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Author Archives: Dr. Joseph Magnant

Dr. Joseph Magnant

About Dr. Joseph Magnant

After 14 years practicing Vascular Surgery in Georgia as part of a large multispecialty group, I moved to Fort Myers in 2006 with the specific intention to limit the scope of my practice to Venous disease evaluation and treatment. My fellowship training and board certification in Vascular surgery enables me to offer patients a comprehensive and balanced approach to their venous disease management. We have the good fortune of having one of the most experienced Registered Vascular Technologists, JT Jarrard, on our staff. Since the introduction of endovenous ablation techniques (LASER and Radiofrequency based systems) in 2000, we have been able to offer patients of all ages and medical conditions, solutions to their venous insufficiency related problems with outpatient, minimally invasive treatments performed under the strictest of sterile techniques, in a spa like facility under local anesthesia.

Do you have “Orthovenous” Disease? When Orthopedic and Venous Disease Collide.

“Orthovenous” disease you ask?  What is that?  Is that even a disease or a word?  Well…not exactly, but it is a neologism I have created to describe a much more common entity I have encountered in my vein focused practice.  Patients with orthopedic disease are of the age group that has a high prevalence of venous insufficiency (varicose veins and other presentations of vein disease).  To help illustrate my point I would like to use an actual clinical case.  Fran, an active medical office manager for her husband’s OB-GYN practice, decided to retire near the Gulf waters in Cape Coral. Happy in her Florida home, Fran, 68, immediately became involved in her community. As she stayed busy with all of her activities, her knee began to swell and ache. It was getting progressively worse until it began interfering with some of the things she enjoyed doing.

“I was having terrific pain in my right knee, the lateral side of the right knee,” she describes. “I also had a pronounced lump in the back of the knee, and I was very uncomfortable. The pain was excruciating. I couldn’t even drive a car for any distance because I would have to keep stopping to get out and walk. I couldn’t climb up a flight of stairs. I couldn’t exercise. It really stopped all activities for me.”

After consulting an orthopedic surgeon and podiatrist about the pain, a vein evaluation was suggested and she was referred to Vein Specialists. Fran was shocked by what Dr. Magnant’s evaluation uncovered.

“They did an ultrasound of the leg and found severe leakiness in the check valves in the main superficial vein (great saphenous vein)” reports Fran. “I had a leaking vein from the groin area all the way down the leg.  After a successful trial of compression hose (some of the pain was relieved with hose) endovenous ablation (heated sealing of the affected vein from within) was performed on Fran’s great saphenous vein under local anesthesia and her response was remarkable, with near immediate resolution of most of her leg discomfort.

Knee Replacement Varicose Veins

So what exactly is meant by the term “Orthovenous Disease”?

Many patients I have evaluated over the past 15 years for all stages of venous insufficiency whether it be large varicose veins, swollen and discolored legs or symptoms of leg fatigue, heaviness or cramps often have had total knee replacement incisions over their knees or have arthritic appearing knees.  Thus I coined the term “Orthovenous” disease.  Knee and hip joint arthritis and venous insufficiency often coexist because they affect the same age patient population, patients over the age of 40. Therefore, patients considering hip, knee or ankle joint arthritis evaluation or surgical treatment, may also have obvious signs of venous disease such as varicose veins, leg swelling or leg skin discoloration or common symptoms of fatigued and achy legs or nighttime symptoms of restless legs and leg cramps.  These patients might want to consider a formal vein evaluation as part of their evaluation.

Although there is a paucity of literature written regarding the treatment of venous disease prior to total joint replacement, there is one study that demonstrated statistically lower rates of deep vein thrombosis (DVT) in patients undergoing total hip replacement*.  We have observed that patients who have their vein disease (whether varicose veins or other presentations) addressed before hip or knee replacement have improved outcomes with reduction in leg swelling and improved response to physical therapy and wound healing.  There are many blogs that have been written by other Vein Specialists and Orthopedic surgeons whose clinical experience matches our own. Whether it’s varicose veins, a swollen leg or discolored skin, patients who have their vein disease addressed before hip or knee replacement may have better postop rehabilitation efforts and compliance because the affected leg may be less swollen going in to joint replacement and the additional post surgical swelling is tolerated better.

In addition to the obvious signs (visual cues) of venous disease noted above, other symptoms of venous insufficiency which might warrant preoperative venous insufficiency evaluation include heaviness, achiness, and fatigue in the legs typically worse towards the end of the day, as well as night time leg symptoms of cramps, restless legs and frequent urination.

Preoperative ultrasound can establish the presence or absence of DVT as well as identify the presence, location and severity of venous insufficiency. With this information, a determination of appropriate further treatment can be made with a complete set of clinical data.  In selected patients, minimally invasive treatment (endovenous ablation) of the leaking veins might be considered before joint replacement to optimize orthopedic surgical outcome.

Endovenous ablation (sealing an abnormal vein with heat) is an outpatient procedure which takes less than an hour with almost immediate full recovery. Future physical rehabilitation or orthopedic surgical intervention may be enhanced due to increased range of motion and mobility due to a reduction of edema.

With so many adults being affected by significant venous insufficiency, there is a thirty percent chance that there is going to be something that can be done to enhance the outcome from a hip or knee replacement. Since the introduction of minimally invasive treatment of venous insufficiency and the refinement of diagnostic ultrasound, which allows us to better identify and stratify vein disease, it makes more sense today than ever to consider venous disease as a potential cause of leg discomfort.

If you have a hip, knee or leg that’s bothering you and you have varicose veins, swollen legs, discolored skin or heavy legs, consider having both vein and orthopedic consultations.

Since her endovenous ablation treatment, Fran states that despite having some knee arthritis, she feels like a new woman and is pretty much back to her normal activities. “Dr. Magnant gave me back mobility that I haven’t had for quite a while. I can walk up and down stairs. I’m back on the treadmill for forty-five minutes a night. Essentially, he gave me back the use of my right leg” says Fran.

If you think you may be suffering from Orthoveneous Disease, Vein Specialists of Fort Myers, Bonita Springs, Cape Coral, and Naples can help! Schedule a Vein Consultation with Dr. Magnant or Dr. Nero prior to your knee replacement surgery.

*Dua A, Nieva SS, Sutherland AG. Is previous varicose vein surgery associated with deep vein thrombosis within 90 days of hip and knee replacement? Paper #32. Presented at the American Academy of Orthopaedic Surgeons 2012 Annual Meeting. Feb. 7-11. San Francisco

June 16, 2017
Dr. Joseph Magnant

About Dr. Joseph Magnant

After 14 years practicing Vascular Surgery in Georgia as part of a large multispecialty group, I moved to Fort Myers in 2006 with the specific intention to limit the scope of my practice to Venous disease evaluation and treatment. My fellowship training and board certification in Vascular surgery enables me to offer patients a comprehensive and balanced approach to their venous disease management. We have the good fortune of having one of the most experienced Registered Vascular Technologists, JT Jarrard, on our staff. Since the introduction of endovenous ablation techniques (LASER and Radiofrequency based systems) in 2000, we have been able to offer patients of all ages and medical conditions, solutions to their venous insufficiency related problems with outpatient, minimally invasive treatments performed under the strictest of sterile techniques, in a spa like facility under local anesthesia.

Venous insufficiency affects men, too.

Working in the engineering department for two local TV stations, Matthew Gaige was on his feet most of the day. Standing on the job got a little tougher during the last few years, as he struggled with a chronic leg condition.

“For about four years, I’ve had blistering sores about three inches around on my right leg above the inside ankle, along with purplish discoloration,” describes Matthew. “I’ve also had some swelling of my left leg.

“The sores would come and go, but at the beginning of this year, they started coming more frequently. It was painful when the blisters would come up, and I would have to drain them, leaving raw skin that was extremely painful. I would put medication on my leg, and then wrap it with an ACE® bandage so my pants wouldn’t rub against the open wound.”

The skin where the sores appeared was scarred and darkly stained. It was an area Matthew had injured years ago, and that injury started the cascade of ulcers that erupted there over time.

“It is an area that was damaged from when I scraped against some barnacles on a New York pier,” explains Matthew. “The damage healed, but left a mark. It’s in that same area where the ulcers started to appear.”

Matthew’s family doctor told him the discoloration and sores were nothing serious, and the ulcers would go away if he put antibiotic on them and kept them covered. They went away temporarily, but returned, repeatedly. Finally, Matthew decided to see a dermatologist, who recommended he visit Joseph G. Magnant, MD, a board-certified vascular surgeon who specializes in treating vein disorders.

Dr. Magnant’s practice, Vein Specialists, is dedicated to the modern evaluation and minimally invasive treatment of leg vein disorders. It has offices in Fort Myers and Bonita Springs. Matthew soon learned Vein Specialists was the right place to be.

“The dermatologist saw my right leg and said I needed to see Dr. Magnant because he believed the problem was coming from the inside,” says Matthew. “Dr. Magnant did an ultrasound on both legs because of the swelling in my left leg. It showed the exact location of failing veins. There was one in the left leg and two in the right.”

Veins are the blood vessels that return deoxygenated blood to the heart and lungs. Inside the veins are one-way valves that assist blood flow against gravity. When these valves become stressed and begin to leak, it causes blood to pool in the ankles or lower legs. This condition, known as venous insufficiency, was the source of Matthew’s symptoms.

“The nurse practitioner at Dr. Magnant’s office said that area of skin probably would have ulcerated on its own, because, as a direct result of venous insufficiency, it was weaker, making it more susceptible to wounds,” notes Matthew. “Then, Dr. Magnant scheduled me for surgery.”

Dr. Magnant suggested an endothermal ablation using radiofrequency energy called ClosureFAST™. During this procedure, the leaking veins are sealed using mild heat (248F) generated by a radiofrequency generator. This procedure scars the vein closed, stops the blood from pooling and improves or eliminates symptoms. Healthy veins then take over the job of returning blood from the leg toward the heart.

New Challenges

Hank* had never been one to sit still. He spent 30 years in the United States Marine Corps before retiring, but he wasn’t done working. He traveled west to Carmel, California, where he bought a restaurant. After retiring from that, he moved to San Diego, where he built a large marina. He then moved again, this time to Fort Myers, where he retired for good.

Hank was active in his personal life as well. Back in 1995 and again in 1997, he challenged himself to walk the Appalachian Trail, putting 500 miles on his feet and legs each time. The wear and tear affected him years later. Now 86, Hank began noticing some aggravating symptoms with his legs.

“My legs started swelling,” he states. “They progressively became larger but not awfully large. They looked funny. There was some dry skin. I had discoloring, not on the whole leg, but close to the ankles.

“When it first started, I had some aches and pains associated with it, but that didn’t become a problem. It wasn’t anything that kept me awake at night. Mostly, the problem was the swelling.”

Hank’s primary care physician initially told him only to keep his legs elevated to combat the swelling. However, when Hank’s symptoms became more prominent, his doctor recommended Dr. Magnant. Hank’s appointment at Vein Specialists mirrored Matthew’s.

“Dr. Magnant suggested I have an ultrasound to see if my internal veins were operating the way they should,” offers Hank. “I had an ultrasound on each leg at two different times. After that, the doctor reviewed the results, and he felt he needed to do his procedure, one leg at a time, in the near future. He did the first one in July.

“The procedure didn’t take long, maybe an hour, and it was totally painless. The only discomfort was after the surgery. It was recommended that I put on compression hose, which for an eighty-six-year-old guy was a challenge. The application was difficult because I’ve never worn anything like that in my previous eighty-five years.”

Leaky Valves

Venous insufficiency causes the valves in the veins to fail, creating pressure that builds up in the veins. This leads to signs and symptoms such as varicose veins, heaviness, achiness or cramping, restless legs and frequent nighttime urination.

“Both Matthew and Hank had swelling, advanced pigmentation and scarring of the skin in the lower third of their legs,” reports Dr. Magnant. “They both had what we call stasis dermatitis.”

Stasis dermatitis is a manifestation of venous disease that appears to be a skin disorder rather than varicose veins or spider veins. Unfortunately, because it is a skin disorder, people often don’t seek treatment for it as a vein problem, and many physicians don’t recognize it.

“Stasis means pooling,” informs Dr. Magnant. “The blood is static in this case because damage to the valves causes high pressure in the veins around the ankle and lower calf. Derma means the skin, and itis is the suffix in Latin for inflammation. Stasis dermatitis, then, is inflamed skin secondary to pooling blood from damaged or leaky valves.

“Another term for the problem is lipodermatosclerosis. Lipo means fat and dermato refers to skin, so the fat and skin are sclerosed, or scarred, down to the surface of the muscle. When the tissue is inflamed, the skin becomes thin, tight and discolored, and that’s what these gentlemen were experiencing.”

Stasis dermatitis can be a precursor to ulceration. Because the skin is unhealthy and scarred, small wounds don’t heal like they would on healthy skin. Instead, the ulcers continue to grow and fester. In Matthew’s case, the skin changes also led to ulcerations. They healed initially, but then reopened. Stasis dermatitis is a progressive condition that begins with swelling when high pressure causes liquid to seep through the thin-walled veins and settle into the leg tissues. In addition to water, other components of the blood, such as red and white blood cells, also seep into the surrounding tissues, causing pigmentation and damage to the skin.

“A more advanced type of venous insufficiency, stasis dermatitis is not always painful,” warns Dr. Magnant. “The legs don’t always ache. It’s an insidious process, and patients usually don’t remember when their legs started turning colors. They just know they’ve been purple for a while.

“Many people who have stasis dermatitis are seen by dermatologists, who might treat them with steroid cream, which only treats the external signs of the disease. Instead, they need to be investigated to determine what’s going on inside the veins leading to the skin changes.”

Gender Neutral

Matthew’s family doctor didn’t recognize his skin discoloration and ulcers as signs of venous insufficiency, and Matthew never suspected his symptoms signaled a vein problem. He was amazed to learn he wasn’t the only man with this condition.

“Dr. Magnant’s nurse practitioner showed me a book with pictures of other men who had the same symptoms: big, red, blistery sores that appeared on the inside of the leg,” remembers Matthew. “I was so surprised that they looked just like what I had. I never would have guessed. When I think of vein disease, I think of varicose veins, and I didn’t have those.”

Approximately 20 percent of the adult US population have venous disease, and 40 to 45 percent of them are men. Yet, men often do not recognize or acknowledge the symptoms and often dismiss the signs of vein disease they experience. They are also hesitant to seek a physician’s help until serious consequences arise.

“Men are usually the last to ask for directions when they’re lost, and when it comes to venous disease, men are oftentimes the last to seek attention,” notes Dr. Magnant. “To them, venous disease is synonymous with a cosmetic concern or a female disease. Men also tend to minimize their problems or dismiss them.”

Dr. Magnant stresses that venous disease is not just a women’s issue. Men are affected at nearly the same rate as women. He emphasizes that men with symptoms or signs of venous disease should not dismiss them and should not take the advice of those who tell them to ignore the symptoms or wait until their legs really hurt to seek treatment.

“That was the advice given sixteen years ago when all doctors had to offer was the morbid, somewhat barbaric vein stripping procedure,” he acknowledges. “However, now we have minimally invasive endothermal ablation with either radiofrequency or laser performed in the office as an outpatient procedure under local anesthesia.”

The direction of the ablation procedure is based on data from a painless, scientific test: ultrasound. This test can identify which veins are leaking but also where and how much. “This advancement has been a game changer for patients with venous disease,” observes Dr. Magnant.

The doctor also stresses that if men are experiencing any of the signs and symptoms of vein disease, including swelling, discoloration, aching, cramping or heaviness, they should not wait until more serious changes develop such as bleeding or ulcers. They should seek attention right away.

“An evaluation is just that. It’s an evaluation,” states Dr. Magnant. “It’s not a commitment to have a procedure done. With a diagnostic ultrasound, the likelihood of finding something that’s fixable is very high, approximately ninety to ninety-five percent. The signs and symptoms will often resolve themselves once we correct the problem.

“I tell patients this is a great time to have venous disease because we have something we can do for it. So men have hope. The days of waiting for the worst of the worst complications before seeking an evaluation are over.

“So men, when you get lost, ask for directions,” says Dr. Magnant. “If the skin on your legs is discolored, ask for a venous evaluation – or demand one.”

No Better Care

The endothermal ablation procedures performed by Dr. Magnant and his colleague, Patrick Nero, MD, are minimally invasive, which provides for a speedy recovery. Results are also seen and felt relatively quickly, as was the case for Matthew.

“Within a week or two of the procedure, the swelling on my left leg went down,” he describes. “I didn’t really have swelling on my right, but I had the sores. My right leg didn’t need to swell because liquid came out of the skin. That has slowed down. The sores haven’t totally gone away, but it’s now to the point where I rarely have an issue with them. I don’t have a problem anymore with long pants bothering them. I feel pretty good.”

Like Matthew, Hank also experienced excellent results. The procedures he underwent closed his leaky veins and reduced his symptoms of stasis dermatitis and venous insufficiency.

“The swelling is so much better than it was before,” reports Hank. “It’s not back to normal yet, but I’d say it’s probably fifty percent better than it was.

“I have absolutely none of the discomfort I had before, and the discoloration is much better. I would say it’s reduced by seventy percent.

“The surgery was very successful,” he adds. “Dr. Magnant really helped my situation.”

Both men have high praise for Dr. Magnant and his staff at Vein Specialists. With their help, Matthew and Hank had exceptional experiences with the endothermal ablation procedures to go along with their excellent results.

“I enjoy the staff, and I like Dr. Magnant,” offers Matthew. “He is very personable. I enjoyed asking questions, and he was very willing to tell me, even at the technical level, what was going to happen. For a surgery, it was a good experience. I highly recommend Dr. Magnant.”

“I like Dr. Magnant,” agrees Hank. “I definitely recommend him. He’s a good guy and has a good bedside manner. I’m very happy with him and his staff at Vein Specialists. They’re all very professional. They do a very nice job. I couldn’t ask for any better care!”

January 19, 2017
Dr. Joseph Magnant

About Dr. Joseph Magnant

After 14 years practicing Vascular Surgery in Georgia as part of a large multispecialty group, I moved to Fort Myers in 2006 with the specific intention to limit the scope of my practice to Venous disease evaluation and treatment. My fellowship training and board certification in Vascular surgery enables me to offer patients a comprehensive and balanced approach to their venous disease management. We have the good fortune of having one of the most experienced Registered Vascular Technologists, JT Jarrard, on our staff. Since the introduction of endovenous ablation techniques (LASER and Radiofrequency based systems) in 2000, we have been able to offer patients of all ages and medical conditions, solutions to their venous insufficiency related problems with outpatient, minimally invasive treatments performed under the strictest of sterile techniques, in a spa like facility under local anesthesia.

Publix deli worker has fashion show after varicose vein removal

Sheila returned to the office today for her second vein procedure. Now two weeks out from her left leg laser endovenous ablation and varicose vein removal, she is the talk of the deli! Not only does her leg feel better but she couldn’t help but to brag to her fellow employees on how good her leg looks. She says, “I’m so glad I don’t have those ugly veins showing and now I am able to wear a dress! The staff was great and the doctor was not so bad either! Like awesome!!” Her excitement over the incredible appearance of her leg sparked envy in another employee whose spouse had the misfortune of having her procedure done at a different vein center and did not have the results they were hoping for.   Its not too late for her to have an evaluation by dedicated vein specialists at Vein Specialists.  Why settle for a Jack of All trades, when you can come to the Masters of ONE!  Vein Specialists! #IlovePublix.

Dr. Magnant

December 13, 2016
Dr. Joseph Magnant

About Dr. Joseph Magnant

After 14 years practicing Vascular Surgery in Georgia as part of a large multispecialty group, I moved to Fort Myers in 2006 with the specific intention to limit the scope of my practice to Venous disease evaluation and treatment. My fellowship training and board certification in Vascular surgery enables me to offer patients a comprehensive and balanced approach to their venous disease management. We have the good fortune of having one of the most experienced Registered Vascular Technologists, JT Jarrard, on our staff. Since the introduction of endovenous ablation techniques (LASER and Radiofrequency based systems) in 2000, we have been able to offer patients of all ages and medical conditions, solutions to their venous insufficiency related problems with outpatient, minimally invasive treatments performed under the strictest of sterile techniques, in a spa like facility under local anesthesia.