MICHEL MARTIN, HOST:
As many as 30% of all adults in the U.S. have some form of chronic venous insufficiency. So let's learn more about it. We've called Dr. Thomas Maldonado for this. He is a vascular surgeon at NYU Langone Health in New York. Good morning, Dr. Maldonado. Thanks for joining us.
THOMAS MALDONADO: Good morning. Good to be here.
MARTIN: So what are some of the early indicators for this? What should people be looking for?
MALDONADO: Well, you know, this is a progressive disease, so there's a spectrum of symptoms and signs. And, you know, early on, this is something that can present with some mild swelling. Oftentimes, people feel some heaviness, some itching in the legs, believe it or not. And then varicose veins is sort of what is the common presentation. People come in with sort of unsightly veins.
They want to look better in the summer. They want those treated. But those are actually a tip-off that there's a problem with the veins and the venous circulation.
MARTIN: You know, the White House released the results of the president's latest physical in April, which is just about three months ago. It showed there was, quote, "normal blood flow and no swelling," unquote, in his extremities. So is it possible that this condition came on that quickly in just a few months?
MALDONADO: Well, probably unlikely. I mean, there are - this is a chronic disease and it's - thus the name chronic venous insufficiency. So it happens really over a lifetime, although it's more common, as we know, in older adults, especially women. But the best way to understand this is that circulation is really simple plumbing. You know, we have a pump, the heart. It kind of propels blood through the arteries which deliver it to the organs, the extremities, and the veins return it.
And these veins, over time, as we fight gravity every day of our life, can become weak. You know, the valves that live in the veins, these delicate little valves can fail, and that really happens over years, so unlikely that it happened overnight.
MARTIN: I was just wondering, though, how or why are his doctors so sure that this is a vascular problem and not a heart problem? Like, why is this the plumbing problem and not the heart problem? Which end...
MALDONADO: Yeah.
MARTIN: ...Of the spectrum, right? Like, is...
MALDONADO: Correct.
MARTIN: ...It a top-down problem or a bottom-up problem? They seem to be convinced it's a bottom-up problem, but why are they so sure?
MALDONADO: Well, you know, there's a workup that goes into place. Anytime you see someone with swelling, you're going to evaluate their heart. If they have heart failure, their liver failure can also, you know, increase your total body water, if you will, and kidney failure the same. So there's a number of different sort of systemic reasons why people can get swelling.
And those are ruled out with various workups, so I'm sure he's had an echocardiogram. It's how you get a full evaluation of the other systems. But common things happen commonly, and certainly, you know, chronic venous insufficiency is a very common disease.
MARTIN: I was reading that women are statistically more prone to develop this condition. Can you just amplify that? Like, why is that? And are there differences in how it presents in men or women?
MALDONADO: Yeah. Well, women - pregnancy, for sure, and repeat, you know, more than one pregnancy can add to the risk factors of developing chronic venous insufficiency. And there's a number of reasons for that. But the symptomatology or how people present is the same. It's the swelling, the aching, the heaviness. And again, in the more severe cases where we have changes in the skin fibrosis, skin breakdown, as you've heard, with ulcers and infection that can develop. So it is not so benign, actually, especially in the later stages.
MARTIN: So - and just one more thing about the president. The White House physician attributed some bruising on the president's hands to, quote, "frequent hand shaking and the use of aspirin, which is used to prevent cardiovascular disease." I'm sure a lot of people do that, take a small aspirin a day. What do you make of that explanation?
MALDONADO: Yeah. I think it's plausible. I mean, aspirin is one of those medications that can be very important for people's vascular health, but can also give you these skin manifestations, where you have sort of bruising or what we call easy capillary breakdown of the vessels, and certainly any kind of local trauma, whether it's, you know, a bracelet or watch, sometimes you see people have bruising in the skin and certainly in the hands.
MARTIN: So before I let you go, are there things that people - regular people like us should do to prevent this or to take care of this?
MALDONADO: Yeah. I think early recognition, like most things. You want to catch this early so you can prevent the progression, you know, compression stockings, leg elevation, exercise, weight loss, more, you know, obesity is one of the important risk factors. So watching your health, staying healthy and wearing compression. You know, you want to recognize these things early so they don't progress to the more severe chronic problem stages.
MARTIN: OK. All right. That is Dr. Thomas Maldonado. He's a vascular surgeon at NYU Langone Health. Dr. Maldonado, thanks so much for sharing these insights with us.
MALDONADO: Thank you.
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