The Vein Game: Navigating Unseen Complexities in Women’s Health

(00:00):
Hi, this is Dr.
Soma.
Just a disclaimer, this podcast is for informational purposes only and isn't intended as medical advice.
Always consult with your doctor before making any changes to your diet, exercise, or health regimen.
Let's go to the show.

(00:55):
Today I'm honored to welcome Dr.
Tony Reinke.
Founder and medical director of the Reky Vein Center in Sugarland, Texas.
Dr.
Reky is a board certified vascular and interventional radiologist with nearly three decades of experience whose journey began as a nurse in the surgical ICU and evolved through roles as a physician's assistant and physician.

(01:18):
Before specializing in vein disease care, driven by compassion and expertise, she launched her independent practice in 2021 to offer minimally invasive patient-centered treatments for varicose and spider veins.
Known for breaking down complex procedures into clear, empathetic care.

(01:38):
She's diagnosed and treated thousands, often helping patients reclaim mobility.
And confidence.
We'll explore her inspiring path, her dedication to community outreach, and how she's reshaping vein health from the inside out.
Stay tuned for a conversation that's as empowering as it is expert.

(01:59):
I.
So it's so great to have you today on my show.
I really appreciate your time.
No, thank you very much for having me.
how are things in Sugar Land right now? Hot.
Yeah I'm used to Texas.
I've been here for 10 years, Very nice.
Where are you from originally? West is where I did all of my training.
Not just for med school, even nursing school and PA school.

(02:22):
It was all the Midwest.
Gosh, you're a nurse, you're a physician's assistant, a physician.
You've been a radiologist.
As well as a surgeon? Interventional radiologist.
Yes.
Interventional.
Okay.
So I did the fellowship.
Okay, got it.
Yes, I did all of it.
Yes, ma'am.
But that's still a lot of hats.
It is.
I don't have any regrets about it at all.

(02:44):
Okay.
I needed to take baby steps.
I'm first generation.
My mom didn't even graduate from high school, paid my way through that.
That's the story.
and I did.
And I'm super thankful for all those experiences, really.
Yeah, of course.
They shape you to who you become.
So where is your family from originally? Mine came from India many years ago.

(03:07):
And we landed in my parents landed in New York and then, we've been in this area since then.
How about yours? My, both of my parents were actually born here.
Okay.
But the ethnic part is my mom is per Filipino.
And Italian got it.
Yeah.
You mentioned, you said first generation, so I wasn't sure.

(03:28):
If you met first generation doctor or first generation.
All of it.
Actually.
It's but first generation to go to college.
Yes.
Yes.
Okay.
Got it.
Yes, ma'am.
Yeah.
It, I guess it depends on who you speak with, because when people say, first generation to me yes.
It, it's like a different connotation.
So I didn't mean to offend you in any kind of way.

(03:48):
Oh no.
And I think that's a good point actually.
I.
I don't wanna misrepresent either.
I just mean I'm the first generation of my people, whatever.
Yeah.
To go to college.
Like I said, my mom didn't graduate high school, I'm sure she has many other skills and talents though.
Not, I almost feel in certain ways.
I became stunted with medical school and residency.

(04:10):
there were parts of me I think that stopped growing because of it.
And it was almost like I had to catch up years later.
Like specifically if you are willing to share it.
Yeah.
Yeah.
No, I think In what way? I think emotionally, right? You have to.
be able to compartmentalize, I think when you are doing such a rigorous training medical school and training and to put others first before your own life.

(04:40):
And I think there's a price for that and I'm hearing that May be a little bit better when it comes to all that stuff, but I have a firm belief that those that people who are entering those kind of professions not just medical school, nursing, what have you, that there should be some type of psychologic care.

(05:03):
That comes with that because you are taking on other people's issues before yourself.
And that takes a yes.
That takes a toll on you emotionally.
I don't care.
Yeah.
I do not care what anyone says to me it does.
No, I.
You can't separate that.
Yeah.
There's no way that you can separate it.
So what It has to affect you.
Yeah.
I agree.
And I think just, paying attention to oneself when it comes to just making decisions.

(05:30):
And it could be relationship decisions, all sorts of stuff.
I just feel like there was just a delay.
Okay.
When it comes to certain things.
And then I think intrinsically my.
My intrinsic interests like music, arts, theater.
Writing any type of creativity, had to had to just be put on hold for many years.

(05:55):
Yes.
I'm sure.
I don't know how kids do it these days.
I see these kids in med school now, and they'll be talking about whatever.
Maybe they're trying to be an influencer or maybe they are right.
Or they're doing lots of act.
I did nothing in med school.
Yeah.
Yeah.
I had two babies.
That's it.
At least, and I studied all the time.
You at least had two babies.

(06:15):
You had that right? Yes.
That's a baby feat.
Yes.
Was huge.
That's a big feat.
It was huge.
Yes.
So no, I didn't have kids at that time.
So yeah, when I think about that's daunting as well.
But yeah, it.
It was super stressful, but I think, but, so for example, having this podcast and just, doing things online and partnering with other people, those were things that would not have even come to mind at that time.

(06:41):
Yeah.
And yes, it looked, the landscape looked different.
There was no social media and all sorts of stuff.
So yes the landscape was different, but it could have been different.
It could have been different, and I think it would've just fed a different part of myself.
I'm not saying I would've had all this time to do it, but I think it would've been helpful to have those things as a human being.

(07:06):
I ask.
So thank you for sharing.
Sure.
I, you probably know, but I am an internist by training.
I see tons and tons of women, and I am a women's health specialist and I mostly focus on women in midlife.
And there a whole spectrum of things that happen, hormonal shifts.
Pregnancies, weight fluctuations, and a lot of women come in during a certain stage of life or where they're like, oh gosh, Dr.

(07:34):
Mandel, my legs, the veins, I'm having swelling.
They, they're, they feel heavy, w what, what should women do during this stage? So what I tell my patients mid midlife when they come in.
The biggest thing that I focus on for all my patients, but I would say definitely these patients, is how much does it affect their quality of life? So I give my patients a quality of life survey to fill out before I speak to them, meaning that the.

(08:09):
Their intake paperwork.
And I wanna get a feel for how much do they feel like it's impinging on their quality of life.
And then if they have other medical comorbidities that are also going on, simultaneously talking to them about prioritizing.
So prioritizing a list, what bothers you the most? And it might not be their veins that bother them the most, hypothetically, they have an issue.

(08:37):
It's sciatica.
It's really bothering them.
They call it leg pain.
I still educate them about vein disease, but I actually don't encourage them to get treated because really their chief complaint is sciatica.
Yes, they might have vein disease, let's educate them, but then I have them go to their primary care physician, talk to their PCP, and then once their real chief complaint has been addressed, hopefully they're getting relief.

(09:04):
Then they can come back to me if they feel like they still have issues with their legs.
If the pain in their legs is taken care of, but they still have throbbing, aching, swelling, et cetera.
A lot of women also assume that having varicose veins it's just a cosmetic issue.
It's just a, thing of beauty.
But can you also talk about.

(09:26):
the medical impacts of having varicose veins, how it affects women and what kind of treatments can be available for them if they're true varicose veins, big bulging veins that you can see on the outside of the legs.
They're symptomatic, they're painful, they're tender.

(09:47):
Even patients like having a bleeding episode in the past.
So if they're true varicose veins.
They're absolutely not cosmetic.
The thing that sort of separates those two is do they have symptoms? Or they don't have symptoms.
so symptoms like we've described or is it purely, I just don't like the way these look.

(10:09):
Sometimes we get patients that come in and they don't like the way they look, but I'm able to educate them.
Actually, you might not think you have symptoms, but there is a little bit more of an underlying medical issue going on.
Doesn't mean they have to be treated medically.
We'll address what their true concern is.
But in terms of treatment options, certainly much different now than, say 30 years ago when I was a nurse.

(10:33):
So treatment options for these patients, we're gonna get an ultrasound because we wanna see what's going on a little bit deeper.
I tell patients it's like a tree.
If you, the trunk of your tree is big and stretched out.
And it's allowing blood to go backwards, towards the feet.
Instead of towards the heart.
Then you have a couple of options you could do nothing.

(10:55):
And wait till your symptoms get bad enough that you feel like it's affecting your quality of life.
You could do minimally invasive procedures, which is what I do.
Okay.
Those are called radiofrequency ablation.
It's a big fancy term for heating and ceiling veins with a catheter ultrasound and covered by insurance.

(11:16):
Then if there's still big bulging varicose veins that are painful or have symptoms, then a phlebectomy, which is an in-office procedure, numbing medication, small little incisions, and then I take out the big bulgy vein.
Okay.
And can you walk through, because a lot of patients have questions about.

(11:39):
Not just insurance coverage, but when they do have certain types of procedures, how long those results would last for.
Is it a permanent thing? Is it a five year thing or a 10 year thing? That's a good question.
And we addressed that in the very first initial evaluation with patients.

(12:00):
These are treatments that I perform.
They're not a cure.
There is no cure for vein disease or venous insufficiency, and there's no way that I can predict how long a patient's going to be, we'll say, asymptomatic or decrease their symptoms after a procedure.

(12:22):
What I can tell them definitively is it's a treatment.
I hope to decrease your symptoms, and that might be for a period of six months, or it could be six years.
And that's all dependent on somebody's really, their anatomy and then maybe other factors.
Do they hope to have more pregnancies? What's their occupation? 'cause all of those things exacerbate underlying vein disease.

(12:49):
They don't cause it, but they exacerbate it, right? what is the main cause of these things? The number one risk factor is genetic, right? So if somebody's.
One, if one parent, it's in men and women.
So I think that's important to discuss or just mention.
'cause sometimes think people think it's just female disease, it's not, it's men and women.

(13:10):
if one of your parents has it, you have a 50% chance of having it.
So it's a number one risk factor.
Both it goes up to 90% chance.
Okay.
So that's the number one risk factor.
I thought I survived my genetics.
I'd gotten pregnancy and then a certain age hit and it was a couple of summers ago, and one of my kids was like, what's that? And I was wearing shorts.

(13:37):
It was very hot outside.
And I knew, I just knew.
Yep.
And I looked down and I was like, how could I have missed that vein? It was right there.
And I was like, okay.
Yeah.
It was one of my parents and it was, 50 50 and yes, I won the lotto.

(13:57):
The, you did the varicose vein lotto.
Yes.
Yeah.
So these are some of the questions, and it's great to be talking with you about this because, I have to go through this with patients.
Your career started as a nurse, as a physician's assistant.
You were in the ICU and then you became an interventional radiologist.

(14:18):
What.
Led to your journey towards specializing in vein treatment.
What inspired you to do this? If I'm completely honest.
Yeah.
It wasn't really inspiration actually.
It was more of a I didn't want when I finished fellowship.
I actually returned back to the hospital where I worked as a neurosurgery pa.

(14:42):
there had been a change in the Department of Interventional Radiology where the hospital fired the whole department and brought in a new person.
So it wasn't really inspirational in that I was a brand new fellow starting out in interventional, which is a very broad.
subspecialty, and I just found that it wasn't really conducive to a new fellow learning, at least for me.

(15:09):
So it didn't take too long, and I really started doing some soul searching and looking at my options, and I knew I wanted to be.
Instead of the jack of all trades.
I felt like it would be better suited for me to be the master of one.
Okay.
And yeah, and I had the catheter skills.
Because I had trained in interventional, my residency was five years, and then I did a fellowship in interventional and all those years, which was six years, I had used catheters.

(15:39):
And so I felt like I could really, that would be a great fit for me.
I did, like I said, I did my research.
I looked what was out there, but I needed that.
To be fulfilled professionally.
I needed to be an expert in something versus doing a lot of things, and I really didn't feel like I was doing.
All those things really well.

(16:01):
Okay.
So yeah, I wouldn't say stumbled upon it, but and I'm extremely happy I did.
Yes.
I love what I do.
And then you founded the Reky.
Is, am I pronouncing your last name correctly? That is correct, yes.
Rinky Vain Center in Texas in Sugarland about four years ago.
Is that correct? Yes.
Yes, ma'am.

(16:21):
Yes.
What inspired you to do that and what has your experience been as an entrepreneur? So it was similar situation where at the time I had, I was part of a small group.
I was a partner.
There were three physicians and there, there was just three of us.
And I was out voted and they wanted to sell to a private equity firm.

(16:43):
Ah.
Yeah, and we did.
And it just conflicted with my professional goals, which I have a strong desire.
To provide one-on-one patient care.
And in an environment where there's plenty of time and for patients to educate them, to discuss their concerns and to answer questions.

(17:05):
the model was changing once the private equity firm came in, it became more of a business model.
Yeah.
And that kind of conflicted with me professionally.
I had already started thinking I need to open my own practice.
And so I did.
I, it was about a year later, I saved my money and I opened the doors in September, 2021 for my own center.

(17:28):
It's me.
It's owned by me.
All decisions are made by me.
Yeah.
So you are the CEO, the medical director? Yes.
And everything owner? Yes.
So the treatments that you provide, obviously, you do a lot of education for your patients, but you also have other ways of educating.

(17:50):
Your patients in terms of not just the conditions, but the treatments that are available.
Can you talk about that in terms of all the digital content that Oh, okay.
Patient education.
Yes.
That's actually been a level up much more of an emphasis recently just because I felt like there was a bit of a gap that I was missing and I could.

(18:11):
Throw the, for the net a little bit wider.
So I started doing videos, short little videos where I address maybe common questions that my patients are asking me.
And yeah, like short form content.
And I put it, I've been putting it out wherever.
Sometimes the ability for people just to have that at home.

(18:33):
That's gonna trigger something like, oh, I just didn't even realize that was an option, or that was even a, I thought that my legs were just swollen every day, that this was a normal thing.
So I, it was very intentional that I started doing this.
And we can already see that it's having an impact.
We have patients that are calling in and coming in because they said, oh yeah, I saw Dr.

(18:55):
Reinke, I saw this video.
I feel good about that.
There are some pitfalls with social media what have you, but I think this is one of its positive effects that you can reach people that you otherwise wouldn't have been able to reach.
And I think it's fascinating, honestly in terms of patients that come to me and the partnerships that I'm able to make with people who are interested in similar things that I like to talk about.

(19:24):
I think It really levels the game in so many ways, but you do more than just that.
You have partnered with community groups like Univision and L-L-G-B-T-Q groups, and you're also very active with health fairs.
Why is that community outreach such a priority in your practice? I think from a personal level, that's where I came from, meaning.

(19:52):
I came from very humble beginnings.
I remember us having food stamps and having to fill those in order to get groceries and different items that we needed.
And so I've never forgotten that and I feel like it's a privilege to give back in that way.

(20:13):
I specifically reach out to groups that I know are going to be servicing disadvantaged undereducated sometimes, or uneducated.
So it's not just by chance that I'm going to those health fairs, it's really intentional efforts that I'm putting forth to go to.
Baker Ripley had a big health fair downtown Houston.

(20:36):
That was all for Hispanic.
Patients and all, none of them had insurance.
Okay.
it's both personal and professional and I do treat some pro bono patients.
I don't like to say that too loudly because I don't want that to be the expectation, but to be honest with you, yes, I have all those patients that I went and saw at Baker Ripley, I offered to treat all of them for free.

(21:02):
Because they didn't have insurance.
And we had one person, one lady that ended up we were waiting for her to get back from Mexico, but ultimately she has very advanced disease and I do hope that she will take us up on that.
I think, there are times when and I'm very exclusive about who I will treat pro bono and when I give my services away without expecting any kind of monetary benefit from that.

(21:28):
That being said, when I'm questioned, when I do that, I always tell people that the universe has a way of paying you back for that.
I agree.
It may come years later.
Or it may come in other opportunities, but for those of us who come from humble backgrounds and beginnings, it is important to stay in touch with that side of ourselves because I feel it actually makes us more attractive to other patients that are able to obviously, to pay for their care.

(22:04):
But that's not, that is obviously not the reason why either you and I do it.
Correct.
So for those women who.
And this may fall even with women who are educated many women don't necessarily know when they should be taking care of their vein health seriously.

(22:25):
Like we were touch, we touched upon that in the beginning of the podcast where we talked about certain symptoms and.
When should women say, okay, you know what? This is just a varicose veins.
I, I'm not having anything else.
Or when should women seek a vascular specialist or an interventional radiologist because they're having other issues? I think any time that they have questions.

(22:53):
Come see somebody.
For me, I give free consultations like legitimately free, right? I want to give them education, so if it's something that they feel like they need more information about, go talk to somebody.
Talk to your primary care.
You do not need a referral to see me.
You shouldn't need a referral unless it's an insurance issue.

(23:14):
But if somebody's offering a free consultation.
You don't need a referral to go to them.
That's the beauty of free consultations.
A lot of people don't give them anymore to answer your question.
However, for me, I tell patients if your symptoms are bothering you and they're progressively getting worse, you are noticing, potentially noticing more veins on your legs or your swelling has increased, or it's now cramping.

(23:46):
Now you have new symptoms on top of older symptoms, go see somebody.
Yeah.
That's what I say.
In a sense, it's not their job to figure out whether or not it should be something they need to address.
If they have a concern, go talk to the specialist and let them educate you and work together, collaboratively to decide, is this something that you need a little bit more that you might need treatment for? Yeah.

(24:19):
I think it's really important for these types of patients to.
Be established with a primary care physician because there are obviously different types of swellings that can happen in the leg.
So you want someone to be able to distinguish is this coming from your heart or potentially any medications that you may be taking versus the veins that are not.

(24:43):
Working properly.
I, in my own practice talk a lot about midlife changes and what that.
How that affects our bodies when women have varicose veins and some of the symptoms that you were describing, the swelling, the heaviness, how does that affect other things like their exercise, their energy levels, their mobility How can the, how can taking care of their veins support a more active lifestyle for them? What I see is that.

(25:20):
If you are having symptoms that are affecting those things, if you have symptoms in your legs, such as swelling, night cramps, restless legs, and then those are preventing you from doing things like exercising, walking just regular activities of daily living, cooking, cleaning, shopping, whatever that is, it's gonna affect your mental health, your physical health, your confidence, et cetera.

(25:50):
So it's not, again, going back to, it's not just gonna affect one aspect of your health.
It affects all of it.
When they get treatments, we always tell them, we may be able to treat if this is like a box of your symptoms.
Whatever part of that vein disease is contributing to, we hope to decrease those symptoms.

(26:11):
But there might be other things.
So we certainly set expectations, letting them know, Hey, just because you get treated, it doesn't mean that all of your swelling or all of your leg cramps, restless legs, heaviness are gonna go away.
That's why it's important for us to work.
In conjunction with patients about, here's what I can do, but we need to work together and your part in this is after you're treated, I'd like to see you do some just walking.

(26:41):
That's the best thing that I can recommend for my patients on a treadmill outside, whatever.
Whatever they can do.
Or if it, or if, say for instance they have really bad arthritis or some medical condition that precludes them from doing weight bearing or.
It's painful.
I talk about swimming or non-weightbearing exercises that they can do.

(27:01):
So I try to work with them together, but certainly it can definitely impact their exercise mental health, confidence, et cetera.
The other question and concern that women often have, and obviously this is not just excluded to women because men can have aims too, but I'm speaking as a women's health specialist.
Often my patients are very busy.

(27:23):
They're working mothers.
And one of their concerns is the downtime required.
What is the most effective treatment? And I understand that, one treatment may not be the most effective for, one other patient versus someone else.
Yes.
So in terms of, let's say, sclerotherapy versus ablation versus a phlebectomy where you remove the vein.

(27:46):
Yes.
What are the typical down times and recovery times in with each procedure? For me, each one of those procedure is an in-office procedure.
All of those patients are back to their normal activities the same day, I would say.
The most uncomfortable of those procedures is probably the phlebectomy where I'm taking out those big bulging, painful varicose veins.

(28:14):
And I usually just tell them, take it easy for today.
You should be back to your normal exercise activities tomorrow.
But there's no like bedrest, downtime, et cetera for those procedures, which is the beauty of the procedure really, because they used to do vein stripping procedures, vascular surgery would go in.
It was general anesthesia surgery and a six week recovery time.

(28:37):
Things have dramatically changed.
So these are minimally invasive.
Okay.
In terms Of after the procedure.
I think a realistic kind of expectation for a patient is you can have some bruising, some tenderness along the course of the vein that I treat, especially with radiofrequency ablation and phlebectomy.
But that's well managed with ice, which will decrease inflammation and swelling, as well as just an over the counter nonsteroidal anti-inflammatory.

(29:04):
If they can take it if there's no contraindication to that.
I have never in 10 years of practicing exclusively vein disease.
I've never once written for pain medication or narcotic.
There are other procedures that patients talk about, and admittedly I don't know much about them, but one that a patient recently mentioned to me was Varithena.

(29:27):
Can you educate us as to what that is and maybe other procedures that I, I haven't touched upon or we haven't touched upon on this podcast? Okay.
I actually, almost every one of my patients gets Athena as well.
Okay.
VE Athena is an FDA approved foam that is used.

(29:47):
I use it in conjunction, not the same day, but in conjunction with radiofrequency ablation.
So probably 80% of that vein.
From the calf up to the groin.
I'm gonna treat with heat, and there are anatomical reasons why I do it that way.
But for the sake of this, I'll just say most of the vein I treat with heat, okay? The varithena is a beautiful procedure that allows the anatomy, the vein that's closer to the ankle, where everything is more compact.

(30:21):
I can inject that.
Foam, that chemical under ultrasound guidance.
And it's done with a little, a small, little but butterfly needle, and it works.
So if you think of vein disease, these big veins my, my job is to shut them down.
I either do it with heat or with varithena.

(30:41):
Okay.
And after I've heated that vein, a different day, they'll come back, assuming insurance approves it.
And then I can just go in butterfly needle ultrasound, one stick.
I freeze up their skin with numbing spray and slowly inject that varithena into the last part of the vein that's open.
It irritates the lining of the vein, and it closes down over the course of several days to about a week.

(31:05):
Okay, so unlike the heat, it doesn't close immediately, but it's a beautiful procedure to comprehensively close down.
A vein without any risk of heat injury, like a skin burn that you could potentially have with a catheter.
A patient came back to me like I, I think two weeks ago, and I usually, if I don't know something, I look it up immediately after.

(31:28):
And I just didn't have the time to do it.
When this opportunity came up for the podcast, I was like, okay, let me make sure, yes, I find out what this is and how it's used.
So what is the varithena specifically? Is it is a chemical, it's called polydocanol.
So it's a chemical that is in a pressurized container and the chemical.

(31:52):
Then it's with nitrogen actually.
So what happens is it's pressurized the liquid then becomes a foam when we dispense it, and then that foam we inject through the butterfly inside the vein and it.
It destroys the innermost lining.
There's only one, but anyways, the intima of the vein is destroyed, so the inner lining and then the vein will just kinda spasm down over time and then close and form scar tissue.

(32:20):
Okay.
Any other procedures that you perform that are effective for these kind of things or any other vein conditions that we haven't touched upon? Those are the ones that I use in my office.
Radiofrequency ablation.
VE Athena, I do sclerotherapy which is the same chemical that's in VE Athena for purely cosmetic veins, which I also do here.

(32:45):
Okay.
But those are not covered by insurance.
A hundred percent.
Not covered.
I would tell you that there are some other options.
If patients, which I don't do here, and there's reasons, but I'll just tell you some options are glue.
So there's medical grade glue that could be used.
So instead of doing a catheter heat based procedure, you could slowly inject glue, think of it like super glue inside a vein to get it to close.

(33:12):
So that's an option.
Patients can look at that, explore their options, risk, benefits, et cetera.
And if their insurance covers it, they could use glue.
There's another, way to heat a vein that's just with laser.
Neither radio frequency nor laser is necessarily better.
It's like having soda and there's Pepsi and there's Coke.

(33:34):
There are obviously times, in my own practice where based on certain medical conditions, age, what have you, where we advise, and it's usually the surgeon and I mutually telling the patient that they're not the best candidates for certain procedures or surgery.
For the procedures that we just talked about, are there ever times where you recommend not having these procedures? Yes.

(33:59):
I think that people would be surprised, at least in this center with me, how many new patients I get that aren't treated.
It's a little bit, what I would say is unique to my center and what I will have to tell you that I pride myself on a little bit.
Every patient that has vein disease does not need to be treated, and they shouldn't feel like there's pressure necessarily to do if you're specifically asking me are there contraindications to the procedure patients that I don't treat because I, I.

(34:30):
I think that they wouldn't be a good candidate.
The answer is yes.
Patient comes in, they clearly have vein disease based on their signs, their symptoms, their history, their physical exam, et cetera.
However, when I check their pulses, they don't have palpable pulses that already tells me, Hey, they've got an arterial issue.

(34:51):
I will usually just do a free screening ultrasound.
Show that they have maybe four blood flow to their leg and then contact their primary care physician or whoever referred me that patient saying, this patient actually needs to see an arterial specialist.

(35:11):
Before I did exclusively vein disease, yes, I'm trained to do arterial, but I don't do that anymore.
So I do have my referral, but I want to be respectful and professional and reach out to the person that referred me.
Potential complex contraindication? I would have to look at the imaging, but it's not a hundred percent, but it's a potential contraindication, bleeding dyscrasia.

(35:35):
So either they have a family history of blood clots, a personal history of blood clots.
That's it depends, but it could be, is what I would say potentially as somebody who's non-ambulatory.
So it's one thing to, to have decreased range of motion.
It's a whole nother thing if you come into my office and you're wheelchair bound.
'cause I can work with people who have walkers or canes, et cetera.

(35:58):
And the reason why is I need for patients to be moving, contracting their muscles, moving the blood out of their leg through their deep veins to keep their wrist low of getting a blood clot, right? Granted, it's less than 1%.
Of getting a blood clot for most patients.
However if you are non-ambulatory, I just consider it, you know that it's a contraindication.

(36:24):
I think that usually those patients have multiple comorbidities.
They tend to be older patients.
And if they're not gonna be up and moving, they also tend to have pretty advanced disease as well.
Just so wound healing is poor and I just, I don't think it's worth it.
Yeah.
For them, for me the risk is too high.

(36:46):
There are times when I have patients and they're usually older and they come back very frustrated, Whomever they saw, if they're turning you away, just think about it.
This is how they make their bread and butter.
They're turning you away.
That's a good thing.
That means that they're honest.
Yes.
So Don't go seeking something and then find yourself someone who's willing to do it just for the sake of doing it because you want it done.

(37:12):
Yes.
So it can, it's very difficult at times to try to convince that person, but most of the time they do heed the advice that they're given.
Yeah.
So what's next for rank events, vein center.
Right now, like I said, it's a little bit of a level, level up, but not crazy.

(37:32):
Yeah.
So my goal was just, I've been doing it for 10 years.
I've established my reputation, I have a good patient base, et cetera.
I just wanted that little extra piece where I was incorporating in the outreach with education, but via social media videos.
Teaching.

(37:52):
I have added in allowing different types of either students or physicians to rotate.
So I started out with family practice physicians.
I've now included, I have high schoolers that are interested.
This summer they just started in medical specialties.
So I've included that.
I have ultrasound students.

(38:13):
Who are rotating with us every month now as well.
And then I think, honestly, I'm not ever gonna be at the point where it's gonna be like multiple centers with multiple physicians.
That doesn't suit me, and it's not where I wanna be.
So I, I'm not looking to.

(38:34):
The way that I practice here is not about numbers and goals related to numbers.
And when I say that, patients or procedures we don't work like that.
So I'm very happy with where I am and I'm super, I've learned a ton just recently, the educational videos and stuff.
So I'm really pretty happy.

(38:56):
And if we wanted to look for these videos and find you via your website and social media where would we go? My website, is Reinke vein Center, R-E-I-N-C-K-E, vein, VEIN center.com.
We have blogs, we have videos.
Short, like TV spots that I've been on.
Instagram is Rinke vain Center.

(39:20):
And then I do have TikTok it's solely for education.
And that's Dr.
Tony Reinke.
I do have a YouTube as well.
It's Dr.
Tony Reinke.
Okay.
So that's where all of my videos and education are.
Perfect.
Perfect.
I'll make sure that we capture all of that for the show notes.
Okay.
Thank you.
But it's always good to Obviously have people who are listening to it be able to immediately go and look you up.

(39:45):
Yes.
Thank you.
It's been very educational.
I think this is, informative for a lot of people.
I would say.
Sometimes patients, they don't know what they don't know.
And so something that I try to do is give them the questions that they don't know to ask.

(40:06):
A for instance and this is my bias opinion, this is my bias, professional opinion, but.
I had to go through just the medical part not before that, but let's just talk about med school.
Residency.
Fellowship.
So med school is four years, as residency was five, and then I did a one year fellowship, and I did that in catheter-based procedures.

(40:28):
I would say, and I do say this to patients.
Research who is doing your procedures and what their credentials and training are.
Because just like anything that you invest in, it's important to understand what you're spending your money on and this is your health.

(40:52):
And to me that's.
The most important commodity that there is.
So I would just tell patients, which is what I do here, do your research.
They know when they're coming here.
Like what? I'm board certified.
I'm an interventional radiologist.
I've been doing this for 10 years.
Okay.
They know that, but not every center is like that.
I think if it's important to you then look at that.

(41:14):
Some of my videos that I've recently done do touch on that.
An easy way to find out what.
A physician's board certification is go to their state, look up their name and see, and if that's important to you, just understanding, okay.
Who would do veins, an interventional radiologist, vascular surgeon, maybe general surgeon.
Those are the top three that I would think of.

(41:34):
And also asking, this is another thing that, because I started out working at a vein center 10 years ago and then transitioned into this, but.
Who is actually doing the procedure? Not just what the medical director is, but is the physician doing the entire procedure here? Yes, I do everything.

(41:56):
I see the patients, I do all the procedures, all their follow ups.
They have my cell phone number so my patients can call me twenty four seven.
Yes, you're the medical director, you're board certified.
this is your board certification, but are you doing the procedure from start to finish again? Does that matter to you? Maybe it doesn't, but it does to me.
there are places where maybe mid-levels or assistants will do almost the entire ablation, and then a physician, they get six patients lined up and a physician just goes and spends one or two minutes with the patient.

(42:26):
That's the entire interaction with the physician during all of their treatments.
that's my bias, but that's not what I would want.
I want the physician to treat me.
Yes.
A PA background.
Yes.
Obviously an MD background and you're highly specialized.
This is not a rant about mid-levels, but we are we are in difficult times where not just for doctors, but more so for patients and I'm hearing this across the board where patients feel very frustrated because they feel like they don't have access to their own doctor.

(43:02):
Yeah.
I will tell you this too, when I started out 10 years ago, having had my background.
What I found is when patients come to a subspecialist, they wanna see the subspecialist and that was something that I said, okay, that aligns with what I want to do professionally.
You wanna see the specialist and I wanna see you.
So I don't have any other practitioners here, but I think I do have this very unique perspective.

(43:30):
It's obvious that I'm not anti nurse or anti mid-level.
I've done both.
I love everybody.
But when patients come for this procedure they wanna see me.
Or the specialist? I'm saying they do wanna see the specialist.
Yeah, but we're in challenging times where it's hard to say where things will go, but it sounds like you, you are handling that in your own way.

(43:52):
So that's refreshing to hear.
But yeah, thank you.
I think across the country, right? It's, yes, it's, it's interesting you mentioned private equity, you mentioned a lot of things that we're all dealing with.
Yes ma'am.
I don't necessarily think patients are necessarily aware of what's going on and why they're losing access to their doctors.

(44:15):
But I think more challenging times are ahead.
Yes.
Texas just enacted the Doctor Act.
Yes.
That's gonna create a whole nother level of controversy.
Yeah.
It doesn't matter.
Just anything that's new, that's different.
So there's pros and cons.
Doesn't matter which side you're on or what you think there, that will present a whole nother level of issues and certification and thoughts.

(44:43):
Et cetera.
And I think it's, I think it's ironic almost because it's such a conservative state.
Yes.
So there's the irony for me, and I'm a Texas physician, And I just found out about it, I think a day or two ago.
When did it come, when did this come out? Think, like you said, I think a day or two ago.
Yeah.
Because this is all over like my news feeds and stuff.

(45:03):
Yeah.
I can see pros and cons.
there will be, more doctors available.
However, I'm like Texas, yes.
In Texas, listen, I thought, I was like I never thought I was done with taking boards, but when I came to Texas.
All those board certifications.
I had three.
I had physics, writtens, and orals.

(45:24):
And then I came to Texas.
I just take a law exam.
So I'm thinking, wait, so you're gonna tell me they don't have to take this law exam? The law exam was hard too.
I never would've passed had I not taken a course.
So you are saying that you will have to continue taking these exams and these potential doctors will not.

(45:47):
that's what I'm saying interesting how, medicine as a whole body how we think about things.
Yeah.
I know things have changed, but you know how training was, at least for me, there.
Good, bad or indifferent.
There was no work-life balance.
That wasn't a word we didn't know about that.
No.
It was just you were somehow awarded for the more toxicity you could take and endure.

(46:12):
And I'm not trying to be disrespectful to the profession because I love what I do and I'm thankful for this opportunity.
But I do think that there needed to be changes For sure.
But.
Yeah, I, I wouldn't wish all these exams on anybody and I don't begrudge if maybe people don't have to take them.
But I was sitting there today even thinking about this question.

(46:34):
I was like, so wait, you mean they don't have to take the law exam and they don't have to know the laws and Oh my goodness.
So yeah.
Pros and cons to everything.
I'm just gonna, I'm just gonna drive in my lane, just drive in my little vein lane and just.
Just keep focused and do a good job for my patients.
That's what I'm gonna do.

(46:54):
Thank you for having me.
And don't forget to like, share and review my podcast.
Remember, it's always ladies first on Soma Says.
Let's make a difference one conversation at a time.