- Insurance Coverage
Question (multiple inquires):
Do you accept my insurance? If yes, will it cover my treatment? How much will it be if there is no coverage?
We do accept majority of common insurance plans, which always can be checked with the front desk and/or confirmed with participating providers directory published by your medical insurance carrier.
In the vast majority of cases the medical insurance carrier covers the entire treatment. Each specific situation, however, should be considered individually. Overall coverage determination is not based on the type of treatment, but depends on presence or absence of so-called “medical necessity”. One common example of the above is the following. Sclerotherapy is indicated and, therefore, would be covered when performed for bleeding varicose or spider veins, but unlikely to be considered for coverage if is being done for “cosmetic” reasons, meaning for simple presence of enlarged veins not causing any symptoms or complications.
In absence of medical insurance or coverage for the specific treatment, the cost of it depends on several factors, some of which include for example some anatomical considerations (number of blood vessels treated, their configuration etc.), the treatment modality (endovenous therapy, sclerotherapy, phlebectomy etc.), type and degree of the disease, complexity of treatment and such.
With rare exception, eligibility for coverage and/or approval for a particular treatment, as well as its cost in absence of such and all other financial and logistic considerations, are determined and addressed completely prior to the beginning of the treatment.
Please call our clinic if you have any additional questions regarding insurance coverage and we will be more than happy to assist.
- Difficulties Walking
Question (Mark S., Manhattan NY):
…simply walking has become very hard for me. Is there an explanation for that other than “old age”?
“…hard to walk…”, it is exactly how the majority of people describe progressively increasing limitation of their ability to move around. Interestingly, despite the common belief that the above problem is due to old age, it is never the case. Moreover, age by itself is never an explanation of health problems. At the same time, statistically, decreased mobility is most commonly due to abnormalities of circulation, among which a condition called superficial venous insufficiency is responsible for a majority of the above.
The most common complaints are the ones describing inability to walk for a long distance or often to stand for a prolonged period, heaviness, weakness and tiredness of the lower extremities. Another group of frequent complaints includes night cramps, swelling around ankles, tingling, “pins and needles”, burning and numbness. As the disease progresses, swelling increases and periodic flare ups of infection begin. Some of complications include thrombophlebitis, trophic ulcers and bleeding. Deposition of brown pigment is another sign of this condition. If you have any of the above symptoms, you should see an appropriate specialist.
- Swollen Ankles
Question (Esther K., Manhattan NY):
My ankles swell so much by the evening; even diuretics do not help any more. Is there another treatment?
Dear Esther, you are right: diuretics do not help, since the problem is not excess of water in your body, but rather abnormal distribution of this water between your lower extremities and the rest of the body. Unfortunately, diuretics being unaware of the above, are trying to remove water from the entire body. Fortunately, however, your kidneys are aware of it and, therefore do not allow diuretics to take effect. Otherwise, if diuretics did work, swelling of your legs would have improved, but the rest of your body would have become dehydrated, which, in its turn, is extremely dangerous for the kidneys and many other organs and systems. Since the problem you have is local, affecting only your lower extremities, the solution should be local as well. Furthermore, like with any other issues with health, it is mandatory to establish a correct diagnosis prior to prescribing any kind of treatment. In your case, it is not unlikely that you do have abnormalities in circulation, which should be carefully evaluated and appropriately treated.
- Non-Healing Lesions, Pain & Swelling
Question (David G., New Jersey City NY):
I have been told for years, that my legs swell due to heart failure; they hurt because of arthritis, while the non-healing lesions were a result of diabetes. Absence of improvement has left me thinking that something must not be right…
Unfortunately, your story is all too common. Despite the fact that your complaints can be explained by multiple diagnoses, it is much more likely that they are all connected and caused by a single disease. In fact, there are certain conditions affecting veins of the lower extremities, some of which are dull aches, cramps, brown pigmentation, and non-healing lesions, which with time, turn into trophic ulcers. It would be, therefore, extremely important for you to see a specialist in circulatory disorders, to obtain a correct diagnosis and to proceed with appropriate treatment prior to development of complications.
- Vein Diseases, Prevention
Question (Marat K., Manhattan):
What kinds of things I should or should not be doing to slow down the progression of vein disease or at least to prevent complications?
Most of the problems with circulation in the legs, just like with many other health problems, are due to inherited predisposition in combination with specific “risk factors”. In the case with superficial venous insufficiency, for example, such factors may include the following: obesity, multiple pregnancies, heavy lifting, prolonged standing, tumors of pelvis or extensive abdominal surgeries, as well as many others. It is important, therefore, first, to establish a correct diagnosis; second, to identify if specific risk factors are present and third, to learn how to avoid or to minimize exposure to such factors.
- Vein Treatment & Pregnancy
Can I start treating my veins while I am pregnant?
In general, it is considered unsafe to undergo almost any kind of elective treatment, including the treatment of diseased veins, during pregnancy. Neither is it advisable during breast-feeding and, in some cases, during first four to six months after delivery. Specific recommendations, however, depend of course on the type of treatment, as well as type and stage of the disease in addition to some other considerations.
- Varicose Veins, Definition
Question (Margarita S., Philadelphia PA):
What are “varicose veins” and what causes them?
Veins and arteries are blood vessels. The force of gravity and the heart move the blood through the arteries to the legs. Veins carry blood from the legs upwards—against the force of gravity. Venous flow relies on leg muscle contractions as well as the function of the “one-way” valves inside the veins. If the valves fail, gravity brings the blood down away from the heart. Increased pressure in the diseased veins causes their dilation and formation of varicosities.
The term “varicose veins” refers to the superficial veins visibly prominent and “twisted”. They can appear anywhere in the body, but the most common location is on lower extremities, where they always represent one of symptoms of a disease called “superficial venous insufficiency” along with many other symptoms, such as pain, tenderness, difficulties walking or standing, cramps, swelling etc. The difference between varicosities and normal enlarged veins, is the fact that varicose veins enlarge not only in their diameter, but also in their length. Because of that, they take sort of a “curvy” or “wavy” course, as opposed to normal enlarged veins, which remain straight.
Heredity is the only, so called, “non-modifiable” factor. Modifiable ones include occupations requiring prolonged standing or heavy lifting, lower body surgery or trauma, multiple pregnancies, increased body weight or height, as well as many others.
It is estimated that there are more than 80 million Americans who suffer from some form of venous disorder. While some people seek treatment for cosmetic improvement, many seek relief from pain, infection or blood clots. Help is available.
- Varicose Veins, Function
Question (Vitay T., Stamford CT):
Do these varicose veins serve any useful purpose? Is it possible to have vein disease
with no varicose or spider veins?
In the vast majority of cases, varicose veins do not serve any useful function. Technically, they are dysfunctional collaterals or tributaries of so-called “incompetent” superficial veins called “saphenous” veins. The normal, or competent, saphenous veins, being rudimentary in humans, often can be used as a conduit for different types of bypassing grafts in cardiovascular surgery. At the same time, incompetent saphenous veins cannot be used for their original purpose anymore due to their uneven and enlarged diameter. Removal or closure of such veins actually improves circulation. In some rare cases, however, when the deep veins of the legs are blocked, even incompetent saphenous veins become functional and should not, therefore, be removed.
As for your second question, varicose veins are only a symptom, not even a very common one, of venous dysfunction. The other symptoms include leg and feet discomfort, deep dull aches, pain, heaviness, fatigue, swelling, muscle cramps, restlessness, itching, burning, numbness and others. They often worsen with prolonged standing.
- Varicose Veins, Treatment
Question (Anna K., Manhattan NY):
Is it always necessary to treat varicose veins and why? Besides varicose or spider veins, what else would I see if I had bad veins? What if I do not treat my veins at all?
Varicose veins represent themselves as just a single symptom of a disease called “superficial venous insufficiency” and, therefore, as such, should not be treated by themselves at all or at least not until the disease causing them is eliminated. In the prevailing majority of cases, appropriate treatment of the above superficial venous insufficiency leads to the disappearance of varicosities as well. In a minority of usually very advanced cases of the disease, some varicosities might remain even after the treatment. In such cases, they can be easily eliminated by one of the modalities of endovenous obliteration.
Visible signs of the vein disease include swollen ankles, bluish discoloration often with brown pigmentation in the skin, blue or purple patches under the skin, bruises with no known trauma (due to spontaneously ruptured veins), slowly-healing wounds and others.
Abnormal venous circulation eventually leads to the development of complications. Some of them are blood clots, bleeding, dermatitis and other soft tissue infections, development of ulcers and even malignancies. Some forms of venous abnormalities can cause pulmonary thromboembolism, a very dangerous condition, during which the blood clots are thrown by the moving blood into the lungs.
Venous disorders should be treated when they cause symptoms: pain, swelling, achiness or fatigue etc. They must be treated, if complications have developed, including blood clots, bleeding, ulcers or infection. If abnormal veins affect your work negatively or interfere with your life-style, or even when they are cosmetically unappealing, the treatment is highly desirable. The benefits of appropriate treatment: relief from current symptoms PLUS prevention of future complications.
Question (Anna K., Manhattan NY):
So what is the very best treatment? What are those methods?
There is no single best treatment. The choice depends on the type of disorder, its stage, kinds of symptoms, comorbidities, contraindications, even skin type etc. Often, a combination of the modalities works best, and requires a comprehensive evaluation at a qualified clinic.
There are two main treatment types. One is conservative therapy, which includes compression stockings or wraps, exercises, weight management and specific measures grouped under the so-called “life style modifications”, such as, for example, frequent feet elevation, avoidance of prolonged immobility and many others. The other group consists of a wide range of corrective measures, usually performed as a non-invasive or minimally invasive procedure: without skin breach or through a small needle correspondingly. These procedures include endovenous LASER, radio frequency ablation, ClariVein® and other types of chemical obliteration, surface LASER, sclerotherapy, phlebectomy, thrombectomy and many others often used in combination.
- Sclerotherapy, Success Rate
Question (Ellen Y., Manhattan NY):
How successful is sclerotherapy?
It depends on the following considerations. The term “sclerotherapy” usually refers to the injection of a specific liquid substance into a blood vessel, usually either varicose or spider vein, for its elimination. Both of them represent not an independent disease, but rather a symptom of the so-called “superficial venous insufficiency”, appropriate treatment of which almost always leads to permanent disappearance of the above varicosities and spiders. In this case, any remaining varicose and spider veins can be easy eradicated forever with sclerotherapy. Alternatively, when varicose and spider veins are treated by themselves or prior to the treatment of venous insufficiency, they always re-appear and multiply in the same location or in its vicinity after a short interval. Furthermore, the injection of the sclerosing agent in the setting of untreated superficial venous insufficiency can compromise the deep venous system and lead, therefore, to permanent disability.
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
What a wonderful experience I've had! The problems with my legs are gone! I only wish I came here much earlier! Thank you, thank you, thank you! –Christine P., Manhattan NY
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
The most outstanding treatment I have received! All questions answered, tests done, procedures performed and I feel like a new person in no time! Thank you so very much! –Peter R., Philadelphia PA
I have suffered from trophic ulcers for 28 years until I got to Dr. Khitin’s office! He has literally saved my legs! If you have problems with your legs and do not want to get an amputation, do not see any other physician: do see Dr. Khitin right away! –Bob from UPS, NY
I have traveled thousands of miles to see Dr. Khitin, who literally returned me my health back! Thank you and all your staff for the most wonderful experience! –Dominique S., Montreal, Canada
On behalf of my father, I would like to express our sincere gratitude for your hard work and dedication: you have returned my dad his life and independence back: previously wheel-chair bound for years, now he is walking by himself! –Andre Y., Newark NJ