Episode 5: Vein Disease: Is There a Cure?

What does it take to cure diseases, not just manage their symptoms? This is Inside the Cure from Allure Medical and its founder, Dr. Charles Moak. He explores world renowned healthcare that benefits patients and the economy. Hi, I'm Cam Carman and today we're talking about vein disease with Dr. Moak and welcome. Dr. Moak, what does it mean to actually have vein disease?

Well, let's start out with a little anatomy. So you have arteries that push your blood to your arms and legs from your heart. Your heart beats and it gives, you have blood pressure and a pulse and those are your arteries. That's something. If your doctor touches your wrist or your foot or they listen to your heart and the blood goes up to your, you know, up to your head, your arms and your legs and it's got to get its way back. Now the head doesn't have any valves and the blood naturally just drains back out. So if you hang upside down, your face will get like swollen, right? You feel uncomfortable. But for your feet, blood pushes all the way down and it's got to make its way back up. And there's a series of one way valves in the veins. They're much bigger than an artery that when the muscle, the cast contracts when you're walking, it pushes the blood up through a series of one way valves. And the calf pump, our calf muscle is responsible for about 80% of the blood flow returned to the heart from the legs. It's really the big part of it. And there's some things with negative pressure, other fluid dynamics, but in general it's this pumping through a series of one way valves. Now vein disease is where people, the typical vein disease called venous insufficiency, and that's where these valves start to fail, right? And they fail in the junctions between the muscle and the skin. There's big one way valves between the muscle and the skin. So the skin veins dump into the muscle. When that valve fails, the blood just kind of sits there. And the earliest symptom might be somebody getting varicose veins. That's very common with those where you have a ropey, twisty vein bulging at the surface. But there's a lot of people don't even get varicose veins and they just get heavy legs, they swell or ache or turn red or get discolored. So those are all still in the scope of venous insufficiency. And that's really what we're focused on. The varicose veins are really obvious and people can treat them for cosmetic reasons or because they hurt There's a lot of people who have venous disease that don't even have any visible varicot. Their doctor doesn't know what's wrong with them. They prescribe them water pills, they send them to a cardiologist to make sure their heart's good, that they're not having heart failure causing swelling or kidney problems. So a lot of unnecessary testing is being done without. Well, I shouldn't say unnecessary. A lot of testing being done with missing. The fact that we can do an ultrasound and see if the valves are broken, which is very easy to fix.

Take us through the process of curing vein disease.

So once these valves have failed, we don't have a way to, like, fix them. But you have all kinds of veins in your legs, and you also have the ability to grow new ones. So we do basically, we identify the ones that have failed, and it'll be like one or two ones in your legs that have failed out of the tons of veins that you have. And we use a procedure with either a medication that damages the vein and makes it die, or we burn it with a laser or radio frequency. And it's pretty painless because we numb it up first.

Right. It sounds painful, but it is painless.

Right. So you're numbed up and you're awake during this procedure, so you come in and get it done. So basically, we identify the area that's bad. We put like an IV in it, and then we numb the vein up. And then we deploy this thing called a radio frequency device or laser that burns the vein. And then that blood that was just kind of sitting there, it's gone, it's pushed out, and the blood just reroutes through different areas that are already established.

Now, does insurance cover the procedure?

Yeah, if they have patients that have symptoms, heaviness, swelling, discomfort, sores, it's definitely covered. Some people get cosmetic veins done, and that's not covered by insurance. And it's even a lot less complex. You don't usually have to deal with the valves when it's just cosmetic.

And talk about the age, typically, who is affected by this? I know, you know, a lot of people who are older get the varicose veins, but some people who are younger also.

Yeah, it's pretty agnostic to age. So our average patient with sick veins is 57. Okay. So that's, I think, relatively young.

Right.

So it's not really an elderly disease. So people that get it typically get it younger in their life. So women will typically get it earlier than men. So a man might not have symptoms until he's 60 and a woman might when she's 20 or 30. But we see a lot of people that are young that have really advanced disease. So it's not really age dependent. It is genetic dependent. So both your parents had venous insufficiency. About 95% chance you will, and you probably get it at a younger age. And we do see older people sometimes because there was nothing available 10 or 20 years ago besides surgery. So they kind of put it off. So by the time people come in to see us, they've usually had them for more than 10 years.

So as we wrap up, let's talk about your patients and how they feel afterwards and when they suddenly are there better and their lives are changed.

There's a little bit of post procedure after procedure discomfort, but it's pretty mild. It doesn't keep you from doing your normal stuff. So you might have some aching or something afterwards. But most people would never even take a Tylenol for it. It's not that much. But that heaviness discomfort actually goes away very, very quickly. Within a few days, it's going away. There's a new technique, it's called Venaseal. It's actually a type of a glue that doesn't require even the anesthetic part is painless. And they feel better actually once they get off the table.

Right. Immediately.

Yeah.

Right.

So that's pretty exciting. It's new enough that we don't have a lot of experience with it yet. It's been about probably they started investigating 10 years ago. It's been on the market, covered by insurance for the past couple years.

That's wonderful. Well, thanks, Dr. Mok. As usual, you've given us some great insight. Appreciate it.

Thank you.

Thanks for listening to Inside the Cure with Dr. Charles Moak. See you next time.