What Lies Beneath

Dr. Robert Goodman knows what some people think when they hear about removing varicose veins. In a quarter-century in practice as a vascular surgeon, he’s heard it often.

“A lot of people out there think we’re treating just the cosmetic aspect, the spider veins. Those are important, and we do treat the cosmetic aspect, but it’s not our main focus,” said Goodman, owner of Goodman Vein and Laser Center, based in West Springfield.

“We treat the bigger varicose veins and the vein systems a little deeper in the leg. We look for the root cause of the problem — not just the cosmetic aspect, but what’s causing it in the first place. We want long-term results, not short-term.”

When someone suffers from a varicose vein, he explained, the blood is not moving through the leg efficiently and recirculating.

“And if it’s not getting recirculated, it’s not going to the lungs and getting oxygenated,” he continued. “It’s unclean blood. And if it stays in the legs, now you have more volume that you’re supposed to, which can cause the fluid to leak out of the vessels into the soft tissues. That’s why you get discoloration or ulcers.”

From a clinical perspective, the arteries bring oxygen-rich blood from the heart to the extremities, while veins channel oxygen-depleted blood back to the heart. When the veins become congested with blood — which typically occurs in the legs — they may manifest as small red, blue, or purple veins on the surface of the skin, which are spider veins; varicose veins are larger, distended veins located deeper under the skin.

Goodman’s work has ranged from varicose-vein treatment to arterial-bypass surgery and stroke-prevention surgery, but in recent years, he has directed more of his attention toward veins.

“As technology has improved over the past 10 years, my interest in the vein side has increased, and my focus has shifted more to that area,” Goodman said. “I still do arterial work and enjoy doing that, but my focus has generally moved to the vein side.”

Likewise, that new technology has made vein surgery more palatable to people who suffer from varicose veins and other conditions.

“What before was a very rough operation — the old-fashioned stripping and ligation — has become, with the advent of lasers, a very sophisticated, outpatient procedure that’s safer and has less risk and less recurrence than the old-fashioned operation,” he said.

In this issue, BusinessWest pays a visit to Goodman’s office, where healing is not just skin-deep.

Laser Precision

Doctors have been treating varicose and spider veins for long before Goodman entered the field, and there was never a shortage of patients who wanted to look and feel better, even though the procedure was typically more invasive and painful in the past than it is today.

“The patients have always been there,” he said, “but the technology has improved and increased in scope, and has let us become more sophisticated in our diagnosis and treatment. In the old days, doctors might even say, ‘there’s nothing we can do for your legs; wear stockings and deal with it.’ Nowadays, we’re able to say, ‘we believe your legs hurt, and this isn’t cosmetic, and we can help you.’”

The aftermath of surgery has changed for the better, too. “You don’t miss any work; there’s no downtime,” he said. “In the old days, you’d have to rest for two weeks, and you felt miserable. Now, patients walk right out of here, and we encourage them to go to the mall and walk around. We want them back at work the next day. It’s a much less invasive procedure.”

Here’s why: vein stripping, as it’s known — the dominant way to treat varicose veins before the new wave of technology — involves actually opening the leg and surgically removing the offending veins. That’s still an option for some patients, but most also have the options of sclerotherapy and laser treatment.

Sclerotherapy, which can be used to treat both varicose and spider veins, employs a tiny needle to inject a medication that irritates the lining of the veins. In response, the veins collapse and are reabsorbed, and the surface veins are no longer visible. Goodman can also perform ultrasound-guided sclerotherapy to treat veins far enough below the surface of the skin that they would otherwise require surgery.

Endovenous laser treatment, meanwhile, is another alternative to surgical stripping of the greater saphenous vein, the large, superficial vein that runs along the thigh and leg. A small laser fiber is inserted, usually through a needle stick in the skin, into the damaged vein. Pulses of laser light are delivered inside the vein, which causes the vein to collapse and seal shut.

“We can accomplish the same thing as stripping without all the trauma,” he said. “It takes 20 minutes, and the patient can drive himself home. They’re fully ambulatory, and can be back at work the next day.”

Ready to Run

Goodman, who is board-certified as a vascular surgeon, said that expertise gives him a diagnostic advantage over other doctors, including general surgeons and dermatologists, who perform vein work.

“The symptoms aren’t just cosmetic,” he said. “You might have heaviness, tightness, or swelling and itching because the fluid is leaking into the skin. There are a lot of symptoms that go along with this that a lot of people don’t recognize. Restless leg syndrome can be due to vein disease. There’s a lot going on here.

“Our focus is on the medical aspects of vein disease. If someone’s leg is bothering them, we take that seriously. By treating the veins, you can significantly improve circulation, and that leads to better leg health while you’re improving the circulation of blood throughout the body. So, medically, there are huge advantages to doing this.”

The job satisfaction isn’t bad, either.

“It’s a lot of fun,” Goodman said. “It’s very interesting from a technical standpoint, but the most exciting thing about this job is seeing people who sometimes don’t even realize how bad their legs were, and then after the procedure, they say, ‘oh my God, that’s great.’ You’re helping people who weren’t getting help before.”

Joseph Bednar can be reached at[email protected]