We live in a society where messages about beauty abound, are easily digested and occasionally, either intentionally or unintentionally, are misleading! Spider veins are now a part of many cosmetic spas and dermatological practices, and marketing about spider veins is overwhelming, and at times misleading! In South Florida, casual lifestyles and hot-weather fashions facilitate a common desire to have attractive legs and, of course, this includes the appearance of the skin. As in many things, appearances can be deceiving.
Dr. Manuel E. Abella, cardiologist, is adamant that everyone know and share important clinical knowledge about varicose and spider veins: unsightly leg veins tell not only about the top layer of skin but also of deeper problems that relate to the heart and vascular system.
“As satisfied as I am with my early years in the cath lab with the most acutely ill patients, I look back and wonder how many more patients I could have helped if I had paid attention to the signs of heart disease in the legs and thighs. There it was, staring me in the face all these years, but we were not trained to pay attention to spiders, relegating them to the world of cosmetic medicine,” says Dr. Abella.
“My colleagues jokingly call me the optimizer,” quips Dr. Abella. “I get referrals for tricky conditions that other physicians cannot or will not treat or the referrals are just to ‘tune up’ the patient before a planned high-risk procedure. I pride myself in recognizing conditions that are often overlooked. I love medicine and this is precisely the part I love the most. I cannot begin to tell you how disappointed I was in myself seeing patients with venous disease that I had been treating for other ‘heart’ conditions that my colleagues and I had overlooked. Frequently, these patients were treated for heart failure or lymphedema and what they had was chronic venous insufficiency. Physicians were reluctant to ‘invade’ or be aggressive with these patients because many of them were diabetic and the physician feared causing an injury that would not heal. Unfortunately, excess passivity is more dangerous than controlled, meticulous well thought out aggressive care. With my new knowledge, I have healed many ulcers that were present for years, whereas before I had treated them with lotions, potions, creams and skin grafts without success. I share these images and stories with my colleagues in an effort to raise awareness of what needs to be done,” shares the doctor.
Frequently, with many diseases the key to a diagnosis is a relatively minor symptom such as spider veins, leg cramps at night, leg heaviness, etc. These symptoms are so vague that even when the patients are asked they deny them. At times the husband or wife will challenge the patient in the room and say, “What do you mean you don’t have restless legs?”, or “You do get leg cramps.” Dr. Abella now gives a free pair of compression hose to all those who he believes have venous insufficiency, so that by wearing them they can remember what “normal” feels like. “While I leave the room and finish my notes, I have my assistants measure the patient and then fit and apply the compression hose correctly to teach the patient how to do it. By the time I come back in the room, the patient already notices the difference. Frequently, I am greeted with a look of shock and disbelief because of the relief of symptoms the patient believed they did not have. If a patient has redness, swelling, ulcers, and/or spider or varicose veins, all of these are cues for me,” says Dr. Abella. These symptoms are part of the symptoms complex of venous insufficiency. However, heaviness, cramps and fatigue at the end of the day are also symptoms that patients attribute to getting older, which they are also not wanting to admit.
Pain, redness and unsightly veins are visually screaming about potentially more serious issues and Dr. Abella is one of a handful of physicians and medical school professors doing what they can to educate the world about participating in a cure to avoid much more serious consequences in the future such as venous ulcers and amputations, as well as years of needless suffering from an easily diagnosed and treated condition.
Sometimes the diagnosis of venous insufficiency has been considered by the patients’ physician and a venous ultrasound has been ordered and reported as “negative.” However, only a standing venous study by an appropriately trained technician in an unhurried environment excludes the disease. Dr. Abella always looks for himself with bedside ultrasound on the initial and follow-up visits to know what to expect from his technician. They work as a team, a concept Dr. Abella emphasizes. Rarely, patients see Dr. Abella because they are blacking out, and, again, he finds the presence of severe venous reflux as the cause, again working closely with his technician.
So how did a South Florida cardiologist approach saving lives by treating the legs instead of just the heart? Dr. Abella practiced medicine for years in the cath lab, where the most seriously ill cardiac patients go. It was in this high-science and vascular-focused environment where Dr. Abella finessed his understanding of circulation and the technical skills required to treat veins.
Dr. Abella teaches within his practice but also nearby at South Florida medical schools. Now in the second half of his career, he is eager to teach his approach. His office has been recognized as a “Center of Excellence” and he is under contract with a large company that brings doctors from around the world to learn from Dr. Abella the use of its products. He will now be teaching the use of two new vascular technologies being released by the FDA that will help add to the armamentarium available for the venous specialist. “I am a teacher, advocate, educator, spokesperson and, of course, physician for this extensive suffering population. I feel both frustrated and inspired to get the word out about venous symptoms. I lecture pro bono to my colleagues about venous insufficiency because, again, we need the team of colleagues to get involved. This team includes podiatrists, dermatologists, vascular surgeons, general surgeons and anyone directly involved in patient care. My colleagues tell me that venous patients are the most grateful patient they see and, as a result, they average three referrals a piece in the hope that their families and friends can also benefit from feeling better,” states Dr. Abella. Perhaps this is why his patient referrals account for over 90% of his work.
Modern medicine is full of miracles and advances. Lifesaving technology and a vast array of specialties contribute to an industry full of choices that can be as helpful as they are overwhelming. It is this paradigm that may contribute to the general lack of knowledge in the field of cardiology and vascular medicine that is the hyper-focus of Dr. Abellas’ practice.
“I love veins,” he says, adding, “I tell my staff, ‘If I win the lotto tomorrow, report to work because I will be doing veins for free!’”
Dr. Abella has become an evangelical marketer and communicator in both English and Spanish. He produces brochures, videos and vignettes, and speaks about his approach and importance of healthy veins.
“The cosmetic industry has brought a lot of awareness to the beauty concerns of varicose and spider veins but the scary part is that spider veins will come back, unless the mechanical deeper issue is diagnosed and addressed. I worry about what I call the ‘slow suicide’ that is part of a frustrated patient’s failure to seek the right doctor to address this issue. Patients become frustrated and give up on themselves. I like explaining the importance of leg vein care and encourage anyone with concerns to call me,” says Dr. Abella.
Dr. Abella is emphatic about patients taking proper care of leg veins issues. If you’re not getting the care you need, Dr. Abella encourages you to be your own best advocate and, if you feel so inclined, give his office a call today.