MedStar Health Blog

Varicose Veins? Know Your Options.

Vein disorders affect approximately 55 percent of American women. Fortunately, today’s minimally invasive treatments can relieve pain and improve appearance, safely and effectively.

If you have painful, unattractive varicose veins, you are not alone: More than 30 million Americans, men and women alike, are affected by the condition called venous insufficiency, which includes varicose veins, spider veins, and telangiectasias. While rarely serious to your health, varicose and spider veins can affect your psychological and physical sense of well-being—from their unsightly appearance to the feelings of pain, cramping, heaviness and fatigue that failing veins can produce. In some cases, changes in the skin, and even leg ulcers, may develop.

“Venous insufficiency occurs when the vein’s valves become damaged and cannot transport blood back to the heart efficiently,” says Misaki M. Kiguchi, MD, a vascular surgeon at MedStar Heart & Vascular Institute and a specialist in the management of vein disorders. “Family history, multiple pregnancies, occupations requiring long periods of standing, obesity and age are all contributing factors.”

Fighting against gravity, healthy veins rely upon valves to open and close tightly, keeping the blood flowing in one direction: back to the heart and lungs. When the valves cease to function as they should, some blood leaks backward and pools in the legs, straining blood vessel walls.

The result is visually swollen veins close to the skin’s surface. Unfortunately, varicose veins will not resolve by themselves and, left untreated, may worsen over time.

Approaches to the common condition range from conservative therapy to surgical intervention.

“Compression hose, which no one likes to wear, actually work by providing extra support and pressure,” Dr. Kiguchi says. “But it’s like wearing prescription eye glasses: You’re not really fixing the problem—only treating the symptoms.”

Today’s improved, minimally invasive techniques can not only relieve pain, but address the root cause of the problem and improve appearance, safely and effectively.

Radiofrequency ablation (RFA), for instance, uses a needle, a small catheter and heat to collapse varicose veins. Similarly, sclerotherapy involves using a chemical injection to close off either spider or varicose veins. For the appropriate patients, these approaches produce results that are as effective as more invasive approaches, with less pain and recovery time.

“RFA and sclerotherapy are both well tolerated,” Dr. Kiguchi concludes. “Most patients are surprised by how quick and easy the treatments are.”

And what happens to those now-destroyed blood vessels? The body eventually reabsorbs them, as other veins take over their important job: keeping blood moving back to the heart and lungs.

The process begins with a comprehensive physical exam, an ultrasound study to define anatomy and function of your veins, followed by a determination of the best treatment for your unique situation.

Take the first step, call to schedule a consult

202-877-3627

As heard on WTOP Radio:

Misaki Kiguchi, MD MedStar Washington Hospital Center

To take the first step, call 202-877-3627 to schedule a consult with Dr. Kiguchi.

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By Heidi Rosvold-Brenholtz

Sixty-nine-year-old Jeff Ferrill of Alexandria, Va., can swallow and eat comfortably again, after nearly three years of appointments to treat a rare and complicated gastrointestinal condition.

Rewind to 2012, when Jeff arrived at the Emergency Department at MedStar Georgetown University Hospital. He was vomiting, delirious and in extreme abdominal pain. The physicians’ rapid assessment revealed gastric volvulus, a condition in which part, or all, of the stomach twists more than 180 degrees.

Similar to a towel being wrung out to dry, blood supply to the stomach is compromised with the condition, commonly referred to as twisted gut or colic. Common in horses, twisted gut is familiar to equine enthusiasts like Jeff. “I never realized the same condition could also happen to humans,” he says.

While rare, gastric volvulus is more frequently seen in older adult males. Without surgical intervention, it is usually fatal. About one third of gastric volvulus cases are associated with hiatal hernia, a condition in which part of the stomach protrudes through a small opening in the diaphragm muscle and into the chest, causing painful pressure, acid reflux and other symptoms.

Jeff ’s long history with hiatal hernia likely contributed to his life- threatening condition. Fast intervention and emergency surgery by the surgical team, headed by Patrick Jackson, MD, at MedStar Georgetown was critical to saving his life and a quarter of his stomach.

“Jeff’s surgery was complicated by the severity of his condition,” explains Nadim Haddad, MD, chief of the Division of Gastroenterology and Hepatology. “A stricture, or blockage, at the surgical site between his esophagus and stomach prevented him from swallowing.”

For circumstances like Jeff’s, there are typically two options available for opening the blockage. One requires major surgery to resect, or cut and connect, the esophagus to the small bowel—an invasive option that greatly impacts a patient’s quality of life. The second option is less invasive and involves endoscopic intervention to stretch the narrowed area between the esophagus and stomach and temporarily implant stents, or miniature metal tubes, that expand to prop the esophagus open.

“Because of our team approach to surgery, we recognized the severity of Jeff’s condition and acted on it immediately, using the less invasive option,” explains Dr. Haddad. “In another setting, a surgical team likely would have moved forward with a resection.”

It’s taken Jeff three long years of hard work and persistence to recover. It’s not uncommon when treating a serious esophageal stricture like Jeff’s for the esophagus to close after stents are removed or, because of scarring, to require more stretching and stenting over many months, according to Dr. Haddad. “Treatment is very challenging for the patient and it’s very important to follow medical advice. It is not just one procedure,” he says.

Finally, after about 10 dilations, Jeff’s esophagus responded and stayed open. “With each stretching, I could swallow a little bit more,” he says. Prior to Dr. Haddad’s treatment, eating was nearly impossible for Jeff. Even with liquid supplements, followed by only specially prepared food as his esophagus began to open, Jeff lost nearly 50 pounds. Now, his weight has stabilized and he eats small portions six to eight times a day.

“My wife, Joan, and I are so thankful to MedStar Georgetown and Dr. Haddad, who has been a great teacher,” Jeff says. “He gave us detailed explanations after every procedure and made sure we understood them so we could follow his instructions.”

Cleared by his surgeons to resume regular activities, Jeff is back to his normal life, which includes long walks, gardening, bicycling, swimming and horseback riding. “They recommend that I don’t fall off a horse,” says Jeff jokingly. “But now every day is a good day.”

Make an Appointment

For more information about Gastroenterology at MedStar Georgetown, call

202-444-8541

Meet Dr. Haddad

Thyroid Cancer: A Simple Test for Early Detection

According to the American Cancer Society, more than 62,000 Americans were diagnosed with thyroid cancer in 2015, and it is the most rapidly increasing incidence of cancer in the United States.

The thyroid gland is below the Adam’s apple in the front part of the neck and makes hormones that help control heart rate, blood pressure, body temperature, and weight. While thyroid cancer is not as common as other types of cancer, it can go unnoticed because it often does not come with symptoms.
 

Risk Factors for Thyroid Cancer:

Gender: For unclear reasons thyroid cancers, like almost all diseases of the thyroid, occur about 3 times more often in women than in men.

Age: Thyroid cancer can occur at any age, but the risk peaks earlier for women, who are most often in their 40s or 50s when diagnosed, than for men, who are usually in their 60s or 70s.

Diet: Diets low in iodine can lead to thyroid cancer, but in the United States this is not as much of an issue. Most people get enough iodine in their diet because it is added to table salt and other foods. A diet low in iodine may also increase the risk of papillary cancer if the person also is exposed to radioactivity.

Without symptoms, how can I tell if I have a problem with my thyroid?

“The most common way to detect if there is an issue is through a physical exam,” Says Dr. Jennifer Rosen, MD, a thyroid specialist at MedStar Washington Hospital. “We feel the gland to identify for any lumps or nodules. If we detect any abnormalities, we will then perform an ultrasound and an ultrasound-guided needle biopsy to determine the nature of the growth. We will then consult with the patient to determine the course of action that is appropriate for them.”

The best option to ensure a cure is the complete removal of the thyroid gland, a minimally invasive procedure called a total or near-total thyroidectomy. When cancer has spread beyond the gland to other tissue surgeons may perform a neck dissection to remove the thyroid and surrounding tissue which contains lymph nodes. Early detection can help minimize this procedure halting the cancer before it potentially spreads.

And what happens once the thyroid is removed? Patients typically return to their normal routine in a few days, but will have to take a thyroid hormone supplement for the duration of their lives to replace what can no longer be provided by the body naturally.

“In the end, a cancer diagnosis can be scary, but with our expertise and treatment approach, the outlook for patients with thyroid cancer can be very good,” Dr. Rosen concludes. “We follow our patients for life to monitor their cure.”

For more information, or to schedule an appointment, call

202-877-3627

As heard on WTOP Radio:

Jennifer Rosen, MD
MedStar Washington Hospital Center

For more information, or to schedule an appointment, call 202-877-3627

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Healing Chronic Foot Pain: Platelet-Rich Plasma Injections

Whether it’s due to plantar fasciitis, Achilles tendinitis or sprains, foot and ankle pain affects over 75 percent of American adults at some point in their life.

Stretching and over-the-counter inserts and anti-inflammatories are generally the first approaches to mitigating the pain. These tactics may then be followed by physical therapy, custom orthotics or bracing and boots.

Dr. Caitlin S. Zarick, a podiatric surgeon at MedStar Washington Hospital Center, says that when these methods don’t help, there is another, low-risk treatment available.

“Treating tendon pain in the foot or ankle with an injection of platelet-rich plasma is a method that’s quickly gaining popularity,” says Dr. Zarick. “It offers a relatively quick recovery and can decrease or completely eliminate the pain.”

During the procedure, a platelet-concentrated sample of the patients own blood is injected into the affected area. This is done in an outpatient setting and takes less than 30 minutes. The platelets stimulate healing and growth of the tissue, which helps to resolve the pain.

Most people are back on their feet within a few days and completely back to normal within a month.

For a consult with Dr. Zarick or another podiatric surgeon, call

202-877-3627

As heard on WTOP Radio:

Caitlin Zarick, DPM MedStar Washington Hospital Center

For a consult with Dr. Zarick or another podiatric surgeon, call 202-877-3627.

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