Articles by Tif Siragusa, MD, FACS

Tif Siragusa, MDVein and Vascular Center of Nashville5651 Frist Blvd, Suite 414 Hermitage, TN 37076

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Varicose Veins, The Good News

SEPTEMBER 11, 2012 BY DR. TIF SIRAGUSA IN VARICOSE VEINS NO COMMENT

The good news is that your timing could not be any better! Over the past decade, there have been major advances in the way that venous disease is diagnosed and treated. This means that if you are one of the 50 million Americans with varicose veins or spider veins, it is now easier than ever to say goodbye to them and move on to a happier and healthier life.

The Difference Between Spider Veins and Varicose VeinsSpider veins are very small veins that are evident on the surface of the skin as red or blue dilated veins. They tend to start off small, but as time and gravity become a factor, they often become enlarged and

increase in number over time. Varicose veins are larger veins just underneath the skin that are often visible, especially while standing.Varicose veins tend to be associated with a variety of symptoms. Recognizing these symptoms is the first key step on the road to kissing your vein problems goodbye!

Seven Vein Problems That May Indicate Chronic Venous InsufficiencyAre your veins causing any significant symptoms in your legs? If any of the following seven problems sound familiar, then you may suffer from Chronic Venous Insufficiency, and the answer is probably yes.1. There are visible bulgy veins or spider veins on your leg. This is the most simple test, if you can see them, then you have them.2. You suffer leg pain or discomfort. If you suffer from leg heaviness, pain, itching, or cramps in your legs, especially after prolonged sitting or standing, there is a good chance you suffer from Chronic Venous Insufficiency.3. Your legs feel tired or heavy. If your legs feel tired or fatigue easily after moderate amounts of activity, this may be a symptom of varicose veins.4. Your legs swell. Swelling that tends to worsen as the day moves on is often a clue that you may have a venous problem.5. Discoloration or scarring of your skin. If you have darker areas of skin in the area just above your ankles, or if you have redness in this area, it may be a symptom of Chronic Venous Insufficiency. This typically results from several years of old blood getting backed up in your veins and leaking out into the skin.6. Open wounds or ulcers along your lower legs or ankles. This problem tends to occur after experiencing a long period of skin discoloration and is referred to as a venous stasis ulcer. The treatments offered for varicose veins are also very effective in healing and preventing recurrent ulcers.

7. Restless legs or leg cramps. When these symptoms occur, especially at night, they are often associated with an underlying venous problem. Patients who can see varicose veins on their legs who also suffer from restless leg syndrome, often obtain excellent results in solving both of these problems once their veins are addressed.

Excellent Long-Term ResultsIf you can relate to any of the symptons mentioned, the question now is, “What’s the good news?” When it comes to treating spider veins, it is now possible to obtain excellent results, using products specifically developed for this problem. Previously, hypertonic saline injections were the mainstay of treatment. These injections typically provided a temporary fix, but also caused significant pain and burning during the injection. The good news is that the new medication used for sclerotherapy is less painful and more effective, producing excellent long-term results.

90-95% Success RateAfter only 3 sessions, our patients will experience approximately 90% clearing of their visible spider veins. The modern treatment of varicose veins and associated venous insufficiency utilizing endovenous ablation offers patients an effective, minimally invasive procedure that is performed in the physician’s office under local anesthesia. This technique is so effective because by sealing off the malfunctioning vein, you eliminate the problem at its source. At the conclusion of this state-of-the-art treatment, you will immediately be able to resume most normal activities, and within one week you may resume more vigorous exercising. Following your initial treatments, you can expect to have a 90-95% chance of being free of varicose veins for the rest of your life.To learn more about this highly effective method of vein treatment or to schedule an appointment, please call Siragusa Vein & Vascular

Center of Nashville at 615-884-7600 or fill out our request a consultation form.This article was written for Health & Wellness Magazine. View the original article.

Blood Thinners: A High Stakes Balancing Act

In 2011, Tennis Super Star, Serena Williams noted leg swelling and the unfamiliar feeling of shortness of breath after walking just a few feet. David Bloom was a talented, well-known, and bold journalist. He died just before his 40th birthday while covering the war in Iraq for NBC. Both of these situations were due to a pulmonary embolism, a blood clot that formed in the leg and subsequently traveled to the lungs. Once in the lungs, the clot gets lodged in one of the main arteries, shutting off the oxygen supply to that section of lung.Mr. Bloom’s untimely death was not really sudden, nor was it inevitable. He had warnings — a terrible cramp in his leg behind his knee — and he had been told to seek medical attention immediately. But as is the nature of war correspondents and youth, he ignored the warnings, took some aspirin and kept on working.Had he followed medical advice, chances are his life would have been saved by a drug that is taken in North America by more than two million people, a number that continues to grow as the population ages. That drug is a potent anticoagulant called warfarin (Coumadin). This is the drug that Ms. Williams was placed on immediately after her diagnosis of pulmonary embolism.

A Dangerous LifesaverWarfarin is a tricky lifesaver, with somewhat of a narrow margin of safety and effectiveness. Too little and it cannot do the job of preventing life-threatening blood clots. Too much and it can cause very serious and even fatal bleeding. Everyone on warfarin must be faithful about taking the right dose at the right time and having clotting times monitored at predetermined intervals.Patients who take warfarin walk a tightrope between bleeding and clotting — several things can tip the balance. It’s a difficult drug to use, with a narrow therapeutic index, but 60 years after it was introduced, it is still the mainstay of oral anticoagulation treatment.

Once a patient is prescribed warfarin, the actual effect of the drug is measured with a blood test called an I.N.R. that is either done in the hospital or in the doctor’s office. The test is a measure of how fast the patient’s blood clots and requires only a few drops of blood from a finger prick. The goal is an international normalized ratio, or I.N.R. from 2 to 3. Since it can take up to five days for warfarin to reach the I.N.R. goal, injections of low-molecular weight heparin (often Lovenox), a fast-acting anticoagulant, are often needed for a few days while awaiting the warfarin to take effect.

Tricky DosagesTo maintain the proper I.N.R., some patients may have to take different doses of warfarin on different days, say, 2.5-milligram tablets five days a week and 5-milligram tablets the other two days. The various doses of the pills are color-coded consistently regardless of brand.Following the doctor’s precise prescription is critically important. Warfarin is taken every day, preferably at the same time each day, with or without food. It is important not to skip a dose, but if one dose is missed, it is also important not to double up the next day. Always be honest with the doctor about missing a dose, since even one missed dose can affect a patient’s I.N.R. and cause the doctor to change the weekly dose incorrectly.Make sure your doctor knows what other drugs, including herbal, natural and over-the-counter remedies and vitamin supplements, you are taking, since many can enhance or inhibit warfarin’s activity. Certain foods, especially green leafy vegetables like kale, Swiss chard, spinach, broccoli and mustard and turnip greens, are rich in vitamin K and can influence the amount of warfarin one needs. Rather than eliminate these very healthful foods, the best approach is to avoid binge-eating these foods but rather to eat them as part of a normal diet, keeping their intake steady from week to week.

Deep Venous ThrombosisFinally, your doctor may urge you to avoid sports or activities that may result in a serious fall or injury. Deep venous thrombosis involving the veins in the thigh and pelvis may result in rather extreme pain and swelling as well as carry a high risk for developing long term complications in the leg. These patients may benefit from treatment above and beyond standard blood thinners called pharmacomechanical thrombolysis. These therapies involve small catheters inside the vein, are done with x-ray guidance, and are offered by only a limited number of vein and vascular specialists.

Dr. Tif Siragusa was one of the first physicians in Middle Tennessee offering pharmacomechanical thrombolysis to patients with severe deep vein thrombosis, and has been instrumental in training other physicians in the area to help care for these patients.To learn more or to schedule an appointment, please call Siragusa Vein & Vascular Center of Nashville at 615-884-7600 or fill out our request a consultation form.This article was written for Health & Wellness Magazine. View the original article.