Dr. Thomas Loh
Bulging veins in your limbs can be unsightly and uncomfortable, but they’re usually more annoying than dangerous. What causes venous insufficiency and varicose veins, and what can be done to help?
“Venous insufficiency is one of the most common ailments in the United States, affecting 20-30% of adults,” explained Dr. Thomas Loh, a vascular surgeon at Houston Methodist DeBakey Heart & Vascular Associates at The Woodlands. “The main thing people notice is swelling in their legs or varicose veins, sometimes both.”
When some of your veins don’t work properly to return blood to your heart, it can begin to collect, causing the veins to expand and bulge. Other symptoms can include:
■ Bleeding
■ Discoloration of the skin
■ Fatigue
■ Frequent wounds from skin that tears easily
■ Heaviness in the legs
■ Pain
■ Swelling
Loh explained a few common questions.
Venous insufficiency occurs when the veins in the legs can no longer efficiently bring blood back to the heart.
There are two primary causes for veinous insufficiency and varicose veins: genetics and gravity.
“Those are two things we can’t do anything about,” Loh said. “But there are lots of things we can do to prevent the disease from progressing. There’s no cure for this lifelong condition, but it is very manageable.”
Varicose veins can cause uncomfortable heaviness in your legs, and wounds can become more frequent and bloodier if a vein near the skin is nicked.
It’s unclear how big a risk of blood clots is posed by veinous insufficiency and varicose veins, but there is an association. The biggest risk, Loh explained, is if these conditions limit your mobility.
“Being mobile is one of the most important things for your health,” Loh explained. “So we work with patients to identify solutions before veinous insufficiency can have a significant impact on their mobility and their lives.”
For many, the first and best treatment is compression stockings. These tall socks squeeze the legs from all angles. The pressure closes the small veins near the skin, forcing blood into the larger vessels deeper in the legs.
“Compression stockings are a mainstay of therapy,” Loh said. “We encourage anybody who sits or stands for a long period of time to use compression stockings, whether they have symptoms or not because they can help prevent problems in the future, too.”
Compression stockings are enough to slow progression and provide relief. However, Loh acknowledged, “Tolerating stockings in Texas, especially during the summer can be very challenging.”
You may benefit from further treatment, such as vein stripping, ablation or the latest treatment, known as VenaSeal. This is where a chemical is used to glue veins closed. You can return to your normal activities within a day or two after the procedure.
There are many treatments for veinous insufficiency and varicose veins. “A team-based approach provides the best possible care for patients,” Loh said. “We leverage technology and we leverage expertise to map out treatment to keep each individual patient safe and ensure they have the best possible outcome.” •
Seek care for your varicose veins from a team of specialists near your neighborhood. To make an appointment, visit houstonmethodist.org/veindoctors-woodlands or call 936.270.3933
Have you been told you snore loudly? Are you tired or sleepy during the day? With obstructive sleep apnea (OSA), the flow of air into the lungs is either partially or completely obstructed in the upper airway, causing at least 10 seconds of unconscious stoppage breathing. A narrow airway, large tongue or obesity are some of the risks for OSA.
If snoring is keeping you up at night, maybe it’s time to act. Getting treatment for OSA can help you get a better night’s rest and avoid serious health consequences, including high blood pressure, heart disease and heart attack, type 2 diabetes, stroke and other health risks.
“Unfortunately, not only is your sleep impacted by sleep apnea, but also your productivity and relationships,” said Dr. Luis D. Neve, an otolaryngologist (ENT) with Houston Methodist The Woodlands Hospital. “It is also considered one of the so-called silent killers that should not be ignored.”
Depending on your condition, sleep apnea treatments can range from breathing machines to surgery. Your doctor can help you find the best option.
Here are the common questions asked about sleep apnea treatment options.
Many sleep apnea sufferers are prescribed a device called a continuous positive airway pressure (CPAP) machine. The CPAP machine delivers oxygen into your nose and mouth via a mask. This air keeps your airway open, preventing any interruptions in your breathing.
Using a CPAP machine to treat sleep apnea can reduce your risk of chronic health disorders, enhance sleep and increase daytime productivity. “To get the most out of this machine, you need to use it every night, but some people find the mask uncomfortable,” Neve said.
If you find a CPAP machine hard to tolerate or unable to fully manage your sleep apnea, sleep surgery may be an option. There are various sleep apnea surgeries, depending on where your specific obstruction is located.
To locate the obstruction, the doctor will perform a drug-induced sleep endoscopy. An endoscope is used to look at your throat and airway to identify exactly where you’re obstructing. “With this information, we can determine the best surgical option,” Neve added.
Advances in sleep apnea treatment have resulted in new, less-invasive techniques for treating moderate to severe sleep apnea. Hypoglossal nerve stimulation is a treatment that uses a device to stimulate your hypoglossal nerve, which is the nerve responsible for controlling several of the muscles in your tongue.
“This device, which is implanted in the upper chest using just two small incisions, is only turned on while you’re asleep,” Neve explained. It works by detecting respiration and, each time you breathe, stimulating your hypoglossal nerve to push your tongue forward, opening your airway.
Proven to work remarkably well, hypoglossal nerve stimulation eliminates the need for a CPAP machine. •
It’s time for you to get the restful night’s sleep you deserve. To speak to a board-certified ENT specialist about sleep apnea, visit houstonmethodist.org/ent or call 936.270.4010
Osteoarthritis is often known as a wear-and-tear disease. Unfortunately, when osteoarthritis strikes the knees, you may decide to take it easy and opt out of the activities you once enjoyed.
Dr. Raheel Ali, a knee orthopedic surgeon at Houston Methodist The Woodlands Hospital, explained that while patients with osteoarthritis may experience knee pain during exercise, physical activity by itself is rarely the cause. “The real culprit for osteoarthritis can be genetics or previous injuries,” he said.
If your parents both had knee replacements, chances are higher you’ll have a problem. Even though osteoarthritis is a wear-andtear disease, living an active lifestyle can help manage the pain. “I strive to help patients get stronger with less pain so they can stay active longer,” Ali said.
Osteoarthritis is the disease process of losing the cartilage in your knee — the tissue that cushions the ends of bones to decrease friction with joint movement. This is different from rheumatoid arthritis, a condition in which the immune system attacks joints and their lining.
You should consult a doctor who can diagnose your knee pain as a symptom of osteoarthrosis or something else. Osteoarthritis has hallmark signs, which may include:
■ Inflammation and swelling
■ Joint tenderness or a feeling of the joint giving out
■ Pain described as deep and aching
■ Stiffness at times, though more common with rheumatoid arthritis
■ Varying amounts of discomfort during an activity or prolonged inactivity
“While pain often occurs while walking or standing, you may also notice it when sitting for extended periods of time. Symptoms are often most noticeable when using the stairs,” Ali explained.
Family history, aging or injury are the common causes of osteoarthritis.
While some studies indicate supplements such as glucosamine can help, there are actions you can take to reduce pain, including:
■ Building strength, especially in the quadriceps (muscles that control the knee) and hips
■ Managing weight to decrease stress on the joints
■ Quitting smoking, because it lowers blood supply and delays healing
“Strength training and exercise is good. And maintaining a healthy weight is important,” Ali said. “The mechanical forces across the knee joint are unique. One pound on your body is anywhere between four and nine pounds on your knee. If you’re overweight, any amount of weight loss will help.”
If your symptoms lead you to decreased physical activity, you may inadvertently add to the problem.
The good news? Your doctor can help you manage osteoarthritis pain by ensuring that your fitness routine builds muscles around the knees. With regular check-ins, your doctor will monitor your symptoms and, if needed, adjust your plan.
When medical care is needed, it often starts with these steps:
1. Topical ointments are available over the counter and deliver skin irritants that stimulate blood flow to decrease pain.
2. Oral medications, such as an over-the-counter acetaminophen or a prescribed anti-inflammatory can help with pain and swelling but require close monitoring of your kidney function by your doctor.
3. Injection therapies are administered by your doctor in the office. He or she will recommend corticosteroids, hyaluronic acid or platelet-rich plasma (PRP) injections, depending on your need.
There is no one-size-fits-all approach. Your doctor will help determine the best course of action for your knees. •
If you are ready to take control of your osteoarthritis or get back in the game of life, we can help. Don’t suffer in pain and discomfort. To schedule an appointment, visit houstonmethodist.org/joint or call 936.321.8000.
If osteoarthritis knee pain is coming between you and your fitness routine, consult your doctor. He or she may recommend exercise modifications to help build strength, manage weight and decrease pain symptoms, such as:
Joining a water aerobics class
Riding a bike on an even terrain
Starting a swim routine
Strength training with a professional trainer
Trying light elliptical or stationary bike exercises
Walking or hiking on a trail with soft ground
When these exercises no longer offer you relief, it’s time to talk to your doctor about injections or surgery.
Dr. Eric Ngo
From a minor cut to a major ache, pain is an uncomfortable, but important, reminder that something is amiss with your body. Pain can be a signal to seek medical treatment or stop activities that could make your situation worse. When pain overstays its welcome, the result can be chronic pain. This difficult-to-treat condition involves pain that lasts three months or longer after the original injury has healed.
Generally, chronic pain is divided into two main categories: chronic primary pain and chronic secondary pain, explained Dr. Eric Ngo, a specialist in pain management at Houston Methodist The Woodlands Hospital.
“Syndromes, such as fibromyalgia, migraine, chronic regional pain syndrome and nonspecific neck and low back pain, are examples of chronic primary pain,” Ngo said. “These cannot be attributed to another pain-causing complaint.”
Examples of chronic secondary pain, when pain is a symptom of another condition, include musculoskeletal disorders, back pain and osteoarthritis. Many conditions can cause chronic pain.
Chronic pain is an individual experience. It can be difficult to understand because one person’s perception of pain can be very different from another’s.
“With chronic pain, there can be a sort of rewiring that happens,” Ngo said. “Pain signals can create a feedback loop that isn’t necessarily related to the original injury. As the brain gets used to this loop, it can be hard to break.”
Initial pain treatments from your primary care provider are likely to include rest, ice and heat, and low-dose medications. If that treatment doesn’t help, it’s time to see a pain management specialist.
“Earlier treatment has the best chance of success, and a specialist can work with you to find nonsurgical options to treat pain,” Ngo said.
There are many reasons for pain, so treatment focuses on
addressing the cause. Your specialist may prescribe nonopioid medications, physical therapy or surgery. Other treatments can include acupuncture, massage, an anti-inflammatory diet or a spinal cord stimulation device.
The medical community frowns on prescribing opioids, narcotics made from the opium poppy plant that block pain signals, because they can be highly addictive. Over time, patients can develop a tolerance to these drugs, decreasing their effectiveness and building dependence. •
Our expert team of neurologists at Houston Methodist The Woodlands work collaboratively to provide exceptional care. To schedule an appointment or learn more, visit houstonmethodist.org/ woodlands-neuro or call 936.270.3900 .
■ Get support: Consider talking to a therapist to help you handle the struggles of chronic pain, including stigma.
■ Try new treatments: Exercise and physical therapy can help you feel better, and stretching can help keep you mobile.
■ Practice self-care: Develop a plan to take care of yourself, like watching your favorite movies. Don’t worry if you fall behind on chores — it’s important to give yourself grace to adjust to a new normal.
If you have been diagnosed with type 2 diabetes, managing your disease effectively is one of the most important things you can do. When uncontrolled, this progressive disease can harm most of the body’s systems as time goes on.
“Living with uncontrolled diabetes can significantly impact your overall health, potentially leading to complications affecting vital organs like the eyes, kidneys, heart and nerves, said Dr. Ali Ahmed, an endocrinologist at Houston Methodist Comprehensive Care Center in Kings Harbor. “The good news is that effective diabetes management plays a crucial role in preventing or delaying the onset of complications.”
DOES DIABETES GET WORSE OVER TIME?
“Improving insulin resistance in diabetes can be done and it involves a holistic approach, including regular exercise, a balanced diet, weight management, stress reduction and medication when needed to enhance insulin sensitivity,” Ahmed said. “By addressing these factors, individuals can improve insulin sensitivity and better manage their blood sugar levels, leading to improved overall health.” Ahmed explained some of the common complications of type 2 diabetes and what you can do to stay in control.
1. Cardiovascular disease: People with diabetes are at higher risk for coronary heart disease, coronary ischemia, myocardial infarction (MI) and silent myocardial ischemia. What to do: Control your blood sugar, manage your weight and see your doctor to check your blood pressure, cholesterol and triglycerides.
3. Hearing loss: Uncontrolled blood sugars can affect your hearing, which leads to a higher level of hearing loss among people with diabetes. What to do: If you have trouble understanding conversations, talk to your doctor about getting your hearing checked.
4. Kidney disease: Diabetes is the leading cause of chronic kidney disease and end-stage kidney disease in the U.S. and worldwide. What to do: Have your doctor measure your levels of urea nitrogen and creatine in your blood regularly.
5. Nerve damage: Between one-third and one-half of people with diabetes have peripheral neuropathy, tingling and painful numbness caused by nerve damage.
What to do: Talk with your doctor about treatment options for symptoms caused by diabetic neuropathy.
Ahmed said managing diabetes isn’t easy and can often be overwhelming, leading to “diabetes distress.” His advice is to find a doctor who understands these challenges and is willing to work with you to overcome them.
“It’s essential to feel comfortable sharing your struggles and working together to find solutions,” Ahmed said. “Remember, you’re not alone in this journey, and with the right support, you can navigate the ups and downs of diabetes management more effectively.”
Type 2 diabetes can progress, meaning your cells become more resistant to your natural insulin production as time goes on, leading to more medications.
2. Foot problems: Diabetic neuropathy causes pain, numbness and tingling in the legs and feet. Infections, wounds and sores can lead to tissue damage and amputation. What to do: Check and wash your feet every day. Have your doctor perform a diabetic foot exam and let him or her know if you have a wound that doesn’t heal.
6. Vision loss: For people between 25 and 74 years old, diabetic retinopathy (DR) is one of the largest causes of vision loss worldwide. The retina of the eyes can scar and diabetes increases the risk of cataracts and glaucoma.
What to do: See your eye doctor regularly for a complete exam, including dilation to check for early signs of DR. •
Houston Methodist Endocrinology Associates offers an integrated team of endocrine and diabetes experts. To schedule an appointment, visit houstonmethodist.org/endocrinology-diabetes-metabolism or call 713.790.3333 .
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