MedSoup 0:04
Welcome to the MedSoup podcast, where we talk about trending healthcare topics. I’m your host, Laura Schumacher, let’s dig in.

MedSoup 0:17
Right. Today we are with Dr. Jeffrey Schmidt, a Paragon Vein Care and Paragon Surgical in Concord, North Carolina. How are you, Dr. Schmidt?

Dr. Jeffrey Schmidt 0:26
Good, I’m doing well.

MedSoup 0:26
Good, good to see you. Can you tell us a little about your background with Paragon Surgical and the vein care services you provide here?

Dr. Jeffrey Schmidt 0:35
Sure. I have been practicing general surgery and vascular surgery here in Concord for about 25 years now. We have always had vein care as part of our repertoire at the practice. What’s changed a lot over the past, I would say 15 years is the technology, the ultrasound technology. Laser Technology that has allowed it to transition from a procedure that requires general anesthesia to an office space procedure

MedSoup 1:09
Could you talk a little bit more about the differences in the procedure from what it used to be when someone had to go under general anesthesia in terms of how invasive that was is compared to what it is now?

Dr. Jeffrey Schmidt 1:17
Yeah, sure it has changed quite a bit. It used to be a procedure that could only be done in the operating room with general anesthesia. And, it required a procedure that was called a vein stripping that created quite a bit of discomfort. It actually didn't work that well, and it caused a fair amount of pain and discomfort. With improving ultrasound technology and laser technology, we have been able to transition to a procedure that could be done in the office. Using small incisions and now we have ultrasounds that allow us to look at the veins in much greater detail so that we can do all of these procedures that used to require general anesthesia now we can do them in the office. We do have to numb the area per se with the solution of tumescent anesthesia. It does require a couple of needle injections of the numbing medication, but after that, the procedures is essentially pain free. 

MedSoup 2:28
That's just one of the vein care procedures that you do here? I  know that one of the things that the staff is mentioned before is it this is the one office you can come to and get everything done in one place and not have to go to different places.

Dr. Jeffrey Schmidt 3:03
Yes, a lot of what draws attention to people with vein issues is if they have the bulging veins and that is actually a surgical procedure that requires some surgical expertise to get rid of those bulging areas. Just doing the laser procedure which is done by lots of different doctors specialties can help somewhat, but to but in order to get the optimal treatment it requires that we remove those bulging veins too and that's a procedure that, really with the surgical expertise that we have it we can do it here in the office.

MedSoup 3:26
So how do you know what type of vein condition someone has?

Dr. Jeffrey Schmidt 3:31
Well, first we do a history and physical, which is I get I guess you talk to the patient you see what has been going on with their legs. What’s bothering them by the type of symptoms that they're having. And the physical exam is really important to see whether they have things that we would see with chronic changes to the skin, ulcers, bulging veins. But ultimately, what helps this directive therapy is the ultrasound. It gives us information about all of the veins in the legs, and we can see which veins are working properly and which ones aren’t. And then, we decide the treatment modalities to the veins that are not. 

MedSoup 4:19
So someone might see a bulging vein on their leg and that it’s ugly, but it’s something to be taken very seriously, is that correct? 

Dr. Jeffrey Schmidt 4:24
Yes, if you have a bulging vein in your legs, there's a reason for that, and it's because the underlying veins aren't functioning like they used to. The most common reason for that is there's some valvular dysfunction as we age. Some of the risk factors include family history, being female, pregnancies all these things can cause the valves in the veins not to function like they used to. They're not getting the blood up the legs like they used to. If you question someone a little bit more specifically you'll note and if you'll find that they have aching, some heaviness, restless legs, throbbing, those sorts of symptoms.

MedSoup 5:12
So is there a situation where someone could have venous insufficiency and their leg and not necessarily know it from looking at their legs like they may have some of those symptoms that you're discussing but they look at their leg and don’t really notice anything. 

Dr. Jeffrey Schmidt 5:31
Yes, so on that note, we actually see that a fair amount. Not everyone who has vein issues or varicose veins or the broader term venous insufficiency has visible evidence of it. Not everybody has the bulging veins. That's why the ultrasound is so important. Because lots of people have leg complaints, leg swelling heaviness of those sorts of things, now certainly, there can be other factors that are causing that, but the ultrasound really gives us the information to see what’s going on with the veins. 

MedSoup 6:01
Are there certain jobs or situations or health conditions that may contribute to varicose veins? 

Dr. Jeffrey Schmidt 6:10
Yes, if you're on your feet a lot. We see lots of patients that come in that are teachers and that are on their feet a lot. Occupations that require prolonged standing, those types of things can predispose someone to having varicose veins. And even if you don't have that type of occupation, it's the risk factors that play an important role. The pregnancies, the family history, especially in men, can play an important part of the problem. 

MedSoup 6:48
Well, I think that’s an important thing to point out that a lot of men have this condition and a lot of women may pay attention to it more because they will notice what's going on with their legs, but men may not think about.

Dr. Jeffrey Schmidt 7:00
Absolutely, I mean it’s more common in women, it can affect up to 40% of women to some degree. Men, about half that, about 20% of men in the end, we find that in men it tends to run in the family more frequently. It may not be their mom or their dad, but if you look back a little bit further, it tends to run in the family we see men that come in that have a lot of swelling, a lot of leg discomfort, especially when they are on their feet a lot throughout the day. 

MedSoup 7:33
Prior to getting a procedure when they come to see you and they have a comprehensive evaluation, did they go straight to the laser procedure or there other steps that they can take to help treat that, or how does that work?

Dr. Jeffrey Schmidt 7:48
The way that it works is that most patients that are evaluated that we feel have a vein issue per se, so then we want to get an ultrasound. So we have two full-time ultrasound sonographers in our office and we do a full ultrasound of the legs. And then once we have the information from the ultrasound we can determine the best treatment for them. If it’s minor if they have certain risk factors that we feel that the laser procedure wouldn't benefit them then we may try conservative therapy. And actually, that’s the only other option besides the procedures that we brought here is conservative therapy with prescription-strength compression hose. When we want to pursue the procedures, the laser therapies, and such, most of the time with insurance and Medicare, Medicaid, they require that we go through a period of wearing the hose for certain periods of time to see whether we get benefit from wearing the house alone.

MedSoup 9:02
As a medical procedure, the majority of the time this is covered by insurance or most insurances cover it? 

Dr. Jeffrey Schmidt 9:10
Yes, most insurance providers cover this procedure. As long as the patient is having symptoms and if there are cosmetic concerns then generally that isn’t covered. The symptoms that are associated with varicose veins, the ultrasound objective evidence that will see those are the factors that help the insurance companies justify that this is a covered treatment. 

MedSoup 9:41
What would someone do if they want to have their legs checked? Maybe they are feeling symptoms, or maybe they see some bulging veins. Do they need to have a physician referral or is it something that they can just call and schedule themselves?

Dr. Jeffrey Schmidt 9:50
Usually, they can just call and schedule it themselves. We can see the patient and talk to them examine them and then decide if we feel like their leg issues are related to a vein problem. Then if we do we can schedule an ultrasound or a lot of times we’re able to provide that the same day that we do the consultation.

MedSoup 10:20
Can someone also go to the website and request an appointment that way? 

Dr. Jeffrey Schmidt 10:27
Yes, they can go to the website and request the appointment and fill out the form and someone will call them. 

MedSoup 10:34
In addition to the Medical Vein procedure that you provide you do have some cosmetic procedures. Now, I know that these are not covered by insurance but, can you describe some of those options?

Dr. Jeffrey Schmidt 10:47
Yes, a fair number of our patients come in with spider veins and some of the what are called the reticular veins which are bluish veins under the surface of the skin that supply the spider veins. We do provide cosmetic square therapy for that. It isn’t covered by insurance but it is a procedure that we do here. When we see someone that has spider veins and that’s a fair number of patients that we see, it’s important that we talk to them and do a complete physical exam to determine whether they have some underlying issues with their veins.  Because then we would want to do an ultrasound. It’s important that we read any underlying issues that they may have with their veins. Albeit with the laser or injections, before we would do any cosmetic therapy because then they went, their results will be much better. 

MedSoup 11:46
Well because if someone has spider veins, I mean there's a reason they have spider veins so it’s not a normal thing. Who handles that in the office? Who treats the spider veins? 

Dr. Jeffrey Schmidt 12:00
Tammy Jenkins is our cosmetic therapist. She’s been with us for a long time, she does an excellent job. 

MedSoup 12:07
How would you describe Paragon and how it distinguishes itself against other vein care practices?

Dr. Jeffrey Schmidt 12:14
I think one of the things that set us apart is our team while we have a motivated team of specialists, doctors, nurses, ultrasound technicians. We’ve been working together for over 15 years. We’ve been doing this kind of started doing this right around the time that the Laser Technology started. So we've kind of got in on the ground floor and have been developing and fine-tuning the practice over the years. From a surgical perspective, you know where we're able to deal with bulging veins that generally wouldn't be treated if you went to a non-surgical practice. One of the reasons that I got involved with vein surgery and vein care, in general, is that it really provides benefits to the patient. It's a it's a relatively safe procedure that we can do here in the office and I feel that the patients get real benefit.  Their legs feel much better, they look better and I enjoy providing the care to someone. 

MedSoup 13:24
Someone who has severe issues with their veins, that can lead to very serious conditions, correct? Like ulcers or sores on the legs, what happens when it gets to that point? 

Dr. Jeffrey Schmidt 13:41
Absolutely. We see a fair number of patients that come in with leg ulcers and leg ulcers are really one of the worst manifestations of severe varicose vein problems and venous insufficiencies. A lot of times it’s longstanding, the veins aren’t getting the blood up out of the legs like they should. The blood sits down in the most dependent part of the body and creates tremendous pressure. That blood can actually leach out of the veins and the pigment in the blood causes staining in the skin. It can cause the tissue to breakdown and you develop ulcers. A lot of times these ulcers are not understood, even in the medical profession. A lot of times it is not understood that it is actually from a vein problem. And we treat these with compression hose, topical ointments, and then we also do the laser procedures in the other procedures that I have talked about. That’s one of the gratifying things that I like to do is treat the patients and allow the ulcers to heal because I can really impact someone’s life.

MedSoup 14:59
If someone has an ulcer, does that become incapacitating?

Dr. Jeffrey Schmidt 15:06
Yes, they can cause a tremendous amount of pain. Not just that but it really affects their lifestyle and creates a situation in which they have to wear bandages. These things can bleed, they can get infected, and they can cause a significant disruption in someone’s life. 

MedSoup 15:28
I think there’s probably a perception that people that are affected by venous disease or varicose veins are some of these conditions that you've been discussing is mostly for older people, but you pretty much see a wide range of ages, is that correct? 

Dr. Jeffrey Schmidt 15:44
Yes, we do see a wide range of ages. It's mostly a disease that affects people in their 40s, 50s, 60s,70s, but we do see patients even younger than that. A lot of times, women start to develop varicose veins during pregnancy. Sometimes, especially in men, if their parents have had issues with their veins that early in life that seems to predispose them.  We will see individuals that are younger coming in for vein issues. Another factor is obesity. Obesity is becoming more prevalent in our society, and that directly plays a role in the development of veins to that extra weight. It creates extra pressure on the veins and this predisposes people to having them. Vein issues like skin issues, we are seeing it more and more. 

MedSoup 16:50
So, definitely being aware of your weight management would be something that someone could do to help minimize their chances of developing varicose veins. Are there some other things that someone can do when they’re younger to help prevent that when they are older?

Dr. Jeffrey Schmidt 17:09
Yes, the main thing is trust try to maintain an active lifestyle. People that are sedentary, you know in addition to all the other health risk factors that predispose you to it, it certainly contributes to a vein or problems. People that are more active, their calf muscles, thigh muscle, they act almost like pumps. They help assist the venous circulation and that’s one of the reasons that people stand throughout the day and don’t move throughout the day in their job are more likely to be affected by this. So with weight loss, more active lifestyle. And if you have a profession that that requires you to stand up, you should get some nice, knee-high prescription-strength compression hose. That’s really the main thing you can do to make your legs feel better and help prevent the progression of vein problems.

MedSoup 16:13
That compression stops the pooling of blood flow lower in the legs, correct?

Dr. Jeffrey Schmidt 16:15
Yes, we all tend to retain fluid especially as we age. Our hearts doesn’t pump quite like it used to, our kidneys don’t filter the blood, so we all retain fluid especially towards the end of the day after we have been up all day long. People that have had vein problems on top of that, then their leg swelling is even more significant. So, wearing compression hose on throughout the day is certainly something that you can do to help with symptoms and help prevent vein issues from worsening. 

MedSoup 15:52
Does crossing your legs create a problem for vein problems later on?

Dr. Jeffrey Schmidt 18:57
No, not necessarily. 

MedSoup 19:00
I didn’t know if that was a myth or a fact. 

Dr. Jeffrey Schmidt 19:05
It’s more of a myth.

MedSoup 19:06
Okay, well that’s good I feel better now. So if someone wants to learn more about vein health or to schedule an appointment, they should call the office at (704) 262-1650 or visit https://paragonsurg.com/paragon-vein-care-aesthetics/. Thank you so much, Dr. Schmidt, for giving us more information about varicose and spider veins. 

Dr. Jeffrey Schmidt 19:27
Thank you for having me.