- About Us
- Vein Conditions
- DVT (CLOT)
- WOUND CARE
- PATIENT FORMS
- Laser Training School
We know that the hallmark sign of venous insufficiency is a patient’s tendency to elevate their legs as much as possible. Observe….
1. Wear compression stockings. According to www.urbandictionary.com, kankle is “a term referring to the body part where the ankle is located, but is not visible due to swelling or a condition preventing the ankle bones from being visible. Kankles are a humorous term referring to the absence of an ankle where it appears the lower leg grows straight into the foot.” Wearing compression stocking can prevent the ankles from getting swollen in the first place. There are even Victoria Secret styled compression stockings, so there is NO excuse not to wear one!
2. Keep your legs elevated. Guys do this all the time, at work or home, putting their feet on their desk or coffee table in front of couch. Women are more self conscious about putting their legs up on their work desk. Do yourself a favor. Get yourself a foot stand under your desk and keep your legs elevated. Repeated swelling can cause you to have more fat deposit on your feet and ankle. Before going to bed, keep your legs elevated above 3 to 4 pillows to drain all the day’s toxins and lymphatics. Your legs will feel much better in the morning.
3. Do weight workouts, but NOT the legs. Even doing cardio can put strain on your legs, stimulating it to get bulkier or irregular. Instead, focus more on upper body and core muscles, and keep the rest in between sets short to get the maximum cardio effect, and watch those legs get sexier. If you love cardio or leg workouts, wearing a tight compression stocking for support during the workout.
4. Avoid sun or tanning booth. Tanning may make your skin look better temporarily, but in the long run, it will result in sun spots, skin cancer, lumps and bumps, and discolorations on your legs. Use a high SPF sun screen when going outdoor this Summer. Getting a melanoma and having leg skin excised will leave ugly scars.
5. Avoid high heels when you can. High heels place your feet at a static position, compromising its venous and lymphatic blood return. If you must wear high heels, get weekly feet massages to promote healthy circulation and drain lymphatics.
6. Get laser hair removal instead of shaving or waxing. Laser hair removal has tremendously improved in its technology and safety as well as prices. Shaving or waxing damages the skin, cause folliculitis, and promotes more hair growth. In addition, laser hair removal will tighten up the leg skin collagen as well as smoothing out the discolorations. Call us today for a free consultation. It will likely be same or lower price than waxing.
7. Drink plenty of water. Yes, yes I know. Water may make your legs swell. However, if you have already implemented the above recommendations, water will only help washing out toxins and lymphatics from your legs, leaving them feeling healthier and looking slimmer and sexier.
8. Take high dose multivitamins. Today’s food are genetically modified and are lacking in vital nutrients. They are merely empty calories, thus giving us obesity epidemic. Taking high dose multivitamins will allow all the enzymes in the body to function better and keep your legs healthier.
9. Get evaluated by a vein specialist. If you have family history of varicose veins, leg heaviness, cramps, charlie horse, restless leg symptoms, or have prominent varicose veins, it’s better to get your legs evaluated and treated early before harms are done to your legs. A duplex ultrasound examination will show you any veins that are not functioning and are dilated. Once varicose veins set in, the treatment becomes more complex and difficult.
10. Get weekly massages. Massage envy has good membership plan. Or get yourself a calf and feet massage to use daily. Massages improve circulation, encourage lymphatic flow, and keep your legs at their best.
I’d like to present to you a patient that I am currently treating because I find him to be such a motivating story for all those of you out there that have poor health. SS is a friendly 33 yrs old caucasian male, weighing at 350 lbs, Height 5’11″ presenting with bilateral venous ulcers, and left posterior thigh pressure ulcer. The patient recalls several years history of leg skin progressively becoming darker and open wounds developing, as well as occasional bleeding from the veins in the shower. He is paraplegic and wheel chair bound since 7 years ago when a car accident left him with T11 spinal cord injury. Patient denies any fever or chills, but does complain of weeping and fluid leaking from the ulcers on his legs, as well as mild redness and warmth extending above the knees. The great encouraging thing about this patient is that even though he is paraplegic and bound to wheel chair to move around, he still works full time as a Financial Company Customer Service Representative! I felt strongly that I needed to help him get better and prevent these ulcers from coming back.
His Past Medical History is complicated by High Blood Pressure, Restless Leg Syndrome, Bladder Problems, and Arthritis. His Past Surgical History is marked by the T11 Spinal cord surgery in 2006. His medications include Lisinopril/HCTZ, Fish Oil, Multi Vitamins, and Ciprofloxacin. No Known Allergies to Medications. Family History positive for stroke, heart attack, varicose veins, and venous insufficiency. His Social History is negative for cigarette smoking or drinking alcohol.
On my physical examination, SS had 5x2cm large Stage II pressure ulcer over the Left posterior thigh, where he was putting most pressure while sitting at his job. His legs had bounding palpable pedal pulses, both DP and PT, bilaterally. There was extensive hyperpigmentation and several minute punctate ulcerations bilaterally, as well as signs of recent bleeding. Venous duplex Ultrasound performed showed the following:
Lower Extremity Venous Duplex Exam
Indication for exam: Varicose vein / Swelling / Heaviness / Restlessness / Throbbing / Itchiness / Tenderness / Eczema / Venous Ulcer / Leg Cramping / Disruption of activities of daily living
Right and Left Deep and Superficial Lower Extremity Venous Duplex Exam was performed using Brightness Modulation, Color Flow, and Spectral Analysis, following ICAVL protocol with the Patient standing up when measuring the Reflux and Diameter of the Superficial Veins under Hydrostatic Pressure.
Right Lower Extremity:
Right Common Femoral Vein is with adequate augmentation and compression indicating adequate flow. All areas demonstrate complete compression of vessels with spontaneous and phasic flow veins augment with no evidence of deep venous reflux.
Right Greater Saphenous Vein is patent and is 7.9/7.0 mm at its origin. Its maximum diameter is 8.9/9.2 mm. There is evidence of 3 sec reflux noted along the right Saphenofemoral Junction, which is present throughout the right Greater Saphenous Vein. There’s no aneurysm noted. There is absence of thrombosis or vein tortuosity which would impair catheter advancement.
Right (Duplicate) Greater Saphenous Vein is patent and is 9.7/7.5 mm at its origin. Its maximum diameter is 9.7/7.5 mm. There is evidence of 3 sec reflux noted along the right Saphenofemoral Junction, which is present throughout the right Greater Saphenous Vein. There’s no aneurysm noted. There is absence of thrombosis or vein tortuosity which would impair catheter advancement.
Right Popliteal Vein shows adequate augmentation and compression indicating adequate flow. All areas demonstrate complete compression of vessels with spontaneous and phasic flow veins augment with no evidence of deep venous reflux.
Right Lesser Saphenous Vein is patent and is 7.6/7.0 mm with 3 sec reflux noted at the right Saphenopopliteal junction. There’s no aneurysm noted. There is absence of thrombosis or vein tortuosity which would impair catheter advancement.
Right Posterior Arch Vein is patent and is 8.5/6.6 mm with 3 sec reflux noted at the right Saphenopopliteal junction. There’s no aneurysm noted. There is absence of thrombosis or vein tortuosity which would impair catheter advancement.
Perforators are incompetent on # 3 (Boyds) 7.5 mm in Diameter.
No evidence of any DVT and SVT of the right lower extremity.
Left Lower Extremity:
Left Common Femoral Vein is with adequate augmentation and compression indicating adequate flow. All areas demonstrate complete compression of vessels with spontaneous and phasic flow veins augment with no evidence of deep venous reflux.
Left Greater Saphenous Vein is patent and is 9.1/8.5 mm at its origin. Its maximum diameter is 9.1/8.5 mm. There is evidence of 3 sec reflux noted along the left Saphenofemoral junction, which is present throughout the left greater saphenous vein. There’s no aneurysm noted. There is absence of thrombosis or vein tortuosity which would impair catheter advancement.
Left (Duplicate) Greater Saphenous Vein is patent and is 7.8/6.9 mm at its origin. Its maximum diameter is 7.8/6.9 mm. There is evidence of 3 sec reflux noted along the left Saphenofemoral junction, which is present throughout the left greater saphenous vein. There’s no aneurysm noted. There is absence of thrombosis or vein tortuosity which would impair catheter advancement.
Left Popliteal Vein shows adequate augmentation and compression indicating adequate flow. All areas demonstrate complete compression of vessels with spontaneous and phasic flow veins augment with no evidence of deep venous reflux.
Left Lesser Saphenous Vein is patent and is 8.4/8.2 mm with 3 sec reflux noted at the left Saphenopopliteal junction. There’s no aneurysm noted. There is absence of thrombosis or vein tortuosity which would impair catheter advancement.
Left Posterior Arch Vein is patent and is 7.2/5.5 mm with 3 sec reflux noted at the left Saphenopopliteal junction. There’s no aneurysm noted. There is absence of thrombosis or vein tortuosity which would impair catheter advancement.
No evidence of any DVT and SVT of the left lower extremity.
RT. and LT. (Network) Mutli. Subdermal and Anterior Medial Saphenous Communicating Tributary Veins were visualize travling Anterior to the Saphenous Sheath with color flow with in the (Thigh) and (Calf) area.
Patient would benefit from laser ablation of (BL) Greater Saphenous Vein , (BL) Accessory Greater Sapheous Veins, (BL) Lesser Saphenous Vein, (BL) Posterior Arch Vein, (BL) Anterior Medial Saphenous Communicating Tributary Veins, RT. Side # 3 Perforators, Sclerotherapy. All risks, benefits and options will be discussed with patient at office visit.
Dr. Kiup Alex Kim.
So we started treating this patient as a whole. First was the cellulitis. We cultured his ulcer, and treated him with Bactrim DS for sensitive MRSA, and the redness and warmth went away.
Simultaneously, we treated his leg swelling and weeping with Unna boots, and his Left posterior thigh with cushion gel dressings. The pressure ulcer shrunk in size and venous ulcers almost all disappeared.
We also started him on Phentermine and Topiramate for weightloss to help lessen the pressure on his legs as well as his thigh.
The patient’s insurance understood the serious condition of this disease, and authorized his treatment. This is his leg after our first evlt of the GSV on left leg which was more symptomatic. It shows the hyperpigmentation, and recent bleeding varicose veins as well as puffy swollen feet.
My hope is once we treat his venous insufficiency, obesity, and allow him to wear compression stockings, we can prevent these ulcers from coming back and threatening his limbs or life.
Lately, I have been trying to convert my clinic into Arizona’s very first completely paperless medical office without spending a fortune on IT costs. The conclusion? It’s difficult, but not impossible. Based on my extensive research (google search being the source of all my knowledge), as well as reading through pages after pages of legal documents and precedents, I will try to implement the following.
We signed up a secure Cloud based corporate server system using google apps, and every staff gets a secure company email account. I have no servers in my office; Just computers connected to the internet. Any email sent to or from these email accounts are easily set to require TLS (Transport Layer Security (TLS), which is one step more advanced and useful for medical setting than Secure Sockets Layer (SSL). Every user gets the entire google suite of Drive, Document, Spreadsheet, Forms, Sites, Vault, etc application. Thus I never have to spend a dime on expensive Microsoft Office licenses. Plus, there are numerous very low cost third party google apps that can give you more protection, auditing, access, exposure control, more things to do like tracking patients and customers and vendors, and more reporting capabilities depending on your paranoid level. I have my documents secured with CloudLock, and external emails secured with Zsentry which is HIPAA certified!
I know you’re saying “Wait a minute. That’s too many details for me to handle!” Yes, that’s true, but there are multiple solid companies and vendors behind each services you need, and that’s a GOOD thing for you. You can change the vendor tomorrow, and not have to upgrade your entire work flow. THAT is the benefit of having modular components to implement your office system. If tomorrow brings a new law and regulations, you can easily adapt by changing to a vendor or service that best fits your need! If you rely on one company to handle all your needs, that company controls you. If you want my help, I’d be more than happy to help out a colleague setting it up.
The reason a secure server system is as fundamental as your EHR, is for business communication. We are constantly communicating with each other, with patients, with referrals or referring doctors, labs, imaging centers, lawyers, governments, and others. If all your faxing, emailing, document sharing, and restricted employee files are easily and securely done, you’ve already won the game. You click a few administrator rules, and that’s your policy and it’s implemented. Use your prudence and common sense. I have often received encrypted emails but they are cumbersome and places excessive strain on users. TLS or SSL achieves types of security that HIPAA requires.
Next is a VOIP system. A cloud based voip system avoids the infamous expensive “IT guy,” and not be at his or her mercy. You may still hire an IT guy, but you get to tell them to make all these components work and get the best ones, or else you get someone else to do the job. A good VOIP will allow you to save on ridiculous archaic analog phone systems, and just use your high speed internet to take care of all your needs. We have both internet and voip through Cox. The telephone system can be configured through a website to set voice messages, what other phones to call, on-call attendants, and myriad of different configurations that gives YOU the total control. No more paying after hours answering services for something you already get in a good cloud based VOIP provider. You program a couple of rules and who to direct the calls or text messages to, and it’s done.
Next is the insurance. Unfortunately, when it comes to pre-authorization for procedures, the insurances are still using fax and re-fax rules. But at least you can get all your own internal documents organized, and fax securely via google apps emails. Email over the letters of medical necessity along with other documents for a doctor or your staff to review, sign electronically, and you can even Notarize them electronically. We use SignNow. Then when everything has been reviewed and signed off, they can be faxed from your email through secure encrypted electronic fax system.
Other nuances include capturing data when interacting with the patients. Vitals, history, stories, complaints. They can all be recorded in a simple dictation system using staff’s phones and simple apps, and have them be automatically emailed to your transcriptionist, off-shore. Everything comes back typed, and your staff assigns the data to correct patients. Done. Other options are using tablet or laptop with EMR that allows easy data entry on the fly. When a physician goes in to talk to the patient, a M.A. follows them and documents in the computer everything the physician speaks and tells about examination results, procedures, etc. That may require some training, but we’ve all taught interns before.
This was a brief overview of how I streamline my office using as much ancillary support and technology to make the work process seamless and smooth. I’d much appreciate other inputs and suggestions! IT is not just a technical thing. The entire work flow and communication process are important. Now we can dramatically revolutionize our old ways, and allow doctors to focus on what they love doing the best: taking care of patients.
Please fill out all the forms below online. Anything entered is electronically secured and encrypted for your privacy. Please help us go Green, and reduce papers, ink, and save the earth. Thank you.
2. Patient Demographic Info
3. Comprehensive Secure Medical Questionnaire
Please provide your phone number, email address, and copy and paste your resume into the field, and we’ll email you with a response. Please do not call our office. We’ll be scheduling all our interviews via email. Thank you. Read more ›
Lasers and intense pulsed light devices selectively damage or permanently destroy abnormal veins with intense heat energy and are used to treat small spider veins where a needle cannot be used. At Bellagio Clinic, our laser expert nurses and doctors will formulate the optimal laser energy and duration settings to achieve the ideal result.
What to expect after spider vein removal / reduction
There are few but most people do not experience it. Just the same, you should know what could happen. The first side effect is hyper pigmentation which occasionally develops when the vein is injected. Fortunately, it does not last that long and normally fades. A very rare side effect is hypo pigmentation in skin phototypes II and III, they also disappear spontaneously (but can take up to 6 months). Your skin may not turn dark but can turn reddish and have inflammation. This happens when multiple veins develop around the injection site. This will disappear in one week. Blisters may appear during 2-4 days, but will dry and fall off (10-14 days) without leaving marks. The last spider vein treatment side effect is superficial phlebitis. This is very rare and when it does happen, the patient will feel pain and the veins will be red, swollen and engorged.
Plain or spider facial telangiectasias disappear in 80% of the cases alter a single session. The immediate extinction is observed while the laser is applied, by vessel coagulation. No purpura effect. In 15% of patients two treatments will be necessary. About 5% of patients will need three sessions.
Before/After Care Recommendations
It’s advisable to use topical glucocorticosteroids. For example: Clobetasol dipropionate cream Immediately after treatment, if there is an intense histamine reaction to the laser treatment. In general, using Aquaphore or antibiotic ointments suffice in optimizing healing time. It’s recommended that you use sun screen for at least 4-6 weeks afterwards in order to avoid color changes of the treated area. If you experience any of these side effects, it is best to call the office immediately and schedule an office visit to examine this further. You should avoid certain activities and taking certain things a week before surgery to prevent any problems. This includes not taking any medication to include antibiotics and not applying any lotion especially in the areas where the doctor will work on. Avoid any extreme heat or cold after surgery. Avoid any type of strenuous physical activity and exercising until advised by your surgeon to do so. If necessary treatment can be repeated, after 4-6 weeks, not before.
Bellagio Vein Clinic
Chandler Location: 333 N Dobson Rd, Chandler, AZ 85224
Phoenix Location: 2601 N 3rd St, Suite 203 Phoenix, AZ 85004
Privacy and HIPAA Policy