How can Baird Vascular Institute at VCU Health help my heel pain?

baird heel pain

Tendons are the tough, flexible bands of tissue that connect your muscles to the bones in your joints, working together to allow all the twisting, gripping, grabbing, bending and lifting in your busy life. But repetitive pounding motions can cause microscopic tears every time you use your tendon. As you keep at it, these micro tears do not have time to heal properly and, unless treated, can get worse, making you suffer for months or years. This condition is often called simply tendinitis (tendon inflammation), but usually is actually tendinosis, tendon tissue that has simply broken down from the overuse and micro tears.

You know the feeling – it’s gotten a little worse with time. That little twinge you felt on your daily jog has now become a knife-sharp sting in the exact same spot with every step you take, every day. It’s impossible to ignore the pain…and you shouldn’t. Tendon injuries need attention. Sometimes, rest, therapy and a change in activities may ease the pain…but often the damage is permanent, and only gets worse.

Sometimes you can cope with tendon injuries with ice, rest, physical therapy and other treatments – particularly if you stop the repetitive activity and rest as soon as you feel the very first twinges. More often than not, people try coping with the growing pain, on the job or at play. However, if the damage doesn’t heal properly, or if you continue the activity and increase the damage, you risk long-term injury, constant pain – and giving up an activity you love.

We can help. Using precision ultrasound imaging guidance and a minimally invasive treatment, we can delicately remove the damaged tendon tissue and get you back to the activities you love in a matter of weeks – with little to no pain. Unlike other medical or physical therapies, this procedure safely removes the cause of the pain at the source, and unlike many traditional surgical procedures, it is far less invasive, requires far less recovery time – and has a much higher success rate. The treatment requires only a local anesthetic and a tiny incision, and is virtually pain-free. We use a targeted application of ultrasound energy to break down the damaged tendon tissue while leaving surrounding healthy tissue untouched.

We then use an FDA-cleared device to remove the damaged tendon tissue. You don’t even need stitches. The entire treatment takes about 20 minutes.

Most people won’t need any further treatment, such as physical therapy. You wear a walking boot for a week or two while the area heals. The most common post-procedure problem reported is some soreness, which can generally be treated with over-the-counter pain medication and typically lasts less than a week. In a recent study, doctors reported no other side effects. More than 25,000 people have had the treatment since 2012, with a high rate of satisfaction. In most cases, patients are back to the activities they love in six weeks or less.

Call us at (804) 828-2600 to discuss whether image-guided treatment is the right option for you.

Why do some people get varicose veins and others do not?

Baird why some varicose veins

Varicose veins, ranging from the blue splotches of spider veins to the thick, ropey and twisted dark varicose veins that can make standing and walking painful, have much in common. They’re unsightly. They can be painful. If left untreated, they can progress to serious health problems. They’re very common: 20 percent of all adults, and 50 percent of adults over 50, experience varicose veins, predominantly women.

Varicose veins are enlarged veins in the legs near the surface of the skin, ranging from tiny to large. Most people associate varicose veins with prominent, swollen, twisted, and ropelike veins wrapping their legs, often dark blue in color – and often quite painful.

Some people do not have any troublesome symptoms at first. Mild symptoms may include:

  • Swelling in your feet and ankles
  • Heaviness, burning, aching, tiredness, or pain in your legs, particularly when you stand or sit for a long time
  • Itchy skin over the vein

More serious symptoms may include:

  • Leg swelling
  • Swelling and calf pain after you sit or stand for long periods of time
  • Skin changes, such as skin color or dry, thin or scaling skin
  • Inflammation
  • Open sores or excessive bleeding after a minor injury

But why do some people get varicose veins, while others do not? Varicose veins can be caused simply by advancing age or pregnancy. They’re caused by weakened valves in the leg veins that flow blood back to your heart. When the valves weaken, blood pools and builds pressure in the leg veins, causing them to swell, expand and twist as the walls of the veins are weakened.

According to the Mayo Clinic, the following factors increase your risk of developing varicose veins:

  • Age. The risk of varicose veins increases with age. Aging causes wear and tear on the valves in your veins that help regulate blood flow. Eventually, that wear causes the valves to allow some blood to flow back into your veins where it collects instead of flowing up to your heart.
  • Sex. Women are more likely to develop the condition. Hormonal changes during pregnancy, premenstruation or menopause may be a factor because female hormones tend to relax vein walls. Taking hormone replacement therapy or birth control pills may increase your risk of varicose veins.
  • Family history. If other family members had varicose veins, there’s a greater chance you will too.
  • Obesity. Being overweight puts added pressure on your veins.
  • Standing or sitting for long periods of time. Your blood doesn’t flow as well if you’re in the same position for long periods.

The weakened valves and veins are prone to clots or hemorrhaging, which is why treatment is so important.

However, not all varicose veins require clinical treatment. In mild cases, home treatment may be all you require to ease your symptoms and keep the varicose veins from getting worse. You can:

  • Exercise to strengthen the muscles and veins of the legs
  • Wear compression stockings to improve blood flow and limit vein swelling
  • Prop up your legs to allow the blood to flow out of the legs easier.
  • Avoid long periods of sitting or standing.

Most insurers typically cover treatment of the more serious, symptomatic varicose veins; some do not cover treatment for spider veins, considering it a cosmetic procedure.

If your diagnosis indicates that you need a specific treatment, our staff will submit all relevant information to your insurance company for pre-authorization, or provide you with the approximate cost of treatment.

Call us at (804) 828-2600 to discuss your options.

 

 

 

 

 

4 questions you may have about ports

VCU Health Baird Port

Many conditions, such as cancer treatment, long-term IV medication or kidney dialysis, require frequent or constant access to your veins. Repeated needle sticks in the same area can be hard on you and hard on your veins. That’s why we specialize in placing vein access ports, so that doctors don’t have to stick you with a needle or restart an IV line every time you need treatment. That makes care easier — and your life easier.

For long term IV access, placing a semi-permanent catheter such as a “port-a-cath,” chemotherapy port or IV access port into a large vein in the upper arm or neck can make treatment easier for patients undergoing treatments that require frequent or constant vein access such as:

  • Chemotherapy or anti-cancer drug infusions
  • Hemodialysis
  • Long-term intravenous antibiotic treatment
  • Long-term intravenous feeding
  • Repeated drawing of blood samples

Unlike most other types of catheters, a port-a-cath is implanted completely underneath the skin. This type of port allows you to bathe and swim without the risk of infection. Port-a-caths can remain in place for months or even years.

If you’ve been told you need a port, you may have questions – here are 4 questions people want to know.

Is having a port painful? Having a device implanted under your skin can seem frightening to many people as is concern for ongoing pain. As with any medical procedure, you can expect some pain after the insertion, but ongoing pain is minimal, and relative to each individual patient’s level of pain tolerance. We talked to Dr. Shep Morano about ports. “You’ll notice that you can see and maybe even feel the reservoir of port area under the skin,” said Dr. Morano, “you can also sometimes feel and see part of the catheter as it runs over the clavicle and into the vein into the base of the neck.” For most people, he continued, “They don’t even notice the port after a while, it just becomes part of their body and it doesn’t bother them or even notice it that much.”

What is a cancer port pillow? A cancer port small pillow with a strap is sometimes used to cover seat belts, purse handles, cross body bags, or other straps that may rub against the port. They can be handmade or found at several online retailers.

Can my port get infected? Just like any other medical device, certain precautions must be taken to care for your port. We wrote a blog post a while back on port care, but the best thing to remember is follow the instructions from your physician and care team, and be sure to contact us if anything seems out of the ordinary.

What is a cancer port tattoo? When we went to research questions related to ports, a cancer port tattoo was something that was frequently searched online. Like many life experiences, some people commemorate their cancer journey through body art like tattoos. A cancer port tattoo is simply a tattoo that uses artwork to cover or minimize the appearance of the scar where the port was placed. Whether or not to have one is a deeply personal choice, but many cancer survivors view their tattoo as a badge of strength, or a symbol of renewal and hope.

If you need a port, or have questions, call us at (804) 828-2600 to discuss your options.

Could I be at risk for PAD?

Baird PAD risk

Vascular diseases range from diseases of the arteries, veins and lymph vessels to blood disorders that affect circulation. Among the most common types of vascular disease are peripheral vascular disease (PVD), peripheral artery disease (PAD) and coronary artery disease. The terms peripheral vascular disease and peripheral artery disease are often used interchangeably, but we discuss both here. Many of the problems we diagnose and treat involve peripheral vascular disease in one degree or another.

The most common type of peripheral vascular disease (PVD) is peripheral artery disease (PAD). Like the blood vessels of the heart (coronary arteries), your peripheral arteries (blood vessels outside the heart) also may develop atherosclerosis. Over time, the plaque buildup narrows the artery, causing increased pressure in the blood vessel. Eventually, the inside of the artery narrows so much that it restricts blood flow and less oxygen is delivered to the tissues, causing a condition called ischemia, an inadequate supply of blood that causes tissue damage.

If a fragment of this plaque from any part of the body breaks loose and clogs one of the arteries supplying the heart itself, the result is a heart attack. If a fragment breaks and blocks an artery going to the brain, a stroke will result. Narrowing of the arteries that supply the kidneys with blood can cause high blood pressure and kidney failure. Any tissue that does not have an adequate supply of blood and oxygen will, over time, become permanently damaged and die. That it is critical to diagnose and treat peripheral vascular diseases before it becomes a more serious problem.

In the early stages of PAD, symptoms include cramping and pain in the legs and buttocks, indicating poor circulation in the legs. Other common symptoms include fatigue, heaviness and discomfort during exercise or activity. These symptoms generally go away when the activity stops or you are resting. This is called “intermittent claudication.”

PAD affects about 8 million Americans. Atherosclerosis can start as early as the age of 20, and becomes more common as one gets older. By age 65, about 12 to 20 percent of the population has some degree of vascular disease. The exact cause is unknown, but several risk factors are known to accelerate the formation of fatty deposits, or plaque, in the arteries:

  • Smoking
  • Family history of vascular disease, angina, heart attacks or stroke
  • Being overweight
  • An unhealthy diet
  • Lack of exercise
  • Diabetes
  • Being male
  • High blood pressure
  • High cholesterol levels
  • Stress

Early diagnosis is critical, as people with PAD have a four to five times higher risk of having a heart attack or stroke. Unfortunately, PAD often goes undiagnosed as symptoms are often mistaken for something else.

If you want to learn more about peripheral vascular disease (PVD) and treatment options, wish to discuss symptoms or problems you may be experiencing or if your doctor has recommended that you see us for a vascular test, please contact us at (804) 828-2600 or email us.

Image Guided Tendon Treatment for Tennis Elbow

Baird tennis elbow

“Excruciating.” That’s the word every active person uses to tell us about the pain of “runner’s heel” (plantar fasciitis), “tennis elbow” and other tendon injuries. That little twinge you felt on your daily jog or practicing your forehand has now become a knife-sharp sting in the exact same spot with every step or every swing you take, every day. It’s impossible to ignore the pain…and you shouldn’t. Tendon injuries need attention. Sometimes, rest, therapy and a change in activities may ease the pain…but often the damage is permanent, and only gets worse.

Until now. Using precision ultrasound imaging guidance and a minimally invasive treatment, we can delicately remove the damaged tendon tissue and get you back to the activities you love in a matter of weeks – with little to no pain.

We’ve talked several times about image guided tendon treatment for plantar fasciitis, but what about tennis elbow? We spoke with Dr. Jeffrey Elbich about the difference in the procedure.

Q. Tell us about the difference in the image guided tendon treatment procedure on the elbow vs. on the heel?

A. The procedure is quite similar; patient positioning is essentially upright in a chair as opposed to lying down. It seems to be a less sensitive area compared with plantar work, but I still give IV medicine (moderate sedation) to maximize comfort. The  procedure time a slight bit quicker because it’s usually smaller treatment zone.

Q. How big is the incision and where is it?

A. The incision is approximately 2-3mm over the lateral (outside) elbow.

Q. What’s the recovery time?

A. For the outpatient procedure, there will be some post-procedural discomfort and swelling expected for a few days, you’ll have some lifting restrictions for about 2 weeks. A patient can expect pain relief an average of 1-2 months after the procedure.

Q. What has the patient reaction been afterward?

A. We’ve had good results with the elbow treatment ~90% success.

Q. What does your ideal patient for this type of treatment look like?

 A. Any individual that has had pain localized to specific location on elbow (lateral epicondyle), going on for more than four months, despite conservative measures and at home remedies. An office visit will confirm the pain location, as well as ultrasound to see if there is targetable tissue.

The treatment requires only a local anesthetic and a tiny incision, and is virtually pain-free. We use a targeted application of ultrasound energy to break down the damaged tendon tissue while leaving surrounding healthy tissue untouched.

Is image-guided treatment right for me?

If you answer yes to these questions, it may be time to discuss our image-guided tendon treatment.

  • Have you given up any activities due to tendon pain?
  • Have you been suffering for three months or longer?
  • Have you taken multiple steps to get rid of your pain without lasting success?
  • Are you tired of masking the pain or enduring it rather than treating it at the source?

Call us at (804) 828-2600 to discuss whether image-guided treatment is the right option for you.

What is reflux in the veins?

baird reflux

Most people associate varicose veins with prominent, swollen, twisted, and ropelike veins wrapping their legs, often dark blue in color – and often quite painful. These are symptomatic varicose veins. They develop over time, with factors such as age, family history, pregnancy, weight gain, and prolonged standing all possible contributing factors. They’re caused by weakened valves in the leg veins that flow blood back to your heart. When the valves weaken, blood pools and builds pressure in the leg veins, causing them to swell, expand and twist as the walls of the veins are weakened – and the weakened valves and veins are prone to clots or hemorrhaging, which is why treatment is so important.

We talked to Dr. Malcom Sydnor about varicose veins, and what the term “reflux” means. “When people have varicose that are large or substantial that is almost always a result of reflux,” said Dr. Sydnor. “What reflux means is that all the blood your body should flow in your lower extremities from your feet, back to your heart and lungs were it picks up oxygen and gets redistributed back through your body.”

“But sometimes the saphenous veins in the legs, which have valves in them to keep the blood flowing north,” he continued, “have valves that become leaky and have problems and then the blood starts falling south instead of moving north.”

“When that happens it’s like an upside down tree – it kind of blows out all the rest of the veins that are supposed to be feeding into it, and that’s actually what you see on the surface with spider veins, reticular veins, and varicose veins.” Dr. Syndor continued, “So, reflux in the legs is when the blood flows south instead of flowing north north the way supposed to be. When that happens, the blood becomes engorged when it sits down in your legs. You can get ankle swelling, you can get pigmentation changes, all because you have a bunch of deoxygenated blood that sitting down there and it’s not getting the chance to get back to your heart and lungs to pick up oxygen the way it should be.”

To treat more serious varicose vein problems, we offer several effective and minimally invasive solutions. After diagnosis, we will discuss your options so you can choose the treatment that best suits your needs. Although effective, no varicose vein treatment, whether surgical or minimally – invasive, can prevent new varicose veins from developing in the future. Most health insurance plans cover treatment of significant symptomatic varicose veins, but some consider treatment of spider veins as cosmetic surgery.

Call us at (804) 828-2600 to discuss your options. You may decide that beautiful legs and pain free legs are worth it.

Who’s at risk for varicose veins?

Baird whos at risk for varicose

Varicose veins are enlarged veins in the legs near the surface of the skin, ranging from tiny to large. Spider veins are small, surface veins, which, while embarrassing, are relatively minor.

Varicose veins are easy to see, especially when you stand up. If you have signs of a deep vein problem like DVT or plan to have treatment for spider veins or symptomatic varicose veins, you may need more tests, such as a vascular ultrasound exam.

We talked to Dr. Brian Strife about who may be at risk for varicose veins. “Varicose and spider veins may have a familial component or an inherited component,” said Dr. Strife. “We often take a family history when interviewing new patient to see if other members of their family suffer from abnormal or painful leg veins.”

Particular situations may also contribute to varicose vein risk. Dr. Strife continued, “Women who are postpartum may have an increased appearance of abnormal veins in the legs, as well as people who have an occupation that requires prolonged standing may be at risk of developing abnormal leg veins.”

Advanced age and obesity can also contribute to an increased risk for varicose veins. Varicose veins may also be a sign of a blockage in deeper veins called deep vein thrombosis (DVT), a serious, sometimes deadly condition in which blood clots forming in your leg veins can break loose and move to your lungs, blocking blood flow (pulmonary embolism). It is always a good idea to talk to your physician if varicose veins appear.

The good news is that most insurers typically cover treatment of the more serious, symptomatic varicose veins. If your diagnosis indicates that you need a specific treatment, our staff will submit all relevant information to your insurance company for pre-authorization, or provide you with the approximate cost of treatment.

Call us at (804) 828-2600 to discuss your options.