Tag: SWOLLEN LEGS

PART 1: WHY DO MY TOES, ANKLE, AND FEET HURT AT NIGHT? VENOUS DISEASE

Posted on by Michael Kokinos

One of the many questions I receive as a vascular surgeon is why do my feet hurt at night?  Though this question may seem simple, every person is different. Before I can provide you with “real” solutions to what’s causing this pain and what can be done to stop it, I need to evaluate multiple factors to understand “Why” this pain exists.  Over the next few weeks, I am going to explore the most common reasons for foot pain at night and why people can have pain in their feet at night caused by venous disease.

For the majority of patients Raynaud’s syndrome, Arterial disease, and Diabetic foot disease explain most of the reasons why people experience pain in their feet at night.  Though pain from problems with bones and muscle can play a role, pain due to these causes usually worsens during the day and with use, not when a patient is resting or lying flat.

In part one of this four-part series, I am going to discuss pain at night caused by VENOUS DISEASE.

Let’s start with a refresher on our bodies “plumbing” (Specifically, how does blood circulate around my body.)

  • Veins are blood vessels that bring blood BACK from the feet to the heart.
  • Arteries on the other hand are the blood vessels that bring blood FROM the heart to the feet.

Veins have specialized structures called one-way valves that allow blood to go up towards the heart but not back down towards the feet.  As we age, veins become dilated (start to leak) because the valves no longer seal properly. These leaky valves allow blood to fall back towards one’s feet which results in an increase in pressure within the veins at the ankle and just above the legs. Gravity tugs on the blood in our veins bringing it down to our feet which causes this increase in pressure

Interestingly, because of the curve that the veins take at the level of the ankle to enter the foot, the increase in pressure is not transmitted directly to the foot and toes.  The increase in venous pressure at the ankle typically results in

  • Varicose veins,
  • Swelling,
  • Dark skin discoloration from the leaking of red blood cells into the skin, and, in the worst cases
  • Ulceration.

Even without ulceration, however, the pain related to swelling and discoloration can be very severe.

People during their normal daily lives spend most of their days either standing or sitting.  Because of this, during the day gravity works in both positions to facilitate the pooling of blood around one’s ankles.  When patients come to me with pain in their feet, I always ask specifically if the pain is localized in the calves and ankles.  When pain is localized to the calves and ankles, I confirm a venous etiology by performing a physical exam and finding varicose veins, swelling, dark skin discoloration and/or ulcers between the ankle and the knee.

Pain that is reported in the foot and/or toes without the physical exam findings of varicose veins, swelling, dark skin discoloration, and/or ulcers between the ankle and the knee is NOT likely to be from a venous cause!  Though vein problems may sound or seem like a rare disease for those who have never had venous disease, patients with vein problems are one of the most common consults I see as a vascular surgeon.  Does foot pain wake you up at night? If you have any of the symptoms or appearance of the leg that I described above, please do not hesitate to call our office on 408-376-3626 to schedule an appointment.

One Final Note:

Though causes from the bones and muscles can play a role, foot pain that worsens at night is rarely due to these causes.  Often pain related to problems with bones and muscles worsen during the day and with use, not when any given patient is resting or lying flat.

Clues that can guide me as a vascular surgeon to the cause include throbbing and aching pain versus numbness and tingling associated with tenderness or pain located in the toes versus pain located in the ankle or just above the ankle in the leg.

 

Dr. Ignatius H. Lau

Vascular Surgeon

Dr. Ignatius Lau grew up in Portland, Oregon. He attended the University of Washington in Seattle for college and Stony Brook University in Long Island for medical school. He then went on to train in vascular surgery at Mount Sinai Hospital in New York City. During his time in New York, he performed over 1600 cases involving aortic, peripheral, venous, and carotid surgery. He has a special interest in limb salvage and treating patients with peripheral arterial disease and has extensive training and experience in treating the full spectrum of vascular diseases. Dr Lau was also very active in medical research during his training, ultimately finishing with twelve peer reviewed manuscripts. During his training in New York he met his wife, Lisa, who is a practicing endodontist. Together they love to hike, try new restaurants, and travel.

WHAT IS “ENDOVASCULAR” SURGERY?

Posted on by Michael Kokinos

As a vascular surgeon, I perform two very different types of surgery: Open Surgery and Endovascular Surgery.

  • Open surgery is just as you might think!  It involves making an incision with a scalpel and using various tools like forceps, scissors, electrocautery, and needle drivers to expose and then repair specific structures.  Since the beginning of surgery itself, all surgeons, not just vascular surgeons, have been practicing open surgery.
  • Endovascular surgery is a recent development that only began in the 1990s.  Motivated by the desire to perform minimally invasive and less harmful interventions on the most sick and highest risk patients, pioneers in vascular surgery developed endovascular techniques.

Though the concept is simple, endovascular surgery now allows vascular surgeons to solve a multitude of problems with blood vessels very differently than they have in the past. Using advanced minimally invasive surgical techniques, vascular surgeons can treat many forms of vascular disease without the need to “cut-open” their patients to treat extraordinarily complex and in some cases life threatening diseases.

Endovascular surgical techniques utilize ultrasound (sound waves) to place the tip of a hollow needle into a blood vessel.  Once these hollow needles have been placed through the needle, we place a very stiff wire that allows us to advance large tubes called catheters into the vessel.  Catheters have many different functions depending on the situation and are used to re-establish blood flow in vessels that are diseased and or blocked.

For peripheral vascular disease, there are blockages in the legs of a patient that prevent blood flow from reaching the foot.  For peripheral vascular disease we can use balloons on the end of the catheter that are inflated to open a blockage.  If balloons do not work, then we can put a self-expanding metal mesh tube on the end of a catheter and then deploy it inside the blockage, thereby keeping it open.  There is also a technology called atherectomy which literally means cutting out plaque.  The atherectomy device has a cutting edge that sands down the plaque and then a suction function that removes all the debris.

For aneurysms, which are dilations of a blood vessel that can rupture, we use stent grafts, which are self-expanding metal mesh tubes that are lined with an impermeable fabric.  We place the stent graft above and below the aneurysm, thereby sealing it from the pressure created by the heart and preventing rupture.

At the end of these endovascular cases, the patient only has one or two 1 mm in size punctures over the arteries that were accessed.  Contrast this to the classic open surgeries where patients could have incisions up to 10 to 20 cm!  As a contemporary vascular surgeon, I take pride and joy in being able to offer both types of surgical interventions to my patients.  If you or your loved one may be suffering from vascular disease, please do not hesitate to call our office at 408-376-3626 to schedule an appointment today!

FOOT PAIN AT NIGHT: IT MIGHT BE MORE SERIOUS THAN YOU THINK

Posted on by Michael Kokinos

Many patients over the age of 65 who have a history of smoking, diabetes, high blood pressure, and/or high cholesterol wake up at night with pain in their foot or toes. Some believe this is arthritis or gout; others think it is the result of just spending too much time on their feet during the day.  Patients often self-adapt to this problem, as it usually develops slowly over time, but when questioned about their sleep habits, they will sometimes tell you that they sleep in a recliner or they sleep with their leg hanging over the side of the bed to make their pain go away.

It is very common for elderly patients to get up at night to go to the bathroom. Sometimes, however, it’s actually foot pain that wakes them up.  Once up, they get out of bed because that makes their feet feel better (again due to gravity) and after walking to the bathroom they can go back to sleep, pain -free for a couple of hours.  Even that small amount of walking helps to get their blood flowing again and makes it easier for them to go back to sleep.

Sometimes, foot pain at night is the sign of a more serious condition.

  • Foot pain at night may be 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.

Foot pain at night may be an early warning sign of critical limb ischemia.

  • Chronic Limb Ischemia is another term for lack of blood flow;  if you experience this rest pain at night and it goes away after hanging your foot over the side of the bed or chair you are sleeping in, immediately call and speak with your doctor to set up an appointment for them to evaluate your symptoms. Although it may come on slowly, the arteries in your feet may be so blocked that they cannot even deliver the minimal amount of oxygen the tissues in the foot and toes need to keep them nourished. Left untreated, this blockage can lead to a more serious problem, amputation or even death.

What’s important for the patient to realize is that chronic limb ischemia causes the foot and leg to get swollen, so the patient is often MIS-DIAGNOSED with a vein problem, not an arterial problem

If this sounds like something you or someone you love is experiencing, it is important to tell your primary care doctor OR schedule an appointment DIRECTLY with a vascular surgeon. These symptoms are a sign that your body is giving you that you may 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, WE CAN HELP

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.

 

 

NOT JUST VASCULAR CARE, EXCEPTIONAL VASCULAR CARE

Posted on by Angelica Rodezno

Your health care is complicated enough… finding the right Vascular Surgeon shouldn’t be!

Experience counts when it comes to your health

Polyxene (Polly) Kokinos MD. RPVI. Board Certified in Vascular and General Surgery

Silicon Valley’s Most Trusted Vascular Surgeon.

Dr Kokinos…The Confidence of knowing you made the Right choice for your Vascular care.

  • The confidence of knowing that your vascular surgeon has been taking care of South Bay patients with vascular disease for almost 30 years.
  • The confidence of knowing that your surgeon built her private practice one patient at a time for almost a quarter of a century…BECAUSE referring PHYSICIANS TRUST Dr Kokinos to deliver the best possible outcomes for their patients: even in the most difficult of circumstances.
  • The confidence of knowing that your surgeon delivers both world class and compassionate care. That Dr Kokinos is the only Vascular surgeon in the South Bay who has built an independent, nationally accredited, state of the art Vascular Surgery Center of Excellence where SHE takes care of her patients…where cutting edge care is at the heart of everything that she does.
  • The confidence of knowing that your surgeon has earned the trust of local physicians. More independent local physicians refer their vascular patients to Dr Kokinos than to any other vascular surgeon in Silicon Valley.
  • The confidence of knowing you will receive the most Advanced and Innovative Care found anywhere in the world…No other vascular surgery practice in Silicon Valley offers a combination of the imaging, device and care options that South Bay Vascular Center can offer to their patients in their private, AAAASF nationally accredited ambulatory surgery center dedicated entirely to the treatment of complex vascular disease. “We offer hope when others say there is none”
  • The confidence of knowing you will receive Personalized Care…” One Doctor, One Patient, One Nurse” …We’re NOT a hospital; we are more. That’s why we provide individualized care. At South Bay Vascular Center, we care for you as a person, not just as another patient. Our job is to understand the “why” so that you have real solutions to living a healthy life.
  • The confidence of knowing you will receive Simplified Care: ALL your vascular care under one roof. Clinical care, Vascular Ultrasound care, and Surgical care. All your care in a single facility.

South Bay Vascular Center and Vein Institute. Silicon Valley’s Vascular Surgeon.

LEG SWELLING: SYMPTOMS AND SIGNS

Posted on by Angelica Rodezno

Do you Suffer From Iliac Vein Compression?

To answer that question, take a few seconds to consider the following:

  • Are your legs swollen? Is your left leg larger than your right?
  • Is it harder to slip one shoe on in the morning than the other?
  • Have you had cosmetic or other surgical procedure done and not gotten the outcome you wanted?
  • Are you a cancer patient undergoing treatment or procedures?
  • Have you ever suffered from a blood clot or (DVT) in your leg
  • Do you visit a wound care clinic with little to no success?

If you’ve answered yes to any of these questions, you MAY be suffering from a well known, but previously difficult to diagnose problem called May-Thurner’s Syndrome.

May Thurner’s Syndrome, also known as iliac Vein Compression, is a condition where the main artery supplying blood to the leg pushes down or compresses the main vein taking blood back to your heart. In the illustration below you can see in the far right graphic a “representation” of this compression. One way to help think of what happens when a patient suffers from iliac vein compressions is to consider what happens when a car tire partially runs over a garden hose in your driveway.

If the hose was “on” when you drove over it, water will continue to come out of the hose end but the flow rate will decrease. In a similiar way, blood returning to your heart will continue to flow if you have developed iliac vein compression, but the rate at which it returns is slowed down, resulting in a pooling of blood (i.e. swelling) in your leg.

Chronic pain and swelling in one leg (especially the left side) may be caused by Iliac Vein Compression. This is a little-known but fairly common condition that can greatly impact your quality of life—and may lead to more serious complications. In fact, studies have shown that in a full 30% of ALL people, the left iliac vein can be significantly compressed by the right iliac artery resulting in some kind of leg symptom….aching, heaviness, and most commonly, swelling or non-healing of wounds in the leg veins.

Swollen legs ARE NOT a normal part of aging or weight gain. And it’s not something you have to “just live with.”

Leg swelling is a special area of interest of Dr. Polly Kokinos, and she has been active in doing clinical research to find better ways to diagnose and to treat this condition. To diagnose and to treat this condition and the potentially deadly side effects caused by it (Blood Clots or Deep Venous Thrombosis) Dr. Kokinos has assembled a highly skilled team of vascular ultrasonographer’s who have developed a specialized screening protocol to evaluate for Iliac Vein Compression. Using state of the art ultrasonic imaging technology Dr. Kokinos’ Registered Vascular Ultrasonographer’s use this new protocol to scan up into the abdomen of their patients to examine the physics of the blood flow in this area. If a compression is identified during this ultrasound exam, Dr. Kokinos is able to further verify and treat this problem using a super specialized device called IVUS (Intra-vascular ultrasound) where she can insert a miniuture camera into the actual vein to determine the length of the compression after which she can place a stent to “re-open” this compressed vessel to re-establish normal blood flow.

To date, Dr. Kokinos has successfully performed over 200 of these iliac vein stent procedures in her state of the art out-patient angiography suite. She has lectured extensively at major vascular surgery meetings on her approach and success helping patients reduce leg swelling, increase the rate of wound healing and return to a normal way of living and is seen by her peers as an expert in this technique.

If you are currently experiencing a swollen leg, have a non healing leg, foot,or ankle wounds or have ever suffered a blood clot (DVT) please contact our office at 408-376-3626 to schedule an appointment.

Don’t suffer from swollen legs or non-healing leg ulcers any longer.

We can help!

DO YOU SUFFER FROM SWOLLEN LEGS? WE CAN HELP!

Posted on by Angelica Rodezno

Do you Suffer From Iliac Vein Compression?

To answer that question, take a few seconds to consider the following:

▪ Are your legs swollen? Is your left leg larger than your right?
▪ Is it harder to slip one shoe on in the morning than the other?
▪ Have you had cosmetic or other surgical procedure done and not gotten the outcome you wanted?
▪ Are you a cancer patient undergoing treatment or procedures?
▪ Have you ever suffered from a blood clot or (DVT) in your leg
▪ Do you visit a wound care clinic with little to no success?

If you’ve answered yes to any of these questions, you MAY be suffering from a well known, but previously difficult to diagnose problem called May-Thurner’s Syndrome.

May Thurner’s Syndrome, also known as iliac Vein Compression, is a condition where the main artery supplying blood to the leg pushes down or compresses the main vein taking blood back to your heart. Previously undiagnosed, major advances in medical imaging technology have given vascular surgeons the tools needed to demonstrate that May Thurner’s syndrome is directly responsible for the slowing of blood going back to ones heart resulting in the swelling and or edema of the leg. These same studies have shown that in a full 30% of all people, the left iliac vein can be significantly compressed by the right iliac artery resulting in some kind of leg symptom….aching, heaviness, and most commonly, swelling or non-healing of wounds in the leg veins.

The Physicians and Surgeons at South Bay Vascular Center and Vein Institute specialize in treating Iliac Vein Compression. To diagnose and to treat this condition and the potentially deadly side effects caused by it (Blood Clots or Deep Venous Thrombosis) Dr. Kokinos has assembled a highly skilled team of vascular ultrasonographer’s who have developed a specialized screening protocol to evaluate for Iliac Vein Compression. Using state of the art ultrasonic imaging technology Registered Vascular Ultrasonographer’s use this new protocol and ultrasonic sound waves to scan up into the abdomen of their patients to examine the physics of the blood flow in this area. If a patient is found to have iliac vein compression, and is symptomatic for this condition, we then recommend IVUS–intravascular ultrasound and iliac vein stenting to re-establish blood flow in this area by opening up the compressed blood vessel in this area.

South Bay Vascular Center is a specialized vascular surgical facility dedicated entirely to treating vascular related illnesses. Unlike in a traditional hospital operating room, South Bay Vascular’s nationally accredited ambulatory surgery center is designed specifically to treat this kind of circulatory disease. Using advanced imaging equipment and device technology designed specifically for vascular related illnesses Dr. Kokinos is able to treat IVC disease in her outpatient surgery center setting in Campbell, CA. Treating her patients in this kinder and gentler environment Dr. Kokinos simplifies what has traditionally been the difficult, unfriendly and often times complicated admissions process of a traditional hospital. To date, Dr. Kokinos has successfully performed over 200 of these iliac vein stent procedures in her out-patient angiography suite and has lectured extensively at major vascular surgery meetings on her approach and success helping patients reduce leg swelling, increase the rate of wound healing and return to a normal way of living.

If you are currently experiencing a swollen leg, have a non healing leg, foot,or ankle wounds or have ever suffered a blood clot (DVT) please contact our office at 408-376-3626 to schedule an appointment.

Don’t suffer from swollen legs or non-healing leg ulcers any longer.

We can help!

408-376-3626

WWW.SOUTHBAYVASCULAR.COM

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

DR. KOKINOS SELECTED TO SPEAK AT 2017 UCSF VASCULAR SYMPOSIUM

Posted on by Angelica Rodezno

Dr. Kokinos is honored to be a featured speaker at this years world renown UCSF Vascular Symposium. Dr. Kokinos will present her on-going research on the treatment of venous ulcers. This years session will be presented on April 6, 2017 in San Francisco, CA. Congratulation’s Dr. Kokinos on your selection as a speaker.

Dr. Kokinos is a Board Certified Vascular and General Surgeon and is the medical director of the wound care clinics at Verity’s O’Connor Hospital in San Jose and St. Louise Hospital in San Martin Ca. Together with her partner, Dr. Carlos Pineda, Dr. Kokinos operates the leading varicose vein treatment center in Northern California and has provided specialized vein care treatment and repair for over 20 years. Recognized as the leading Vein Specialist and Varicose Vein Doctor in Northern California, Dr. Kokinos is known as the Doctor’s Doctor and is honored to work alongside her patients to help them return to a healthy and normal lifestyle.

ACHING TIRED OR HEAVY LEGS?

Posted on by Angelica Rodezno

DR. KOKINOS SELECTED TO PRESENT AT THE AMERICAN VENOUS FORUM

Posted on by Angelica Rodezno

Dr. Kokinos will be presenting an abstract on her clinical research regarding iliac vein compression at the national American Venous Forum in New Orleans early next year. This meeting is the largest venous meeting of the year, and is sponsored by the Society for Vascular Surgery.

Dr. Kokinos has been recognized nationally as an expert on May-Thurner’s Syndrome, or iliac vein compession. This problem can cause symptoms of (predominantly) left leg swelling, heaviness, aching, deep venous clots, and non-healing ankle or leg wounds. She has performed more intravascular ultrasound exams and stents of the deep venous system than any other doctor on the West Coast in the last year. She will be presenting her clinical research on using regular ultrasound, done by the specially trained registered vascular technologists in the ICAVL accredited Institute for Vascular Testing to diagnose this fairly common but widely underdiagnosed issue. Previously, patients needed to get CT scans which used significant amounts of radiation and contrast for the diagnosis. This problem is not only seen because of a common anatomic situation, but also often as a result of an undiagnosed blood clot (DVT) in the iliac or femoral vein after orthopedic, back, or gynecologic surgery.

If you have one leg that is more swollen or painful than then other, or have had a leg blood clot in the past, please call us at 408-376-3626 or visit us at www.southbayvascular.com.