Total Body Surgical Blog

Varicose Veins....an ugly term for an ugly and troublesome condition.  Almost everyone remembers a relative that had or has hideous looking legs.  When they show them, the kids run for the hills.  Today, I would like to discuss why the problem occurs and what can be done about it.  Also, a little history to show you how things have changed.....they are a whole lot better today!!

Varicose veins are a wastebasket term for chronic venous insufficiency.  Both are big descriptions for a complex problem.  The issue can range in severity from small spider veins, which most people have a smattering of, to the big ropey veins, to swelling in the lower legs, skin color changes and even leg ulcers that won't heal.

  A picture of spider veins.

  Picture of large varicose vein.

To be nice, I won't show an ulcer, they are ugly!!

The cause of these problems are usually hereditary, but can occur from leg injuries, clotting in the legs, and other factors.  They are made worse by working conditions, pregnancy, but usually not caused by them.  Of course, the human vascular system starts with the heart.  It pumps blood rich in oxygen to the rest of the body.  The blood travels around and exchanges oxygen for CO2 (the byproduct of the cells working), it then must get back to the lungs for the exchange of CO2 for new oxygen and the process repeats.  The veins don't have the heart to pump the blood, so, the musculature of the extremities compress the veins and make the blood move towards the chest and lungs.  In the normally functioning vein, there are valves present that allow the blood to only go towards the chest....up....against gravity that wants it to go down.  In the diseased vein, these valves don't work and the blood pools and stays in the leg or arm.  These pictures are a good visual for how this works.

If the valves do not work properly, pressure builds.  This is reflected in the branches of the larger veins and they enlarge over time creating the large varicose veins we have all seen.  These become painful as they stretch the surrounding connective tissue and the pressure, combined with the lack of flow causes the iron from the blood to break down in the skin.  This can lead to rust colored changes in the skin, rashes, and eventually skin breakdown. 

Treating this problem has changed significantly in the last decade or so.  Since the problem is usually the saphenous vein (kind of an intermediate vein in the leg), we used to remove it surgically and called it stripping.  Many have heard horror stories about removing these veins, having general anesthesia and the recovery time required.  With modern ultrasound and laser technology we can now remove this vein from the circulation without stripping, without general anesthesia, and without a long recovery time......great news!!  We do them in the office, patients walk, in then walk out. There is almost no down time...if any.

For the large, tortuous, ugly branches, we remove them through tiny incisions, as small as the end of a pen.  Because we have stopped the flow into this vein by lasering the saphenous vein there is very little blood loss and again, almost no down time.  The little incisions heal nicely and are not noticed after a few months.

Most of the time, if you are having symptoms of pain, swelling, skin color changes and have a visible varicose vein, insurance will pay for the procedure...after jumping through a few hoops.  Spider veins are considered cosmetic and are not covered though we can treat them with injections or laser.

So if you have vein issues, come see us today at Total Body Surgical where we can help.  Our goal is to try to make your legs look and feel as normal as possible. Call 918-786-7780 today!!

It hurts when I eat!!!  This is a common complaint I hear almost daily.  As you know, at Total Body Surgical, we not only take care of Cosmetic Surgery patients, Vein patients, and obesity problems but General Surgical problems too.  Many times, procedures can be combined to tackle two problems at once. 

Abdominal pain comes in all forms and everyone experiences it differently.  Pain in the right side of the abdomen under the ribs is a very common problem.  This type of pain is usually the indicator of a failing gallbladder.  It starts with pain after fatty foods but may advance to pain after any food.  This pain may be felt in the back, usually at the tip of the shoulder blade.  It may also present as indigestion.  The pain usually starts as mild discomfort but as time goes on, it becomes more severe with spells becoming closer and closer together.  It may be associated with nausea and vomiting as well as changes in bowel activity.

What is a gallbladder???? 

The gallbladder is a small, pear shaped organ at the base of the liver seen in the picture above. What does it do??  It is a small storage depot for bile.  What is bile?  Bile is a salt in solution that is formed and recirculated by the biliary system in the liver.  What does it do?  Bile is a solution that helps us digest and absorb dietary fat.  Without it, fat just sails on through the digestive system and causes diarrhea.  With it, the fat is emulsified and absorbed to use for energy.  When a meal is eaten that contains fat, the normal gallbladder is stimulated to release a bolus of bile into the intestine.  The bile mixes with the fat and it is digested and absorbed.  What goes wrong to cause pain and gallstones? Pain is caused when the gallbladder is stimulated and it cannot contract properly.  This causes a cramping type of pain (colic) in the right upper abdomen, back, etc.  Bile is a salt in solution.  If you take a jar and put salt and water in it, mix it up and keep it moving, the salt stays mixed in the water.  If you stop the mixing, it can settle and form crystals at the bottom of the jar and if you roll those crystals around they can come together to form larger crystals or stones.  This is what happens to the gallbladder.  It loses its ability to release the bile when stimulated and the bile salt comes out of solution and eventually the crystals form gallstones.  The stones are a symptom of the real problem....the gallbladder itself. 

Once the symptoms become severe enough, most people will seek medical attention.  The diagnosis is made with some fairly simple tests.  First, the ultrasound.  This is a simple and pain free test to detect stones.  If stones are present and you are having symptoms the gallbladder should be removed....more about that in a minute.   If the ultrasound is negative and the symptoms are convincing, usually a HIDA scan is ordered.  This test is done to see how the gallbladder is working.  It involves an injection to fill and then another to stimulate it to work.  If it does not eject its bile normally, it should be removed.

Today the gallbladder is almost exclusively removed using a laparoscope.  This is usually an out patient procedure done through small incisions and recovery is pretty quick.  Incision placement is pretty standard... Here is a picture of gallstones....not too pretty.

  We can live normally without a gallbladder in most cases, especially a sick one.  Some people may experience a little diarrhea that usually resolves but most importantly, the pain is gone.  If the disease is not treated, the stones can escape the gallbladder and get into the duct causing bigger problems that we won't discuss here.  The gallbladder can also become infected which can be an emergency.

This procedure can also be combined with a tummy tuck when done electively.  The incisions are not made through the skin but under it so nobody will ever know....pretty cool!

Come see us at Total body surgical Cosmetic and Vein Clinic where we can discuss General surgical, Cosmetic, Vein, and Obesity issues.  Don't forget our special pricing AND keep an eye out for our soon to be announced spring roll out!

To continue the conversation about body contouring after weight loss surgery, this installment will address the thighs and knees.  After the weight loss, the tummy tuck, the arm reduction, the breast lift, and the butt lift, many people are ready to address the thighs.  You may not need all of these procedures, you may only need one or two.  If more than one procedure is required, I usually save the thighs for last.  Why??  Well, to be honest, it is a difficult recovery because of where the incisions must be placed.  Do you need a thigh lift, or will liposuction cure the problem?  It depends on the amount of extra skin that is present.  Too much sagging skin will not contract with liposuction and will need to be removed.  A problem area of fat depostion can be liposuctioned. 

Incisions for a thigh lift are in the groin, following the contour of the upper thigh.  To lift the knee, the incision travels down the inner thigh, making a kind of "T".  Removing this skin allows us to make the thigh tighter and removing the skin in the groin allows us to pull the skin up getting rid of the sagging and re-shaping the thighs.  The incisions are placed in a high motion area that stays moist and is close to areas that can be difficult to keep clean.  These factors can make wound healing a challenge in the best of circumstances.....thigh lifts are not for the faint of heart.  They can, however, make a huge difference in appearance and wardrobe. 

Come see us at Total Body Surgical for all of your body contouring needs.  Time is running out to take advantage of the Breast and lap band specials so don't miss them!!

More next week.