All posts by Lee Shulman MD

Dr. Lee G. Shulman M.D. was one of the very first physicians to be invited to take the board certification exam in Phlebology (the medical specialty devoted to the diagnosis and treatment of venous disorders), and even has the board certification certificate number #00045.He was also done original work, being the first physician to ever lecture on the treatment of hand veins for cosmetic improvement, and the treatment of patients taking the blood thinner Coumadin. Dr. Shulman has been a member of the American College of Phlebology, the North American Society of Phlebology, the American Registry For Diagnostic Medical Sonography, the Society of Diagnostic Medical Sonography, the American College of Angiology, the American Medical Association, and the New York State Medical Society.Dr. Shulman has volunteered and gone to Mexico as a medical missionary with the Hackett Hemwall Foundation treating varicose veins and ulcerations in an indigent patient population on the outskirts of Guadalajara Mexico.

Varicose Veins, Spider Veins, And Exercise

Does exercise like running cause leg varicose or spider veins to form?

One question that vein specialists and vein centers are always asked is about varicose veins and exercise. According to Dr. Lee G. Shulman M.D. of the Shulman Vein And Laser Center in Long Island and NYC, “ the question is often asked, but the answer is not really that straight forward”.
The development of either enlarged, ropey varicose or smaller red spider veins in the legs is due to many factors. Among them are genetics, body weight, pregnancy, history of blood clots and venous insufficiency (a condition wherein blood is not returning upward from the legs to the heart as efficiently as it should). As for exercise, as Dr. Shulman points out- it’s complicated.
Often patients with large leg veins feel better when they walk or otherwise move their legs as opposed to having the legs remain stationary. Prolonged sitting can lead to increased swelling (edema) and pooling of blood in the legs. This is because for blood in one’s ankle to make it all the way up to the heart it has to overcome at least four obstacles.

  • It has to travel uphill against gravity
  • It has to travel about four feet or more in most adults
  • It has to overcome the bodies weight
  • It has no ‘heart’ to pump it upward

Dr. Martin L. Shulman M.D. likes to point out, “with exercise you are using both legs equal amounts but some patients have many varicosities or spider veins on one leg and not the other, yet both legs were ‘used’ the same amount”. While exercise is a great ‘pump for the leg muscles’ to push blood northward it’s really not all that much different than walking. The muscle activity is very similar but the rate of ‘compressions per minute’ is much faster.
As a very rough example, imagine that with regular leisurely walking a person’s right calf and thigh muscles contract 15 times in one minute. Now imagine that this same person is running at a rapid pace and thus contracting these same muscles 30 times a minute. This is obviously twice the number of compressions but is it effecting the possible formation of leg veins”? This helps promote the return of venous blood in the leg veins upwards but it’s not known if it helps promote the formation of either varicose and or spider veins, and again as Dr. Shulman points out, not every pair of legs is exactly symmetrical.

Three Types Of People At Risk For Developing Varicose Veins

vericose veins myths

What Are Varicose And Spider Veins?

Varicose veins are the swollen, twisted veins that can be seen just either under the surface of the skin or jutting above it in the legs. Spider veins are in some ways similar to varicose veins but smaller in size . They are always closer to the surface of the skin than varicose veins.

What Are Some Common Causes Of Varicose And Spider Leg Veins? 
While it is known that there are numerous causes of both types of veins in the legs its generally believed that there is no one single all-encompassing reason for developing either varicose or spider veins.

Among the many recognized precipitating factors are

  • Increasing Age- It’s a well recognized medical fact that as we are our vascular system develops more medical problems, be it more heart disease, more hardening of the arteries (atherosclerosis), or more leg varicose or spider veins. As Dr. Martin L. Shulman M.D. likes to joke ‘We don’t treat teenagers, so my grandchild have even less reason to call’.
  • Congenital Defects In Vein Valves- This is something which is only rarely seen and when diagnosed it is often later in life. There is nothing to do about it other than the be vigilant in having veins treated and removed before they become medically problematic.
  • Obesity– More weight adds more pressure onto the leg veins and in turn helps varicose veins form. Obviously not every varicose vein sufferer is obese and even thin people develop veins but it certainly doesn’t help.
  • Pregnancy- See below for more information
  • History Of Blood Clots In The Legs- Having had prior blood clots, or phlebitits, increases ones chances of developing varicose veins. The vein valves in the vein walls are often scarred and the pressure in the veins increases over time.
  • Family History- This is a big factor and obviously one over which you have no control. Dr. Shulman also notes how often patients ‘blame’ their fathers who had varicose veins more than their mothers who seemed to have it less commonly.

Who Is More At Risk For Developing Varicose And Spider Veins?

There are three types of people who are, tend to develop leg veins more than others.

  • Pregnant Woman- There are numerous reasons why pregnancy causes leg varicose and spider veins to appear. There is the ever increasing weight of the enlarging baby and uterus. The increased blood volume to support the baby and uterus. And the ever increasing levels of hormones to help both the pregnancy and the delivery.
  • People Who Work Standing- When standing the blood pools in the leg veins more than when a person is moving about and thus contracting the muscles of the legs. It is that muscle contraction which acts like a ‘heart in the leg’ to push blood up towards the true heart. Even sitting puts less pressure on the leg veins then standing does as the pressure in the legs is less than that achieved while standing in one position. When standing occurs continually over prolonged periods, it can result in inflammation of the veins. This inflammation may progress over time to chronic and painful varicose veins.
  • Obese People- While most of us would like to weigh less than we do there is a venous component to being overweight. Often, people overweight may not even realize they have varicose veins as their swollen veins are not visible on the surface of the skin, due to excess fat. Being overweight or obese will very often put extra pressure on the legs and veins. Over time, the pressure in the weakened leg veins may cause damage to the skin on the lower leg. It is times such as this that people will usually go and consult a vein specialist or vein center. This is a major issue in the overweight population and they are at greater risk of leg ulceration.

If you think you have varicose veins or spider veins and would want to schedule a FREE vein screening with a board certified vein specialist, call the Shulman Vein And Laser Center. Our offices are in Manhattan, as well as both Nassau and Suffolk counties on Long Island.

Author: Dr. Lee Shulman / Shulman Vein & Treatment Center NY

Information About Laser Treatment Of Leg Varicose Veins

If you are suffering from achy swollen and tired feeling legs, and have enlarged ropey bulging varicose veins, then seeing a vein specialist or vein center for laser treatment may be just what you need. While old-fashioned vein stripping has fallen by the wayside there are a few different procedures for treating and removing varicose veins.

The use of laser is one of them and is actually very easy for patients and the results are outstanding. When done in the Shulman Vein And Laser Centers of New York City and Long Island, patients require only local anesthesia into the area of the leg near the veins to be treated and all patients are able to walk out of the office immediately and drive themselves home right afterwards.

When the endo venous laser therapy (intravenous laser treatment) is done, patients are at rest lying on an exam table. Dr. Shulman likes to start the procedure by telling patients to ‘pick a topic’ as patients most often speak to the doctor and the staff during the procedure. It is also done under sterile conditions so that Dr. Shulman and the staff are wearing surgical gown, and sterile gloves, hats and masks.

A small needle is inserted into the vein to be lasered. As a patient you would feel that small needle but it’s no worse then any other intravenous shot you have ever had before. Once the vein needle is in the correct location, a laser fiber is inserted into the vein through that needle. Just as you don’t feel blood flowing inside your veins, you also don’t feel the laser fiber inside the vein. It is also so thin that it truly is painless. Once the fiber is introduced into the enlarged vein, a Doppler ultrasound machine is used to make sure the laser is correctly positioned. It is positioned so as to best shut the vein for as long an area as possible.

Once the correct positioning has occurred then the local anesthesia into the leg around the vein is given. Ironically the anesthesia is often the least enjoyable part of the procedure. When it he first shot is given into the leg, there is no anesthesia and the patients feel the needle. Once the second shot is given there is already some anesthesia inside the leg so it gets easier and less sensitive with each injection. Generally when lasering leg veins about a dozen shots are given and by the time the final few injections are given patients often don’t even feel them.

Once the leg and vein are fully anestizized the laser fiber is turned on and the laser energy acts on the inside of the vein wall to cause it to scar shut onto itself. We often tell patients it’s like squeezing down on a drinking straw. The two opposing sides of the veins are brought into contact with each other and the vein will scar itself shut.

After the laser has been fully withdrawn from the leg two ace bandage like wraps are applied to the leg. The entire laser procedure takes about 25 to 30 minutes. At the shulman Vein And Laser Center all laser patients are given Dr. Shulman’s personal cell phone number and all are called in follow-up both that day and the following day.

As the anesthesia is also very effective there is almost never a need for post laser treatment painkillers.

If you have varicose veins and would like to see a board certified vein specialist we suggest calling Shulman Vein And Laser Center for a free no obligation vein screening.

What Causes Varicose Veins During A Pregnancy ?

Varicose Veins During A Pregnancy

It is not at all uncommon for women to develop varicose and spider veins while pregnant. There are certain well understood reasons for this and we will explain a few basic principles here.

Genetics And Varicose Veins

Dr. Lee G. Shulman M.D. of the Shulman Vein And Laser Centers in Long Island and New York City likes to tell patients “You get the genes from your parents and your own pregnancies often cause varicose leg veins to develop. It’s the ideal family guilt disease- you get to blame everybody”. In many respects this is correct, as genetics often predispose a person (here a woman) to developing vein problems.

Previous Pregnancy Varicose Veins

Of course if a woman has varicose veins before becoming pregnant they will almost certainly worsen as the pregnancy progresses. While the veins may have appeared in previous pregnancies and then improved after delivery, there is an increased tendency for them to return and often even more severely then in earlier pregnancies. With each pregnancy a woman is obviously older and the veins have often been ‘challenged’ by all the factors leading to the development of leg varicose veins.

Blood Volume

During a pregnancy there is also an increased volume of blood in the body of the expectant mother. This is because there is now another growing tissue, the uterus, and the baby that both need blood to develop. The blood volume increase is so large in fact that its almost 50% of the baseline, non-pregnant amount of about one and a half gallons. This volume of blood continues to increase as the pregnancy advances and the baby and uterus enlarge.

Hormones And Pregnancy

There are also hormonal changes during pregnancy that cause the veins to dilate more and have less ability to constrict. The hormone progesterone increases throughout a pregnancy. It is first produced by ovaries and then later on by the uterus itself. The “loosening” or laxity it produces allows the ligaments of the pelvis to more easily stretch to help in the delivery of a baby but it also predisposes to the formation of varicose veins.

Pressure During Pregnancy

Even in the non pregnant state blood in the legs has to travel upwards against gravity, the bodies weight and distances as long as three or four feet to reach the heart. As both the baby and uterus enlarge, they add both weight and increasing compression on the veins of the legs and pelvis. The effect of this is to further inhibit venous bloods return to the heart and the development of more varicose veins.

Women who are concerned about their veins and pregnancy are encouraged to seek the advice of medical experts in vein therapy. Vein specialists are known as Phlebologists and the more educated ones are board certified and best able to answer your questions. Should you desire to speak to vein specialists in Long Island or New York City feel free to contact Dr. Martin L. Shulman M.D. or Dr. Lee G. Shulman M.D.

Are the pains in your legs from Venous Insufficiency?

What Is Venous Insufficiency?

Venous insufficiency is a condition in which the blood in the leg veins is not returning upwards from the legs to the heart as well as it needs to. Often people with varicose veins or even spider veins, in their legs suffer from insufficiency. The resulting congestion of blood in the legs can cause symptoms such as tiredness, heaviness, throbbing , swelling (also called edema) and ulcerations (loss of tissue in the skin). These conditions don’t generally all occur at once but rather develop over years as the leg veins worsen.

What Are Symptoms Of Venous Insufficiency?

It is common for people to not realize that their leg pains are the result of the stagnation of venous blood. As Dr. Martin L. Shulman of the Shulman Vein And Laser Center, likes to point out, ‘if a person didn’t urinate for a whole day, their bladder would be more enlarged then it should be and discomfort would occur. The same thing can happen with venous insufficiency when the veins are more distended then they should be’. The most common underlying cause is superficial venous reflux. To further explain this, first understand that the venous systems of the legs are primarily divided into superficial (surface) and deep vein networks. There are one directional valves in the veins that help the blood return to the heart in a step-by-step upward direction. The valves prevent blood in the leg veins from traveling downward due to gravity. If your legs have varicose veins, the valves become to far apart to meet and blood can then be held in the legs or drawn downward due to gravity. This all can lead to the congestion, swelling, throbbing and other symptoms that cause leg pains.

What Can Be Done To Treat Varicose Veins, Spider Veins And Venous Insufficiency ?

Fortunately the invasive and painful stripping and ligation of yesteryear have been replaced with newer modern ways to treat both varicose and spider veins. Treatments are virtually painless and done in our offices and require either no anesthesia or only local anesthesia, and all patients are able to drive themselves home. If you are suffering from leg pains, swelling or varicose and or spider veins, schedule an appointment at one of our vein centers today. Our qualified team of board certified physicians and staff would be happy to assist you on the path to regain your leg health.

12 Questions to Ask Your Long Island Vein Center

It’s Time To Fix Those Veins

You are ready: you know you want to stop by a vein laser center to treat your spider veins or varicose veins. But how do you choose between all of the different vein centers? The doctors at the Shulman Vein and Laser Centers in New York and Long Island have compiled 12 questions to ask of any vein center you are considering. Ask these questions and you’re sure to receive the best vein therapy experience.


Experience, experience, experience.


How much experience does the vein doctor who will be treating you have? The doctors at the Shulman Vein and Laser Center strongly believe ‘practice makes perfect’. The longer a physician has been practicing a specific field, the better they will become as they treat a wider range of patients and cases. You want a vein center with experienced doctors who have specialized in vein therapy for years.


Does the doctor treat all veins or just certain ones?


Some vein center doctors only like to treat enlarged varicose veins, while others only want to treat smaller spider veins. This is inconvenient for the patients. It’s like going to two different restaurants for your appetizer and your main course. Make sure that the doctor you are seeing is equipped to treat all of your veins.


Is the doctor board certified in vein treatment and diagnosis?


Any physician who is a board certified Phlebologist has taken and passed rigorous exams to prove his or her extra strong knowledge and devotion to the field of venous medicine.


Who is actually treating the patients?


Are physicians seeing patients, or are students, learning residents or nurses attending to patients? Again the more experience anyone has in any field the better they should become. Yes, doctors in training do have to learn on somebody, but wouldn’t you prefer not to be their guinea pig?


Does the vein center offer a variety of treatment methods?


Seeing a doctor who doesn’t offer at least three types of treatment options such as laser therapy, micro surgery and injection treatment is just limiting your chances of getting the best results possible. Your best case scenario is working with a doctor who specializes in veins and knows all of the latest treatment methods for treating spider veins and varicose veins.


Does the vein center only use FDA approved medicines?


While it may be appealing for a physician to use cheaper, non-FDA approved medications, it is absolutely imperative that you as the patient ask for better. FDA-approved medications have stood the test of time and are manufactured to a higher standard than cheaper, imported medications.


Does the vein doctor follow up after procedures?


While some patients may not want to be bothered after treatment, the doctors at the Shulman Vein and Laser Center personally call each new patient the day after treatment starts to make sure they are doing well and to answer any questions they may have. You want your doctor to be available and invested in your health after you leave the vein center offices.


Is the doctor ‘reachable’ after office hours?


Every physician should have an answering service which is directed to an immediate contact or your doctor if a patient has a question or concern when the office is not open.


Does the physician ever give out his personal cell phone number to patients?


As ‘crazy’ as it sounds Dr. Lee G. Shulman gives his own cell number to all patients who have come from out of town, have had a laser or micro surgery procedure and most hand and temple vein patients. “My belief is that there are amazingly few concerns and if there are, it’s just more efficient to let patients contact me directly” says Dr. Shulman.


Is there a vascular laboratory to check the circulation?


Any true vein specialist should have a duplex ultrasound with color flow technology. This is vital in diagnosing blood clots and ‘looking’ at the veins themselves. This vascular assessment is also what is required to determine if a patient is a candidate for treatment and which method of treatment is best suited to the patient’s individual case.

While having a ‘vascular laboratory’ is a bare minimum, its best to also make sure the lab is certified and accredited in vascular testing. This guarantees the testing is done with a high degree of accuracy and competence. This certification is only given to laboratories that have passed a strict certification process and are deemed to be among the most qualified to do vascular testing.


Are the ultrasound technicians also certified?


This means that the physician or the ultrasound technicians are certified as RVT’s (registered vascular technologists). Much like a laboratory must apply and be accepted and approved to be recognized for its competency so should the people working in the laboratory. The RVT designation is only achieved after passing a series of extensive written and photograph examinations and assures you the patient that the work is being done with a high degree of competence.


When searching for a vein center to treat your varicose veins and spider veins, you want complete confidence that you are going to best place for you. Use the above 12 questions to decide whether a vein treatment center meets your standards, and call the Shulman Vein and Laser Centers to discuss your situation and how we can help.

Family History and the Prevention Of Varicose Veins—Is It Even Possible?

One of the most common questions vein specialists get asked is, “How can I prevent getting new or more varicose veins in my legs?”  In many cases, the answer can be very simple: Pick your parents wisely.

Enlarged and ropelike varicose veins are only seen in the legs and are common in both men and women.  While there are many factors that can play into the risk for varicose veins, a history of vein problems in the family can be attributed to about half those people who develop them. Although it may sometimes skip a generation entirely, venous problems or varicosity in the family tends to be the largest contributing reason why an individual would develop varicose veins themselves. The family history might just be simple uncomplicated veins, or more advanced conditions such as leg ulcers, ankle discoloration, swelling or even blood clots originating from the legs. Dr. Shulman even likes to joke with female patients, that veins are the ideal family guilt disease. “You can get the genes from your parents and your pregnancies can make the veins appear, so you get to blame everybody!”


Yes, pregnancy can trigger the onset of varicose veins or even worsen them. This seems to be even more pronounced if a woman has had twins or multiple pregnancies. With each pregnancy, a woman is a bit older and dealing with another period of increased pressure on the legs, as well as elevated hormone levels and blood volume. As you can imagine, carrying more than one baby can be even harder on the leg veins. So, as luck would have it, even those precious little family members yet to arrive in this world can play a part in the onset of varicose veins.


As we are now between Mother’s Day and Father’s Day, we hope you all can be thankful to your parents for all they have done for and given you—even if it includes setting you on a course towards veiny legs.

Varicose Veins Around the Knees

One of the most common areas of the legs vein specialists are asked to treat is both varicose veins and spider veins on the various areas around the knees. While they may occur in the entire leg, veins do occur more commonly in certain areas and there are good reasons for this.

The veins in the legs can be divided into two main systems: one is the superficial, or surface, and the other is a deep venous system, located deeper inside the legs. The two systems are connected to each other at numerous points and ideally blood only flows from the surface veins into the deeper veins.

The knees are an area where both larger varicose veins as well as the smaller red or darker blue spider veins can often be seen. On the inner side of the knees the largest of the superficial veins, the greater saphenous vein, passes as it travels from the ankle towards the groin helping return blood to the heart. Normally, is it not visible but may be palpable (easily felt on simple physical examination) especially in thinner people. The other larger surface vein in the legs, the small saphenous vein, starts in the inner ankle and empties into the deep system in the knee crease area. Its not nearly as common but varicose veins can be seen and even palpated on the knee cap (also called the patella) or the outer side of the knee.

The back of the knee where the skin is thinner is called the popliteal fossa. Because the skin is thinner there, the venules, which are not quite large enough to be called varicose but are certainly larger then the spider veins, can often be easily seen. They often take on a darkened green type coloration similar to what can be seen in the arms inner elbow area.

The area of the inner and lower thigh just around the knee is a very common location to see spider veins. They often appear as groups of elongated veins but can also, although less commonly, be seen as just a few scattered red or blue colored veins. The longer they have been present, the darker in color and larger in both length and diameter they become.

Vein specialists such as the doctors at the Shulman Vein and Laser Center in New York and Long Island use multiple treatment methods to eliminate these veins. Lasers are often used in the treatment of the larger veins although some are also removed using micro surgery or injection therapy. For the venules and spider veins the unquestionably most effective treatment has been vein injection treatment using FDA approved medications.

Bleeding From Varicose Veins Or Spider Veins In The Legs

A recent report from England of an elderly woman who died from a bleeding varicose vein in her leg has prompted a few calls to both my Long Island and New York City offices. While there are always occasional reports of deaths from ruptured veins, (one surgical journal suggested as many as 23 deaths in the U.K. in one year, although that number seems exceedingly high to us) the good news is that is still a very rare phenomenon.

This post is designed to both help out in the event of a hemorrhage and address common underlying reasons that bleeding from varicose vein or spider veins  may occur.

When a Vein Bleeds, What Should You Do ?

• First thing to do is to remain calm. Spontaneous outflows are often from very small openings and are more likely to ooze then spurt blood. The pulsatile squirting of blood is seen with arteries and not with veins.

• Apply direct pressure over the open wound. It’s extremely unlikely that more than one break of the skin has occurred so start by applying either a finger or a cloth over the opening and applying direct and firm pressure.

• Elevate the leg. Lifting the leg above the heart is ideal but even lifting it above the waistline will alleviate much of the pressure in the veins and dramatically slow or even stop the seeping of blood.  We often tell patients to hold pressure for longer than they might think is necessary to fully ensure a scab and clot have formed.

• DO NOT use a tourniquet !! Tourniquets are used to ‘trap or hold’ blood in the veins. (For example, when drawing blood for testing.) If applied incorrectly, the compressive wrap can actually do more harm than good.

• Seek medical attention. Once the bleeding has stopped there is a significant chance of recurrence.  By seeing a doctor for treatment of the veins you can dramatically reduce the chances of it happening again.

• As one would expect, the incidence of bleeding from veins far exceeds the incidences in fatalities resulting from ruptured veins. In two surgical journal articles, the reported rate at which patients were seen at local ER’s in Chicago was only 14 patients in 4 years, while in a large European hospital it was 124 bleeds over 5 years.

Factors Predisposing To Bleeds From Leg Vein

• Minor trauma- While sometimes a rupture seemingly occurs without any underlying physical contact obviously a bang or bump on the legs can break the skin. A very common place to experience a hemorrhage is in the shower. While it’s not really a trauma, the rubbing or touching of enlarged superficial veins while washing may be all that it takes to pierce the tissue.

• Increasing age- As a person ages their varicose and spider veins tend to worsen and become  more likely to burst. They may also be disoriented and unaware that  they are bleeding.

• Leg ulcers- These are due to the presence of venous insufficiency (blood not returning up towards the heart as it should due to vein problems). In some cases the ulceration may erode into the vein itself and thus bleed.

• Other medical conditions- Beyond venous insufficiency conditions.

1. Heart failure- This increases the pressure on the veins and also can make bleeds more difficult to stop.

2. Liver failure (cirrhosis)- This has two negative consequences. It increases the pressure in the leg veins as well as potentially effecting the livers ability to produce blood clotting factors.

3. Blood coagulopathy (clotting problems)- Some problems are genetic or acquired while others are the result of medications. The genetic and acquired conditions include  Von Willebrands Disease and hemophilia. Medically induced situations that ‘thin the blood’ include the taking of aspirin, NSAIDS, coumadin and Eliquis.  Some of these actually do ‘thin the blood’ but more likely they make clotting and clot formation times longer.  If they are being used it’s assumed that they are medically necessary for other diseases.

4. Social isolation and dementia- Unfortunately in some cases nobody is around to help someone who is bleeding.

5. Restricted mobility- As the legs merely ‘hang,’ the blood pools more due to gravity and there is increased pressure on the veins. Any activity where there is compression of the legs muscles, walking or running for example, helps return blood towards the heart and lessens the venous pressure.

Again, its easier to treat veins before complications occur but should there be a hemorrhage stay calm, apply pressure, elevate the leg and seek treatment.

Leg Swelling And Two Potential Ways To Help It

Vein Problems Can Cause Swollen Legs And Ankles- Here Are Two Simple Tips To Help Reduce Swelling

Both the smaller spider veins and well as the larger rope like varicose veins can cause discomfort and leg distention also known as edema. Read on to see what the doctors at the Shulman Vein and Laser Center of New York and Long Island suggest to help your vein problems.

Keep Moving….

The first and least difficult thing to do is to remain active. Every time you walk, you are squeezing the muscles in your legs and also contracting the leg veins so blood can be pushed back towards the heart.  Often we find leg vein patients even tell us that they feel better with walking then just standing in one place.  This simple act of walking can help provide relief from swollen legs, feet, and ankles as well as the symptoms of throbbing and achiness.

This has benefits even beyond the health of your veins as physical activity is known to reduce hypertension, diabetes, stroke, and heart disease to name just a few of the perks.


Mind Your Pants…..

The clothes you wear below the waist also can be causing excessive fluid to collect in the legs. If very tight stockings or the overly tight bottoms of outfits like gym pants are to tight (below the level of the waist) they may be acting like tourniquets and actually adding to the fluid buildup.  An easy way to imagine this is to think of what happens when a tourniquet is put on your arm to draw blood.  The overly restrictive and compressive band, easily compresses the veins and blood flow in them is restricted.  This stagnation of venous blood flow often  leads to leg enlargement.

Its also important to understand that support hose may help reduce the distention in the legs but its very important that they fit well and help ‘push’ blood back upwards from the legs.  Good fitting support hose have been described as ‘ice cream cone like’- tighter at the bottom and looser further up the leg.

If you suffer from leg swelling and live in the New York CIty or Long Island area your veins and the their condition can be evaluated at the  Shulman Vein and Laser Center by the Dr.s Shulman.   They and their medical team perform throught evaluations of the legs and veins and can explain if and how they can help your situation

Varicose Veins And Vein Valves

Vein disorders in vein valves are very common , but how much do you really know?  To learn how vein disorders are caused, and treated using  laser vein treatment options, micro surgery and vein injection treatment  it is important to first understand the venous valves that may be the underlying cause of spider veins, varicose veins, and venous insufficiency.

About two thirds of the blood in the body is held in the veins and a large percentage of that is in the leg veins.  Delivering blood out to the body is done via the arteries and is helped greatly by the pumping of the heart.  Gravity also helps for those areas that are located below the heart. However the return of blood back to the heart via the veins is much more challenging and complex.

The blood in the legs of an adult has to travel upward to reach the heart and lungs. There are also many obstacles it has to overcome.  These include its need to flow uphill against gravity, against the bodies weight, a distance of up to four or five feet (from ankle to heart) and all without  the benefit of a constant pump like the heart. Fortunately mother nature has helped aid this with the presence of one way valves in the veins.

These valves are essentially two flaps of tissue located within the walls of the veins and are scattered throughout the length of the veins. They allow blood to travel towards the heart by opening as blood is flowing through them. As they are only uni-directional they prevent the back flow of blood away from the heart. A very good video showing the function of vein valves can be seen here. This is essential for the circulation as you can imagine its not possible for blood in the ankle to simply ‘jump’ up to the heart in one step.  With the help of valves it is more of a step by step northward flow in the leg veins. In varicose veins the valves are often not functioning meaning that they are allowing blood to regurgitate back into the legs and not advance towards the heart.

The occurrence of these faulty valves has many underlying causes. These include factors such as  pregnancy, hormonal changes, obesity, increasing age and prior blood clots that can cause valves to malfunction. A family history of leg vein problems or being born with weak vein valves also contribute to the problem in some varicose veins patients..

Valves themselves can’t be fixed to work correctly but fortunately the treatment of their effects, varicose veins, spider veins, and vein valve failure, is often done using lasers, vein microsurgery and injection compression therapy.  Also it is always done on an outpatient basis at centers such as the Shulman Vein and Laser Center in Long Island and New York City.

What Causes Spider Veins?

Spider veins are small yet visible veins most often seen in the legs. They may be red or a darker blue in color and are most often seen in clusters. These small veins are not necessarily a medical problem but can be treated for cosmetic improvement when they are present. Spider veins are also known medically as telangiectasia.

The causes of spider veins are often broken into congenital (conditions a person is born with) and acquired factors. While there are about a dozen congenital underlying etiologies that can cause spider veins, yet they are still rare. Among the most prevalent are Klippel_trenaunay syndrome, Maffucci’s syndrome and Sturge-Weber syndrome.

Among the most common acquired causes of spider veins there are some that are controllable and others that are not. The unavoidable reasons for spider veins developing include normal aging, the presence of female hormones, pregnancy, prolonged sitting or prolonged standing, and a history of trauma. As for possibly controllable causes of spider veins there are a few which can be mentioned. These include other local varicose veins leading to greater venous hypertension, excessive sun exposure, obesity, long term application of steroid creams, and possibly hormone replacement or oral contraceptives in women.

At the Shulman Vein and Laser Center we often tell patients that ‘spider veins are like gray hairs- they are most often not a result or anything you are doing or not doing, but more commonly just something that occurs with aging’.

Blood Clots And Travel- Advice and Information

With the Christmas holiday season upon us and many people traveling it’s a good time to discuss the relationship between blood clots and traveling.

While generally a rare occurrence, potentially dangerous blood clots most often  form in the veins of the leg and can in certain situations leave to leg veins and travel up to the heart and lungs. This detached blood clot is almost always from the deep veins in the legs and is called a pulmonary embolism.

The condition has also been known as ‘economy class syndrome’ because it is seen mostly with long plane flights. A blood clot in either varicose or non varicose veins can always occur but there are some simple things you can do to decrease the risk of developing these DVT’s (deep vein thrombi-aka clots).

The risk of developing leg blood clots is increased if you ….
-are pregnant
-are obese
-have varicose veins
-are immobile
-have had prior blood clots or have a blood clotting disorder
-have cancer
-are dehydrated

When taking unusually long flights of many hours you can….
-drink lots of fluid as people dehydrate at high altitudes which makes the blood ‘thicker’ and more likely to clot
-benefit from drinking as it will force you to get up and walk to   the bathroom which helps by squeezing the legs muscles and preventing blood stagnation in the veins
-take aspirin before flying for a few days as this will act as a mild blood thinner
-wear support hose again to compress the leg veins so less blood  is stagnant in them
-avoid having to much alcohol to drink as it is actually dehydrating
-stretch your legs by either getting up and walking, or just  lifting your heals while keeping your toes on the floor

People who are concerned about developing blood clots or who have varicose veins and are at greater risk of blood clots can set up a complimentary consultation with the doctors at the Shulman Vein and Laser Center which in in New York City and Long Island. We have over 55 years combined experience treating both varicose and spider veins using lasers, microsurgery and injection sclerotherapy.  You can contact us at or by phone at (212) 987-0500 or (516) 482-4477.

Wintertime Treatment of Leg Spider and Varicose Veins

“Are  varicose and spider vein treatments in the winter a good idea ?” is a question we are often asked at the Shulman Vein and Laser Center.

While there is no ‘season of vein therapy’ per se, it makes sense to start treatment early as it takes time for treated veins to heal and disappear.

Many of our current patients know that the most common, and always temporary, side effect of vein injection therapy is very minor bruising around the treated areas in the leg. While most patients experience little to none of it, it can occur so treatment in times of the year when the legs are not exposed, winter vs. summer, is logical.

In terms of this temporary discoloration, should it occur, it is not uniform. The areas in the legs where we see it most, is in the upper inner thighs, if veins there are treated. The skin is not as tight as elsewhere in the leg and while most patients do not get black and blue, we prefer to warn our patients it may occur. Treatment of the veins in the hands and arms almost never bruise,  while treatment of chest and breast veins are more likely to but again its always temporary should it occur.

Patients undergoing the EVLT, endo venous laser treatment for varicose veins or ambulatory phlebotomy, micro surgery for vein removal, are more prone to bruising or hematomas. In the laser vein therapy it is due to the use of local anesthesia injected around the veins to be lasered.  Some patients get none and some can get easily visible darking from the blood but again it is always temporary. Patients treated by sclerotherapy (injection therapy) are the ones least likely to bruise.

What are Varicose Veins?

Varicose veins are abnormally enlarged, twisted, tortuous veins, which are on the surface of the skin, and most often are seen in the legs. They generally worsen over time if a person does not have vein treatments. The causes of varicose veins are numerous but always include faulty or weakened valves in the veins.

Varicose veins form because of the challenges the blood in the legs must overcome to return up to the heart. Blood in the ankle for example has to travel uphill at least three or more feet, against the pull of gravity and against the bodies weith, ot make it to the heart. It’s not physically possible for blood in the ankle to just return to the heart in one quick jump. It also lacks the constant propelling force the heart has on the blood in the arteries to push blood out to the body. The ‘legs heart’ however, does help, with the contraction of calf and thigh muscles aiding in the pushing of blood back up towards the heart. This is all aided by the one-way valves, which allow the blood return to occur in multiple steps.

In varicose veins, the venous valves are not working. This condition thus allows blood to ‘fall back’ downward into the veins of the legs. This reversed flow in the circulation is due to gravity. The non-working valves are allowing what should be a one directional flow pattern, back up towards the heart, to become a two directional system as the blood back-flows downward into the legs.

Fortunately today there are modern and minimally invasive treatments for varicose veins. The primary methods involve lasers, microsurgery, and injection treatments and often a combination of these options. Its best to see a vein specialist to have all treatments explained to you and decide how best to treat your varicosities.

Leg Vein Treatments & Sun Exposure

Can varicose veins and spider veins be treated in the summer or can you go into the sun after leg vein treatments ? these are two of the most commonly asked questions we hear at the Shulman Vein and Laser Center, and with summer approaching these are very good questions.

In one word, YES, its OK to be in the sun after treatment of leg varicose and or spider veins. Just think about this- vein treatment is done in sunny areas like florida and arizona on a daily basis and the patients do just fine.

In terms of sun exposure after leg vein therapy there are a few principles to remember. Some patients have a darkened discoloration even before seeking vein treatments and in some cases its tattoo like- permanent and a result of delaying vein care. In some cases there is a tendency for skin around veins to darken, but this is most commonly due to the condition of the veins before treatment.

Experienced vein specialists can very accurately predict how veins will look in the short term after vein injection therapyand advise patients accordingly. If veins are prone to darkening, you can still be in the sun, again think of the florida patients, but its best to use a sun block with a high SPF to help get the best results. The sun always darkens the skin and if its darker from either long standing venous insufficiency or as a result of vein treatments, the goal is not to make it even darker.

Whether or not a person has leg vein treatment, its a good rule for all people to not get to much sun exposure for all the risks and negatives that we now know the suns rays expose us to.

Leg Veins Quality Of Life Study

The Shulman Vein and Laser Center in Manhasset and Commack on Long Island, and Park Avenue in New York City, is conducting a brief survey from our new and existing leg vein treatment patients. The focus of the short questionnaire is about how you feel about having visible varicose veins or spider veins and how it is effecting your quality of life. The survey is just a few questions long, totally anonymous and will help in our research in the vein field. If you participate in the study, all the vein treatment methods and medicines we use will be the same as those which we have successfully used in the past. This research study is not in any way using our patients as ‘lab rats’ for experimental leg vein treatments. It is totally a quality of life investigation, not a medical treatment study. The short question and answer form we are using is to be filled out when you are in our offices and is not being offered as an online download.

As a way of thanking those patients who participate in the research, we are offering our leg vein injection treatment therapy at a reduced fee of $225 for ten injections, as opposed to our regular fees of $375 for ten injections. We do not yet have a date when we will be finishing the survey but hope to enroll enough patients so that we can use the data generated to publish a quality of life and leg vein paper for publication in the future.

For those patient’s interested in having varicose veins and or spider veins treated (at a reduced fee) we ask that you phone our offices and schedule an appointment. You can let the nurses know you would like to be enrolled in the research group and when we see you the paperwork form can be filled out.

Thank you to all those who have already participated
Dr. Martin L. Shulman M.D.
Dr. Lee G. Shulman M.D.