Category: Blog

DOES FOOT PAIN WAKE YOU UP AT NIGHT

Posted on by Angelica Rodezno

Many patients as they get older, get up at night to go to the bathroom or because of difficulty sleeping. One serious problem that can wake people up at night is pain in their foot or toes.

This most often occurs in patients over the age of 65 who have a history of smoking, diabetes, high blood pressure, and/or high cholesterol. Some believe this is arthritis or gout, but it is often related to having poor circulation in the foot. The name for this in medical terms is “rest pain”. This is not “pain at rest” but rather pain that happens because the circulation cannot support the tissues even when they are at rest.

This is a sign of critical limb ischemia—another word for lack of blood flow. The arteries are so blocked that they cannot even deliver the minimal amount of oxygen the tissues in the foot and toes require to be happy. Patients often self-adapt to this problem, as it does usually develop slowly over time. They sometimes will tell you their foot doesn’t bother them at night, but on further questioning, you learn they sleep in a recliner or they sleep with their leg hanging over the side of the bed.

The trick here is that when the leg is hanging down, gravity helps pull down a little more blood to the foot so that it doesn’t hurt. Interestingly, the foot often also gets swollen, so the patient is often MIS-DIAGNOSED with a vein problem, not an arterial problem. …that’s why it is the “Right” experience that matters in diagnosing these kinds of vascular problems and why more local independent physicians refer their vein and vascular patients to Dr Kokinos than to any other vascular surgeon in the Silicon Valley Region.  https://www.southbayvascular.com/blog/the-right-experience-counts-when-it-comes-to-your-health/ The patient often thinks that they get up at night to go to the bathroom, but the truth is the foot pain wakes them up, they get out of bed because that makes it feel better (again due to gravity), they go to the bathroom because they think they have to (or maybe really do), and then they can go back to sleep pain -free for a couple of hours. Usually , the pain does wake them up multiple times a night, and that ‘s why they often end up sleeping in a chair.

If this sounds like something you or someone you love is experiencing, it is important to tell your primary care doctor or to schedule an appointment DIRECTLY with a vascular surgeon. These symptoms are a sign that your body is giving you that you need immediate help. This truly is a sign that your foot is starving for oxygen and blood and that if left untreated, might lead to an unnecessary amputation. Help is possible, however and if treated early enough, those suffering from these symptoms can be helped significantly.

If you suffer from painful feet in the middle of the night, contact us today  at 408-376-3626 to learn more about PAD and how Dr. Kokinos can help, click here.

South Bay Vascular Center and Vein Institute: We Offer Hope When Others Say There Is None.

MILLIONS WITH LEG PAIN HAVE PERIPHERAL ARTERIAL DISEASE

Posted on by Angelica Rodezno

A NY Times Health Care blog published in April of 2016 screamed out with the title “Millions With Leg Pain Have Peripheral Arterial Disease”.”More than eight million older Americans have a condition that can cause leg pain when they walk even short distances. Yet half of those who have the condition don’t know it and consequently don’t get treated for it, putting themselves at risk for a heart attack, stroke or worse.The condition, called peripheral artery disease, or P.A.D., is marked by diseased or blocked arteries in the legs. More than half of those with such circulatory problems in the extremities also have coronary or cerebral artery disease, noted Dr. Iftikhar J. Kullo, a cardiovascular specialist at the Mayo Clinic, in The New England Journal of Medicine in March. Failure to diagnose and treat blocked arteries elsewhere in the body can result in more serious, or even fatal, problems if they affect the heart or brain.It may seem odd that people who have serious difficulty walking normal distances would not know something is wrong and get checked out. Yet, as Dr. Kullo noted, P.A.D. is both underdiagnosed and undertreated. And the number of cases of P.A.D. is only likely to rise as the population ages, he said.”The article in its entirety can be read by clicking on the link below

https://well.blogs.nytimes.com/2016/04/11/millions-with-leg-pain-have-peripheral-artery-disease/

San Jose’s South Bay Vascular Center surgeons specialize in the care and treatment of patients suffering from PAD. Recognized as one of California’s leading Vascular Surgeons, Dr Kokinos has a special interest in peripheral re-vascularization procedures. Essential to her success in treating PAD is her ability to perform these re-vascularization procedures in her nationally accredited, custom built, state of the art peripheral arterial disease (PAD) treatment center. This facility, located in Campbell, CA., was specifically designed as a PAD treatment facility and is where South Bay Vascular Center physicians leverage advanced imaging systems (Ziehm C-Arms with Flat Panel Detectors and Phillips Intra Vascular Ultrasound imaging systems) to provide the most advanced surgical techniques available in this area. This advanced technology, together with a vast inventory of specialized medical devices not found in traditional operating rooms allows our surgeons to perform advanced, minimally invasive surgical procedures in their efforts to provide the best possible outcomes in the most difficult circumstances.Diagnosis
Many types of health care providers can diagnose and treat PAD. Family physicians, internists, physician assistants, nurse practitioners and vascular specialists can all diagnose PAD by examining a patient’s medical and family history, performing a physical exam, and conducting diagnostic tests. PAD can be diagnosed through a variety of diagnostic procedures including:

  • Ankle-brachial index (ABI):A common test used to measures the difference between blood pressure at the arm and at the ankle. A difference in the two areas indicates restricted blood flow.
  • Ultrasound
  • CT and MR angiograms
  • Angiography
  • Blood tests

Treatment
Over the past 15 years the interventional treatment of peripheral arterial disease (PAD) has changed significantly. Endovascular techniques have replaced many traditional open surgically invasive procedures as the dominant intervention. More recently, pedal access techniques, accessing the blocked area from the toe versus a traditional access point in the patients groin, has shown, in certain instances, to be significantly more successful that earlier methods of revascularizing the impacted area. Dr. Kokinos has performed more pedal access approach procedures that anyone in Northern California and because of this she able to provide patients with more options for treating their disease than many other surgeons.There are multiple options for treatment of PAD, ranging from medical interventions, surgical revascularization, and endovascular therapy. Vascular Surgeons are uniquely qualified and trained to treat patients diagnosed with PAD. Approaches to treatment include:

  • Minimally invasive endovascular procedures
  • Medical management
  • Exercise and lifestyle modifications
  • Surgical bypass Amputation

Early detection and treatment are important to control the disease and to allow patients a full selection of treatment options. If you suffer from non-healing leg wounds and or have difficulty walking short distances, ask your physician if you can have a vascular ultrasound study to evaluate your risk of PAD.

South Bay Vascular Center and Vein Institute is the recognized as the regional treatment center for the treatment and care of patients suffering from Peripheral Arterial Disease. Dr.’s Kokinos’ specialized training and state of the art interventional facility offers patients a unique alternative to a hospital setting and provides the highest level of care for the treatment of PAD as an alternative to limb amputation.

If you or a loved ones suffers from PAD, call our office today at 408-376-3626 to schedule a visit.

We offer hope when others say there is none.

www.southbayvascular.com

WHEN HIP PAIN MAY BE MORE THAN JUST ARTHRITIS

Posted on by Angelica Rodezno

Do your legs hurt when you walk? Can you only walk a block or two before you start experiencing cramping in your hip or buttock? Often times, patients are told this is just a normal part of getting older and probably due to arthritis. But sometimes it isn’t. If your pain only happens when you walk a certain distance and stops when you stop walking, it may be a circulation issue known as claudication. Claudication is a vascular condition that occurs when your leg muscles do not get enough blood flow while they are being used. This is generally caused by a build-up of plaque in the arteries–known as atherosclerosis–in your abdomen or legs. This build-up of plaque on the inside of the arteries, which carry oxygen and nutrients to your organs and muscles, restricts how much blood and therefore oxygen can get to the muscles. When you walk, you use energy, and your muscle requires more oxygen and nutrients to work. If the muscle does not get this needed oxygen, it begins to cramp up. This causes pain, and ultimately causes you to stop walking. Those at risk for this happening are people over the age of 60, those who smoke or were smokers in the past, those with high cholesterol or high blood pressure, and those who have heart disease or have had an ischemic stroke.

This problem can occur in one or multiple arteries from your belly button to your knee. It can be easily diagnosed on exam by simply feeling pulses in the patient’s groin, behind their knees, and at their ankles to check for blood flow. We can also listen for an abnormal sound called a “bruit” in the abdomen or the groin with a stethoscope. Where the pain is in your leg gives a clue as to where the problem is in your arteries. If there is a problem in the arteries in your abdomen or pelvis (the aorta and iliac arteries), it will cause buttock or hip pain with walking. This is often confused as hip arthritis or bursitis by medical doctors and patients. At SBVC, we have seen many patients who have had multiple injections into their backs or hip joints with no relief. On exam, we find they do not have pulses in their groin. An ultrasound done by specialized vascular technologists checking blood flow in the arteries will confirm this exam finding and can help plan treatment. Most treatments today are directed at opening the blood vessels up with surgery or a stent procedure. These are very safe and can immediately provide relief from pain and allow the patient to walk much longer distances than before. If you believe you are suffering from claudication, please talk to your doctor about your options. You may benefit from seeing a vascular surgeon for ultrasound and possible treatment.

BLOOD CLOTS AND SURGERY

Posted on by Angelica Rodezno

Most hospital surgeries require patients be put under general or epidural anaesthesia. Anaesthesia allows the patient to “sleep” through their procedures helping patients avoid both the physical and emotional stress of the operation. Anesthesia is also very important because it keeps the patient from moving during surgery. This “stillness” allows the surgeon to undertake their procedure without jeopardizing patient safety due to unwanted movement.

This same lack of movement, however might also cause other problems for the patient. The most concerning of these problems is the formation of a blood clot developing in the legs, or deep venous thrombosis (DVT) while the patient lies motionless on the table. In fact, in some surgical procedures (typically those lasting more than 3 hours, those involving bones or the back, or those done to treat a cancer) the risk of developing a blood clot can be as high as 80%. For that reason, national guidelines recommend that patients undergoing these long and complex surgeries (as well as some minor surgeries) are treated prophylactically- in advance- of a problem. This treatment can include the use of blood thinners before and after surgery, the use of compression pumps, and the use of early mobilization after surgery.

Blood clots that develop after a knee or hip surgery are also very common; unfortunately, these clots can be quite difficult to diagnose. One expects the affected joint to be painful and swollen after a procedure. Unfortunately, what could be a life threatening condition is often overlooked or misdiagnosed.

How can one know if post operative swelling is a part of the normal recovery or something more concerning? Only by getting a vascular ultrasound study can a definitive determination be made as to the presence or absence of a clot.

It is important to ask your surgeon to order an ultrasound if:

  • You feel tenderness and swelling in your calf or thigh after a surgical procedure.

  • These symptoms last longer than what your doctor told you to expect.

  • These symptoms prevent you from performing the activities for recovery you expected to do.

A special note of caution: ultrasound studies can be done at the hospital or at a nearby vascular surgeon’s office where the technologists are specialists in examining the veins and arteries of patient’s legs for clots

At SBVC, we perform dozens of exams for DVT monthly; mostly for orthopedic surgeons, podiatrists, and primary care doctors who want fast and accurate results. We also help these doctors immediately start treatment should a DVT be diagnosed because we can evaluate their patients immediately and if necessary we can beginning them on blood thinners in the office. As vascular surgeons we are able to begin care immediately saving patients from an expensive, frustrating, and time-consuming visit to the emergency room. We are aware how difficult this unsuspected surgical complication can be, especially when you are still in pain and recovering, but, we do our best to help you through this unfortunate occurrence.

If you experience any of the post surgical complications outlined above and suspect that it may be a blood clot, contact your surgeons office immediately to schedule an appointment.

BLOOD CLOTS AND AIRLINE TRAVEL

Posted on by Angelica Rodezno

People are more mobile today….everyday traveling to more and more places by plane, train, and automobile. Now, more than ever, vast numbers of business people and pleasure seekers cross the globe on a daily basis for work, opportunity and adventure.

As difficult (and as exciting as travel can be) extended periods of immobility during these long trips carries a hidden risk…a sometime fatal risk…especially if one is squished into the middle seat in the back of the plane for hours on end making it difficult to get up and move: the risk of developing a DVT (more commonly known as a blood clot) in the deep veins of their legs.

Veins are a network of blood vessels that work to return blood TO the heart (as compared to arteries which are blood vessels that transfer blood AWAY from the heart) Veins work by using a series of very small valves to keep blood flowing in a single direction and, generally, prevent blood from going back towards the ground even though gravity exerts a constant force to pull the blood down.

One’s calf muscles play a critical role in the venous system. These muscles, when activated, act like a “pump” to help squeeze blood back up through the veins and back up to their heart. When immobile,especially common during long periods of travel, the muscles cannot help the veins do their job, and the blood just sits in your legs. Blood naturally has proteins in it that helps it clot so that you don’t bleed to death after a cut or injury. When these clots develop, the leg can become swollen and painful. Many people develop leg swelling during long plane or car travel. However, one big differentiating factor between that kind of swelling and a DVT is that a DVT usually only happens on one leg. Often, the swelling persists for more than a little while after you get moving again. In addition, the leg, especially in the area of the calf muscle, is often tender when squeezed.

In the event that you experience the kind of symptoms explained above it is vitally important to go to the doctor or emergency room immediately. The most feared complication of a DVT is when the clot in the leg travels to the lung causing a PE—a pulmonary embolus. This can cause shortness of breath, chest pain, and even death. In fact, PE is the third most common cause of death in the United States, and few regular people know about it. If you do think you have a blood clot, it is important to get an ultrasound to diagnose it and to be started on blood thinners. It is also very important to see a doctor who specializes in blood clots, often a vascular surgeon, to evaluate whether or not there is another reason in addition to travel that this may have happened. Occasionally, having a DVT is a sign of a more serious underlying issue, and the travel just precipitated its occurrence.

At SBVC, our physicians and surgeons aggressively work up patients who present with the symptoms of a DVT to make sure there is no other contributing factor. We work closely with your primary care doctor, and occasionally call in hematologists (specialists in blood problems) to consult as well. If you or anyone you know suffers from non resolving swollen calf’s or legs following a long flight please call our office at 408-376-3626 to schedule an immediate visit to determine the extent of and appropriate treatment for DVT.

To learn more about blood clots and flying click on the attached link to visit a more detailed article on healthline.com

https://www.healthline.com/health/dvt-and-flying

SOUTH BAY VASCULAR ANNOUNCES THE LAUNCH OF “VIRTUAL APPOINTMENTS”

Posted on by Angelica Rodezno

South Bay Vascular Center and Vein Institute is excited to announce the availability of “Virtual Appointments” for our patients.

Beginning November 1, 2019 patients wishing to schedule an appointment can request a “virtual” appointment to speak with one of our vascular surgeons from the privacy of their home or office. Additionally, virtual appointments can be scheduled to include care givers and or other family members in remote locations whom the patient may wish to include in their medical appointment. Now, family members from anywhere in the world can be included in patient physician appointments without the expense of travel or the risk of mis-interpreting the diagnosis and care plan for loved ones.

Please note that not all medical conditions can be evaluated remotely. When requesting a “virtual” appointment our scheduling coordinators will be able to assist you in determining if a virtual appoint is right for your specific medical condition.

In the event of a medical emergency, patients must call 911 immediately to request medical care directly to their location.

Technology Requirements:

Patients wishing to leverage our HIPPA compliant telemedicine platform must have an email address, an internet connected device (desktop, laptop, smartphone or tablet) equipped with a working camera and microphone. All virtual patient communications will be recorded and saved in the patients medical chart and will be included as part of their medical record.

It is the complete and total responsibility of patients and patient advocates when requesting a “Virtual” appointment to insure that the remote location in which the virtual visit is conducted maintains standards for patient privacy and safeguards patient medical information.

DIABETIC WOUND CARE IN SAN JOSE-TREATMENT FOR DIABETIC WOUNDS

Posted on by Angelica Rodezno

Silicon Valley’s South Bay Vascular Center and Vein Institute physicians are recognized as the leading wound care doctors in the greater San Francisco Bay Area. Dr. Kokinos is the current medical director at both the Verity/O’Connor Wound Care Center in San Jose and at St Louise Hospital Wound Care Center in Morgan Hill, CA. She is recognized as one of the regional experts in Northern California and provides cutting edge treatment for the care and treatment of Non Healing Diabetic wounds. Together with her partner Dr. Brad Hill who served as chief of Kaiser Hospital’s entire Northern California Vascular Surgery Department for over 17 years, South Bay Vascular Surgeons provide unmatched cutting edge and compassionate care to patients suffering from non-healing diabetic foot wounds.

Millions of Americans suffer from wounds that don’t heal. It’s a problem most don’t even think about until they or a loved one develops this type of wound. After all, every one of us has fallen or hurt ourselves with a resulting wound. It generally hurts for a little, we put a little Neosporin or a band-aid on it, and forget about it. Pretty soon, it is gone, and there is a little or big scar in its place. However, as we get older, and develop medical issues, this healing may not happen. A wound that has been “open” for more than four weeks, is called a chronic wound, and often needs the special attention of a wound care center. In these centers, team of specially trained nurses and doctors use a variety of diagnostic and therapeutic tools to help promote healing.

Diabetics must pay special attention to their feet and ankles and it is vitally important to NOT ignore a small wound when it develops. Diabetic wounds, when left untreated, are the cause of 85% of the amputations that occur in these patients. Once these ulcers develop, they often DO NOT HEAL just by putting a Band-Aid over them, or even with wound care and ointments prescribed by your primary care doctor.

Several different problems can contribute to wound healing. The most common of these is a circulation issue. Either the arteries are blocked that supply oxygen and nutrients to help heal the wound, or the veins that promote drainage of toxins and fluids are not functioning properly. This can occur either because they have leaky valves, or because they too are blocked. In general, it has been discovered that about 70% of wounds seen in wound care centers have an underlying vascular issue. This problem is most often an issue with leg or foot wounds. For this reason all of these should be consulted on by a vascular surgeon, a specialist in treating circulation problems. Simple tests, most of which are not invasive, can reveal problems in the arteries and veins. It is very important to do this, because treating these issues alone can greatly improve the wound healing rate.

If you suffer from non-healing leg or ankle wounds, especially if you are a diabetic, call the diabetic wound care experts at South Bay Vascular Center to schedule an appointment to have these wounds evaluated. We offer hope when others say there is none. 408-858-3586.

WHY DIABETIC FOOT WOUNDS DON’T HEAL

Posted on by Angelica Rodezno

One of the main complications of diabetes is the development of diabetic foot ulcers. Diabetic foot ulcers occur in 15% of all patients with diabetes. There are four primary contributing factors to the developments of these ulcers.

  • The presence of peripheral neuropathy (loss of feeling over the toes);
  • Changes in the architecture (shape) of the foot causing it to have pressure on areas ot built for it;
  • Poor blood flow to the foot;
  • A decreased ability to fight infection in the foot.

The main reason why diabetic wounds do not heal is due to lack of blood flow to the ulcer and ongoing pressure to the wound

Diabetics must pay special attention to their feet and ankles and it is vitally important to NOT ignore a small wound when it develops. Diabetic wounds, when left untreated, are the cause of 85% of the amputations that occur in these patients. Once these ulcers develop, they often DO NOT HEAL just by putting a Band-Aid over them, or even with wound care and ointments prescribed by your primary care doctor.

Care of Diabetic Foot Wounds

It is very important to see both a podiatrist (foot specialist) and a vascular surgeon (blood flow specialist) to examine your foot. These doctors can help with special treatments such as debridement (cleaning the wound), off-loading (taking pressure of the wound) and improvement of blood flow to help your wound heal. Debridement helps remove dead tissue and bacteria from the wound. Off-loading and special inserts or shoes allow the pressure to be removed from the wound so that it can heal. Diabetes causes blockages with calcium deposits inside your small blood vessels, which are below the knee, and this prevents oxygen and nutrients from getting to your feet. The vascular surgeons at South Bay Vascular Center have a special interest and expertise in opening these blood vessels in order to bring flow to your toes and feet that can help save patients from amputation. If you or anyone you know suffers from diabetes and are experiencing foot wounds that do not heal, call us immediately at 408-376-3626 to schedule an appointment to have these wounds evaluated.

GILROY CA. NON-HEALING LEG WOUNDS AND VASCULAR SURGERY

Posted on by Angelica Rodezno

Chronic wounds (wounds that do not heal after four weeks) are a silent epidemic in the United States and affect almost 7 million people. If not healed in a timely fashion, they can lead to loss of limb and in some instances can lead to amputation or death.

Many patients suffering with non-healing leg wounds are seen in wound care centers for the treatment of their foot and leg ulcers but unfortunately, many times the physicians in these wound care centers are quick to put on expensive savs or other advanced treatment options without treating the underlying circulatory issue.

The best wound care centers treat by guidelines rather than simply treat the symptom of what might be a deeper,underlying condition. Guidelines are a scientifically proven set of steps that have been shown to help wounds heal faster.

For EVERY non-healing wound on the leg or foot, the very first step must be to assess BLOOD FLOW. This means that every patient with a leg or foot wound that hasn’t healed in four weeks MUST be seen by both a vascular surgeon AND a podiatrist (foot specialist).

A vascular surgeon will assess the circulation and order appropriate diagnostic tests, such as vascular ultrasounds to look at the blood flow. This is important to examine, as a large number of the patients who have ulcers, have not previously been diagnosed with an arterial or venous problem. Without fixing the underlying cause of the ulcer, even if it does heal initially, it will soon recur, and cause further problems. It is important for patients to take an active role in asking for these referrals so that the problem does not progress and become a wound that can lead to an amputation.

Recognized as one of the most experienced and respected vascular surgeons in Northern California, Dr. Kokinos is focused on restoring the circulatory health of their patients thereby helping them heal their wounds and return to a normal way of life.

With offices in both Gilroy and Campbell, CA, South Bay Vascular’s Board Certified Vascular Surgeons bring cutting edge wound care treatment to the South Bay communities of Gilroy, Hollister, Salinas and the Hwy 152 corridor to the Central Valley. With a state of the Art Vascular Ultrasound Lab now located in Gilroy at our 8420 Church Street office expert vascular care is simplified as patients can now get world class care in their own community.

If you or anyone you know suffers from a Non-Healing leg wound or ulcers of the foot and leg, call our offices at 408-376-3626 to schedule an appointment.

AWARD WINNING WOUND CARE IN SAN JOSE

Posted on by Angelica Rodezno

The O’Connor Wound Care Center, which celebrates it’s 25th Anniversary this year, was the site of a ceremony on Thursday, June 18th 2019 honoring it with a Commendation from the City of San Jose. The honorable Sam Liccardo as well as all the City Council Members were involved in recognizing the O’Connor Wound Care Center for distinguished service to the citizens of San Jose. The plaque was presented by Council Member Dev Davis to Dr. Polly Kokinos of South Bay Vascular Center, who is the Medical Director of the O’Connor Wound Care Center, as well as to the entire staff of the Wound Care Center.

Chronic wounds are a silent epidemic in the United States affecting almost 7 million people. If not healed in a timely fashion, they can lead to loss of limb and life. The wound care center was started 25 years by Drs. Bruce Lehrman, Peter Schubart, and Jude Roussere, who are still active in it today. It is a testament to their vision and understanding that chronic wounds are best treated by a multidisciplinary approach and by a team that focuses on them. Their are 10 physicians from 6 different specialties all of whom are have special training in wound care, advanced treatment modalities for wounds, and hyperbaric oxygen therapy. Our team of twelve nurses and five additional staff members are committed to these patients, and several of them have worked at the center for decades. We follow published clinical practice guidelines to ensure the best outcomes and our wound healing rates are over 98%.

We are the only JHACO accredited center in the Bay Area, and are proud to offer advanced therapies such as skin substitutes, the LUNA laser system, and Hyperbaric Oxygen treatment for difficult to heal chronic wounds. We have treated and healed over 15,000 patients.

Should your patient need our expert help, please call us at 408-947-2804 for an appointment.