well, Dr. Kamran, we’ve got lots more questions that have been submitted by listeners of the podcast and by all the fans of your Facebook page at Scarless Vein Care as well. going to have to have another Q &A session coming up for all of you listening. Please continue sending in those questions. We want to make sure they’re answered.
Dr. Kamran, it’s a pleasure as always. Thanks so much.
Dr. Kamran (16:34)
Thank you very much for joining us.
