12 Valuable Pointers for Venous Health by Top Vein Expert

Varicose veins or venous reflux occurs when unidirectional valves in the veins don’t close properly and blood starts to travel backwards. Veins start to dilate the channels that otherwise would not be visible forming tortuous and enlarged superficial veins among other symptoms and signs. The regions of the lower extremities that are commonly affected with varicose veins are the thighs, calves, ankles, and feet. Venous reflux can also be the cause of Deep Vein Thrombosis (DVT) as well as Superficial Thrombophlebitis (SVT) which can originate  occlusive blockage of blood or non occlusive blockage. When there is presence of a blood clot, pain, swelling, and redness will occur. Patients would try to avoid movement because of the discomfort this situation causes.

In cases that are very serious, a blood clot can cause a pulmonary embolism because the clot can disconnect. It then travels in the bloodstream to the heart and lungs. When this happens, it is considered an emergency situation and rapid response is advised to prevent death. There are symptoms that can help us identify the presence of a DVT or blood clot such as:

Leg pain: leg pain can occur when a blood clot is present even when we are not moving; but pain can increase when you are walking, standing, or going up and down stairs.

Leg Swelling: leg swelling is another symptom of a blood clots. Swelling can be prominent in the area affected with a clot. Some examples are the thigh area, behind the knee area, proximal, mid, or distal calf area, and ankle area and foot.

Leg fatigue: Leg fatigue is very common with the presence of a blood clot because leg feels heavy when moving around and therefore it is painful and tiring to change position.

Increased temperature: Area affected with a clot can be warm or hot to the touch as well as reddish and swollen with discoloration in the different areas that are affected.

Dilated painful veins: For superficial veins that becomes clotted, a cord like visible dilated vein in the surface of the skin is painful to the touch, swollen, and visible.

Pulmonary embolism symptoms: If a blood clot is dislodged and travels to the lungs, it can cause symptoms that are considered severe, serious, and should be treated with emergency. Some of the symptoms are chest pain, chest pressure, increased heart rate, dizziness, vomiting, and coughing with blood.


Situations in life can get together to cause a DVT ( Deep vein thrombosis) or Superficial Thrombophlebitis (SVT). Many times if we become aware of this situations we can help to prevent what can be avoided such as:

Moving around avoiding immobility: In times when we sit for long periods of time like in a long car ride or air flight, frequent stops are recommended or walking around each hour for 10 minutes. In case where immobility is unavoidable, then the use of other methods like medical compression hoses or certain exercises involving flexion of the muscles or physical therapy must be done to improve circulation and diminish blood stasis.

Controlling body weight with aging: A healthy life style and diet is recommended to control excess weight which could cause extra pressure in the lower abdomen and lower extremities increasing this way the risk for venous disease and thrombus formation, specially as we get older or other risk factor also contribute.  

Health Habits: Avoiding harmful choices like smoking is beneficial to circulation and helps to prevent health complications related to Chronic Pulmonary Obstructive Disease (COPD) in relation to Venous Disease, Deep Vein Thrombosis (DVT), and Pulmonary Embolism (PE). Do not smoke, this will help to prevent immobility and hyper coagulability because of COPD and at the same time you will prevent risk of venous thromboembolism and venous disease.  

Pregnancy and Conservative Management: Pregnancy and the extra weight in women can also be a risk to develop venous disease, clots, and varicose veins. Be aware that there are conservative managements that can be implemented during pregnancy to manage the extra weight and venous stasis. There are also minimally invasive procedures to manage varicose veins after pregnancy offered by vein experts in Venous Disease. A vein specialist can help you get in control with the use of medical compression stockings, exercises, position management, and if necessary advanced vein treatments.  

Trauma and Operative Procedures: In times when bedrest cannot be prevented, there is risk for Venous Thromboembolism (VT) and the way it can be prevented is by taking medication that makes the blood thiner and wearing medical compression hoses.

Genetically Predisposed: Medical management is recommended if there is family history of disorders or a genetic condition that puts you at risk to develop venous thromboembolism or venous disease.


Resources to Help You With Varicose Vein Treatments


Varicose vein in relation to venous disease. Chronic Venous Insufficiency as a result of vein reflux in the superficial veins is a common disease affecting many people and maybe even for a long time without management or treatment. If the condition is not treated on time, it can lead to complication that ultimately affects and limits the life of those who suffer from this condition.

Current management options as technology advances are called minimally invasive techniques. Nowadays, minimally invasive procedures are used to treat venous reflux, replacing in great percentage surgical procedures such as ligation and stripping where a deep incision had to be made at the groin area as well as other surgical cuts at the knee and below. Some of the surgical procedures had the risk of complications like nerve and lymphatic system damage as well as long recovery time after the procedure.


Minimally invasive procedure options. One of the procedures done currently with minimal access in place of surgical procedures that were done in the past is called Endovenous Ablation. The latest endovenous ablation technique is called radiofrequency ablation which is not invasive like the surgical procedure and produces less complications than surgery as well. This procedure was approved by the FDA more than 17 years ago, back in 1999 and since then it has had excellent results and patient outcome as well as fine cosmetic results for varicose veins.

The technology behind radiofrequency ablation can be explained very easily. High frequency flow of energy targets the refluxing vein in the form of heat delivered to the tissue through a special catheter which tip is heated by radio frequency energy. The refluxing vein receiving the treatment with heat begins to shrink around the catheter as the catheter is taken out after treating each portion of the bad vein. The special catheter used is called Closure catheter which is manufactured by VNUS Medical Technologies, only one commercially available for radiofrequency ablation. There are 2 sizes of catheters that are frequently used and depending on the size of the vein, the vein expert chooses the correct size for the patient.


Procedure technique. When venous insufficiency is diagnosed in one of the superficial veins like great saphenous vein and small saphenous vein. One of the procedure choice that can be used to target the vein is radiofrequency ablation. Ultrasound imaging is one of the tools that vein specialist uses to image the anatomy and pathology. A map is also marked in the skin of the patients in many cases to help the vein specialist design his approach and point of entry. The limb is properly cleaned and local anesthesia is used to access the vein. Local anesthesia is also applied to the entire vein portion to be treated. Vein expert uses ultrasound imaging throughout the procedure to visualize the catheter advancing to the correct position to start delivering the high frequency energy far enough from the deep veins, only targeting the refluxing superficial vein. Catheter is withdrawn with exactitude by the vein specialist at the same time that each portion of the vein shrinks.

After the radiofrequency ablation then what?  After the catheter has been completely removed, the leg is cleaned and small incision is covered and rapped. The imaging ultrasound is used to check that the vein shrank and that there is no flow inside the targeted vein. There is no need to repeat this procedure in the vein that was treated because typically the procedure works very well.


Measures to take good care of the targeted vein. After the procedure and ultrasound confirmation right after the treatment, medical compression stockings are placed in the patient’s leg with a pressure of at least 20-30 mmHg. The reason why the compression stockings are used is to reduced any pain or bruising as well as to help the the legs with the venous circulation. Stockings are recommended to be in placed without removal for the first day and night. Then, they can be on only during the day and not at night while sleeping. If the patient agrees, compression stockings can be used also in both of legs, the treated and the untreated leg, to improve venous flow circulation. It is recommended to not do weight lifting and heavy exercises for two weeks after the treatment; however, normal activities and walking are important to maintain and are advised. Between 3 to 7 days after the procedure, the patient has to return to see the veins specialist for a follow up ultrasound imaging for a check of deep vein patency and closure of the treated vein. Vein expert then advises how to continue care. 

What To Do About Lower Back Pain


Lower Back Pain Overview. Lower back pain is common and at some point anyone could have an episode of it. Low back pain regarding anatomical location is considered to be below the ribs and above the thighs; but sometimes extends to the knees or below. Low back pain is typically acute or chronic and knowing the difference between the two can help to decide treatment course or development. Acute symptoms or changes come rapid or suddenly after a trauma and last for a shorter period. On the other hand, chronic symptoms last for long time could be months. Also, acute symptoms could potentially become chronic.

Lower back pain risk factors can be mentioned such as aging, trauma or injury because of overuse or strain, arthritis, fractures, herniated disc, congenital spine issue, and a disease or an illness.


Lower Back Pain Symptoms. It depends on what the real cause of the pain is and this can be diagnosed and evaluated by a Pain Specialist. Symptoms are wide and the pain can sometimes be sharp and other times dull. It can be localized to one point or it can expand to a wider area.

Leg pain can also happen because of lower back pain and it can cause tingling sensation, numbness, and knee pain or below knee pain. However, if symptoms worsen causing lack of feeling in the bowels and/ or bladder, or if lower extremities become very weak and weaker each time, or when sitting you cannot feel, then it is recommended to seek prompt medical attention for this situation.


Low back pain diagnosis. Board certified pain doctor will go in detail over your past medical history, symptoms, and regular activities. Clinical evaluation is done and imaging test results like MRIs, CT scans, and X-rays are sometimes necessary and recommended by the pain specialist to be able to target your specific complaint and try to help you.

Generally, pain specialist will ask the patient for detail and description of the symptoms and prior medical history. In other cases, imaging tests are needed as well. Sometimes it will depend on the imaging to determine whether it is just a muscular pain or more than that.

Pain can be localized as a result of back strain which means that pain does not radiate down or to the legs. Spasms can happen and soreness to the touch is common. The product of heavy lifting or a movement that is sudden or rapid and even falling can cause a back sprain.



Treatment options. Pain specialist recommendation is to try to diminish physical activity as soon as you have recognized the pain, but continue to be active by walking and taking analgesics as needed. Physical therapy is also helpful to maintain strong muscles with special exercises. What physical therapy do is prevent future injury by making the patient improve the balance and posture as a consequence of making the muscle of the body in the trunk become stronger.

For more severe symptoms, it is recommended to see a pain specialist for a multi dynamic approach. This is available and offered in the Pain Center in New York. Taking care of your back pain will help prevent bigger impact in your life like chronic back pain that can lead to complications.

Procedures that are offered at the New York Pain Institute by the pain experts are minimally invasive procedures that use ultrasound guidance for injections, x-ray imaging devices that are digitally precise for epidurals, kyphoplasty, spinal cord stimulation,  and radiofrequency ablation. These procedures lower the need for surgical procedures and shortened recovery time tremendously.

5 Tips To Help You Get Rid Of Spider Veins

Background on spider veins. Spider veins can be commonly seen in the legs and other areas of the body; however, spider veins can also be painful giving the patient a dull ache of the lower extremities especially when working for long hours in one position and sitting or standing for a long time. When these symptoms mentioned above show up, the spider veins stop being hazard free and point out a more serious underlying cause such as venous disease.

Some of the common factors that contribute to spider veins are family history, multiple pregnancies, aging, sun damaging rays, lower extremity trauma, prolonged standing, weight lifting, and being a woman. To a small degree higher number of women than men present spider vein and varicose vein.

Taking action matters. Always pay attention to yourself and what you feel. Just because spider veins are seen as a superficial concern or cosmetic issue, it is not always like that. Spider veins and varicose veins can be the cause of a more severe underlying venous disease leading to complications like leg heaviness, leg fatigue, cramping, leg swelling, itching, ulcers, and even blood clots. A vein expert and board certified in Venous and Lymphatic Medicine should evaluate you if any of the symptoms mentioned above occur.

Very importantly always maintain healthy habits and be active. It is essential to exercise somehow. Walking is the easiest way of all and can be done at any moment even in the busiest schedule if you have the physical ability. Being active maintains the venous circulation active in the lower extremities. It is an aid for venous blood return to the heart.

Maintaining a healthy diet and the exercise can help you keep body weight under control and the pressure is reduced in the legs helping the normal function of the venous circulation. Your vein specialist can also recommend and measure you for medical grade compression stockings. The use of medical compression stocking can help reduce discomfort from the venous disease complications; however, they are effective only when they are on.

Things to avoid. Avoiding prolonged standing or sitting by moving around each hour is important and prevents the pressure that we put on the veins by being still. The Calf muscle pump can help the return of the blood from the legs back to the heart. The only way this is done is by moving around without restrictions or if we are sitting calf muscle exercises can be done.

Avoid too tight clothing that limits flow circulation. Limiting the flow circulation without even noticing can increase varicose veins and spider veins development.

Avoid excessive heat that will also help to degrease vein dilation that leads to blood pooling.

The best way to know if you are a candidate to treat your spider and varicose veins is by consulting a vein specialist that will do a complete evaluation for you including imaging ultrasound avoiding this way to miss legitimate care. Veins specialist can help you design a treatment plan for your case.

Spider vein procedure and options. Vein specialist should give you advice on how to proceed in reference to treatment options and alternatives. Vein specialist will evaluate you for venous thrombosis beforehand that if present will need to be addressed as a priority to prevent complication before any other treatment is done for vein reflux. After careful review of the medical history, family history, ultrasound imaging results, signs and symptoms, and physical examination the vein expert will decide if varicose veins and spider veins are the main issue or if there is an underlying link where other veins need to be targeted first. If this is the case, advanced treatment options that are offered by Vein Experts in New York and New Jersey are Endovenous Radiofrequency Ablation and Venaseal as well as other treatments that are used in combination with them such as Ultrasound Guided Sclerotherapy and Ambulatory Phlebectomy.

General tips. For spider vein treatment a vein specialist that is board certified should perform your procedure. A prior initial examination where medical history and family history is taken as well as  completing ultrasound imaging beforehand makes the path to choose appropriate treatment plan. Before and after photos are very helpful to be able to compare and contrast. It is important to know treatment options and costs as well as medical insurance coverage if applicable. Be certain of your appointments time and prior preparation as well as how long they will take. This way you will be more calm and prepared and at the same time  delays will be prevented. Ask your vein specialist how many treatment sessions are expected and common side effects that you should be aware of.

Preventing venous diseases: Tips from Manhattan vein specialist

Can all risks of vein problems be avoided? Probably not. Genetic predisposition, medical conditions, and other factors play a role in your chance of developing venous diseases. The good news is that there are several daily lifestyle adjustments that can help in preventing venous diseases. Manhattan vein specialist, Dr. Michael Nguyen, and his team at Vein Institute & Pain Centers of America share these guidelines.

The power of motion

The body relies on a network of arteries and veins to nourish tissues. Arteries carry oxygenated blood from the heart to organs and extremities. Veins bring “used� blood back to the chest for enrichment. The movement of large muscle groups in the legs is vital to healthy blood flow. Physical activity causes these muscles to stretch and compress, helping to move blood upward, from valve to valve.

Excess pounds accumulate on the inside of the body, as well as where they are visible. Fat puts pressure on vein walls, contributing to dysfunction. Just 30 minutes of daily exercise that works the legs (such as brisk walking, running, or swimming) also benefits veins by helping to maintain healthy BMI.

Sitting compresses large veins in the thighs. Standing makes the circulatory system work against gravity to move blood upward. Long periods of sitting or standing may result in venous congestion – a buildup of fluid in veins. Remember the 2/20 rule – get up and move your feet and legs for two minutes, every 20 minutes.

Other healthy changes

  • Elevate your feet when sitting.
  • Wear flat shoes, rather than high heels (which constrict movement of calf muscles).
  • Choose clothing that doesn’t bind at the waist, legs, or groin.
  • Eat a low salt/high fiber diet.
  • Don’t smoke.

Call Vein Institute & Pain Centers of America in Manhattan at (212) 810-9525 for information on preventing venous diseases.

Recognizing varicose and spider vein symptoms in Manhattan

Varicose and Spider Vein Symptoms Manhattan NY
Vein problems can be easy to ignore, especially in the early stages when there is little discomfort or disfigurement. Left untreated, however, abnormal veins progress and multiply, and can lead to health issues. You should recognize varicose and spider vein symptoms because in Manhattan, effective treatment options are available at Vein Institute & Pain Centers of America.

Spider veins

The technical name for spider veins is telangiectasia. They are broken capillaries formed when small blood vessels close to the surface of skin dilate. Most spider veins are found on the face and legs. They are red, brown, light blue, or purple in color. Spider veins resemble sunbursts, roadmaps, or web patterns (hence the name). They rarely cause discomfort and are not a health threat, but they mar smooth skin tone on legs and can be a source of embarrassment.

Spider or varicose veins?

The major differences between spider and varicose vein symptoms include:

  • Size – Varicose veins are usually larger; more than a quarter inch in diameter.
  • Topography – Spider veins are flat, while varicose veins are usually raised, distended, ropey, and twisted.
  • Color – Varicose veins tend to have more hue – darker blue or purple.
  • Discomfort – Varicose veins may trigger symptoms ranging from restless legs to fatigue, heaviness, swelling, aching, cramping, itching, changes in skin texture and color, and leg ulcers.

Varicose veins are often a precursor to a serious condition called CVI – chronic venous insufficiency.

There is no need to let abnormal veins spoil the appearance of your legs and cause pain. You don’t have to wear slacks in summertime. Why avoid the pool, golf course, or dance floor? Learn to recognize varicose and spider vein symptoms, and call Vein Institute & Pain Centers of America in Manhattan for a range of minimally invasive treatments– (212) 810-9525.

Doctors in Manhattan helps patients avoid consequences of venous insufficiency

There is a common misperception about varicose veins – that they are only a cosmetic problem. In truth, they can present health risks. Dr. Michael Nguyen, lead physician at Vein Institute & Pain Centers of America, encourages patients to consider the consequences of venous insufficiency before choosing a treatment provider in Manhattan.

Venous insufficiency

Many people use the terms “venous insufficiency� and “varicose veins� interchangeably, but there is a difference. Venous insufficiency is failure of veins to circulate blood properly. It results in blood pooling the lower extremities, a situation that causes varicose veins.

Associated health problems

  • Discomfort –Leg pain, cramps, aching, itching, and swelling.
  • Bleeding– Skin becomes thinner as we age. This can result in spontaneous and significant loss of blood from varicose veins, with little or no pain. Even a slight bump or clothing rubbing can be dangerous.
  • ST –Superficial thrombophlebitis is inflammation of a vein just beneath the surface of skin from decreased flow of blood. The vein feels firm, warm, and tender. Skin is red and there is commonly localized swelling and pain. Without treatment, ST may progress into a severe condition called deep vein thrombosis – a blood clot in a deep vein.
  • CVI –Vein disease is progressive.Failure to treat varicose veins may result in chronic venous insufficiency. Skin becomes dry, scaly, and discolored (stasis dermatitis).
  • Ulcers –Enlarged veins do not drain fluids away from skin efficiently. Swollen skin receives insufficient oxygenation, and ulcers form. These open sores can be difficult to heal, especially for diabetic patients.

Benefits of specialized care

While a family physician may accurately diagnose vein problems, the potential consequences of venous insufficiency are serious. In Manhattan, patients trust their health and appearance to the specialized care of Vein Institute & Pain Centers of America. Call (212) 810-9525 to schedule an examination and consultation.

Manhattan doctor explains varicose vein causes

Knowing more about varicose vein causes helps patients in the Manhattan area understand how the condition develops and what they can do to minimize risk. Drs. Michael Nguyen, Namrata Khimani, and Mary So of Vein Institute & Pain Centers of America share this information.

Improper vein function

Arteries carry oxygen-rich blood from your heart to organs and muscles throughout the body. Veins return “used� blood to the heart. Veins deep beneath leg muscles are responsible for most of that flow. However, about ten percent of blood is sent back to the chest from veins near the surface, somewhat visible and not well-supported.

Leg muscles help move blood upward, but that function relies on a system of one-way valves in veins. They work against gravity, which tries to force blood downward. When valves stop sealing properly, varicosity results. Vein walls are pushed apart, resulting in chronic dilation. Blood pools, rather than moving from one valve to the next. Veins bulge and twist.

Ladies are more likely

Women are about four times as probable as men to develop varicose veins at some point in their lives. The condition of their veins is affected by hormonal changes from:

  • Puberty.
  • Birth control pills.
  • Pregnancy – Veins may appear during the first trimester, and resolve naturally within a few months of delivery. With each subsequent pregnancy, abnormal veins typically become more prominent.
  • Menopause.
  • Hormone replacement therapy.

Other contributing factors

  • Abdominal strain from heavy lifting or constipation.
  • Age – half of Americans over 50 have varicose veins.
  • Chronic (usually congenital) heart valve problems.
  • Clothing that places pressure on the abdomen.
  • Excess weight.
  • Family history of varicose veins.
  • Leg injury.
  • Sedentary lifestyle.
  • Sitting or standing for long stretches of time.
  • Smoking.

Regardless of your varicose vein causes, you will find treatment solutions at Vein Institute & Pain Centers of America in Manhattan. Call (212) 810-9525.

Managing varicose vein risk factors with the help of a specialist in Manhattan

Are some people predisposed to vein problems? What are varicose vein risk factors? Patients in the Manhattan area often pose these questions to our premier vein doctors, Michael Nguyen, Namrata Khimani, and Mary So, because they know they can trust them for understandable explanations and sound advice. Our doctors provide information to help these individuals evaluate their personal tendency to develop abnormal veins, find conservative methods to reduce their risk, and effective medical treatments to resolve vein issues.

Who gets varicose veins?

Statistically, the highest risk profile is:

  • Female.
  • Over age 50.
  • Has had at least one full-term pregnancy.
  • Overweight.
  • Smoker.
  • Not physically active.

However, it is important to note that anyone – either gender and all lifestyles – can develop varicose veins at any age. Heredity and medical conditions play a role.

Factors you can influence

The team at Vein Institute & Pain Centers of America welcomes opportunities to advise patients on simple daily changes that reduce risk of varicose veins. Here are some good-sense tips for better vein health and overall wellness:

  • Participate in cardio exercise to lose pounds. Weight lifting can cause abdominal strain that triggers varicose veins.
  • If your job requires long periods of sitting or standing, move around as much as possible on breaks. Walk the halls, take the stairs, or do foot flexing exercises that stretch and compress calf muscles.
  • Avoid constipation with a well-balanced diet that includes plenty of fiber.
  • Wear comfortable clothing that doesn’t put excess pressure on the midsection.
  • Ask for help with smoking cessation.

Ideally, we want to help you enjoy smooth, comfortable, vein-free legs. We provide counseling on conservative techniques to minimize discomfort from veins that already exist. You can count on personalized attention to find your best treatment options to eliminate significant varicose veins. Call Vein Institute & Pain Centers of America at (212) 810-9525 today to schedule a consultation.

More than unsightly: Venous insufficiency explained by a Manhattan doctor

In straightforward terms, venous insufficiency is when leg veins don’t properly return blood to the heart. The veins in your legs contain venous valves that are meant to handle this job. When they do not function efficiently, blood pools, forming spider veins, larger reticular veins, or raised, corded varicose veins. Venous insufficiency is often dismissed as an appearance issue, but Board-certified Manhattan vein doctors, Michael Nguyen, Namrata Khimani, and Mary So caution patients that the condition can be a real concern.

Risk factors associated with venous insufficiency

These circumstances may increase your likelihood of developing venous insufficiency:

  • Excess weight.
  • Standing or sitting for long periods of time.
  • (women are more prone, due to the hormone progesterone).
  • Pregnancy.
  • If you are very tall.
  • Age.
  • Heredity – a family history of vein problems.

When unsightly becomes significant

Varicose veins affect more than 30 million women and men in this country. Their tortured, enlarged blood vessels are more than a cosmetic problem. Venous insufficiency can cause discomfort and have serious consequences including:

  • A dull ache or feeling of heaviness.
  • Leg cramps.
  • Tingling and itching sensations.
  • Pain from standing.
  • Leg swelling.
  • Changes in skin color and condition on legs and ankles.
  • Ulcers on the skin.
  • Slow healing on lower extremities.
  • Chronic venous insufficiency – a long term condition.

Start improving your health and comfort with a call to Vein Institute & Pain Centers of America in Manhattan, at (212) 810-9525. We begin with a thorough physical examination and evaluation of your medical history. Ultrasound testing helps the doctor analyze blood flow and rule out other potential problems. If the diagnosis is venous insufficiency, you may only need to make a few lifestyle changes to halt its progress conservatively.

For severe cases, we utilize time tested methods and the latest effective treatment technologies including sclerotherapy, radiofrequency ablation, VenaSealâ„¢, EVLT, and ambulatory phlebectomy.