On episode 581 of the 40+ Fitness Podcast, Dr. Mason Mandy and I discuss vein health and what you can do to improve it for better overall health.
Let's Say Hello
[00:02:33.080] – Allan
[00:02:36.260] – Rachel
Hey, Allan. How are you today?
[00:02:38.100] – Allan
I'm doing all right. Good weather, busy season at Lula's. Daughters getting married soon. So we're starting to book that trip. Tammy and I are talking about it because we want to see family. When you have family that's in their upper 70s and 80s and you start saying, Okay, I got to get got to make the point because you can't just say, I'll do it next year. So we're going to stay a little bit longer in May than we thought we would just to get all that in. But we've been talking through how to do that. And I'm a weirdo, but you already knew that. I just prefer to arrive in one location and get a rental car and just hook it on in the car. You can throw your bags in there once and you just go. And it just makes things so much easier, in my opinion. Now, yeah, you do spend more time because you got to drive. But if you think about flying to a location, getting a rental car for a day or two, and then going back to an airport and flying again, actually got to turn in that car and fly again, pick up another car, yeah, it's faster, but there's so many moving parts.
[00:03:55.470] – Allan
So a late plane and I missed this. And now you're not getting into your hotel when you planned on it. And then you got to try to get that done. So there are still a lot of moving parts because I have to get my CPR. The last one I got was online because COVID. I need to get it done in person this time. That would be nice. They might let me get away with another year of online, but I don't live in the state, so I don't have them here. I have to get them when I'm in the state. So this year, going into the states, mine is going to… I think it actually is going to be close to expiring about the time I get there. So I want people to dillydally or get in there and get it done. And so I'm trying to slide that in there. Oh, and there's the wedding.
[00:04:43.700] – Rachel
Yes, the whole reason you're coming up here.
[00:04:45.380] – Allan
I was like, Hey, I could do this on Saturday. What time is that wedding? I was like, You are not. No.
[00:04:53.700] – Rachel
Oh, my goodness. What a trip.
[00:04:56.440] – Allan
Yeah. So yeah, we're probably going to be flying into Miami, spend some time with family there, drive up to North Carolina, spend some time with family there, go to the wedding, and then drive on over, I think, to Kentucky, spend some time with family there, and then head back out. Awesome. Yeah, but it'll be a lot of driving, not as much driving as we usually do, and not for nearly as long as we usually would, and not normally when we would. But all those things all considered, we'll make the best of the trip we can and get it all done. But how are things up there?
[00:05:27.980] – Rachel
Good. Today's a good day. We have blue skies today. We're in the thought.
[00:05:33.560] – Allan
The numbers I was seeing about power outages and stuff like that.
[00:05:38.300] – Rachel
Yeah, it was brutal. In fact, there's still a lot of people out of power. We lost it briefly just for a few hours. Thank goodness. But one of my cousins was out for four and a half days. Yeah, it was just brutal. And there's still people that are out and we are expecting another pretty serious weather event happening to be determined whether it's going to be more ice or more snow, but yeah, we're still recouping from that last storm.
[00:06:05.440] – Allan
Do you guys have a generator?
[00:06:07.020] – Rachel
We do. This house has a generator that will run our furnace and we have a well, so it'll run water for us. So it does, it works just fine. It's really funny. We lived in Florida for seven years, Allan, and the first thing we did when we moved there was we bought a generator because it's hurricanes down there. Never once needed to use it in Florida. And up here, we've used the generator, I think, in every house that we've been in since we moved back and several times per year. So yeah, I'm glad we have it.
[00:06:40.560] – Allan
Lula's had a generator, but it's this old little beater, and I don't even know if it worked. I haven't tried to start it. And then I brought one down. I had a Honda that I used for tailgating, but we put it away. I haven't pulled it out. And so the power goes out regularly. Oh, no. At least once a month, we have an unplanned power outage. And then probably about once a month, we have a planned power outage. But I haven't pulled them out. And it's just one of those things you have a whole list of things you really should do. And then you just don't do them because there's other things you'd rather do like watch Netflix or go for a walk or anything else.
[00:07:22.780] – Allan
So yeah, I should really get that generator out and get it serviced.
[00:07:26.390] – Rachel
It could be handy. But if you've never needed it, though.
[00:07:29.380] – Allan
But you do. No, because when the power goes out, we don't have water. We have a pump that pumps the water through our house and without that pressure, there's no water. So we tell people, if we know the power is going to go out, it's like you got one flush and done, so make it matter. But if we don't know the power is going out, that's when it can get a little bit dicey.
[00:07:50.440] – Rachel
Yeah, that could be helpful to have. Yeah, it's good to have one here because same thing in the middle of winter, it's not fun to lose power for an extended period of time. In the summer, we can manage, but it's a little harder in the winter.
[00:08:04.950] – Allan
Yeah. All right. Are you ready to talk about vein health?
[00:08:08.500] – Rachel
[00:08:56.920] – Allan
Dr. Mandy, welcome to 40+ Fitness.
[00:09:00.690] – Dr. Mandy
Thank you. Thank you for having me on.
[00:09:04.160] – Allan
When I was working corporate, I traveled a lot and I spent a lot of time on airplanes. In fact, I did one time did the Newark to Singapore flight, which was over 18 hours. So I spent a lot of time. And so at that point, you're reading a lot about get up and move around, wear these compression socks, do these things because you really don't want this deep vein trombosis. And so I would do the basic stuff when I was on a plane that long, moving around, doing what I needed to. But I guess I never really wrapped my mind around the fact that all of this from the spider veins and Varicose veins that I remember ladies at the lunch line had with all their compression socks to this is really just a continuum, if you will, of the same issue of vein disease.
[00:10:01.440] – Dr. Mandy
That's exactly right. That's the perfect way to put it. It's all a continuum of the same disease. And flying is such a big risk because it's a microcosm of all the risk factors for blood clots, like you mentioned, DVT, as well as vein disease in general. So anytime you're sitting in one place or standing in one place and your blood is not really pumping and moving like it should, it just sits there in the veins and isn't really circulating the way it should be. And so that can lead to blood clots in the deep veins. And it can also lead to a lot of pressure on the veins underneath the skin. And that pressure causes those veins to overstretch and allows blood to actually flow backwards. Normally, blood should only be flowing up in the veins in your legs. But due to a variety of things, being in one position for a long time, having genetic predisposition, having multiple pregnancies, variety of things like that, those veins can be overstretched and that causes blood to flow backwards, which can lead to all the things you discussed earlier, the bulging vericose veins, the pain and symptoms and swelling, and in some cases, severe cases, blood clots as well.
[00:11:14.240] – Allan
Okay, so let's walk through a few of these just so folks know what we're talking about here. So spider veins are what exactly?
[00:11:23.700] – Dr. Mandy
So spider veins are the small… They can be a purple color, light pink color. They're those little tiny, wispy veins right on the surface of your skin. They're usually very small and they usually don't bulge out. So meaning they're just flat underneath the skin, so you can't feel them. And that's the most minor form of vein disease or most minor sign of vein disease.
[00:11:45.040] – Allan
Okay. So those are just a discoloration that you see because the blood is not flowing through those little veins the way it needs to.
[00:11:51.840] – Dr. Mandy
Exactly right. Normally, those veins are so tiny, you'd never be able to see them with the naked eye. But because they've been under a lot of pressure, they're several times bigger than they should be. Even though when we look at them, they appear very small, they actually should be much, much smaller than they are. And so it's all, again, like you said, it's all part of the same process. So those veins overstretch and becoming bigger than they should be.
[00:12:13.040] – Allan
Now, Varicose veins, they actually are a little bit worse because they're bigger and a lot of people suffer from pain from these. Can you talk a little bit about what Varicose veins are? Exactly.
[00:12:23.570] – Dr. Mandy
So Varicose veins, typically are those big bulging veins that you see some people have. Maybe you mentioned your grandparents. So you could see them bulging out. They could be very large like that. They don't necessarily have to be that dramatic, though. Any vein that bulges out from the surface of the skin is a Varicose vein. So sometimes they're actually quite small, and they're those giant ropey looking veins. But if they bulge out and you can feel the vein when you rub your hands over the surface of the skin, that's a Varicose vein. And those can be more dangerous because those can lead to bleeding. Sometimes the bleeding spontaneously, or in worst case scenario, they'll actually clot and those can lead to TBTs and other problems associated with that.
[00:13:09.050] – Allan
Okay. Now, chronic venous insufficiency is the next stage along this continuum. Can you get a little bit into what that is? Right.
[00:13:17.290] – Dr. Mandy
So chronic venous insufficiency is where the big, we call the trunkle veins underneath the skin, have become too large and the little valves that pump the blood up the leg against gravity have become broken. And so instead of keeping the blood moving up, a lot of it is going backwards. And that ultimately is what causes Varicose veins in many of the spider veins you see. The root is really those bigger veins deeper inside the skin that you can't see that are allowing blood to back up into those Varicose veins and spider veins. So one way to think of an analogy I tell a lot of the patients that we see is the big veins that are deeper are like the trunk of the tree. We literally call them trunk of veins because they're like the trunk of the tree. And then those bulging varicose veins are like big branches on the tree. And then the little spider veins are like little leaves on the tree. And so the trunk is where the problem is. So when the trunk goes bad, blood just backs up into the branches and the leaves. And that's what causes all the visible veins and those big varicose veins that you can see.
[00:14:20.120] – Allan
Okay. And then, like I said, when I was on an airplane, you can get into this pretty quickly versus over a series of years, but you could still get there. Deep vein thrombosis is actually now we're starting to get into some really dangerous stuff here. Exactly right.
[00:14:36.320] – Dr. Mandy
Yeah. So like you said, that can happen for a variety of reasons. It can be, in your case, your example of being on an airplane, that's where you can get a little dehydrated on a plane, the blood just sits in those veins. And anytime the blood sits and doesn't move, it can clot. What keeps the blood from just clotting throughout your body? Part of it is the motion of the blood constantly moving. And so if it's sitting in one place, there's a much bigger risk of it clotting. So an 18 hour flight from Newark to Singapore, where you're not doing a lot of moving, you're just sitting in one place, that blood is not really moving effectively. And that's why people can get clots on airplanes.
[00:15:14.040] – Allan
And it's not really… I mean, it is the clot in the leg, but it's the clot that moves that's the dangerous one. And that causes a thing called pulmonary embolism. Can you talk about what's going on there?
[00:15:25.780] – Dr. Mandy
That's exactly right. So blood clots in the legs themselves can be painful and can cause swelling and all those things. But the really feared complication of that is an emboli, which is where part of that blood clot or embolism, which is where part of that blood clot breaks off from the leg and travels up the veins in your body to your heart and ultimately your lungs. That can cause anything from shortness of breath. Sometimes people don't even notice them. Worst case scenario, they can be life threatening and be a true surgical emergency. So those are extreme cases. That doesn't happen with most people, but it can. And it can and does happen occasionally.
[00:16:02.200] – Allan
Now, we talked a little bit about being on an airplane in the period of time that you're sitting still, and you talked a little bit about dehydration, but what are some things that we might be doing to ourselves that are causing a higher risk of these complications happening to us?
[00:16:18.680] – Dr. Mandy
Yeah. So any sedentary lifestyle, especially over a period of years. So any prolonged sitting, especially obesity, certainly smoking, those are all major risk factors for BVT. And the reason is they all injure the lining of the veins, and that can lead to clot formation and things like that. So being active, getting up and walking, moving, and being able to prevents clots. Obviously, maintaining a healthy lifestyle in terms of diet and being physical and not being overweight, all that helps prevent blood clots as well. And certainly avoiding smoking. So there are some things that are just genetic and can't be really prevented, but those are some major risk factors that can be prevented.
[00:17:05.760] – Allan
So for a lot of us, if we start seeing more of that little outward signs like the spider veins or the Varicose veins, that could very much be an indicator that we want to go get checked out and make sure this isn't something worse.
[00:17:20.150] – Dr. Mandy
Absolutely. Yeah. Especially Varicose veins, but spider veins as well can be a sign of wors vein disease, especially if they're around the feet. If you see a sudden increase in the number of small veins around the feet and the ankle, that can be a sign of pretty significant vein disease.
[00:17:37.010] – Allan
Okay. So if we notice some of that, we're going to come in to one of your clinics, the Metro Vein centers. What's going to happen and what are some of the treatments that would potentially be available to us, given where we are in this continuum?
[00:17:50.500] – Dr. Mandy
Yeah. So the first thing we do is I talk to everybody who comes in, we go through their symptoms and the problems that they're having, and we do a thorough look at what could be causing these. And then the objective test that we do is an ultrasound of the legs. So an ultrasound is very similar to when pregnant women have an ultrasound of their abdomen to look at the fetus and the growing baby. We do the same thing just on the legs. And what we look for when we look at the veins is the size of the veins as well as the direction of the blood flow. So the veins should be fairly small, only one, two, maybe three millimeters at the largest, and the blood should only be flowing up. But in the disease veins, the veins can be many times bigger than that, and the direction of the flow is actually backwards. And when those two things are there, the veins being too large and the blood flowing backwards, we know there's a disease and that needs to be treated.
[00:18:44.480] – Allan
What are some of the treatments that we could go through to make sure that just to fix it? Obviously, I'm always going to be a proponent of lifestyle, but sometimes our lifestyle can't reverse this. So what are some of the treatment options that would be available?
[00:18:55.760] – Dr. Mandy
Well, thankfully. The treatment is usually very easy. So it used to be in the past, there was a major surgery to treat these veins called vein stripping and some similar type procedures. And those oftentimes while staying in the hospital, major cuts on the leg can be very painful, high blood loss. And now we treat them in the office, usually takes 10 minutes or less to treat one vein. There's no cutting, no stitches, no surgery. People usually walk in and out on their own, go back to work a lot of times. And there are different types of treatments we can do based on where the vein is, how big it is, what the patient's goals are. And one of those is injecting a medicine into the vein, which causes the vein to shrink. Another one is called radio frequency ablation, where we use radio frequency, not radiation, but radio frequency to shrink the vein. And another one is where we inject a medicine that seals the vein called VenaSeal. And the goal of that is to prevent the blood from flowing backwards. But they're all very quick, easy procedures that insurance pays for.
[00:20:01.440] – Allan
And you want to basically, as soon as you start noticing some of the outward signs of this, you want to get in as quickly as you can, right?
[00:20:08.180] – Dr. Mandy
Exactly right. Unfortunately, veins only get worse over time. So once they go bad, there's nothing you can really do in terms of lifestyle or behavioral changes or medication that's going to reverse that. So all you can do is treat the veins to prevent that backflow of blood. And that's what we do in our office. So it's good to maintain a healthy lifestyle and do all those things. But once the veins go bad, they only get worse over time.
[00:20:33.270] – Allan
Still going to encourage you to quit smoking if you're doing that. And I'm going to encourage you to move around because that's still good for you to do. But then yeah, get in and see a specialist on this. Now, your clinics are located in New York, New Jersey, Connecticut, and Michigan. Last time I checked, you're still in those places, right?
[00:20:52.900] – Dr. Mandy
We're still in those places and we're continuing to look for new locations as well. So hopefully in the future, we'll be expanding beyond that.
[00:21:00.980] – Allan
Yeah, we're down here in Panama if you're looking for a satellite office.
[00:21:05.390] – Dr. Mandy
Sounds good to me. Yeah. Looking out my window in 25 degree weather, Panama sounds really nice.
[00:21:11.690] – Allan
It was 25 today Celsius.
[00:21:18.170] – Allan
Dr. Mandy, if someone wanted to learn more about you, learn more about the Metro vein centers and all that you do there, where would you like for me to send them?
[00:21:27.100] – Dr. Mandy
Well, they can visit our website at metroveincenters.com, and we have a wealth of information on there. It gives the locations of our offices how to contact us, but also just a lot of good information on vein disease. We try to make it as user friendly as possible. And I think people would get a lot of valuable information from that. You can also follow us on social media or on Instagram and TikTok and all those things. So we try to provide information on things on that as well.
[00:21:55.120] – Allan
I learned quite a bit reading your blog, so I do appreciate the information and the time you took to put that out there because it is very clear and easy to follow and understand what these are and how they relate to our health and fitness. And again, it can seem like it's just an unsightly thing, but when it gives you an idea that it's a bigger thing than that, you've got to take a moment and figure it out. And I'm glad you guys are out there helping provide this information and the treatments.
[00:22:25.360] – Dr. Mandy
Thank you. Yeah, it affects a lot of people. Some people estimate 20 to 30% of people in the United States. And it's one of those things, even when I went to medical school, a lot of my professors would say, it's just people get older, they get veins. And like glue it off is not a really important problem. But it is an important problem and it can cause significant lifestyle disabilities in terms of being able to exercise and enjoy normal walks in the park, even because of the heaviness and discomfort. And so thankfully, we can help treat that now very easily. And so that's not something you just have to live with. Just because you see some big veins, we can take care of all those things.
[00:23:04.620] – Allan
Well, Dr. Mandy, thank you so much for being a part of 40+ Fitness.
[00:23:08.840] – Dr. Mandy
Thank you very much for having me. I really appreciate it.
[00:23:21.420] – Allan
Welcome back, Ras.
[00:23:22.660] – Rachel
Hey, Allan. It's been a really long time since I even gave any thought to vein health, Varicose veins, or any of those things. I remember my grandparents used to have problems. I said, I think it was the Varicose veins that were very painful for them, and so they would go to the doctor and have them treated. But yeah, it's just something that hadn't been on my radar for a long time. But it's pretty important.
[00:23:48.140] – Allan
Yeah. And growing up, there's the different types of jobs I had. I worked in a library, so a lot of the librarians would have them. And I worked in a pharmacy. And so the pharmacists and clerks that work that were on their feet all day, every day, they would have them. And then, of course, then I got into travel and I'm on an airplane for up to 18 hours or more. And you just know you've got to do some things to take care of yourself. So I have the compression socks. I made a point of getting them. I was trying to stay hydrated, all those different things. But if you start to notice that you have problems, this is the one thing I didn't know before I got into this, this is progressive. If you start noticing a problem, it could be indicative of something worse happening later. So it's worth going in and getting it looked at just to make sure there's no long term problems. You can get it treated. You can start making some lifestyle changes, and that's definitely going to help.
[00:24:48.740] – Rachel
Yeah, my goodness. I didn't realize the extent of how dangerous it could be to have the veins and to pay attention when they do show up, those little tiny ones before they get into the bigger vericose or the deep vein thrombosis. That's pretty serious stuff.
[00:25:06.110] – Allan
Yeah. It doesn't happen that often. So it's not like people are just all over the place. But just something to be aware of, if you have Varicose veins or you have the spider veins and you're going to go on a long trip, do the self care. If you can talk to a doctor first just to make sure I've got these condition, how am I going to do with this trip? Because we don't take international travel on just a whim. You usually have some time and that you know it's going to happen. So it's worth it. You can go in and see a doctor, see if you can get it treated or at least know what preventative care. I still own my compression socks. I don't know that I'll ever need them to go because I think the longest flight we even take out of here is four hours. So I don't know that I'll need them again like I did when I was traveling all the time. But I had them. And so it's like, just take precautions if you think you're going to put yourself at risk because it can be pretty serious.
[00:26:05.570] – Rachel
Yeah. Interesting. It was really interesting to hear that and to be reminded. Good interview.
[00:26:10.970] – Allan
It is something I haven't talked about. And I just thought, I know this was a health problem that I knew older people got. And Tammy's mother has some leg vein problems. So it is something that you just… It's out there. It's just not super common. But enough so that if you start noticing you have a problem, go get it fixed.
[00:26:34.160] – Rachel
Yeah, that sounds good.
[00:26:36.320] – Allan
All right, talk to you next week.
[00:26:37.780] – Rachel
Take care, Allan.
[00:26:39.040] – Allan
You too. Bye.
[00:26:40.050] – Rachel
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