FROM THE PUBLISHER

Iam pleased to bring you another issue of Florida MD. Sometimes a patient may have the opportunity to participate in a clinical trial. Sometimes a patient may need specialized treatment that is not available in Central Florida. And sometimes there’s no money for that patient to get to those places. Fortunately there is Angel Flight Southeast to get those patients where they need to go. I asked them to tell us about their organization and how you, as physicians, can help. Please join me in supporting this truly wonderful organization.

Best regards,

Donald B. Rauhofer Publisher

ANGELS ON EARTH HELP PATIENTS GET TO LIFESAVING MEDICAL TREATMENT

Everyone knows angels have wings! But did you know in Florida and many parts of the nation they have engines and tails with dedicated volunteers who donate lifesaving services every day? Leesburg, Fla.-based Angel Flight Southeast is a network of approximately 650 pilots who volunteer their time, personal airplanes and fuel to help passengers get to far-from-home medical care. A member of the national Air Charity Network, Angel Flight Southeast has been flying passengers since 1993.

Almost all of its passengers are chronic-needs patients who require multiple, sometimes 25-50 treatments. Passengers may be participating in clinical trials, may require post-transplant medical attention or are getting specialized treatment that is not available near home. Each passenger is vetted to confirm medical and financial need and is often referred to Angel Flight Southeast by medical personnel and social workers.

Angel Flight Southeast “Care Traffic Controllers” arrange flights 24 hours a day, 365 days a year. In the event of a transplant procedure, the Care Traffic Controllers have precious minutes to reach out to its list of volunteer pilots who have agreed to be prepared on a moment’s notice to fly a patient to receive his or her potentially lifesaving organ.

The organization is completely funded through donations by individuals and organizations. A typical Angel Flight Southeast pilot donates $400 to $500 in services-per-trip. In fact, Angel Flight Southeast has earned the Independent Charities of America Seal of Approval as a good steward of the funds it generates from the public. Each $1 donated generates more than $10 worth of contributed services by Angel Flight Southeast.

The charity always seeks prospective passengers, volunteer pilots and donations. For additional information, please visit https://www.angelflightse.org or call 1-888-744.8263.

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Publisher: Donald Rauhofer Photographer: Donald Rauhofer / Florida MD Contributing Writers: JJohn “Lucky” Meisenheimer, MD, Jason Malone, DO, Omar E. Beidas, MD, Mark A. Vollenweider, MD, MPH, Tabarak Qureshi, MD FCCP, Sonda Eunus, MHA, Michael Patterson NHA, OTR/L, CEAS, Juan Lopez, Pharm D, John Meisenheimer, VII Art Director/Designer: Ana Espinosa Florida MD is published by Sea Notes Media,LLC, P.O. Box 621856, Oviedo, FL 32762. Call (407) 417-7400 for more information. Advertising rates upon request. Postmaster: Please send notices on Form 3579 to P.O. Box 621856, Oviedo, FL 32762. Although every precaution is taken to ensure accuracy of published materials, Florida MD cannot be held responsible for opinions expressed or facts expressed by its authors. Copyright 2022, Sea Notes Media. All rights reserved. Reproduction in whole or in part without written permission is prohibited. Annual subscription rate $45.

Florida Vein Care and Cosmetic Center

EndoVenous Laser Treatment (EVLT) – A Minimally Invasive Option for Vein Disease

By Margaret M. Sloane, RN, BSN

Since 1999, EndoVenous Laser Treatment (EVLT) has become the therapy of choice for patients with painful and painless varicose veins. Now the standard of care and FDA approved, EVLT is minimally invasive, done in the doctor’s office in under an hour, requires no general anesthesia or stitches and provides immediate relief from symptoms. Patients return to normal activities right away. “Over the past 20 years, the demand for EVLT has skyrocketed 200 percent,” says Richard Bragg, M.D., medical director for Florida Vein Care and Cosmetic Center in Lake Mary, Florida. “The procedure has really directed patients away from stripping and ligation done in the hospital.”

According to the American College of Phlebology (ACP), more than 80 million Americans suffer from some form of venous disorders. Phlebology is the field of medicine that treats vein disease such as spider and varicose veins. Varicose veins occur when the one-way valves in the veins don’t function efficiently and the veins become visibly distended with blood. The condition can cause pain, heaviness and/or throbbing in the legs and are often a cosmetic embarrassment for the patient. Nearly 40% of women and 25% of men suffer from varicose veins. Heredity is the primary contributing factor for varicose veins. Other predisposing factors include multiple pregnancies, aging, leg injury and occupations that require standing for many hours. Spider veins are small, thread-like clusters of red, purple, and blue veins that are usually considered an aesthetic annoyance. They most commonly appear on the thighs, calves and ankles.

Patients who come to Florida Vein Care and Cosmetic Center seeking relief for these conditions can expect Dr. Bragg and his

This varicosed anterior thigh circumflex vein was removed by a phlebectomy using 3mm incisions. No sutures are required, and the after picture is 4 weeks post-op.

Immediately after endovenous laser treatment, patients walk for 20 minutes in the office on the treadmill. A post-op dressing and compression stocking is worn for 1 week after treatment.

All patients are screened with the bi-directional doppler to rule out saphenopopliteal junction incompetence prior to any treatment.

healthcare team to provide a comprehensive three step process that includes consultation, treatment and follow up.

Consultation - The consultation phase consists of a careful medical history evaluation followed by an initial vascular exam known as a “Doppler,” a quick, painless, non-invasive test to determine the extent of the problem. During this time, Dr. Bragg enjoys getting to know his patients, answering questions, and exploring the many options available to treat varicose and spider veins. In some cases, additional diagnostic testing using an ultrasound is required in order to create an effective treatment plan. These painless diagnostics are conveniently performed by Dr. Bragg in the office.

Treatment - Florida Vein Care and Cosmetic Center offers a personalized treatment plan that includes safe, effective, state of the art procedures for varicose and spider veins. Dr. Bragg notes that he has seen an annual growth of 40% in his office over the past seven years and EVLT accounts for a large portion of that growth. EVLT has the same if not better results than vein stripping and ligation, once considered the gold standard for treatment of varicose veins. Clinical studies indicate that EVLT has a 95% initial success rate and excellent long term outcomes. Candidates for EVLT usually fall between the ages of 20-60 and must be able to walk immediately following the procedure.

Typically, EVLT uses laser energy to target a faulty valve at the saphenous femoral junction located in the groin. The saphenous vein runs up the inside of the leg. A small laser fiber is inserted at the knee and advanced up the leg to the groin using non-invasive ultrasound for accurate placement. As the laser is withdrawn, pulses of light cause the vein to heat up, collapse, and then seal itself. During the process, local anesthetic is delivered inside the vein so the patient doesn’t feel the heat. When the laser tip is withdrawn back to the knee, the

COVER STORY physician removes it from the vein, applies a small piece of tape along with a Sigvaris graduated compression stocking. The patient is asked to get up and begin walking in the office to check for bleeding and reduce the risk of clots. “With EVLT, there is reduced risk of anesthesia, reduced risk of infection, reduced cost and instead of a one inch scar as is the case with vein stripping, the patient has a tiny three millimeter incision at the knee,” remarks Dr. Bragg. “Female patients say they can finally wear skirts without being embarrassed and teachers are amazed that their legs feel fine at the end of a long day on their feet.” Dr. Bragg has done over 1500 EVLT procedures since 2002.

After nearly every EVLT procedure, Dr. Bragg points out that it is usually necessary to have an ambulatory phlebectomy on the remaining bulging veins. “This is a micro-surgical removal of surface varicose veins using a small vein hook,” says Dr. Bragg. “Phlebectomy is also done in the center under local anesthesia through tiny incisions that require no stitches and leave nearly imperceptible scars.” After the vein has been removed, a bandage and stocking is worn for one week.

Sclerotherapy is used in treatment for spider and varicose veins and has been developed and refined by experts since its introduction in Europe nearly a century ago. It’s become popular in the United States in the past decade. Once diseased veins are identified, a sterile solution of “sclerosing” material is injected microscopically into the vein altering the walls of the vein causing them to collapse and dissolve. The simple procedure is safe and virtually painless and essentially improves the circulation in the legs by diverting blood flow into nearby healthy veins. Treatment does not prevent the development of more spider veins, but the removal of existing spider veins can dramatically improve the appearance of the area. Often, two or more sessions are required to achieve optimum results.

For tiny veins on the legs, face or chest, a laser procedure using a high energy light source can be used. The laser light passes through the skin without damaging it and selectively targets the spider vein. The light is absorbed by the red blood cells in the vein. The resulting heat causes the walls of the vein to seal together and disappear. Laser light treatment may be used in conjunction with sclerotherapy.

When considering treatment options, Dr. Bragg ensures that his patients understand the risk and limitations and that patients have realistic expectations for outcomes.

Follow-Up - Follow-up is an important component of Dr. Bragg’s care management plan. Unlike with vein stripping and ligation which requires bed rest and limited activities, patients who undergo non-surgical treatments are expected to get moving. “We want our patients to walk 30-40 minutes a day for up to three weeks to facilitate resolution of the treated veins,” says Dr. Bragg. A Sigvaris support stocking should be worn for one week after the treatment and patients must schedule a brief follow-up appointment to evaluate the results of the procedure.

580 Rinehart Road, Suite 110 • Lake Mary, FL 32746 7009 Dr. Phillips Blvd., Suite 240 • Orlando, FL 32819 10902 Dylan Loren Circle • Orlando, FL 32825 407.805.8989 Office • 407.805.8833 Fax www.floridaveincare.com

and then seal itself. During the process, local anesthetic is delivered inside the vein so the patient doesn’t feel the heat. When the laser tip is withdrawn back to the knee, the physician removes it from the vein, applies a small piece of tape along with a Sigvaris graduated compression stocking. The patient is asked to get up and begin walking in the office to check for bleeding and reduce the risk of clots. “With EVLT, there is reduced risk of anesthesia, reduced risk of infection, reduced cost and instead of a one inch scar as is the case with vein stripping, the patient has a tiny three millimeter incision at the knee,” remarks Dr. Bragg. “Female patients say they can finally wear skirts without being embarrassed and teachers are amazed that their legs feel fine at the end of a long day on their feet.” Dr. Bragg has done over 1500 PHOTO : BY TERRY CUFFEL / CORPORATE VISUAL SERVICES Dr. Bragg sees all patients in consultation. He explains venous anatomy, pathology and EVLT procedures since 2002. treatment options.

After nearly every EVLT procedure, Dr. The consultation, the in-office diagnostic ultrasound, and the Bragg points out that it is usually necessary procedure is covered by most insurance plans. to have an ambulatory phlebectomy on the Laser treatment holds great promise in the field of phlebology, remaining bulging veins. “This is a micro- says Dr. Bragg. Today, EVLT can be used on the greater saphesurgical removal of surface varicose veins nous vein, short saphenous vein and perforator veins. These three using a small vein hook,” says Dr. Bragg. “Phlebectomy is also done in the areas cause most varicose veins seen in the legs. center under local anesthesia through tiny incisions that require no stitches Dr. Bragg received his pre-medical Bachelor’s degree from and leave nearly imperceptible scars.” After the vein has been removed, a Louisiana State University in 1988. After graduating from Louibandage and stocking is worn for one week. siana State University Medical School in 1992, he was selected

Sclerotherapy is used in treatment for spider and varicose veins and for internship and residency at Florida Hospital’s Family Practice has been developed and refined by experts since its introduction in Europe residency program. He remains board certified in family practice nearly a century ago. It’s become popular in the United States in the past medicine. Dr. Bragg is an instructor with the National Procedures decade. Once diseased veins are identified, a sterile solution of “sclerosing” Institute and teaches physicians who come to him from around material is injected microscopically into the vein altering the walls of the the world injection sclerotherapy, ambulatory phlebectomy and vein causing them to collapse and dissolve. The simple procedure is safe EVLT techniques. An active member of the American College of and virtually painless and essentially improves the circulation in the legs Phlebology, he volunteers many hours a year to educate physiby diverting blood flow into nearby healthy veins. Treatment does not cians, nurses, and lay people about venous disease. prevent the development of more spider veins, but the removal of existing Dr. Bragg’s main office is located at 580 Rinehart Road in Lake spider veins can dramatically improve the appearance of the area. Often, Mary, Florida. His other locations are at 7009 Dr. Phillips Blvd. two or more sessions are required to achieve optimum results. and at 10902 Dylan Loren Circle in Orlando.

For tiny veins on the legs, face or chest, a laser procedure using a high For more information log on to www.floridaveincare.com energy light source can be used. The laser light passes through the skin or to schedule an appointment, call the office at (407) 805-without damaging it and selectively targets the spider vein. The light is 8989.  absorbed by the red blood cells in the vein. The resulting heat causes the walls of the vein to seal together and disappear. Laser light treatment may be used in conjunction with sclerotherapy.

When considering treatment options, Dr. Bragg ensures that his patients understand the risk and limitations and that patients have realistic expectations for outcomes.

Follow-Up - Follow-up is an important component of Dr. Bragg’s care management plan. Unlike with vein stripping and ligation which requires bed rest and limited activities, patients who undergo non-surgical treatments are expected to get moving. “We want our patients to walk 3040 minutes a day for up to three weeks to facilitate resolution of the treated veins,” says Dr. Bragg. A Sigvaris support stocking should be worn for one week after the treatment and patients must schedule a brief follow-up appointment to evaluate the results of the procedure. The consultation, the in-office diagnostic ultrasound, and the procedure is covered by most insurance plans. Laser treatment holds great promise in the field of phlebology, says Dr. Bragg. Today, EVLT can be used on the greater saphenous vein, short saphenous vein and perforator veins. These three areas cause most varicose veins seen in the legs. Dr. Bragg received his pre-medical Bachelor’s degree from Louisiana State University in 1988. After graduating from Louisiana State University Medical School in 1992, he was selected for internship and residency at Florida Hospital’s Family Practice residency program. He remains board certified in family practice medicine. Dr. Bragg is an instructor with the National Procedures Institute and teaches physicians who come to him from around the world injection sclerotherapy, ambulatory phlebectomy and EVLT techniques. An active member of the American College of Phlebology, he volunteers many hours a year to educate physicians, nurses, and lay people about venous disease. Dr. Bragg’s main office is located at 580 Rinehart Road in Lake Mary, Florida. His second office is at 7009 Dr. Phillips Blvd. in Orlando. For more information log on to www.floridaveincare.com or to schedule an appointment, call the office at (407) 805-8989.

Dr. Bragg sees all patients in consultation. He explains venous anatomy, pathology and treatment options. PROOF PHOTO BY TERRY CUFFEL / CORPORATE VISUAL SERVICES 580 Rinehart Road, 7009 Dr. Phillips Blvd., Suite 110 Suite 240 Lake Mary, FL 32746 Orlando, FL 32819 407.805.8989 Office 407.352.9877 Office 407.805.8833 Fax 407.351.0755 Fax

www.floridaveincare.com