Ep.67 These Don't Have to Be Your Momma's Varicose Veins

More than 80 million Americans suffer from vein disease.  We mostly think of varicose veins, which for some, can makes us self-conscious about the appearance of our legs, but they can be downright painful.  Pregnancy, heredity, and what do you know, menopause, can all play a role.

Cindy Asbjornsen, DO, found a passion and calling for helping people with vein disease.  She is committed to educating her patients about vein health so that they can make informed decisions about the best treatment options.  As a board-certified phlebologist, Cindy is utilizing the latest in technology to ensure optimal outcomes to not only improve her patients' self-esteem, but also their overall health and wellbeing.  

In this episode Dr. Asbjornsen and I discuss:

- How Cindy became interested in vein disease
- Defining vein disease and the symptoms
- Risk factors for men and women
- Pregnancy and varicose veins
- When it's a good idea to wear compression stockings
- The heredity link and vein disease
- Current treatments and how far we have come 
- The importance of getting help and asking questions of your provider if you have concerns about your veins

You can find Dr. Cindy Asbjornsen at:
https://veinhealthcarecenter.com/meet-dr-asbjornsen.php
Check out her website - there is some great education and patient testimonials

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Transcript

Asking for a Friend Podcast
These Don't HAve to Be Your Momma's Varicose Veins
Michele Folan
Cindy Asbjornsen, DO

vein, vein disease, venous disease, patient, legs, oftentimes, people, medicine, varicose veins, feel, symptoms, men, subspecialty, treatment, big, first trimester, ultrasound, pregnancy, problem, wearing, compression, stockings, menopause, women

Speaker 1  0:00  
until I started doing research for this episode, I had no idea how many people in the US are affected by vein disease. Namely, I think of varicose veins. But there are lots of different types of vein disease. For some of us, there are no symptoms. But let's be honest, not being comfortable wearing shorts or a dress because we aren't confident in the way our legs look is no fun. But worse, the aching pain and discomfort can ultimately be what prompts us to seek help from a medical professional pregnancy, heredity, and what do you know, menopause can all play a role here? The great news is that there are specialists out there and technology has come a long way. These don't have to be your mama's varicose veins.

Speaker 1  1:08  
Health, Wellness, career, relationships and everything in between. We're removing the taboo from what really matters in midlife. I'm your host, Michele Folan. And this is asking for a friend. Welcome to the show, everyone. When I was at a family wedding in May, I was speaking to a dear family friend who also listens to the podcast and she mentioned that she thought that today's guests would be perfect for this demographic and I'm so grateful. She put me in touch with Dr. Cindy Asbjornsen. Did I say that? Right? They were close. S B yarn, son. Okay. How do you say it again?

Speaker 2  1:57  
Asbjorsen

Speaker 1  2:00  
All right, good. She is a board certified phlebologist who is committed to educating people about vein health, so that they can make good informed decisions about the best treatment options. More than 80 million Americans suffer from vein disease. And Cindy wants to not only improve patient's self esteem, but also their overall well being. Welcome to the show. Dr. Cindy Asbjornsen. Perfect. Thank you very much. Oh, man, that's a mouthful. I know. Welcome to the show. I first of all, would love for you to just tell the audience where you're from, like where you went to school, and any other personal details you'd like to share.

Speaker 2  2:51  
I went to the University of New England, the College of Osteopathic Medicine right here in Maine, I graduated and had a interesting path to being care actually opened my practice the main health care center. 13 years ago, when I did that I had three goals, I first wanted to provide excellent patient care, which seems like it should be a goal of every medical practice out there. But secondly, Phlebology, or vein care is a very young field, I really wanted to further the field with research. And then lastly, education, not just the education of my patients, my community, my colleagues, but really of everyone. And I have found that that's actually the hardest thing to do. So I'm thrilled that you have invited me to your podcast, because this is just one of those educational outreach opportunities that helps me fulfill that goal. Thank you for having me here.

Speaker 1  3:47  
Oh, you are so welcome. I'm curious about your path. So you're a do and you got this interest in Phlebology. How did that happen?

Speaker 2  3:57  
It was a long path getting here. When I went to school, I always thought I would be a primary care physician. That was the passion that really got me to medical school. But early in my training, I realized in primary care, you manage a lot of problems, you don't necessarily fix a lot of problems. And I've always been someone who enjoys building, fixing, creating, not necessarily managing and maintaining. Early on in primary care, I realized this might not be the thing that feeds my soul. I realized that when I started, actually my program und was wonderful about getting us real practical experience right out of the gate. And I saw these amazing primary care doctors working and helping people but helping them in a way where they found the problem. They presented the problem and then they push the treatment like say blood pressure. For example. Someone comes into a well office visit and they might have some high blood Pressure, they don't even know they have that. So they're not very motivated or excited about treating it or fixing it. First, you know, you blindside somebody, you have high blood pressure. And then you say you have to take this medicine or else you're gonna have bad things happen. And all of that just was so far outside my comfort zone, I was like, I don't think I'm gonna be very good at this. So, because I was always crafty, I was actually a woodworker for a while, and I thought maybe orthopedic surgery would be a good match. So I went there. And from there, I think, had a job in an emergency room in an urgent care side of things. And every stop I had, I learned what I liked and what I didn't like. And I learned pretty quickly, I like motivated patients, like when someone comes to the emergency room, you know, they have a fishing hook in their finger, they want that out, I can do that I can help I can provide those solutions. I like motivated patients, I like fixing things. Surgery was great. But I like healthy patients being cared just was the perfect niche that fulfilled the things that I enjoy doing. And I think when you enjoy doing something, you do it in a different way. I was very fortunate to really stumble into vein health, I had a dear colleague who pointed me in this direction and said you should check it out. And initially, I was like, oh, no, I wouldn't want to do pain care that sounds barbaric, stripping things and all that. And he said, by the time you finished your training, there's going to be a whole new world of medicine called Phlebology. And if you get interested now and you learn what you can, you'll be right on the crest of this wave that's going to come and change everything. And he was just spot on. I went to my first Phlebology meeting and I felt like the clouds parted the dove saying I had found my home. It was everything I wanted in medicine. Oh, that's so

Speaker 1  6:58  
neat. I came from the pharmaceutical industry. And I used to call on vascular surgeons. When I was reading more about you and I was hearing about Phlebology. Like that is a new term to me. So I was curious when that really started to make headway within medicine.

Speaker 2  7:20  
It's a very young subspecialty. Okay, it really just got its subspecialty recognition within the past 20 years. And it's been an interesting progression because a lot of the modern Phlebology techniques have really only come into play in the last 20 to 25 years. First, the AMA accepted it then the AOA accepted it as a subspecialty of Internal Medicine, which is interesting. A lot of people think this is a surgical practice. And I'm oftentimes correcting people saying, Oh no, these are small office procedures. These are not the big open surgeries that you might think of in terms of treating things. I think as a subspecialty of medicine, we have a completely different approach than a surgical practice where we might just jump in and fix something and not see a patient again, there is that element of primary care that I thought I would always love, which is you form relationships with your patients, most people who come to this practice will be our patient for at a minimum of a year. And that might mean only being seen every couple of months, but six visits in a year you get to know people and form relationships, which is nice.

Speaker 1  8:30  
That's a nice balance to have a specialty but then also, it feels a little bit like family practice where you do develop some relationships. I like that when you define vein disease, what are the symptoms and what are people typically coming into your practice complaining about or whether they're issues.

Speaker 2  8:51  
It's a vast spectrum. Vein disease really refers to any restriction or limitation of getting old stale, deoxygenated blood back up to your heart. So we can get freshened up with some new oxygen so we can get delivered again. There's many different ways you can have a vein issue of obstruction with clotting or bow failure with insufficiency, and sometimes even just the actual pump, which is not your heart can fail. Generally speaking, we think of our calf muscle as the pump of the venous system, which is interesting, but because there's different ways to fail, there's many different presentations of symptoms. But the take home is any bein symptom is on a continuum where it might start very mild, and it can progress slowly over time. Which is interesting because oftentimes I'll see someone and they'll have a big bulky bear capacity and they'll come in and they'll say my leg aches, it's heavy. I have cramping every night I get numb by the end of the day. I'm so small and I'll say geez, I think this could be your bed. And they'll say, oh, no, I've had those veins for years, the symptoms are new. And because of that, they don't necessarily relate what they're feeling to that vein that's just always been there. So generally speaking, when a vein first fails, you might not even have any symptoms. A lot of times the early symptoms are swelling and swelling can have a lot of different causes. And sometimes you don't see big bulging veins, so people don't know that they have the vein problem. The hallmark of being symptoms is usually that they're not necessarily there or very present in the morning. But after gravity's been at play, meaning you've been standing with your feet lower than your heart for some portion of the day. There's always kind of a defined the onset, most people will say, yep, every day I go to work. At noon, I just feel like I need to sit down, I really look forward to my lunch breaks. And sometimes that's all I get for a symptom. I look forward to my lunch break. And I say, Hmm, could be, but they always progress. And because of that, oftentimes we'll see people later in the process where their symptoms are more debilitating or more bothersome. But I think the classics are pain, aching, throbbing, restless leg when people go to bed, cramping, and sometimes numbness.

Speaker 1  11:18  
Okay. And then when we look at men and women, how would their symptoms be different? Or are they

Speaker 2  11:26  
not necessarily different, but I think men present differently. And what I mean by that is, a lot of time, I'll see women earlier in the process, because they'll notice these horrifying spider veins or bulging varicosities, that they just don't like the way they look when they're concerned that something's going on. Whereas men in general tend to have more hair on their legs, and that hair actually hides those early signs, those smaller spider veins, and even sometimes the bulging varicose veins, I'll oftentimes see men when they're further progressed, some of the end stages of venous disease include skin breakdown, where people will actually get sores that just won't heal them by their ankles, and I see more men with those type of ulcers than women. I oftentimes think women are just more proactive or more in tune with their health. But then I remember, maybe it's just that it's easier to see it.

Speaker 1  12:22  
I do have a question. How often is vein disease confused sometimes with maybe a symptom of diabetes? Or are they ever related,

Speaker 2  12:34  
they are often related, but diabetes tends to wreak more havoc with the arterial side of the equation. And not just the arterial side, but the very small arteries. And with that, sometimes, it can look a lot like vein disease, and sometimes you can have superimposed venous disease and diabetes. A lot of times people will get those brown, Woody appearing shins with diabetes, which is also very common in some of the advanced stages of venous disease. Sometimes people with diabetes will just go through thinking, Oh, this is because my sugar's have been so bad. And then I'll see him and I'll say, oh, no, this is a reversible state. We can fix this, we just need to treat the venous backflow which will actually help your legs feel better all over. It's always kind of a glory moment when someone learns that this isn't something they're stuck with, they can actually turn it around.

Speaker 1  13:27  
When I think of varicose veins. I often think of women spider veins and varicose veins. But do men present with the same same exact

Speaker 2  13:35  
thing? Yes. That's very interesting. The other thing is oftentimes people think this is a problem that only happens in our senior years. But my practice, I have men as young as their teen years, I have men deep into I think my oldest male patient right now is in his late 80s. I have several female patients in their 90s and I have teenage girls, it's truly a continuum we see all ages, both sex, really, it can happen to anybody. Venous diseases, not picky.

Speaker 1  14:08  
I went to go vote yesterday. And I was coming out of the polling location, and I saw this beautiful pregnant woman in front of me. And she had very noticeable varicose veins. They were huge. And I was like, Oh, poor thing. And I wasn't sure if that was painful or not. But do those typically go away over time?

Speaker 2  14:36  
Usually not. Usually when someone has valve damage, which is oftentimes the cause of those big ropey looking varicosities. Once the damage happens, it's there. The nice thing with pregnancy at least is oftentimes after delivery, they'll get smaller, they might not be quite as pressurized, but they usually don't just go away by themselves. It's always possible if it's from the physiologic barrier, then they can go away. But more commonly they just improve a little bit and still require treatment.

Speaker 1  15:09  
Okay, our compression stockings still recommended for pregnancy.

Speaker 2  15:15  
Yes, but curiously, not so much in the third trimester like we used to say. But more in the first trimester. We know there's three high risk times in a woman's life hormonally. And that's menarche, when a woman first gets her period, and not just that first cycle, but the entire year after Well, her body actually regulates into a monthly rhythm. During that time, you can get some hormonal surges that really aren't that different from your first trimester pregnancy, that actually can do some damage to your veins. Same with pregnancy, that first trimester is really when the big hormonal shifts happen. And a lot of the damage happens. Sometimes the damage will happen in the first trimester, but it won't start to show up until that third trimester. And that's why historically, we thought that was when problems were happening. But curiously, the last hormonal challenge, as you probably are guessing, menopause,

Unknown Speaker  16:13  
I knew you're going to say that when

Speaker 2  16:16  
women start going through that final change, again, we can get those big hormonal surges. And that's what can really wreak havoc with our venous system during high risk times. And not just hormonal high risk times. But high risk times like you just hopped on a plane to Australia, high risk times 20 to 30 millimeter mercury graduated compression stockings is one of the most recognized preventive methods that we have, we always say more is better. So meaning if you can go higher, like a full set of pantyhose, that's going to do more good than just knee highs. But even a knee high is incredibly helpful. Other things that are advised and very helpful, especially first trimester of pregnancy, again, hydration status, just drinking as much water as you can to help keep those veins nice and plump. So those valves aren't challenged by little side dehydration. And then the last one, believe it or not, is just walking, I had mentioned the calf muscle pump is more or less the heartbeat of the venous system. When you walk, you create these wonderful rhythmic calf contractions, which literally massage those deep veins, the veins underneath the muscles and force that blood up and out of your legs. So walking, hydration, status, compression, and lastly, elevation, when your legs are tired, don't be shy about putting them up higher than your heart, it really, really makes a big difference. And it doesn't take a lot. I mean, even three minutes will make a big difference.

Speaker 1  17:49  
I asked this because a lot of my listeners have daughters, or maybe family members that are in that childbearing age. And I just thought this would be such great information for them to hear. But you mentioned the elevation of your legs. I was going through physical therapy. And they told me to do that at night anyway. So probably that's not a bad best practice.

Speaker 2  18:15  
I know. It really isn't. We oftentimes look at global incidences of medical issues. And it's fascinating to me that we see much more venous disease in what we refer to as our industrialized countries. But when you look at places that have low incidences, places like Central and South America and other warm climate areas, you might expect more venous disease. But those are countries that also take siesta and use hammocks. And when you're in a hammock, it's so easy to get your feet up higher than your heart and taking that midday break where you just sit down and elevate. I think it really makes a difference.

Speaker 1  18:55  
So interesting. What is the hereditary link with Vein disease? Because if your mom had them, are we more at risk?

Speaker 2  19:04  
Much more at risk? Yeah, one parent, whether it's your mom or dad, you have a 40% increase of risk both parents a 90% risk. We know there's something to do with genetics, yet we haven't been able to isolate one gene that carries a predispose or for venous disease. It's out there but we're not 100% clear about it. The other big risk factor we know that contributes is environmental risk jobs where you're standing for long periods, working on hard floors, and not being able to take those breaks where you can elevate standing or sitting much worse than positions where you're encouraged to move freely.

Speaker 1  19:48  
My mom had a couple procedures that I know of on her veins. My dad was a doctor and I think he kind of poo pooed some Have those alternative treatments? He came from the old school of vein stripping, which I want to get into a little bit. Sure. But I know at one point she was doing I think it was sclerotherapy. I know she had tried laser in her later years. So I think this might be a great time to really talk about what different modalities are employed today. And then how effective are some of those less invasive modalities? Is there any time when you really have to get in there and do something a little more invasive?

Speaker 2  20:35  
That's such a great question. I think what's really changed the world of vein care, from the days where stripping is where our gold standard is the use of ultrasound. With ultrasound, we can diagnostically see exactly where a problem starts. And when we can see that we can treat there. Whereas when we go in surgically, we don't like to treat right where it starts. Because at those connections, if we pull too hard, or we're working right next to a healthy vein, we run the risk of damaging them. With all of the modern topology techniques, we're able to get very, very close, especially with some of the endo thermals, like the laser and radiofrequency wave treatments, we can get right to the spot where healthy flow becomes unhealthy flow. And basically what we're doing is ceiling being shut from the inside, forcing the blood flow to stay where the health is, we're no longer removing the veins, we're letting your immune system do that work. And we're just setting your body up to win. We have many different modalities. And believe it or not, we still do sclera therapy, but we do it differently. These days, we might use a light or an ultrasound machine or work off a map made by an ultrasound, where we know exactly where problems start. And we can do very targeted treatments putting medicine exactly in that specific spot to seal the vein Shep from the inside. For those who don't know sclera therapy is really just a simple injection of a medicine that seals the vein shot from the inside it most sclerosing agents make the vein sticky. And then we have you wear compression stockings while it heals and it just heals basically stuck shut. But we have many different medicines, many different injectables, we have mechanical chemical types of sclerotherapy, where we have little gadgets that will scar the vein wall mechanically, and then we spray sclerosant Donna and it just helps make a perfect seal. We even use superglue in veins. Now. The technology and the progress with treatment has just gone crazy in the last 20 years. But the real I think Game Changer was just being able to see what we're doing with ultrasound. Everything I'm talking about is done through tiny little, either IV accesses or needle sticks, really never bigger than your typical blood draw. They're really truly minimally invasive.

Speaker 1  23:09  
Do you numb patients at all? Is there any kind of anesthetic? Okay,

Speaker 2  23:14  
oftentimes, we use a local anesthetic. Some of those sclerosing agents actually have an anaesthetic built in as a side effect of the medicine. Every procedure is different, every patient is different. Care is truly designed or tailored to each person's needs. And we always treat based on where a problem starts, how big it is, and how much backflow we see,

Speaker 1  23:38  
this gives people so much hope because I do believe oftentimes, we just kind of live with things because we don't really know what's out there in regard to treatments. But just knowing that there's been so much done in this specialty, it's really fascinating because I've not heard any of this. So in speaking to the family friend, this was someone who was a runner, and she was a huge runner, and she got sidelined. And when people have to be sidelined from something that they dearly love, and you can make a change in their life for them and improve their quality of life. It's gotta be so incredibly rewarding.

Speaker 2  24:28  
It really is. I love, love, love what I do. That's so

Speaker 1  24:32  
great. Do you mind sharing any patient stories that you have success stories, because I think these really resonate with our listeners. It's

Speaker 2  24:41  
wonderful that you're asking and absolutely yes, I will. But I want to do a little plug. Remember I said in the beginning, education is a big part of what we do. One of the things we started doing early on when we opened was we make little newsletters if you will, or a little magazine that we send to Primary Care Doc's then on our website, we have many of our archived issues. And the last feature in every archived issue is a little story that we call one patient's perspective. And we've made these newsletters, things like it might be athletes in vain. And we might have someone like your friend who was a runner featured if she was willing, of course, and the people in this one section one patient's perspective, tell their story. It's not a saying, Tell them how great your legs feel, it's why they came, what their apprehensions were, why they didn't come sooner, what actually got them into our office, what they learned what we did, and what their results were. They're wonderful, wonderful stories all from patients who really literally volunteered to speak out, because they want other people to know the power of vein treatment and that you don't have to suffer with what you're dealing with. As I was thinking about talking with you today, I was thinking about a patient who I saw many years ago, actually. But she stays with me. She was just a hot ticket. She was someone who was deep in the fashion industry. She worked in fashion, she was possibly the most fashionable woman I've ever known. She had that elegance and that grace that I think comes when you truly care about how you present to the world. And she came in and she always wear these lovely long pants. And in one of our early visits, she told me that she hadn't worn a skirt or a dress, she had a whole closet full of clothes that she hadn't mourn for more than 20 years, because she was so embarrassed of her legs. Wow. And she came to me because she actually had an ulcer that was actively draining a lot of fluid, and it was affecting her at work. She couldn't do her job because of this ulcer. She couldn't hide it anymore, really is what she was saying to me. We talked, we did a diagnostic ultrasound, we got her set up with treatment. And I'll never forget the day she came in wearing a short skirt. And she looked amazing, of course, but it wasn't how her legs look. It was how she felt wearing that dress or that skirt. She was back. Oh, and I think those are the stories are the kind of results that just I don't know, they fill my heart with joy. I love helping people be their best

Speaker 1  27:27  
that touches your heart. I mean, that's life changing for someone that gets their confidence back.

Speaker 2  27:33  
I've had many people say a newly sunlight, they feel like they're back.

Speaker 1  27:37  
And from the perspective of having that pain. I'm sure you have athletes and even weekend warriors that may not be performing to their best, just because they have a vein issue.

Speaker 2  27:54  
Absolutely. I try to always say I'm not going to shave time off your race scores, but your legs are going to feel so much better during that recovery phase after you work those muscles really hard. Because when you work a muscle hard, you call a lot of blood to that area. And if you don't have a good way to get that blood back up and to your heart, your legs just can't recover quickly. So many benefits of having a healthy venous return.

Speaker 1  28:21  
I do want to know about your vein health center because you said you really focus on education. How have you been able to really set yourself apart other than being so specialized that you don't? I'm not sure you have a ton of competition in Maine. But how have you been able to set yourself apart in this specialty?

Speaker 2  28:42  
It's interesting, I don't know that we actually compete for patients in healthcare. But there are so many people with venous disease, we definitively need more bein doctors, especially in Maine. But I think I've set myself apart really by just listening and doing what we do the way we do. There aren't many practices out there where you can walk in, and my first appointment with everyone is actually not even with me. I have four providers here. My two nurse practitioners usually do the first visit. And they take oftentimes up to an hour if not more, where they sit down. And they really listen. A lot of times people will come in and they'll say, you know, I have this pain that shoots down my leg or something that's completely not venous in nature. And they'll be able to take the time to hear that and understand that even if they do have the vein pain. That's not what got him here. So let's get them into the hands of the person who's going to be able to help them the most. If after that first visit. We think that what's driving their issue for being here is actually their veins. Then we set them up with a diagnostic ultrasound. And after that ultrasound, that's when I actually get to meet people and it's great because I almost feel like I know them Before I even meet them, because we do a lot of sharing within our team, the providers, none of us have a single patient, we try very hard to share every single person who walks through this practice, because so much of what we do is education. And even if all four of us are saying the exact same thing, we all say it a little differently. And one of us will resonate with one person, someone else will resonate with someone else. And from our perspective, all we want to do is get the information out there. It doesn't matter who connects. And we just want to make sure the connection happens. Yeah, but usually after I have my meeting, which is like putting the grand finale on AI, I know this person through my nurse practitioner, I know them from staring at pictures of the outside of their legs, the inside of their legs, and then I finally get to put a face to them. Those visits are really a great first true connection. And that's where we define the treatment plan and the treatment plan can be so buried, I mean, for some people, they come in after having worn stockings for 20 years. And their goal is to get out of stockings. For some people, they have a problem and they just want a little relief. And their answer could be just wearing stockings. It's completely varied and very individualized. We always try to cover what they want out of their visit what they want out of their treatment and try to deliver it to the best of our abilities.

Speaker 1  31:23  
I think we need more doctors like you. I say that because one of the things I hear most often on this show is that it's hard to find practitioners sometimes not always, but sometimes that really take the time to ask the questions to find out what the concerns are, what are the pain points, and then really show that concern of hey, I really want to help you here. We want a good outcome. This is incredibly refreshing. I love it, I would love for you to tell the listeners where they can find you if they want to check out your website, she have some great information on your website. By the way,

Speaker 2  32:06  
our website is bein healthcare.com. We are located at 35 photon road and South Portland. As much as I would love for every one of your listeners to come see me. I really want my take home message to be if you have concerns about things if your legs don't feel good if they don't look the way you want them to. If you're just worried because you have a family member with venous disease. You don't have to come see me but don't feel like you have to live with this. Talk to your primary care doctor. Talk to providers who can help and know that there is help out there know that there's many, many, many things that can be done. If somebody tells you Oh, you're just being been there wrong and keep asking. But know that first venous disease can affect your quality of life, but it can be a bigger player in your overall health. Don't ignore things that you know aren't right.

Speaker 1  33:02  
Perfect way to wrap this up. Thank you so much, Cindy. I really appreciate you being here. Thank you so much.

Unknown Speaker  33:09  
You bet. Thanks for having me.

Speaker 1  33:18  
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