Get up-to-date information daily on the coronavirus at masslive.com
Better Health D
SUPPORT: Helping those who have lost loved ones, D2 BREATHE EASY: HMC helps patients with respiratory issues, D3 TRAVEL: India’s Wine Country, D5
| SUNDAY, MARCH 15, 2020
|
Don’t let
varicose veins
cramp your
style
By Anne-Gerard Flynn
don’t know how frequent the condition is - depending on Dr. K. Francis Lee, founder how you define venous insuffiand medical director of the ciency it is said between 20 to Advanced Vein Care Center, 50 percent of the population is a board-certified general has it - and how insidious it and laparoscopic surgeon who is and how much it affects specializes in the treatment of people’s lives,” Lee said. vein disease. “My patients have told His Springfield-based me they don’t wear skirts, practice, with the motto, “Feel shorts or sandals and wear Better, Look Better,” is where long pants when they go to he treats patients for such the beach in order to hide the conditions as venous insufficondition that is visible in 10 ciency that is most commonly to 30 percent of cases because seen in women through the they are embarrassed by it presence of varicose veins. and have been for decades.” These veins may be visiSurgery under general anble as raised and discolored esthesia was once needed to lines on legs and ankles, can address chronic venous insufbe painful and often prompt ficiency. The underlying vein women to wear clothing that hides the veins’ appearance from view. “Varicose veins are the very large, bumpy veins that pop out on some people’s skin as well as smaller ones called reticular veins,” said Lee, a graduate of Harvard Medical School and former chief of trauma services at Baystate Medical Center. “They are very common, and caused by an underlying condition called venous insufficiency and this, simply put, means insufficient vein circulation.” was removed, or stripped out, Developing varicose veins through incision. Today, these in most people is said to be an veins can be closed off and inherited condition and they taken out of circulation, using can appear in young as well as minimally-invasive options older women. Lee said they that employ heat delivered by often go unaddressed because laser or catheter into the vein patients have come to live to internally shut it down after with both their appearance it is initially numbed under and any related pain. local anesthesia. Newer meth“Most women, as well as ods use an adhesive or foam some health care providers, that can be administered to Special to The Republican
close off the vein without local anesthesia. The varicose veins on the surface are deactivated in separate procedures during which they are removed or closed off through injection. “You walk in and you walk out, everything is outpatient,” said Lee of options done in his office to treat varicose veins and venous insufficiency. “The condition is very treatable nowadays, and requires very little interruption to someone’s work. Twenty years ago, varicose veins were treated by vein stripping which was done in the hospital, in the operating room under general anesthesia.
overcome it can cause veins to stretch and bulge and blood to pool. “The role of the veins is to get the blood back to the heart after it has circulated oxygen and nutrients,” Lee said. “But sometimes that doesn’t happen in some of the veins in the leg where, because of gravity, the blood, instead of going back to the heart from the legs, starts going back toward the feet.” The body’s veins include what are called superficial ones in the fatty layer of skin tissue through which blood flows toward deep veins in muscles. These muscles help, through such actions as walk-
causes the varicose veins to pop out toward the skin from the underlying veins that are abnormal. You see the varicose veins, but the condition underneath is what we called venous insufficiency.” Lee lists on his website conservative treatment options such as walking, wearing compression stockings and weight loss, but said to “fully treat venous insufficiency you basically have to close that vein that is abnormal” and “most of the time you have to get rid of those varicose veins on the surface whether by removing them through tiny punctures or injecting them to make them close, with either
This is often use for spider veins, which are frequently regarded as a cosmetic issue and not covered by insurance but, Lee said, “can be related to venous insufficiency.” Options used to treat underlying abnormal veins include radiofrequency occlusion which involves the insertion of a catheter to deliver radiofrequency energy that causes the vein wall to heat and seal shut. Heat transmitted by lasers inside a catheter is also used to close off the abnormal vein. Lee added that the abnormal veins are expendable and their deactivation makes the work easier for the normal veins that have been trying to maintain proper blood flow. “The blood in these abnormal veins has been going in the opposite direction of the traffic,” Lee said. “Once we shut down these veins, all the other veins that have had to reroute the venous blood from the abnormal veins will be able to reroute it much easier for proper circulation.” Venous insufficiency can be one cause of night leg cramps, and Lee said one of the “most consistent improvements People were hospitalized for ing, to compress blood flow option appropriate depending symptom-wise from our treatment is improvement several days and laid up for a more efficiently toward the on the size of the varicose in cramps either to zero or couple of weeks to a month. heart. Short veins connect the veins.” every-night cramps to once a It was very painful and most superficial and deep veins. “You have to close the physicians then said it was not “Venous insufficiency insufficient vein underneath, week or two-or-three timesworth treating.” occurs in either the superficial and then remove or inject the a-week cramps to once a month.” Veins carry blood back to or the deep veins, though you veins on the skin,” Lee said. Valve failure that leads to the heart, and leg veins are can’t see it happening,” Lee Options used to treat variamong those that have onesaid. cose veins include sclerother- the chronic backward flow way valves to prevent back“But this insufficient circuapy, where a solution is inject- of venous blood in the legs is also associated with other ward flow, but sometimes lation causes high pressure ed into the vein to cause it to gravity and the pressure to inside those veins and that disappear over several weeks. SEE VARICOSE, PAGE D3
“The condition is very treatable nowadays, and requires very little interruption to someone’s work. Twenty years ago, varicose veins were treated by vein stripping which was done in the hospital, in the operating room under general anesthesia. People were hospitalized for several days and laid up for a couple of weeks to a month. It was very painful and most physicians then said it was not worth treating.”
%%SATFOL-%%3MONTH%%2DATE
D2 | SUNDAY, MARCH 15, 2020
THE REPUBLICAN | MASSLIVE.COM
Supporting
those who have lost
loved ones
to the death or the deceased. Unmanaged PCBD increases There are not many certainties in life. We all know Most notably, the desire to the risk of suicide, physical/ life is unpredictable, change be with the deceased creates medical and psychiatric moris constant and death is part a disruption in our social bidity. Thus, it is essential to of the human experience. identity. This social identity recognize symptoms that are Nonetheless, the loss of a disruption can lead to distrust not diminishing with time loved one is an adverse event in others, detachment from and are limiting our functionthat many of us will never other people, and social ing in the world. be prepared to experience. isolation. Life is perceived as How can we support those Unfortunately, the world will meaningless or empty, ambi- who have lost a loved one? not stand still and allow us to guity as to one’s “new” role in By creating space for them recover or take time to prolife, and difficulty or disinter- to talk without judgment or cess, life continues with all of est in pursuing any plans for attempts to get them to move its responsibilities. the future. on. We do not need to offer If you have never experiIt is expected that with time a solution or have a perfect enced the loss of a loved one, the bereaved individual will phrase, all we have to do is it is hard to comprehend the naturally integrate and learn hold space for them to be magnitude of emotional, to live with the loss. However, heard and be held. How can physiological, behavioral, when the individual continwe help ourselves if we have and situational disruption it ues to experience difficulty lost a loved one? Allow the creates for those left bemanaging persistent and pain to be present, do not hind. During acute grief, the pervasive symptoms of grief, mask what you are experibereaved individual experithey are likely experiencing encing, avoid guilt narratives, ences persistent longing for what is known as ‘persistent focus on day-by-day and the deceased, engage in intense sorrow active self-care and emotional We do not need to offer a solution routines. Loss pain. At times painful and or have a perfect phrase, all we have isdebilitating; preoccupation it with the derequires you to do is hold space for them to be ceased and the to be comcircumstances passionate heard and be held. associated with with yourself, the death is conrecognize we stant and intrusive. The difcomplex bereavement disor- all deserve to be loved and ficulty of accepting the death der’ (PCBD). PCBD occurs live happily. can bring denial, emotional in around 4% to 10% of the Finally, the most important numbness, inability to remgeneral population and at part to survive this process inisce positively about the higher rates for at-risk popu- is to not believe that we are deceased, anger related to the lations, such as women older alone. Ask friends, family loss and self-blame or guilt. than 60 years, and individu- members, coworkers, neighSome may engage in avoidals with preexisting mental bors to help, however they ant behaviors (i.e., people, health issues. The prevalence are able. We do not need to places, and situations) related of PCBD for at-risk populaalienate ourselves. When we tions is estimated to be about help others, it gives us a sense 20% in dementia caregivers, of purpose. If symptoms do 50% for HIV caregivers and not attenuate, seek profesin cases of violent death of sional help or attend a local a close relative or death of a grief support group. spouse, the rate was found to be much higher (78%).
Mayra Rodriguez-Figueroa is a Bilingual Integrated Behavioral Health Consultant for BHN at Brightwood Medical Center. BHN is a growing non-profit health agency that provides mental health and addiction recovery services to children and families in western Massachusetts.
Get Well. We Can Help. Mental Health | Addiction | Crisis Call Today
Agawam: (413) 786-6410 Greenfield: (413) 737-2439 Holyoke: (413) 536-5473 Springfield: (413) 733-1423 Ware: (413) 967-6241 Westfield: (413) 568-6141 24-Hour Crisis Lines Springfield: (413) 733-6661 Westfield: (413) 568-6386
www.bhninc.org
Recognize signs of a
heart attack
in women Many people are familiar with the image of a heart attack sufferer clutching his or her chest or feeling surprising, tingling sensations in his or her left arm. While those symptoms are common, heart attacks can produce a wide array of symptoms, and some of them may actually be much less apparent than chest pain or tingling in the left arm. That’s especially so for women. The organization Go Red for Women, which highlights women’s heart health during the month of February, advises that many symptoms women can experience when suffering from heart disease may be overlooked or misunderstood as signs of less threatening conditions. However, jaw pain, nausea, pressure, and sweating all may be indicative of a heart attack. A failure to recognize that and act quickly could prove fatal. The American Heart Association says that heart disease is the foremost killer of women in the United States. The Heart and Stroke Foundation says heart disease and stroke kill 31,000 women in Canada annually. Despite those figures, many women are unaware of the threat of heart disease and its symptoms. Heart attack occurs when blood flow to the heart is blocked by a buildup of a substance called plaque in the coronary arteries. Heart attack can strike any woman, though women who deal with high stress, are overweight or are heavy smokers are at the greatest risk.
Symptoms of heart attack Symptoms of heart attack in women generally are more subtle than in men. These can include but are not limited to:
· shortness of breath as though you just ran a marathon · a feeling of a squeezing rope tied around the upper back · dizziness · lightheadedness or actual fainting · unusual fatigue · neck, jaw, shoulder, upper back, or abdominal discomfort · indigestion · perspiration
How heart attacks are different for women
Women tend to have blockages not only in their main arteries, but in the smaller ones that supply
blood to the heart. This is a condition called coronary microvascular disease, says the Mayo Clinic, and it may be why symptoms are more vague and not as apparent in women as they are in men. Women also can have symptoms while resting or even when asleep, and emotional stress can trigger heart attack symptoms in women. A woman’s risk for heart disease increases if she has diabetes, has experienced mental stress or depression, smokes, has gone through menopause, has had complications during a pregnancy, has an inflammatory disease, and/or is physically inactive. Women of all ages should take heart disease seriously and schedule a check-up with a doctor to discuss risk and heart health. Women who suspect or notice any symptoms of heart attack should not hesitate to call for help. If you suspect you are having a heart attack, call 9-1-1 immediately; do not drive yourself. Women can learn more about heart disease at www.heart.org.
SUNDAY, MARCH 15, 2020 | D3
%%SATFOL-%%3MONTH%%2DATE
THE REPUBLICAN | MASSLIVE.COM
Breathe
easy
The Holyoke Medical Center Pulmonology Centers Pulmonologists: M. Saleem Bajwa, MD, Andrey Pavlov, MD, and Miguel Rodriguez, MD
The HMC Pulmonology Center helps patients cope with common respiratory conditions. Dr. K. Francis Lee, founder and medical director of the Advanced Vein Care Center, is a board-certified general and laparoscopic surgeon who specializes in the treatment of vein disease. (PHOTO BY ANNE-GERARD FLYNN, SPECIAL TO THE REPUBLICAN)
Varicose CONTINUED FROM PAGE D1
conditions and complications, Lee said, such as restless leg syndrome, leg fatigue as well as legs that feel heavy or achy, particularly in people whose jobs require a lot of standing. “Most people do not realize the true range of symptoms that bother them from venous insufficiency,” Lee said. “There are women who, after a day’s work, go home and they have to sit and put their legs up for half an hour before they can do anything else.” Lee said he sees women who, because of demands on them, have put the health of others before their own in ad-
safe” and said he discusses the particular benefits and risks of each procedure with his patients. “We tell them everything, so each person can choose,” Lee said. He said a 90-minute appointment is generally allotted, though the procedure itself generally takes about 30 to 45 minutes and the leg temporarily wrapped with the recommendation to wear compression stockings for five days if possible, for added comfort. He said some patients feel able to return to work that day. “Vein treatment has really evolved from a very painful, hospital experience to a very
major risk.” A second appointment six weeks later checks on any other areas of concern. There is a recurrence rate of about 25 percent, Lee said “not in the veins that we treated, but other veins are pre-disposed” and he added a greater risk for this is if the patient is “carrying a lot of belly weight as that pushes down and the blood cannot get out of the leg, or if they have a job where they are sitting or standing all the time.” “Walking gets the blood flowing, sitting or standing does not and creates more problems,” Lee said. Results in terms of appearance over time, Lee said, can depend on how long the wom-
“I get a lot of patients who come just before their retirement who tell me I am going to get this done now because this is my time, or, when their kids have completed high school or college and they tell me, ‘OK, I am done. I am going to take care of myself,’” Dr. K. Francis Lee said. dressing their varicose veins. “I get a lot of patients who come just before their retirement who tell me I am going to get this done now because this is my time,” Lee said. “Or, when their kids have completed high school or college and they tell me, ‘OK, I am done. I am going to take care of myself.’” However, Lee said he felt more women today who are bothered by their varicose veins would seek treatment earlier if they understood today’s options make it “easier to have them taken care of.” “A lot of women live with it and their quality of life is bad because of it,” Lee said. “They don’t know that now it is easier to have them taken care of.” Lee said “there is some genetic disposition” for vein deformity related to an “abnormal collagen structure in those veins.” “Varicose veins can start at any age, we recently treated a patient as young as 24 and have treated as young as 20 though not before, but most people present with them in their 50s, 60s, and 70s,” Lee said. “Even if you are older, because it is not traumatic, you can be treated. We had another recent patient who was 95.” Lee termed treatment options for varicose veins and venous insufficiency “very
straightforward one except for a commitment of time,” said Lee, referring to the fact that venous insufficiency in the superficial and deep veins is addressed first and then, if needed, the visible varicose veins are addressed in a second procedure a few days later. “You are not really restricted much after the surgery.” There is usually a follow-up appointment in about a week for an ultrasound to make sure there are no blood clots, which Lee termed “not a
an has lived with varicose veins. “It depends on how far the varicose veins have gone,” Lee said. “If it is early, the results can be great and like normal, but if the surface is full of veins and skin discoloration it is harder. We do the best we can and the legs will look much better than before but it will not be as if you have never had it. This is why it is important that women come sooner than later.”
If you’re having trouble which teaches patients breathing, your quality of how to manage symptoms. life can suffer. Fortunately, Supplemental oxygen may there’s help nearby: The also be prescribed to help Holyoke Medical Center Pulimprove breathing. monology Center. It’s staffed ASTHMA by three pulmonologist: M. • What it is: Asthma is a Saleem Bajwa, MD, Andrey chronic condition that Pavlov, MD, and Miguel Rocauses inflammation in driguez, MD. the airways, leading to Pulmonologists manwheezing, chest tightness, age diseases involving the coughing and shortness respiratory tract. Here are of breath. The severity of the most common conditions the condition varies from treated at the HMC Pulmonperson to person. In 2017, ology Center: 26 million Americans were CHRONIC diagnosed with asthma, OBSTRUCTIVE according to the CDC. PULMONARY DISEASE About 10 percent of Massa(COPD) chusetts residents have the condition. • What it is: COPD refers to a variety of lung diseas• How it’s treated: Medicaes that make breathing tions taken on a regular difficult, including chronic basis help prevent asthma bronchitis and emphyattacks. Corticosteroids, sema. Nearly 16 million which prevent and reAmericans suffer from the duce airway swelling, are disease, which is the third commonly prescribed. leading cause of death in They are inhaled or given the U.S., according to the in pill or liquid form. When Centers for Disease Conan asthma attack occurs, trol and Prevention (CDC). short-acting beta agonists, The leading cause of COPD which are inhaled, relax is smoking, followed by the muscles around the airexposure to air pollution. ways and relieve symptoms quickly. Other medications Symptoms include coughing can help reduce the body’s or wheezing, shortness of response to allergens, breath, the production of which play a role in asthma excess phlegm and diffiattacks. If an attack is seculty taking a deep breath. vere, emergency treatment The disease is diagnosed may be required. using a test that measures lung function. Early detec- INTERSTITIAL LUNG tion is important because DISEASE it can help prevent the • What it is: This is a term disease from progressing. that refers to disorders that can cause scarring in the • How it’s treated: There’s no lungs, such as idiopathic cure for COPD, but medipulmonary fibrosis, hypercations called bronchodisensitivity pneumonitis, lators are often prescribed. sarcoidosis and asbestosis. They work by increasing Scarring causes the lungs the flow of oxygen to the to become stiff, making lungs. Lifestyle changes are breathing difficult. Doctors also recommended. They don’t usually know what include quitting smokcauses these diseases, ing and participating in but in some cases they pulmonary rehabilitation, are linked to exposure to
hazardous materials like asbestos. In the case of hypersensitivity pneumonitis, an allergy to inhaled dust, fungus, molds or chemicals causes lung inflammation. Symptoms include shortness of breath or cough and chest X-ray abnormalities. • How it’s treated: Treatment includes medications that reduce inflammation, such as steroids. Anti-fibrotic medications may also be prescribed to slow scarring in the lungs. Unfortunately, the only cure is a lung transplant.
BRONCHIECTASIS
• What it is: Bronchiectasis is a condition in which the airways become damaged, usually from infection, and are unable to clear mucus. When the airways can’t clear mucus, recurrent lung infections may occur. The condition can also be caused by cystic fibrosis. The disease is more common than it was once thought: A 2013 study estimates that between 340,000 and 522,000 Americans have bronchiectasis. Symptoms include coughing up yellow or green mucus daily, shortness of breath, fatigue, wheezing or whistling while breathing, and fevers and/or chills. • How it’s treated: Treatment involves antibiotics (occasionally given intravenously) and mucus-thinning medications. To schedule an appointment with the HMC Pulmonology Center, please call 413.534.2582. The Pulmonology Center is conveniently located on the first floor of Holyoke Medical Center at 5 Hospital Drive, Holyoke.
The Pain Management Center
EMADENTAL P RO ST H O D O N T I C S
Prosthodontics EMADENTAL P RO ST H O D O N T I C S The Dental Specialty of Tooth Replacement Prosthodontics Complimentary Consultations In April The Dental Prosthodontics Specialty of Tooth Replacement Dental problems answers, The Dental Specialty ofhave Tooth Replacement Complimentary Consultations In April don’t let dental concerns your effect quality life!of life! Dental problems have answers, don’t let effect dental concerns your of quality Complimentary Consultations In April save-ability, concerns, Tooth Tooth save-abilitydental , dentalimplant implant questions questions &&concerns, Dental problems haveversus answers, esthetic smile questions, removable versus non-removable esthetic smile questions, removable non-removable don’t let dental concerns effect yourdifficulties quality of life! tooth replacement options, denture difficulties. tooth replacement options, denture Tooth save-ability, dental implant questions & concerns, esthetic smile questions, removable versus non-removable tooth replacement options, denture difficulties.
Dr. Vincent Mariano - Dr. Alissa Mariano Dr. Vincent Mariano, Board Certified Prosthodontist Board Certified Prosthodontists Oral Rehabilitation & Dental Implants Dr. Thomas Vergo - Dr. Catherine Cagino Dr. Alissa Mariano, Board Certified Prosthodontist Maxillofacial Prosthodontists Dr.Call Vincent Board Certified Prosthodontist Today For Your Complimentary Consultation Oral Mariano, Rehabilitation & Dental Implants Oral Rehabilitation & Dental Implants East Longmeadow 413.731.8800 • Northampton 413.584.4411 Dr. Thomas Vergo, Maxillofacial Prosthodontist EMADental.com Dr. Alissa Mariano, Board Certified Prosthodontist Removable Prosthesis & Intraoral-Extraoral MFP Experience The EMA & Specialty Difference Oral Rehabilitation Dental Implants NE-321026 Dr. Catherine Cagino, Maxillofacial Prosthodontist Dr. ThomasProsthesis Vergo, Maxillofacial Prosthodontist Removable & Intraoral-Extraoral MFP Removable Prosthesis & Intraoral-Extraoral MFP East Longmeadow 413.731.8800 Northampton 413.584.4411 Dr. Catherine Cagino, Maxillofacial Prosthodontist EMADental.com
Stop Hurting. Start Living. Our board-certified physician utilizes innovative and comprehensive treatments to personalize your care and identify long-term solutions to:
Joint pain
Back pain
Nerve pain
Migraines
Book your appointment today. Call the Pain Management Center at (413) 535-4933.
HolyokeHealth.com