Top Warning Signs You Should Go Visit A Vascular Doctor

Postponing Your Vascular Health

I regularly meet patients that tell me about leg symptoms that have been ongoing for several months to years. A lot of them thought about seeing me sooner, they just didn’t know when to enlist the help of a specialist. Common reasons for postponing vascular care include:

• “My symptoms weren’t that bad”
• “I thought my family doctor would handle it”
• “A doctor once told me my vein disease was cosmetic”
• “It looks bad, but it doesn’t really hurt”

Please imagine me virtually rolling my eyes to all of the above excuses because the fact is that there is no real reason to delay seeing a vascular specialist. Let’s break down the 4 excuses patients use when they don't want to see a vascular doctor. 

Your Warning Signs To Visit A Vascular Doctor

• “My symptoms weren’t that bad.”
  • “Bad” is a relative term, meaning my definition of “bad” probably differs from yours. Many people subconsciously downplay their symptoms and learn to compensate for them, and therefore don’t spend a lot of time thinking about them. Nonetheless, the symptoms are real and persistent and may progress without intervention. Critical symptoms that should not be ignored include, but are not limited to, the following:
• Pain or cramping in the calves, thighs, or buttocks, that comes on with walking or other type of exertion, and subsides with rest
• Predictable pain is classic for vascular disease
• Pain, coldness, or numbness of the toes at rest and/or with elevation
• Discoloration of the skin of the legs or feet
• Slow-healing or non-healing wounds of the legs or feet
• Swelling of the legs or feet
• Achiness and fatigue of the legs that progresses as the day goes on
• Tender or bleeding varicose veins of the legs, groin, or private areas
• Pelvic pain, pressure, or heaviness without a gynecologic explanation
• Severe menstrual cramping and/or pain during and after sex are also common in women with pelvic vein disease
• Any sudden symptoms- pain, cramping, coldness, swelling or color changes of the legs or feet that comes on suddenly should be evaluated right away

The Story I hear Patients Tell Themselves

• “I thought my family doctor would handle it”
  • I am fortunate to know and partner with many excellent family doctors that do treat vascular disease. However, they will admit that there are certain tools and techniques for addressing vascular disease that only a specialist possesses. In order to help your family doctor do their best for you, it is important that you do the following:
    • Self-advocate: Report your symptoms. Don’t rely on your doctor’s questions, examination, or lab results to tell you if you’re “okay.” YOU are the one that tells THEM if you are okay, based on how you feel. If something doesn’t feel right, you need to speak up.
    • Self refer- If you family doctor is unable to address your symptoms to your satisfaction, find a specialist yourself. Ask friends and family for their recommendations and make an appointment for evaluation. Your family doctor should not mind you involving another provider. Two heads are better than one!

• “A doctor once told me my vein disease was cosmetic.”
  • I’m not exactly sure where this misconception comes from, nor why so many of my patients have been told this. The bottom line is that cosmetic problems don’t cause symptoms. If you suspect your veins may be causing you pain, itching, or swelling, or that they may be contributing to changes in your skin color or texture, you deserve to be evaluated by a vascular specialist. And yes, vein treatment is covered by most insurances.

• “It looks bad, but it doesn’t really hurt”
  • This one can be tricky. Some of you have impressive pain tolerances. Some of you are already taking pain medications regularly for other conditions which may mask pain in the legs or feet. Some of you have peripheral neuropathy which makes self-evaluation difficult. And some arterial blockages develop very slowly over time, blunting the pain felt by patients. But regardless of how your legs and feet feel, if you are noticing skin changes like discoloration, rough texture, or hair loss, these symptoms should not be ignored. It is time to seek out an experienced vascular specialist.

Type of Vascular Specialist To Visit

Another barrier to receiving proper vascular care is the fact that some patients may be confused about what type of vascular specialist to see. There are lots of us out there, but not every vascular specialist treats all types of vascular disease. Let’s break down some of the basics so you at least know the right questions to ask to get you headed in the right direction.

• Treating versus diagnosing - Does the practice treat arterial disease, or just diagnose it?
  • Some clinics perform ultrasounds and other tests to identify arterial disease but they then refer patients out to interventionalists or surgeons for treatment, which can delay care

• Maintenance and follow-up care - Does the practice offer long-term monitoring after procedures or surgery, or do they refer you to someone else for follow-up care and testing?

• Types of treatment options - Does the practice offer minimally invasive, outpatient procedures for vascular disease, or do they exclusively offer vascular surgery in a hospital setting?
  • Some vascular providers specialize in surgery and are therefore more likely to suggest surgery at an earlier date. We can debate the pros and cons of this some other time, but many patients feel more comfortable trying interventional approaches prior to resorting to invasive surgeries.

• Know the types of vascular disease the doctor treats- Does the practice treat chronic vein disease like superficial venous insufficiency, pelvic congestion syndrome, or May-Thurner Syndrome?
  • Chronic vein conditions are notoriously underdiagnosed and undertreated. For that reason, it is not uncommon for these patients to leave a vascular specialist’s office with nothing more than a prescription for compression socks, which is sorely inadequate for most.
    • Go online or call before you go! Check out the practice website or ask the front desk staff about these conditions by name, and if they hesitate or put you on hold while they figure out the answer, you should probably keep looking. You need an expert in this field to truly address your condition.

Not all Pain is a Vascular Issue

One final consideration regarding vascular care is simply you may not need it. Certain symptoms are often thought of as “circulatory” but aren’t. It is best to visit your primary care doctor to help you determine that. 

Examples of non-vascular symptoms include:

• Sharp, shooting, or stabbing pain
  • Most circulatory disease causes dull, achy pain or cramping. Sharp or “electric” pains in the legs may need to be evaluated by an orthopedist or a neurologist.
• Weakness of the legs
  • Circulatory problems may cause leg fatigue, but this doesn’t typically present as actual weakness. Low-grade weakness of the legs may be the result of normal aging and a physical therapist may be able to help, but sudden or significant weakness of the legs can indicate a serious condition involving the nerves of your spinal cord. You would need to see a neurosurgeon about this condition.
• Pain in the joints, especially if it improves with position changes or movement
  • Pain in the joints that is worse in the morning and improves as you walk around is classic for arthritis. See your PCP, an orthopedist, or a rheumatologist for further evaluation.
• “Pins and needles” or burning on the bottoms of your feet
  • Occasionally, this can represent vascular disease, but more often, it is peripheral neuropathy. Your PCP or a neurologist can evaluate you for this.