A Conversation With Dr. Z Catherine Navarro

The Vein Center of the Palm Beaches in Palm Beach, Florida, specializes in atypical vein disease, skin care and Med Spa therapies. “I do skin care, hair removal, all that wonderful cosmetic stuff, but what I’m known for worldwide is doing specialized vein care, especially the difficult cosmetic procedures on patients that have vein issues,” says Navarro.

“I see many people that have ulcers, large bulging veins, veins that have been treated by somebody else, or they may have had surgeries that failed and now have developed secondary tributaries that grow like wildfire all over their legs. If you don’t know how to treat them, you start injecting them willy-nilly and never get to the root of the problem. The patient will never get a good result.”

“I do a lot of repair of damaged skin secondary to ulcerations or pigmentations caused by the veins. I also do a lot of edema or swelling secondary to untreated, undiagnosed or poorly treated vein disease. And for that reason, if I’m getting rid of the veins, or the cosmetic complications of the veins, it is important to use the compression hose, not just cosmetically, but medically, too.”

The compression hose problem

The number one obstacle is that patients don’t want to wear the hose. “There is so much negativity and noncompliance from patients using the hose and the reasons are multiple. Some of the hose out there are extremely uncomfortable, they will bind, or be too tight in certain areas and slightly loose in areas where they should be more firm. What happens is the patient will have constriction and discomfort because the stocking is compressing with too much pressure in one particular area.”

Navarro adds, “Traditionally, stockings have come in maybe four or five SKUs and configurations, and the mentality is “one-size-fits-all” where all you need to do is expand the size a bit and you should be okay. But that makes no sense. If you see the American population, you have people that are tall or short, people that are squat or thin with maybe thick thighs or tiny ankles, and people with no thighs at all and huge piano ankles, so you need to have more SKUs to treat the patient.”

Standardized measurements for vein treatment

Measurement standards are the key, according to Navarro. “First of all, we should have standard measurement for consistency by using the same tape measure and measuring at a certain time of the day, because during the morning the legs are not as swollen as they are in the evening, and making sure that the leg is measured at certain distances or landmarks, like knees and ankles. But there is still plenty of room for human error."

"When we don’t adhere to these standards, we end up putting the patient in a stocking that may be ill-fitting or inappropriate for them. Compression stockings are the standard of care for vein treatment, but if patients don’t wear them, all of the advances in technology and techniques we have available to us – all that time and work – is wasted.”

So how do we overcome this? She’s got a system whose time has come.

The Bauerfeind Image 3D

For the last year and a half, Dr. Navarro has employed the use of Bauerfeind’s Image 3D, a digital measurement system for custom compression therapy. As the only phlebologist in Florida to use this technology, she’s building a reputation for advanced care and management of varicose veins and has quickly become an advocate for more broad-scaled use of the technology that has been used in Europe as a standard of care for some time.

The measurement process uses a platform with a smooth 360° rotation while wearing a gridlined stocking on the leg. A video camera captures multiple images – about 3 pictures per second – and then converts the data to the system. The result is a 3D model of the individual leg. From there, the measurements can be sent directly to Bauerfeind’s factory in Germany where the stocking is manufactured and shipped to her office, usually within 10 days.

“That’s why I’m so excited about it,” says Navarro. “When I first saw this, it was basically a system that was sold more to orthopedists to help fit braces and I thought ‘this is a no-brainer for vein care.’”

“This is contact-free measurement and sometimes people that don’t want to be measured because their legs are so painful and they don’t want to be touched,” adds Dr Navarro. “If you come in and you have one leg that has a clot in it and that leg is four times bigger than the other, we obviously don’t have a standard stocking. And even if we had a pair of stockings, like thigh-highs, they come matched, and the same size."

"This is really where Bauerfeind shines. If you were to do a custom stocking with anybody else, you’d have to physically measure it, not a contact-free measure, which could allow for a lot of human and operator error. But in addition, when you hand measure and you send the data off to get the stocking weaved, they have to interpret your measurements and then hope they understand what you measured, and then it takes them three to six weeks to get it done. In the end, you’re talking about a stocking price that will cost you $200 or $300.”

The benefits of the Bauerfeind Image 3D

By standardizing the measurement process – the “grid stocking”, a standing measurement, equipment at a fixed position to ensure accuracy each time and measuring each leg individually – one can virtually eliminate human error, resulting in less failure for the patient."

“With this system, we can press a button to send the info over to Germany, and they will custom weave either two separate stockings, or pantyhose with one big leg and one little leg, or the appropriate fashion, and then we will get it in 10 days and the stocking ends up being less than $200. That’s unheard of – you get a completely custom stocking in 10 days, and this just didn’t happen before. So now when I treat my patients who have had failed treatments before and have not worn their stockings, I fit them into a product that is comfortable and easy for them to wear and my results are outstanding.”

Navarro also uses an herbal homeopathic approach with arnica gel, arnica tablets (prior to and after procedures), a proprietary tissue-repair gel, a walking plan and nutritional guidance for quicker, less painful recovery. “That’s the other thing that I learned from my European colleagues. They use a lot of herbal and homeopathic products with great success.”

Spreading the word on vein disease management

Dr Navarro finds that her passion for vein care and the management of vein disease has given her another focus - education. “Nine out of 10 people have venous problems. Most go undiagnosed. Venous problems create huge embarrassment and there is a social stigma attached, so people don’t discuss it. We saw recently with NBC news correspondent David Bloom, who had leg pain, according to what we heard in the general news, and he brushed it aside because he thought it was maybe due to playing too much basketball at age 45."

"He flew to Afghanistan to cover the war and two weeks later he came back in a box because he had issues with clots in his legs and ended up having clots in his lungs, which killed him. This doesn’t just happen to old people, either. About 20% of pregnant women develop problems like blood clots because of hormones and the baby pressing on the vein structures. And women who smoke and take birth control pills are sitting ducks for clots.”

Navarro goes on to say that every year, a football field full of people die unexpectedly from complications of vein disease and people hardly ever follow through. “It is a silent killer and it’s important to know this. Now we also know that if your veins aren’t working then your lymphatic system isn’t working, which in turn means you’re not detoxifying and that lowers your immune system, increasing your inflammation.”

Navarro sees opportunities in her future for providing this education with a developing focus on training other physicians about what needs to be done and how to follow up with the patient because it’s not just an amalgamation of parts, but everything interconnects.

“There was a time that we didn’t think that vein disease had any impact on anything – now we know that vein disease can be directly related to heart disease. By having vein insufficiency, we are actually predisposed to a heart attack if we don’t treat it. I want to get this message out and train other doctors and nurses and therapists about the possibilities with good vein care.”