• CAROTID STENOSIS
    circulation;-disease;-carotid-stenosis

    Transient ischemic attack, or TIA, is a temporary neurological dysfunction caused by a short loss of blood flow to either the brain or spinal cord with no permanent cell damage, or infarction. As opposed to permanent damage, or stroke, the symptoms of TIA resolve within 24 hours. TIA is a risk factor for eventually having a stroke.


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  • CORONARY ARTERY DISEASE
    • Chest Pain

      Chest pain in general is considered to be an emergency, even though it can be a symptom of a number of medical conditions, the majority of which are not related to the heart. Some of the diseases causing chest pain include coronary ischemia, aortic dissection, pericarditis, cardiac tamponade, pulmonary embolism, pneumonia, pneumothorax, gastro-esophageal reflux disease, costochondritis, radiculopathy, panic attack, anxiety and many others.


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    • Shortness Of Breath

      Shortness of breath goes by the term dyspnea, or air hunger, and represents a subjective perception of breathlessness. Shortness of breath occur normally during heavy physical exertion, but is pathological if happens in unexpected situations, which is in majority of cases due to diseases of the lungs or the heart.


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  • THORACIC AORTIC DISSECTION
    • Back Pain

      Back pain caused by aortic dissection is a so-called radiating pain, or the type of pain felt in a location remote from its origin. It differentiates from such pain as for example local back pain, due to abnormalities in muscles, nerves, bones, joints and other structures of the spine.



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    • Chest Pain

      Chest pain in general is considered to be an emergency, even though it can be a symptom of a number of medical conditions, the majority of which are not related to the heart. Some of the diseases causing chest pain include coronary ischemia, aortic dissection, pericarditis, cardiac tamponade, pulmonary embolism, pneumonia, pneumothorax, gastro-esophageal reflux disease, costochondritis, radiculopathy, panic attack, anxiety and many others.



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  • ABDOMINAL AORTIC ANEURYSM

    Abdominal pain is a symptom of the widest variety of transient disorders and serious diseases. A triad of hypotension, pulsatile mass in the abdomen and abdominal pain points to the ruptured abdominal aortic aneurysm.


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  • ILIAC ANEURYSM

    An iliac aneurysm is a dilation of the iliac artery due to decreased elasticity of its wall. The main risk factor of this condition is atherosclerosis; the others include hypercholesterolemia, hypertension and smoking. The so-called, iliac pseudoaneurysm, or false aneurysm, may be caused by trauma or surgery. People with an iliac aneurysm often have no symptoms. When symptoms are present, they include lower back or lower abdominal pain and pain in the groin. The larger an aneurysm becomes, the greater the risk of its rupture. The ruptured aneurysm causes life-threatening internal bleeding.


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  • PERIPHERAL ARTERIAL DISEASE
    • Claudication

      Claudication usually refers to intermittent pain in a muscle. This pain is triggered by physical exertion and relieved with a short period of rest, but recurs again after the same type of exertion. Typically, claudication is a symptom of peripheral arterial disease, or arterial atherosclerosis. It occurs during walking in a group of muscles furthest from the heart – the calf muscles. Claudication, however, can take place in any other part of the body. More generally, claudication describes any kind of predictable intermittent pain caused by certain activity and relieved once this activity is ceased. For example, the term “venous claudication” denotes pain in ankles with walking or standing, which is normally relieved by rest with elevated feet..


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    • Rest Pain

      The term "rest pain" usually refers to a symptom of arterial insufficiency, or ischemia, when an organ does not receive a sufficient amount of blood, not only during physical activity, but even at rest. In an extremity, the rest pain is the next stage after claudication and is followed by a stage called tissue loss, implying formation of ischemic ulcers or dry gangrene. In the heart, pain at rest represents more severe coronary ischemia then the previous stage - pain during exertion - and is followed by irreversible damage called myocardial infarction.


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    • Ischemic Ulcers

      In general, the term ulcer refers to a chronic three-dimensional defect in the soft tissues. The ulcers almost always develop from acute lesions or a wound not healing due to different reasons. Circulatory ulcers are usually divided into three major types: ischemic, venous stasis and neuropathic. The ischemic ulcers are a result of arterial atherosclerosis and, therefore, are caused by insufficient delivery of fresh blood. That is the reason why they commonly develop on the tips of the toes, the places most remotely located from the heart. The venous stasis ulcers have a different mechanism of formation. They usually appear due to leakage of soft tissue edema, preventing accidental wounds from healing. That happens most often in parts of the body with the most gravity dependent congestion - the ankles. The neuropathic ulcers, including diabetic ones, form on the bottom of the foot, the place with the highest mechanical pressure. That is where innocent accidental wounds fail to heal due to abnormally regulated blood flow in the microscopic blood vessels - capillaries.


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  • POPLITEAL ARTERY ANEURYSM

    'Asymptomatic', usually refers to a disease or its stage with no symptoms, either subjective or objective. Absence of symptoms can be due to the early stage of a disease or the absence of nerves responsible for the specific perception in the affected organ. It can also result from the damage of such nerves, causing a subjective lack of perception.


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  • LYMPHEDEMA

    Edema, or swelling, means accumulation of fluid in between cells of our body. As opposed to accumulation of fluid inside a specific space, such as a pleural space, for example, which is called hydrothorax, edema is a diffuse phenomena and, therefore, does not have a specific space or cavity where it would collect. In general, edema which affects the entire body is due to global problems affecting the entire body, such as renal failure, hepatic failure, heart failure, etc. Local edema, or swelling of a specific organ or a part of the body, is due to problems affecting this organ exclusively. Some examples of local edema are blunt trauma to an extremity, hepatitis, etc. Isolated edema of the lower extremities is almost always due to circulatory problems of lower extremities. An extreme form of edema of the skin is called anasarca, which refers to fluid diffusely leaking from the skin due to the build up of extreme pressure in soft tissue.


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  • DEEP VEIN THROMBOSIS
    • Pain

      "Pain" usually refers to a symptom of arterial insufficiency, or ischemia, when an organ does not receive a sufficient amount of the blood not only during physical activity, but even at rest. In an extremity, the rest pain is the next stage after claudication and follows by a stage called tissue loss, implying the formation of ischemic ulcers or dry gangrene. In the heart, pain at rest represents more severe coronary ischemia then the previous stage, or pain during exertion, and is followed by irreversible damage called myocardial infarction.


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    • Swelling

      Edema, or swelling, means accumulation of fluid in between the cells of our body. As opposed to the accumulation of fluid inside a specific space, such as a pleural space, for example, which is called hydrothorax. Edema is a diffuse phenomenon and, therefore, does not have a specific space or cavity where it would collect. In general, edema affecting the entire body is due to global problems which affect the entire body accordingly, such as renal failure, hepatic failure, heart failure, etc. Local edema, or swelling of a specific organ or a part of the body, is due to a problem affecting this organ exclusively. Some examples of local edema are blunt trauma to an extremity, hepatitis, etc. Isolated edema of the lower extremities is almost always due to circulatory problems of the lower extremities. An extreme form of edema of the skin is called anasarca, which refers to fluid diffusely leaking from the skin due to the building up of extreme pressure in the soft tissues.


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  • SUPERFICIAL VENOUS INSUFFICIENCY
    • Swelling
      Veins,-Superficial-Insufficiency,-Edema-2

      Swelling, or edema, is caused by superficial venous insufficiency and is often being confused with cardiogenic or nephrogenic edema, caused by heart or kidney failure correspondingly. Subsequently, edema of venous insufficiency is commonly being treated inappropriately. One of the common examples of such treatment is the one with diuretics, or water pills. When our body retains an excessive amount of water, like in the case of heart or kidney failure, diuretics are appropriate. If, however, the edema is due to superficial venous insufficiency, a problem affecting only lower extremities, the cause of it is not retention, but rather inappropriate distribution of water. That is why diuretics are usually ineffective and often are contraindicated for the treatment of lower extremities edema which is caused by superficial venous insufficiency.


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    • Pain

      "Pain" from superficial venous insufficiency is a highly variable symptom. It ranges from vague dull discomfort to deep ache, throbbing and soreness, to frank pain. The pain is aggravated by standing, prolonged periods of sitting or by walking, particularly at a slow pace. As opposed to the prevailing majority of other conditions affecting lower extremities, the pain of venous insufficiency does not correlate with degree of physical activity. It is usually brought by or worsens with periods of decreased mobility while standing in the vertical position. In the most typical case, the pain during standing improves with walking, since contractions of leg muscles propel the venous blood just like contractions of the heart move the blood through the arteries. Typically, venous pain increases in intensity throughout a day, and is more severe in hot weather. Another hallmark sign of venous insufficiency is the pain during the first few steps, which alleviates with continuous walking, however comes back with prolonged walking. Such pain is called “venous claudication”. As opposed to classical arterial claudication, when sharp “cramp-like” pain develops suddenly in the calf muscles, with venous claudication, the pain increases gradually in the ankles, and is typically being relieved by rest sitting down and not by standing still, like with peripheral arterial disease. In absence of suitable sitting space, people suffering from venous claudication must lean their bodies or lift and shake their feet. In other words, they try to take the weight off their legs. As the disease progresses, so does the pain. Persistent or night pain is an indicator of so-called “trophic changes”, or pathological developments of the tissue structure, when even with normalization of perfusion, the symptoms persist. This is different from the earlier stages of the disease, when the pain can generally be relieved by rest and limb elevation. Since the venous insufficiency is also responsible “sensory neuropathy”, or damage of neuro-receptors, the actual perception of tissue damage can be either exaggerated or blunted, causing severe pain with burning and tenderness or decreased sensation with eventual development of numbness correspondingly. Pain of superficial venous insufficiency, just like any other type of pain, is a part of our defense mechanism, a signal indicating location and degree of damage our body sends to our brain. That is why, just like with any other types of symptoms, it is incorrect to only treat the pain, but rather to treat the pathological condition responsible for it.


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    • Claudication

      Claudication, or intermittent limping, usually refers to a pain or discomfort in a part of a body, usually a limb, brought by a certain level of physical activity and relieved by rest. In the prevailing majority of cases, claudication is caused by abnormalities in circulation, or blood flow. Claudication is different from limping, which is constant pain during physical activity, not being relieved with rest and occurring usually due to neuro-muscular and skeletal abnormalities.


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    • Cramps

      Cramps are defined as exertion of a muscle or a group of muscles without the contraction appropriate for such an exertion. Cramping can take different forms and be tonic, clonic, diffuse, etc. Tonic cramping is painful sudden hardening of a muscle with no visible movement in an extremity supplied by this muscle. Tonic cramping at rest is the most typical symptom of superficial venous insufficiency. Diffuse cramping suggests contractions of the individual fibers in a muscle which are independent from each other. They are usually perceived as a so-called paresthesia, or unpleasant non-painful sensation, and often described as feelings of "crawling", "pins and needles", etc.


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    • Numbness

      Numbness is a type of so-called paresthesia, or non-painful but unpleasant subjective sensation. More specifically, numbness refers to a decrease in tactile sensation, or an extreme form of which is anesthesia, or complete absence of sensation.


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    • Varicosities
      symptoms,-Varicosities.

      In spite of common belief, varicosities or varicose veins, are not a disease, but rather a symptom of a disease called superficial venous insufficiency. Coincidentally, varicose veins are by far not the common symptom of the above disease, meaning that the majority of individuals suffering from superficial venous insufficiency do not have visible bulging veins on their skin. Technically speaking, in the majority of patients with superficial venous insufficiency these varicosities can be seen with the ultrasound, but only some of those people have visible enlarged and twisted veins depending on the thickness of the skin, amount of subcutaneous fat, stage of the disease, depth of these veins, etc. The difference between normal, prominent veins and varicosities, is the presence of tortuosity. When veins become wider under pressure, they also become longer and develop tortuosity without having enough space to remain straight.


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    • Spider Veins
      Symptoms;-Spider-Veins;

      Spider veins, officially called telangiectasia, are dilated capillaries, terminal venules and terminal arterioles. Their increase in diameter is usually due to either or both congenital weakening of the vessel wall and acquired increase in pressure of the blood entering them. Venous telangiectasias of lower extremities are almost always caused by superficial venous insufficiency. Being usually asymptomatic lesions having only cosmetic importance, rarely such telangiectasias can rupture and cause serious external bleeding.


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    • Fatigue

      Fatigue is one of the typical symptoms of superficial venous insufficiency, that develops for several reasons. One of them is the fact that swelling represents the accumulation of water in between cells of soft tissues. This water, therefore, increases the weight of the entire extremity, making it heavier. The heavier the leg, the faster we develop the symptoms of fatigue. Additionally, due to the reversal of blood flow through incompetent veins, tissues of the affected lower extremity receive “used” venous blood, which is deprived of oxygen and is saturated with end-products of metabolism, such as lactic acid and others. Muscle cells in absence of normal nutrition become tired quicker. Coincidentally, such fatigue is often described as “legs getting tired out of proportion with the rest of the body”.


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    • Pigmentation
      symptoms-pigmentation

      One of the typical signs of superficial venous insufficiency is a brownish-black discoloration of the ankles of the affected person, or pigmentation. It differs from many other conditions with similar symptoms. Under high pressure, not only does serum leak into the tissue causing swelling, but also red blood cells sometimes escape through overstretched walls of the affected veins. They quickly become entrapped and destroyed in the tissues surrounding such veins, releasing hemoglobin, the degradation of which frees up the iron. Oxygenated molecules of iron give the skin this typical and characteristic for venous insufficiency, brownish-black pigmentation.


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    • Burning

      A subjective feeling of increased temperature of the skin of a certain area of the body, or burning, is a type of “paresthesia”, or a non-painful but unpleasant subjective sensation. It is subjective because when measured, the real, or objective, temperature of the skin is normal. Burning of the ankles and feet is a common symptom of superficial venous insufficiency.


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    • Heaviness & Tiredness

      Heaviness, tiredness, weakness, easy fatigue, sense of the legs being dragged behind during superficial venous insufficiency, is not only due to the swelling, but also because of deep abnormalities in circulation. This is the only disease, when the legs receive already used venous blood. Not only does such blood deliver an insufficient amount of oxygen, but also brings an admixture of end-metabolites, such as lactic acid, which is supposed to be removed from the tissues.


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    • Restless Leg Syndrome

      The condition typically referred to as “restless leg syndrome” or RLS, is usually due to superficial venous insufficiency. Abnormalities of circulation during this condition result in a “contamination” of the muscles with end-metabolites, such as lactic acid. When the body is reclined or is in horizontal position, such as during driving or at night, venous circulation of the lower extremities becomes near normal. At this time, any kind of contraction of our leg muscles restores efficient circulation. People suffering from the restless leg syndrome usually cannot find a comfortable place for their legs when they are going to bed and, therefore, keep moving around, trying to fall asleep.


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Anatomy


Visiting Dr. Khitin was a refreshing experience. I've visited multiple physicians and it looks like most of them treated me like a number. Dr. Khitin has an amazing ability to patiently explain all of the intricacies of the disease. Treatment went smooth. I feel 15 years younger! Thanks doc! –Anastasia L., Manhattan NY

I usually don't write reviews, but I feel that Dr. Lev literally saved my leg. I am 35 and not the typical patient for this kind of stuff, but I had an open ulcer on my leg for 3 years!!! Compression, creams, special diet - nothing helped. After Dr. K's treatment, the ulcer slowly began disappearing and it was gone in 6 weeks. If you ever had an ulcer, you know exactly how I felt! Thank You! Thank You! Thank You! – Mike B., Fair Lawn NJ

I was referred to Dr. Khitin by my primary after suffering for many years from restless leg syndrome and varicose veins. Dr. Khitin is the best! Knowledgeable, experienced, but most importantly, he cares! Relief came shortly after the very first treatment. Definitely recommend this doctor. –Samantha K., Manhattan NY

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Thank you so much for all your terrific work. I have spent over a decade trying to find the right doctor, while my legs have been getting worse and worse. Dr. Khitin has changed my life and returned my freedom: finally, I can walk independently! –Donna W., Manhattan NY

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