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The Truth About Vein Health: Why 1 in 4 People Suffer from Vein Disease" · Building the Best You

• 0:00
  Speaker 1: You know you have to think of veins like a tree.
• 0:03
  Speaker 1: So what you look at on the surface, if you're looking at your spider veins, those are the very top branches of the tree.
• 0:12
  Speaker 1: When you go further down, to the branches that connect to the trunk, those are the ones that become varicose.
• 0:20
  Speaker 1: And the trunk itself is supposed to have one-way valves that close and shut in half a second or less to prevent the blood from getting sucked back down towards your feet.
• 0:34
  Speaker 1: And once these valves become incompetent genetics, pregnancy, occupation, so forth and so on then these valves don't close properly and the blood that's been collected from all those branches into that trunk is only supposed to go up towards your heart and not get sucked back down towards your feet.
• 1:02
  Speaker 1: So that's the whole principle behind vein disease.
• 1:09
  Speaker 2: Welcome to the House of Germar podcast where wellness starts within.
• 1:13
  Speaker 2: The House of Germar is a lifestyle brand, empowering women to live all in through interior design and personal wellness.
• 1:21
  Speaker 2: We are a destination for women ready to reimagine what is possible in their homes and lives and then create it.
• 1:28
  Speaker 2: We are honored to have you join us on our mission to empower 1 million women to live all in.
• 1:34
  Speaker 2: I am your host, Jean Collins, and I invite you to become inspired by this week's guest.
• 1:42
  Speaker 2: Welcome to the House of Jarmar podcast where wellness starts within.
• 1:45
  Speaker 2: I'm your host, Jean Collins, and today we are talking veins everybody.
• 1:49
  Speaker 2: I am so excited we have Dr Ashar on as a guest and he lives locally here in Connecticut, but I wanted to have him on to talk about his business, the Vein Institute, because I think there's so much education that we can all gain from his knowledge, even if you don't live in Connecticut.
• 2:04
  Speaker 2: So, Dr Ashar, thank you.
• 2:06
  Speaker 2: Welcome for joining the show.
• 2:07
  Speaker 2: Thank you for having me Great, Okay.
• 2:09
  Speaker 2: So first, before we get started, I love to share everyone's career journeys because we don't start out like I said to you before we started.
• 2:17
  Speaker 2: At 10 years old, you didn't sit there on the playground and say, yes, I want to be a vein doctor.
• 2:22
  Speaker 2: Yes, I want to be a vein doctor.
• 2:23
  Speaker 2: So if you wouldn't mind sharing with everybody a little bit about your career journey and how you got into vein health and, honestly, just a career in health in general, Happy to Well.
• 2:34
  Speaker 1: Again, thank you for having me A little bit unconventional, in the sense that I did my primary education in Europe at an English boarding school, wow yeah.
• 2:53
  Speaker 1: And after coming to the States I attended George Washington University and at the same time I was doing a fellowship at NIH National Cancer Institute and one of the primary focuses of our project was to cut blood supplies to tumor cells, and that's kind of a summary of the route that got me into vascular business.
• 3:28
  Speaker 2: Interesting.
• 3:29
  Speaker 2: So let's talk about the Vein Institute and first and foremost talk about vein disease.
• 3:37
  Speaker 2: And what is that?
• 3:39
  Speaker 1: Well, it's very important to first distinguish the difference between veins and arteries.
• 3:45
  Speaker 1: There's quite a bit of difference, even though commonly we think of the vascular system as one system.
• 3:52
  Speaker 1: But veins in particular, one of their major functions is storage.
• 3:57
  Speaker 1: That's why pregnant women who have about 50% extra blood in their system that's about two and a half liters of extra blood they can't store that blood anywhere, but they're in their veins.
• 4:12
  Speaker 1: That's why veins stretch.
• 4:14
  Speaker 1: That's why after pregnancy you see more vein conditions than you would otherwise.
• 4:19
  Speaker 1: Veins take blood back.
• 4:21
  Speaker 1: Just simply put, veins take blood back to the heart.
• 4:26
  Speaker 1: So veins have this cumbersome work of pulling all the blood against gravity to make it back to the heart from, let's say, your feet or your legs.
• 4:38
  Speaker 1: It's why the veins have to fight gravity.
• 4:42
  Speaker 1: That's why inside your veins you have these one-way valves that only promote blood going up towards your heart and not leaking back down.
• 4:54
  Speaker 1: But once these valves become incompetent age well, actually most common cause is genetics Then it's two or more pregnancies, occupation, female and age doesn't help anything, quite honestly.
• 5:17
  Speaker 2: You are so correct, my friend.
• 5:20
  Speaker 1: So what happens is the blood that's trying to go up to make it back to the heart gets sucked back down by gravity and it pulls to your feet and ankles.
• 5:30
  Speaker 1: That's an overall summary of what a vein condition is.
• 5:36
  Speaker 2: That's fascinating.
• 5:37
  Speaker 2: I had no idea that it worked only in one direction interaction.
• 5:46
  Speaker 2: So is that why this concept of varicose veins that many women have, especially those of us that have stood a lot for our careers, happen in our lower extremities, like I see them in my legs?
• 5:53
  Speaker 2: I don't see them in my arms or other places, but I notice them the most in my legs.
• 5:57
  Speaker 2: And is that because gravity is pulling it down?
• 6:00
  Speaker 1: That's absolutely true.
• 6:02
  Speaker 1: Yes, that's exactly right, even though you can have varicosities elsewhere, like in the pelvic region or lower abdomen or places like that.
• 6:15
  Speaker 1: But you're absolutely right Most most common reason is gravity.
• 6:20
  Speaker 1: Yes, Avetis.
• 6:26
  Speaker 2: So your website?
• 6:26
  Speaker 2: On your website you mentioned that one in four people suffer from vein disease and I was personally shocked by how big that number is.
• 6:31
  Speaker 2: And so is that any type of vein disease?
• 6:35
  Speaker 2: Because on your website you talk about all types of different things, ranging from varicose veins to spider veins to hemorrhoids I had no idea hemorrhoids fit into that category To one of my favorites, which I was fascinated by and want to dig into a little bit restless leg syndrome.
• 6:52
  Speaker 2: Wow, so all of those are considered vein disease.
• 6:57
  Speaker 1: Well, I mean restless leg syndrome is not vein disease, but it's one of the two causes that we know of.
• 7:05
  Speaker 1: One is low iron, the other is vein disease.
• 7:09
  Speaker 1: So one of its causes is vein disease.
• 7:12
  Speaker 2: Yes, Got it Okay, so we're going to dig into that in a minute.
• 7:16
  Speaker 2: So all of this in terms of let's just talk a little bit about the science behind this, right?
• 7:22
  Speaker 2: So you talk about how the blood is flowing down their valves.
• 7:25
  Speaker 2: So it doesn't flow up, the blood is flowing down.
• 7:26
  Speaker 2: So I'm assuming gravity is not helping.
• 7:31
  Speaker 2: Sorry, the blood's supposed to flow up.
• 7:33
  Speaker 2: I got that backwards.
• 7:34
  Speaker 2: The blood's supposed to flow up, not down.
• 7:36
  Speaker 2: Gravity isn't helping.
• 7:38
  Speaker 2: Therefore, you end up with I'm going to assume and you can correct me if I'm saying this wrong blockages in your veins, which is why, when you have things like varicose veins and spider veins, they stick out and you can see them.
• 7:51
  Speaker 1: It's actually the opposite of blockage, it's more leakage.
• 7:55
  Speaker 1: Oh yes, because you have to think of veins like a tree.
• 8:10
  Speaker 1: So what you look at on the surface, if you're looking at your spider veins, those are the very top branches of the tree.
• 8:13
  Speaker 1: When you go further down, to the branches that connect to the trunk, those are the ones that become varicose.
• 8:20
  Speaker 1: And the trunk itself is supposed to have one-way valves that close and shut in half a second or less to prevent the blood from getting sucked back down towards your feet pregnancy, occupation, so forth and so on.
• 8:43
  Speaker 1: Then these valves don't close properly and the blood that's been collected from all those branches into that trunk is only supposed to go up towards your heart and not get sucked back down towards your feet.
• 9:02
  Speaker 1: So that's the whole principle behind vein disease.
• 9:08
  Speaker 2: So helpful.
• 9:09
  Speaker 2: You said it much better than I did, so thank you for that.
• 9:11
  Speaker 2: Okay, so what do people do about this?
• 9:16
  Speaker 1: It's good to review a little bit of history when it comes to this condition, and the history of treating vein disease was that we used to tell patients to just deal with it over compression stockings, even if you were in Houston, texas, scars on your legs, lots of post-operative pain afterwards, until the beauty of laser and radio frequency and all this good stuff on the light spectrum came about, which really really is all about thermal energy.
• 9:46
  Speaker 1: So what we do is we advance a catheter which is kind of doing that is a little bit more than giving blood at the blood station.
• 10:21
  Speaker 1: We advance a catheter into the section of the vein which has no pain fiber, so it's painless to the section that we want to close, which is mostly the trunk, and thermal energy under local anesthesia will close that section shut.
• 10:44
  Speaker 1: You pull out the catheter, you put a band-aid on, you put compression stockings on and it's done and can be, really can be done during a lunch hour these days With a competent surgeon.
• 11:00
  Speaker 1: It can be done during people's lunch hour.
• 11:03
  Speaker 1: Imagine it can be done during people's lunch hour.
• 11:08
  Speaker 1: One thing that is interesting is that we hear laser and radio frequency and infrared light and all these fancy names, but it's all about thermal energy.
• 11:19
  Speaker 1: We use thermal energy.
• 11:22
  Speaker 1: That's what they do in our field.
• 11:26
  Speaker 1: Laser emits thermal energy.
• 11:28
  Speaker 1: That's why we use it for ablation, whether it's your leg veins or your heart, and radio frequency does the same thing.
• 11:37
  Speaker 1: When you apply thermal energy to a vessel that's made of protein, the proteins break down and the vein collapses.
• 11:46
  Speaker 2: That's what happens, Got it.
• 11:49
  Speaker 2: So through that process that vein is no longer a working vein.
• 11:55
  Speaker 2: Am I correct in that that's?
• 11:56
  Speaker 1: correct, and one of the common questions that we get asked is oh, don't I need that vein.
• 12:04
  Speaker 1: You really do need everything that's in your body, otherwise you wouldn't be there in the first place.
• 12:10
  Speaker 1: But with veins we have quite a bit of liberty, to the point where we can remove all the veins on somebody's hand just for beautification purposes, and nothing happens, because ablating a leg vein that's incompetent is like closing an exit off of a long highway.
• 12:33
  Speaker 2: Okay, so the blood is still going, just in a different way.
• 12:37
  Speaker 1: It's just using a different, so many different veins.
• 12:40
  Speaker 2: Right, different paths to get there, correct, yes, wow, okay, so let's talk about the different types of services that you would offer.
• 12:50
  Speaker 2: And so you're talking spider veins, which you talked about, which are on the surface, varicose veins.
• 12:57
  Speaker 2: What's the difference between?
• 12:58
  Speaker 2: A varicose vein is just deeper.
• 12:59
  Speaker 2: Is it larger?
• 13:00
  Speaker 2: Is it when we see those larger, really raised bumpy veins on our skin?
• 13:05
  Speaker 2: Is it when we see those?
• 13:06
  Speaker 1: larger, really raised bumpy veins on our skin.
• 13:08
  Speaker 1: So if we think of that tree that we discussed earlier, spider veins are like.
• 13:15
  Speaker 1: It's like looking at the tree from the top.
• 13:17
  Speaker 1: Spider veins are the very top branches.
• 13:22
  Speaker 1: Those are spider veins.
• 13:23
  Speaker 1: Then when you go down you get to a larger vein.
• 13:27
  Speaker 1: Those are called reticular veins and those are those greenish, bluish veins that don't bulge, but you see them on your leg.
• 13:36
  Speaker 1: Okay, Yep.
• 13:37
  Speaker 1: Quite unsightly.
• 13:38
  Speaker 1: But they're not always pathological.
• 13:42
  Speaker 1: They could be normal, could be the color of your skin.
• 13:45
  Speaker 1: Pathological they could be normal, could be the color of your skin.
• 13:46
  Speaker 1: And then, past that, you get to the final branch, before you get to the trunk of that tree.
• 13:53
  Speaker 1: Those final branches, they get congested, just like during pregnancy.
• 14:03
  Speaker 1: They get congested with blood because all the blood is not draining from them to go back to your heart.
• 14:06
  Speaker 1: Some of it is leaking back down by force of gravity.
• 14:09
  Speaker 1: And then they bulge out and become ropey and you see them on your legs.
• 14:13
  Speaker 1: Those are varicose veins.
• 14:16
  Speaker 2: Got it.
• 14:16
  Speaker 2: I had no idea the difference between all three.
• 14:19
  Speaker 2: That's so helpful.
• 14:20
  Speaker 2: So then you okay, so we have those services.
• 14:23
  Speaker 2: Then you also have the concept of cosmetic veins.
• 14:27
  Speaker 2: So talk to me a little bit about why someone would come to you for help cosmetically with veins.
• 14:33
  Speaker 1: Well, you know spider veins, even though they are part of that tree network that we just discussed, all of our treatments are covered by insurance, including government insurance, including Medicare and Medicaid and all the major insurance companies.
• 14:49
  Speaker 1: The spider veins, though, are considered cosmetic, so if somebody comes to us for just cosmetic, they're coming just for spider vein treatments.
• 14:59
  Speaker 1: They have no symptoms like heavy legs, cramping, swelling, restless leg syndrome, as you mentioned.
• 15:08
  Speaker 1: Like I had a patient here the other day with an ankle ulcer.
• 15:12
  Speaker 1: Most common cause of ankle ulcers are vein-related, so they don't have any of those stuff, they just see some unsightly purplish veins on their legs, and that's what they want treated.
• 16:14
  Speaker 2: Got it.
• 16:14
  Speaker 2: So I was shocked to find out that much of your vein treatment is covered by insurance, as you just said.
• 16:21
  Speaker 2: I was amazed at that and I would think a lot of people don't realize that it is covered by insurance, even though in my mind it's elective whether you're choosing to deal with this or not, because not everybody does, but if the statistics are that one in four of us have this issue, I think that's pretty amazing that insurance does cover that type of service.
• 16:43
  Speaker 1: If you have symptoms that relate to vein condition.
• 16:49
  Speaker 1: They don't have to be like they're not going to make you take time off work because your legs hurt so bad.
• 16:57
  Speaker 1: Your legs just feel heavy at the end of the day and most of us think that's kind of normal, is because we work so hard all day.
• 17:05
  Speaker 1: Right, whether we have or not, that is a different matter.
• 17:09
  Speaker 1: But you know, legs feel heavy, they feel tired, they feel you get cramping, mostly during the day, not at night.
• 17:21
  Speaker 1: You have, you know again, restless legs, swelling.
• 17:25
  Speaker 1: If you have those kinds of symptoms then and your condition, after doing a simple ultrasound of your legs, is confirmed to be potentially from vein disease, then that's all covered by insurance.
• 17:40
  Speaker 1: The only part that's not covered are the, the spider veins so talk to me about how.
• 17:46
  Speaker 2: What's it like if someone signs up to go to your practice?
• 17:49
  Speaker 2: What happens?
• 17:51
  Speaker 2: How do you identify what might be causing these symptoms that people have?
• 17:55
  Speaker 2: And we can even use me as an example, because I do have restless leg and I do have spider veins, but I don't think I have varicose veins.
• 18:02
  Speaker 2: But I definitely have restless leg and it is hereditary and other members of my family have it as well.
• 18:08
  Speaker 2: So how do you go about identifying if that's a cause of vein disease is what's contributing to the restless leg?
• 18:16
  Speaker 1: Okay, so, first of all, because the restless leg is such a common and really, really disabling condition because it doesn't let you sleep at night, the first thing that anybody should do before even seeing a doctor is improve their iron intake.
• 18:38
  Speaker 1: So, even if your blood work is completely normal, you know we look at hemoglobin and hematocrit and then we look at other indices to see whether it's iron-related, b12-related, folate-related.
• 18:52
  Speaker 1: So, regardless, if you improve your iron intake in your diet especially if you've had heavy menstrual cycle in the past, if you've been anemic in the past or if you've not and your iron has been on the lower side of normal, that should improve things by itself.
• 19:11
  Speaker 1: Interesting Independently.
• 19:14
  Speaker 2: No one's ever told me that.
• 19:15
  Speaker 2: And I've had by itself Interesting Independently no one's ever told me that and I've had restless leg for a really long time.
• 19:18
  Speaker 2: Magnesium I take magnesium, but iron no one's ever told me about iron.
• 19:27
  Speaker 1: Very, very common problem.
• 19:28
  Speaker 1: Just like cramping, just like swelling.
• 19:31
  Speaker 1: And then what happens is somebody makes an appointment.
• 19:48
  Speaker 1: They come in not forgetting that the diagnosis should be made by the physician and the patient, not by imaging studies.
• 19:50
  Speaker 1: Imaging studies are supposed to be something I learned at the National Institute of Health I'll never forget.
• 19:54
  Speaker 1: Imaging studies are supposed to confirm your diagnosis, not make it Got it.
• 20:02
  Speaker 1: So when they come in, signs and symptoms, Symptoms are what you feel, all right, Again, going through the list cramping, heaviness, tired legs, swelling, all the things, even discoloration around your lower legs from your ankle up.
• 20:23
  Speaker 1: That's a big sign, Ulcers, of course.
• 20:28
  Speaker 1: So, based on that, then we examine the legs, just physical examination.
• 20:35
  Speaker 1: Once we see that the signs are the things that we see, the symptoms are the things that we hear, and all the comorbidities if somebody has one, you don't have to have one if they have diabetes, but most of the patients we actually see are perfectly healthy Then we say, okay, I think this could be a vein condition that can be treated.
• 21:05
  Speaker 1: Then we do a simple no radiation again covered by all insurances ultrasound Everybody's had one and take a look at how these one-way valves open and close, shut, and does it take them half a second to open and close shut, or does it take those valves five seconds or 10 seconds to close and open?
• 21:32
  Speaker 1: Shut those valves five seconds or 10 seconds to close an open shot?
• 21:39
  Speaker 1: If the valves are incompetent and they take much longer to close or don't close at all, then we move on to get pre-approval from insurance companies.
• 21:45
  Speaker 1: We have to do some conservative management, kind of a little bit waste of time, but it has to be done, it's worth it.
• 21:52
  Speaker 1: It's worth it, yeah.
• 21:54
  Speaker 1: So then we move on to conservative management, which is walking, exercising and wearing compression stockings for a few weeks Some say six weeks, some say 12 weeks and then after that we can schedule the patient to get their treatments done, and the treatment is done from the trunk up to the top branches, but spider veins are not covered by insurance?
• 22:25
  Speaker 2: Not part of it.
• 22:25
  Speaker 2: Got it.
• 22:26
  Speaker 2: Okay, that makes perfect sense.
• 22:28
  Speaker 2: Is treatment like you said?
• 22:31
  Speaker 2: You can do it over lunch?
• 22:32
  Speaker 2: Is it really a one time?
• 22:34
  Speaker 2: You come in once and then you're wearing I'm assuming compression socks.
• 22:38
  Speaker 2: I don't know, you tell us afterwards for a little while.
• 22:40
  Speaker 2: Or is it a repetitive treatment that you have to go back again and again?
• 22:45
  Speaker 1: That's an excellent question and the answer to that is it's never once.
• 22:51
  Speaker 1: But if insurance is not involved which insurance often is for most of us if insurance is not involved, things can be bundled.
• 23:03
  Speaker 1: Okay, so we can do two, three sections at once.
• 23:08
  Speaker 1: When insurance gets involved, then we can only do one section of a vein at a time.
• 23:15
  Speaker 1: And because of that, think about, if you've got four trees that are incompetent, then you have to do four trunks, then you have to do four trees, branches, then you have to do the injections, and so it will become multiple, multiple visits, and so it will become multiple, multiple visits, but for none of them one needs to go home, rest, elevate or anything like that.
• 23:46
  Speaker 2: You go back to your normal activities, right off the table.
• 23:49
  Speaker 1: So that's one advantage.
• 23:50
  Speaker 2: so much, and have you seen that since you started, because you've been doing this for 20 years.
• 23:54
  Speaker 2: So have you seen the technology change a lot over let's even say the last five years.
• 24:01
  Speaker 1: Absolutely, absolutely.
• 24:03
  Speaker 1: There was a time that we used a lower wavelength laser, a lower wavelength laser A lower wavelength laser targeted hemoglobin to close the vein shots.
• 24:17
  Speaker 1: When you target blood cells to close the vein shots, you injure the blood cells.
• 24:27
  Speaker 1: That's painful, right.
• 24:29
  Speaker 1: So patients would have some pain for a couple of days, not longer yeah since then.
• 24:36
  Speaker 1: Now the new lasers use, as they use, a higher wavelength, which targets water in the vein wall yeah, so it's completely pain-free.
• 24:47
  Speaker 1: That is amazing, that's.
• 24:49
  Speaker 1: That was a big advancement.
• 24:52
  Speaker 2: That is amazing.
• 24:53
  Speaker 2: Wow, how do you stay on top of all the new technology?
• 24:58
  Speaker 2: Running a practice, being busy?
• 25:00
  Speaker 2: How do you stay on top of it all?
• 25:01
  Speaker 1: We just ask the reps to bring lots of lunch and teach us what to do.
• 25:05
  Speaker 1: No, I mean, you know it's medicine, medicine.
• 25:11
  Speaker 1: You really can never be caught up, but you know, fortunately.
• 25:17
  Speaker 1: Fortunately I am a big fan of technology, for at least our field, because fortunately, these days, as soon as something new comes up, you get emails from your society and you get emails from American Medical Association, and you get.
• 25:35
  Speaker 1: So the articles just get fed to you.
• 25:39
  Speaker 1: All you have to do is read them, and that's the hard part.
• 25:43
  Speaker 2: Make the time make the time to find that.
• 25:46
  Speaker 2: Yes, that is fascinating.
• 25:48
  Speaker 2: So just for the people who live in Connecticut, let's talk about the location of your practices.
• 25:52
  Speaker 2: Where are your practices located, we kind?
• 25:56
  Speaker 1: of have researched areas that there was a need.
• 26:01
  Speaker 1: And we have our new town office which serves all the greater Danbury area and new towns and surrounding towns.
• 26:14
  Speaker 1: Then we have Shelton, which it's become.
• 26:18
  Speaker 1: Shelton has exploded in terms of restaurants and because it's a great town, another great town to live in.
• 26:27
  Speaker 1: And then we have Fairfield, which we've been for a very long time, at least I.
• 26:35
  Speaker 1: I want to say 12 years or more, actually 15 years or more.
• 26:38
  Speaker 1: And then our newest office is in Milford.
• 26:43
  Speaker 2: Oh, ok, so you cover a big geography.
• 26:47
  Speaker 1: Cover a big geography?
• 26:49
  Speaker 1: Yeah, fortunately Connecticut is not that big, so it's easy to cover.
• 26:55
  Speaker 2: That is true.
• 26:56
  Speaker 2: You can cover a big geography, so that's a lot.
• 26:58
  Speaker 2: It's a big job to be a doctor and to manage four offices.
• 27:02
  Speaker 2: So how do you find time in your life for wellness for you?
• 27:06
  Speaker 2: Because I feel like anyone who's in the medical field wellness, you know.
• 27:10
  Speaker 2: You never want to walk in and see a doctor who's huffing and puffing and really fat and overweight and looks like they don't take care of themselves.
• 27:18
  Speaker 2: So it's not a good sign.
• 27:19
  Speaker 2: So I feel like everyone I've ever met in the medical field is very interested in their own personal wellness.
• 27:24
  Speaker 2: So if you wouldn't mind if we probe a little into you and your life?
• 27:28
  Speaker 2: How do you make a priority for that?
• 27:30
  Speaker 2: Because, just like many of the people who listen to my show, many of them are entrepreneurs and it doesn't matter what business you're in.
• 27:36
  Speaker 2: This is a struggle to run a business and make time for yourself.
• 27:40
  Speaker 2: So if you wouldn't mind sharing, how do you make personal wellness a priority?
• 27:44
  Speaker 2: And what do you know?
• 27:44
  Speaker 2: I do this kind of podcast and things to help educate people.
• 27:58
  Speaker 1: You know, a few times a year at least, and your questions are excellent.
• 28:04
  Speaker 1: Absolutely All the questions I hear from patients these are questions from medical students that we teach and things like that.
• 28:12
  Speaker 1: So that is super.
• 28:14
  Speaker 1: Now, when I started close to 20 years ago, you know I came in strong.
• 28:22
  Speaker 1: I wasn't all in veins.
• 28:25
  Speaker 1: I had one of the largest primary care offices, actually the largest primary care office in Newtown, and unfortunately, you know, the thing with Sandy Hook happened also, so it wasn't, but regardless.
• 28:38
  Speaker 1: You know I went in as a young doctor to change the world, right, sure, and you know I was there first thing and you know, back then again because of the technology wasn't there, we would have to sit down at the end of our shift or end of last patient.
• 28:54
  Speaker 1: We would see and sit down and write charts and calling medications and call patients who had abnormal blood work that were kind of dangerous and needed to know right away.
• 29:06
  Speaker 1: And I did all of that and I looked in the mirror and what I saw was somebody who would not be able to help anybody very soon it literally that's exactly what I saw.
• 29:23
  Speaker 1: I was like, well, you know, you may be doing a good job, but it won't be for long.
• 29:27
  Speaker 1: So exercising, you know, health, health in general has to be priority, right.
• 29:38
  Speaker 1: Otherwise, whenever I've said, oh, ok, I'll do this and then I exercise, maybe I'll do that and then I exercise, more often than not it doesn't happen.
• 29:49
  Speaker 1: So what I did was I made sure at first I got a trainer at our local gym yeah, so I'm accountable.
• 30:00
  Speaker 1: Yes, so I'm accountable.
• 30:01
  Speaker 1: And then, once I was on a roll, my schedule always includes exercising when I'm not having a big ribeye steak.
• 30:12
  Speaker 1: A healthy diet, a nice healthy diet.
• 30:17
  Speaker 1: Unfortunately, these days you can have tasty healthy diet.
• 30:22
  Speaker 1: When I was very young, to eat healthy was kind of what is that?
• 30:28
  Speaker 1: What's healthy?
• 30:29
  Speaker 1: You had a salad with your steak.
• 30:31
  Speaker 1: You didn't have a salad as a meat, you know.
• 30:34
  Speaker 1: So I made it priority, really, really, and it changes things.
• 30:40
  Speaker 1: It changes the way you think, it changes the way you feel.
• 30:43
  Speaker 1: It changes the way you enjoy life, you're able to perform.
• 30:52
  Speaker 2: It changes absolutely everything I agree.
• 30:55
  Speaker 2: Couldn't agree more.
• 30:56
  Speaker 2: And I did have one of those mornings where I was like, okay, after I do this little work project, I'm then going to go work out.
• 31:02
  Speaker 2: And before I knew it the time was over and I was like note to after I do this little work project, I'm then going to go work out.
• 31:04
  Speaker 2: And before I knew it the time was over and I was like note to self, I know better.
• 31:06
  Speaker 2: I should have worked out first.
• 31:10
  Speaker 1: Always.
• 31:11
  Speaker 2: Always, always, always.
• 31:12
  Speaker 2: It's normally on my calendar first thing in the morning and if I don't, you know at least now in Connecticut the sun is out and it's light later, so you know we can at least get out later.
• 31:24
  Speaker 2: But still, I'm with you if you don't do it first thing in the morning, and I think for all of your patients, since, based on some of the protocol that you mentioned for insurance, it's like ensuring that they do get exercise, that they do get movement, so their blood flow is moving, and that's really an important part of helping in the cure is making sure that your clients are moving and that helps our vascular health in general, especially for your legs.
• 31:47
  Speaker 1: It helps everything.
• 31:49
  Speaker 1: It helps everything, Jean.
• 31:50
  Speaker 1: Yeah, it really does.
• 31:53
  Speaker 1: Actually, one of the things that we do tell our patients is they must walk every day.
• 32:01
  Speaker 1: We actually have them walk 30 to 40 minutes a day, which is, yeah, I mean, one of the questions.
• 32:12
  Speaker 1: I'm glad you brought this up.
• 32:13
  Speaker 1: One of the common questions that we get is what can I do to prevent new veins after I get treatments?
• 32:23
  Speaker 1: Or you know, since it's, you see, vein condition has treatments.
• 32:28
  Speaker 1: Yeah, so it's like diabetes it has treatments.
• 32:33
  Speaker 1: It's like hypertension it has treatments, but none of those chronic conditions have a cure, Right?
• 32:40
  Speaker 1: So you cannot cure diabetes, but you can keep it in check.
• 32:45
  Speaker 1: You cannot cure hypertension, but you can keep it in check.
• 32:50
  Speaker 1: That's the definition of a chronic disease that it may or may not have treatments, but it's not curable yet.
• 32:59
  Speaker 1: So, to prevent further veins from popping up, keep your weight in check, which means exercise, especially walking.
• 33:12
  Speaker 1: Biking, ellipticals and things like that are great forms of exercise, but they don't do anything for your veins because they don't cause calf compression.
• 33:24
  Speaker 2: Wow, I didn't know that.
• 33:26
  Speaker 2: Yes, okay, wow, all right, all the more reason to keep walking.
• 33:31
  Speaker 2: I do have a walking desk.
• 33:32
  Speaker 2: I have a treadmill under my desk, anything that?
• 33:36
  Speaker 1: causes calf movement.
• 33:38
  Speaker 1: So like pressing the gas pedal in the car, that causes calf movement, that kind of a movement, because we actually call your calf muscles your second heart.
• 33:51
  Speaker 1: Because, it's the second most important muscle for your circulation.
• 33:58
  Speaker 2: All your veins sit inside your calf muscles, so that's why, when you walk on a plane and you don't get a clot, is because your calf muscles are squeezing your leg veins.
• 34:14
  Speaker 2: Ah, all the more reason to get out and get your steps.
• 34:17
  Speaker 1: Walk run, walk run, yes, but you know, be careful with your knees If you're a little bit older, you know.
• 34:22
  Speaker 1: Walk on a you know comfortable surface, soft surface, comfortable shoes, of course.
• 34:27
  Speaker 1: And then when you travel long distances on the plane or by car, if you can wear a, you know, even over the counter is better than nothing.
• 34:40
  Speaker 1: Compression stockings, even if they're knee highs, that helps as well.
• 34:47
  Speaker 1: Hydration helps Exercising walking hydration.
• 34:51
  Speaker 1: So those things prevent new ones from popping up so quickly.
• 34:55
  Speaker 2: I love that.
• 34:56
  Speaker 2: Now do people have to walk in their compression socks, or not necessarily from your client perspective.
• 35:13
  Speaker 1: It's better if they do, but the principle behind.
• 35:15
  Speaker 2: They call them gradient compression stockings because they're tighter around your ankle and lighter compression as they go up the leg.
• 35:21
  Speaker 1: That promotes blood flow going towards your heart.
• 35:26
  Speaker 1: Okay, so that's the whole principle behind compression socks.
• 35:33
  Speaker 2: That's fascinating, I will say.
• 35:34
  Speaker 2: I've used compression socks when I used to fly from New York to California on a pretty regular basis and I definitely wore them on the plane and I did notice a difference.
• 35:44
  Speaker 1: And some people just naturally their feet and legs swell after a flight and that prevents that.
• 35:53
  Speaker 2: Yes, very much.
• 35:54
  Speaker 2: So.
• 35:54
  Speaker 2: Yes, I definitely noticed a difference.
• 35:56
  Speaker 2: I haven't worn them in a while, so you're reminding me I need to get them out for some upcoming trips.
• 36:01
  Speaker 2: I have but, and they're not necessarily fashion forward, but that is okay.
• 36:08
  Speaker 1: Actually that's not true anymore.
• 36:10
  Speaker 1: You can really get fashionable compression socks nowadays.
• 36:15
  Speaker 1: I don't know if you can get fishnets, but you can get fashionable and comfortable and inexpensive.
• 36:23
  Speaker 1: Quite honestly.
• 36:24
  Speaker 1: You know, back in the day you could only get those.
• 36:29
  Speaker 1: I had a patient once who said her son was walking on the beach and somebody had compression stockings on and her son told her oh, mom, mommy, look at that guy, he's got prosthetic legs.
• 36:43
  Speaker 1: Wow, compression stockings don't work that way anymore.
• 36:48
  Speaker 1: They're much more fashionable nowadays.
• 36:50
  Speaker 2: They're much better.
• 36:51
  Speaker 2: Oh, I love that Well, and just the form of treatment sounds like it's much better.
• 36:55
  Speaker 2: Anyone who, as a doctor, says they have a treatment for something where there isn't pain involved or a lot of pain involved, is definitely a sign me up.
• 37:03
  Speaker 2: That sounds incredible.
• 37:04
  Speaker 2: So question for you what's on your bucket list professionally?
• 37:09
  Speaker 2: What would you like to do that you haven't done yet?
• 37:11
  Speaker 1: That's an excellent question.
• 37:12
  Speaker 1: One of the things, actually, that has always a passion of mine was longevity, which is being studied extensively, but that's still at its very infancy, so I'm kind of just learning about it and studying it.
• 37:30
  Speaker 1: But professionally, we're just going to continue to expand and help as many people who need help in areas that they can't.
• 37:40
  Speaker 1: So that would be the next bucket list.
• 37:43
  Speaker 1: Next on the bucket list yeah.
• 37:45
  Speaker 2: Yeah, longevity is fascinating the things that happen in blue zones and things like that, I think is actually very, very, very interesting because it's a lifestyle.
• 37:54
  Speaker 2: I think, from the little bit that I know, it is all about really adapting a lifestyle and I am a huge proponent of getting listeners of this podcast to understand that everything I do and I talk about and the guests I bring on, we all do different things and provide different services, but this is a lifestyle and it's a lifestyle and a commitment to wellness.
• 38:12
  Speaker 2: It's not a one and done.
• 38:13
  Speaker 2: We never talk about just taking a pill and it's over.
• 38:16
  Speaker 2: Everything is about a lifestyle 100%.
• 38:20
  Speaker 1: I couldn't agree more.
• 38:21
  Speaker 1: And I think one of the things that we mustn't forget about is, you know, we get out there, we run and we get on the treadmill, we run, and then we lift some weights and we stretch, and then, you know, we put our music on and get to work.
• 38:36
  Speaker 1: We forget about activity for our minds and our brains, which also, you know, brain is also a type of muscle.
• 38:47
  Speaker 1: It needs to grow, it needs to be healthy, it needs to, it needs exercising, meditation, yoga, things like that.
• 38:57
  Speaker 2: I'm a huge proponent of all of those things and continual learning, which is why I think it's always interesting to have entrepreneurs on and ask them what's on their bucket list, because you can see how they aspire to learn new things.
• 39:08
  Speaker 2: Most people, without me prompting, have things they want to learn as entrepreneurs, because entrepreneurs just innately are curious people.
• 39:16
  Speaker 2: So what is on your bucket list personally?
• 39:20
  Speaker 2: It's always nice to get a little peek at someone personally.
• 39:22
  Speaker 2: So what's on your bucket list personally?
• 39:24
  Speaker 1: One of them is kind of boring because everybody wants to travel, right, but currently I am trying to improve my kite surfing.
• 39:33
  Speaker 1: Oh wow, good for you.
• 39:36
  Speaker 1: I'm kind of a big wakeboarder in summertime.
• 39:42
  Speaker 1: That's what I am kind of.
• 39:44
  Speaker 1: I try to improve a little bit every year.
• 39:47
  Speaker 2: You can't possibly be doing that here in Connecticut.
• 39:49
  Speaker 2: We don't have enough waves.
• 39:51
  Speaker 1: No.
• 39:53
  Speaker 2: Where are you going?
• 39:53
  Speaker 1: to do that.
• 39:54
  Speaker 1: We have the wind.
• 39:56
  Speaker 2: Right, we have plenty of wind, but we don't have waves.
• 39:57
  Speaker 2: It's not real ocean here, so where do you go to do that?
• 40:04
  Speaker 1: Actually, the best place I have found to do that because the water is clear, warm, shallow and the wind is not crazy for a beginner like me is Turks and Caicos.
• 40:15
  Speaker 2: Oh well, hey, that's a great reason to go there.
• 40:17
  Speaker 2: I love that.
• 40:18
  Speaker 2: Thank you for sharing.
• 40:20
  Speaker 2: All right, so before we go, two last questions for you.
• 40:23
  Speaker 2: One is there anything that I didn't ask you that you want to make sure you communicate to the listeners and to the viewers on?
• 40:30
  Speaker 1: YouTube.
• 40:31
  Speaker 1: Just have to get a consultation by a reputable physician or a surgeon.
• 40:36
  Speaker 1: You get an ultrasound done that will confirm everything that's been discussed.
• 40:50
  Speaker 1: The treatment is covered by insurance.
• 40:53
  Speaker 1: The time to get treated because of insurance criteria could be long, but overall the results are fantastic.
• 41:00
  Speaker 1: Removing varicosities has more than 98% improvement and that's a national average, so that's really good in medicine.
• 41:10
  Speaker 1: You know back to your normal activities, covered by all insurances, so I don't think you missed anything at all that's wonderful.
• 41:20
  Speaker 2: Well, I will definitely be coming to you guys for my restless leg situation, because I had no idea that that could be dealing with my veins might be a way to help that.
• 41:30
  Speaker 2: So thank you for sharing that.
• 41:32
  Speaker 2: Okay, last question for you.
• 41:33
  Speaker 2: I love to ask all my guests to recommend a book that has impacted them either personally or professionally that they would like to recommend to the audience.
• 41:40
  Speaker 2: I am a huge proponent that books change lives, so what book would you like to recommend?
• 41:42
  Speaker 2: Or books?
• 41:42
  Speaker 2: Audience?
• 41:42
  Speaker 2: I am a huge proponent that books change lives, so what book would you like to recommend?
• 41:45
  Speaker 2: Or books?
• 41:45
  Speaker 2: You can recommend more than one.
• 41:47
  Speaker 1: There is a book that I am reading as we speak, and that book is called E-Squared.
• 41:54
  Speaker 1: The reason I look down because I'm trying to find the name of the author.
• 42:00
  Speaker 2: That's okay.
• 42:00
  Speaker 2: I'll link it in the show notes so you don't even need to.
• 42:04
  Speaker 1: You know, when you say it's about quantum physics, then people just switch off it is, but it's not.
• 42:17
  Speaker 1: You know, it's one of those things that I certainly wasn't listening to in class when they taught it, but it's about improving your mindset.
• 42:24
  Speaker 1: So you see the things that you want to see, instead of the things that you don't want your brain to see Negativity.
• 42:34
  Speaker 2: Oh, my goodness, I have to read that.
• 42:37
  Speaker 2: I'm all about mindset, so I have to read that one.
• 42:41
  Speaker 1: It's short and, to prove its concept, it has exercises, very simple exercises, and, like we discussed a few minutes ago, I think exercising our brain muscle is just as important as exercising our biceps.
• 43:02
  Speaker 1: So that's what this book is for.
• 43:06
  Speaker 2: Oh, I agree.
• 43:07
  Speaker 2: Thank you so much for sharing that.
• 43:09
  Speaker 2: I am absolutely going to go check that out.
• 43:11
  Speaker 2: I love everything to do with mindset and, as a mindset coach, anything that taps into that I find fascinating.
• 43:16
  Speaker 2: So thank you so much, dr Afshar.
• 43:18
  Speaker 2: It's been such a pleasure to meet you.
• 43:20
  Speaker 2: Thank you for taking time out of your very busy schedule to be on the show to share your wisdom, to share your knowledge.
• 43:25
  Speaker 2: It was a pleasure to meet you and I personally will be coming to your clinic for some assistance.
• 43:30
  Speaker 2: So thank you.
• 43:30
  Speaker 2: I hope you have a beautiful day.
• 43:32
  Speaker 1: Thank you so much.
• 43:33
  Speaker 1: It's been an honor to see you and treat you if needed be.
• 43:39
  Speaker 1: I've really really enjoyed our time together today.
• 43:42
  Speaker 1: Thank you need it be.
• 43:43
  Speaker 2: I've really, really enjoyed our time together today.
• 43:45
  Speaker 2: Thank you, perfect.
• 43:47
  Speaker 2: Thank you have a great day.
• 43:51
  Speaker 2: Thank you for joining us for another episode of the House of Jermar podcast, where wellness starts within.
• 43:54
  Speaker 2: We appreciate you being a part of our community and hope you felt inspired and motivated by our guest.
• 43:59
  Speaker 2: If you enjoyed this episode, please write us a review and share it with friends.
• 44:04
  Speaker 2: Building our reach on YouTube and Apple Podcasts will help us get closer to our mission to empower 1 million women to live all in.
• 44:12
  Speaker 2: You can also follow us on Instagram at House of Jermar and sign up to be a part of our monthly inspiration newsletter through our website, houseofjermarcom.
• 44:22
  Speaker 2: If you or someone you know would be a good guest on the show, please reach out to us at podcast at houseofgermarcom.
• 44:31
  Speaker 2: This has been a House of Germar production with your host, jean Collins.
• 44:35
  Speaker 2: Thank you for joining our house.