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COVID Vaccine Concerns and Blood Clots

Johnson & Johnson Vaccine Blood Clot Concerns: What is a Deep Vein Thrombosis (DVT)?

Blood clots associated with the Johnson & Johnson vaccine have caused pause and concern. As a result, the United States is recommending a pause on administering the single-dose Johnson & Johnson coronavirus (COVID-19) vaccine after reports of six women experiencing blood clots within three weeks after their inoculation, according to the CDC. Specifically, six women between the ages of 18 and 48 developed unusual blood clots in combination with low platelets, 6 to 13 days after vaccination.  There have been no reports of blood clots related to the Johnson & Johnson vaccine in San Diego County (out of nearly 60,000 doses given). It is unclear if the rare blood clotting disorder is related to the vaccine administration or not, as 7 million people have received the vaccine.

A deep vein thrombosis (DVT) is a blood clot in one of the veins in the deep venous system. There are 2 types of veins in the legs, deep and superficial. Deep veins are deep within the muscle and are responsible for 90% of the blood return from the legs to the lungs and heart. These veins are necessary for life. Superficial veins are in the subcutaneous tissue and lie outside of the muscle, closer to the skin. Blood clots located in a deep vein, most commonly occur in a leg or arm.

Johnson and Johnson Vaccine and Deep Venous Thrombosis (DVT) blood clots

Johnson and Johnson Vaccine and Deep Venous Thrombosis. Deep venous thrombosis is when a blood clot forms within the leg veins

Blood clots occur when the blood thickens and sticks together. A blood clot in the deep veins can break off and travel up through the bloodstream, becoming an embolism. The most serious and immediate concern is a pulmonary embolism (PE), which is when the blood clot travels to an artery in the lungs and blocks blood flow.  This can cause damage to the lungs or other organs and can cause death. A blood clot in the thigh is more likely to break off than a clot in the lower legs. DVT and PE are also known as VTE (venous thromboembolism). In general, VTE affects as many as 900,000 Americans each year.

What are the signs and symptoms of a blood clot?

Many people with DVT have no symptoms at all. Symptoms depend on the size of the clot and the veins affected. But here are the most common symptoms that occur from a DVT in the legs:

  • Swelling (typically in the leg. Blood clots in the arm can cause arm swelling)
  • Leg Pain (especially with walking)
  • Tenderness
  • Redness of the skin
  • PE Symptoms
  • Difficulty breathing
  • Faster than a normal or irregular heartbeat
  • Chest pain or discomfort, which usually worsens with a deep breath or coughing
  • Coughing up blood
  • Very low blood pressure, lightheadedness, or fainting
Johnson & Johnson Vaccine Blood Clot Concerns. A Deep Vein Thrombosis (DVT) blood clot in the leg

Johnson & Johnson Vaccine Blood Clot Concerns. A Deep Vein Thrombosis (DVT) blood clot in the leg can cause pain and swelling.

How is a deep vein thrombosis (DVT) diagnosed? A DVT is diagnosed by a venous ultrasound of the leg. A physician will decide if a blood thinner is needed for the treatment of the blood clot based on a variety of factors. If a blood clot is suspected, an ultrasound is necessary immediately and a physician should be notified. Read more about venous ultrasound imaging at La Jolla Vein Care to detect blood clots. 

 

COVID Vaccine Concerns and Blood Clots2021-11-05T11:31:24-07:00

Dr. Bunke interviewed by Modeliste Magazine!

Modeliste April202021 Sexy Legs for Spring Photo 2

 

Tell us about La Jolla Vein Care and what makes it so unique and such a leader in vein treatments.

La Jolla Vein Care is unique because we exclusively specialize in vein disorders. This means we are able to perform all ultrasound diagnostics in-office and offer all treatment options for vein conditions vs.a one-size-fits-all approach based on more limited treatment availability. Since we are skilled in all modern treatment modalities, we can truly customize a treatment plan to the unique needs of the patient. Our leading edge treatments are able to treat most vein conditions, including large varicose veins without surgery, using endovenous techniques.

Read the full interview on our media page
To see the full magazine online

Dr. Bunke interviewed by Modeliste Magazine!2021-04-11T23:28:39-07:00

Dr. Foghi in the News

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Daily Business Report

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Dr.Foghi

Vein specialist Dr. Armin Foghi joins La Jolla Vein Care

La Jolla Vein Care (LJVC) announced the hire of Dr. Armin Foghi, M.D., vein specialist and recognized invasive/non-invasive cardiologist. With approximately 50 percent of the population suffering from some sort of heart or blood vessel disease, this latest addition to LJVC’s team is designed to both accommodate growing demand and add an additional complementary layer of medical specialization to the practice.

With more than 15 years of experience in advanced circulatory system treatment, Foghi’s career trajectory has included prominent roles such as assistant professor at the University of New Mexico School of Medicine, chief of cardiology at Eastern New Mexico Medical Center and founder and medical director of cardiology at the Myo Vein Clinic. During his tenure at Myo, the organization was recognized nationally as the Center of Excellence for complete and comprehensive vein treatment and served as a training center for physicians across the U.S.

Foghi has also served as the medical adviser for the New Mexico Athletic Commission, where he worked directly with professional athletes participating in competitive combat sports. With a passion for service to others through education, he is also an active cardiovascular disease educator and lecturer and has served in various residency training and clinical professor at physician assistant programs.

Dr. Foghi in the News2021-04-11T02:59:20-07:00

La Jolla Vein Care introduces Procedural Telemedicine

La Jolla Vein Care is pleased to announce it’s partnership with Avail Medsystems to bring the cutting edge technology of Procedural Telemedicine™ to our practice.   Utilizing this collaborative equipment we can consult with remote staff and vein experts throughout the Avail network to facilitate quick, informed resolutions to even the most complicated procedures.  La Jolla Vein Care prides itself in offering the most updated technology in our quest to offer the very best vein expertise to patients while continuing to provide the quality of care they have come to expect from San Diego’s best accredited vein center.

 

Avail’s Procedural Telemedicine System facilitates medical expertise sharing and collaboration during live procedures by connecting physicians in the treatment room to remote medical industry professionals and healthcare providers, enabling physicians to deliver the right knowledge, at the right time, regardless of location. The System was built by a team with deep expertise in medical technology and healthcare who understand the day-to-day needs of medical experts.

 

“We are very exciting to be able to use this technology to better serve our patients,” said La Jolla Vein Care’s Medical Director, Nisha Bunke, MD FAVLS, RPhS

“La Jolla Vein Care has led the way in the new field of Telemedicine for vein care and this a new and exciting aspect that allows us to be able to provide real time instruction during a procedure that is beneficial to patients, doctors and our team.  At La Jolla Vein Care our patients are our top priority and we pride ourselves on offering the newest technologies along with personalized care.”

 

Remote Console Ortho surgery Avail logo

Avail Technology610008

 

Avail’s Procedural Telemedicine system is a mobile, interactive, end-to-end hardware/software technology platform that allows treating physicians to connect with remote healthcare professionals or medical device representatives and collaborate in real-time during live medical procedures.

The Avail System consists of a mobile Console that sits in the procedure room with high-definition pan-tilt-zoom cameras, plug-ins for external imaging, and a large display monitor showing views that are shared by the remote party.

A remote healthcare professional or medical device representative can use an iPad or laptop to instantly join a procedure and control camera and imaging views, annotate on screen, and communicate two-way with operating physicians.

La Jolla Vein Care introduces Procedural Telemedicine2021-11-13T16:50:59-08:00

Dr. Bunke in Authority Magazine

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From an interview with Candice Georgiadis Candice Georgiadis 

Dr. Nisha Bunke of La Jolla Vein Care: 5 Things You Need To Know To Grow Your Private Practice

ASa part of my interview series with prominent medical professionals about "How To Grow Your Private Practice" I had the pleasure of interviewing Dr. Nisha Bunke, MD, FAVLS, RPhS.

Dr. Nisha Bunke is a venous disease specialist, who founded La Jolla Vein Care, San Diego's only accredited vein center in 2010. She was the first physician in the United States to complete fellowship training in this specialty supported by the American Vein and Lymphatic Society and is a diplomate of the American Board of Venous and Lymphatic Medicine. She is also the author of the medical textbook, The Vein Book (Oxford Univ. Press 2013), numerous scientific publications, and CEO of Recova, Inc.

am a venous disease specialist, meaning I treat the entire spectrum of superficial venous disease affecting the legs, including painful varicose veins, leg ulcers and blood clots. This is a niche specialty that has been growing over the past decade because vein conditions are so common. I was the first physician in the United States to complete fellowship training in this specialty, which is supported by the American Vein and Lymphatic Society. Venous disease is pervasive. During the early years of my private practice, I also served as a volunteer clinical instructor at UCSD, where I treated patients at UCSD Medical Center as well as the Veteran's Affairs Medical Center.

Earlier on, I did not plan on having a private practice. However, while working in university and government medical settings, I saw obstacles that prevented patients from getting fast and convenient access to vein care. I liked the idea of being able to control the patient experience and creating a concierge-style, individualized and patient-centered practice. Being a physician and business owner allows you to exercise both parts of the brain. The medical decision-making, science and data-driven part of the brain is ingrained in any physician, but the business owner side allows one to be creative, making creative decisions from areas ranging from website functionality and design to how to effectively market and grow the practice.

As a provider and business owner, I tried to do everything myself for many years. That is a quick way to experience burn out. For balance, I've learned to delegate things that can be delegated. As a physician, I can't delegate patient care and my judgment, but I can delegate business-related roles, which is why it is valuable to surround yourself with a strong and supportive team. The right team members will make your job a lot easier.

When I'm seeing patients, I'm 100 percent dedicated to patient care, not considering business at all. With a heavy patient load, I used to find myself working on the business itself on the weekends and evenings, until I eventually hired other physicians and nurse practitioners to help with the patient load. This allowed me to have more administrative time, which is important for accomplishing work related to quality of patient care like quality assurance reviews, overseeing our facility accreditation and allowing time to have team meetings, staff training and other marketing and business administration tasks. If you really care about your practice, it makes sense to spend time on things that count — from the quality of care you provide to patients to the attention and training employees receive.

Ultimately, it is the practice owner's responsibility for the quality of care delivered and upheld within the practice.

The biggest hurdle that is prominent in my mind is the financial hurdles medical practices tend to experience. I think you have to be open-minded that it can take several years to really become established, especially when your business is heavily reliant on word of mouth referrals. There is so much to prove, and it takes patience and, of course, time.

I had to learn it was all simply part of the process. Without failure, there are no learning curves to grow from. One of the most important things a person should keep in mind if they're hoping to start their own practice is realizing there are going to be failures, just like any other business will experience.

Know your patients. You know your patients and what is in their best interest. Use this knowledge to your benefit and market your business and experience to the audience accordingly. If you have patient reviews and testimonials, for instance, learn from them to improve a future service or to boost your practice's credibility and reputation. Knowledge is power. Take what you know about your patients and use that to reach future individuals who may not have even been aware they needed your service.

Be involved with the management of your team. Patients tend to compliment my staff often, and they say that employee attitudes trickle down from the top. I agree with this, and I have noticed if customer service is not on par, it usually is tied to the top. If there is a staff member who tends to be a little less friendly, maybe it's because their boss isn't too friendly themselves.

Research EMR options. This is a must! There are many different types of electronic medical record (EMR) options, some are specialty-specific. I have seen EMRs that are touted but would not be right for my practice because of my documentation preferences and need to incorporate ultrasound and leg images, or inability to utilize text and email appointment reminders, or lack of billing capabilities. All EMRs are very different. I recommend trying different EMRs out before committing to one.

Consider outsourcing billing. I outsourced billing for the first few years of my practice, which is a cost-efficient option for practices starting out. If you choose to do billing in-house, your billing expert needs to be experienced and detail-oriented.

Consider outsourcing HR. For small practices, it doesn't make sense to hire a full-time HR professional. Instead, we use a professional employer organization (PEO) company to offer employee benefits, facilitate payroll processing, provide risk management resources, human resource consulting, employee training and more.

Yes, this was huge for me. I never wanted to charge people for my services. Most physicians go into medicine because it is an altruistic profession. At some point you realize that you have a special skill set that most people don't have and that brings value. And while you want to make things affordable for patients, you will not be able to offer any services if you can't pay the rent or pay employees. To mitigate this struggle, I have designated personnel to handle invoices and payments from customers.

If possible, I put my work down and start fresh at another time. I'll choose to go for a walk, exercise when I am able to or pull my senior staff aside to talk or brainstorm ideas. Anything that will give me a mental break for a fresh, focused start.

My mentor was Dr. John Bergan, who I trained under during my fellowship. He was a world-famous vascular surgeon known not only for his academic brilliance, but also for his great bed-side manner. I had the opportunity to work with him at his private practice. I was able to observe his approach, how he treated people and made them feel important — from his staff to patients.

Every day, he had a pearl of wisdom I could learn, especially about giving presentations to other physicians.

He also taught me you can't make everyone happy all of the time. As a physician, if one patient is upset or leaves a bad review, it can be taken to heart. You need to focus on the fact that you make most patients happy. The same with staff, there's always someone who's going to complain. You can't make everyone happy all of the time.

I relied a lot on interfacing earlier on, from conferences and face-to-face instructional dinners to webinars educating physicians on what it is we do. It was a way to get to know people on a personal level, while also giving them a taste of your extensive knowledge and experience in the industry.

I can't remember specifically any very bad advice. I can tell you that everything has been trial and error, so some people give you suggestions and you have to be open and know they might not work for your practice.

The classic, Good to Great: Why Some Companies Make the Leap and Others Don't. Studying business failures is as important as understanding business successes.

Blog at ljvascular.com

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Thank you for these great insights!

WRITTEN BY

Candice Georgiadis

Candice Georgiadis is an active mother of three as well as a designer, founder, social media expert, and philanthropist.

Authority Magazine

Authority Magazine

Leadership Lessons from Authorities in Business, Film, Sports and Tech. Authority Mag is devoted primarily to sharing interesting feature interviews of people who are authorities in their industry. We use interviews to draw out stories that are both empowering and actionable.

Dr. Bunke in Authority Magazine2022-01-04T04:04:50-08:00

Ultrasound Findings of Normal vs. Diseased Great Saphenous Vein

The Great Saphenous Vein (GSV) is the most commonly affected superficial vein to become diseased (valves no longer function and become leaky).  While venous reflux can involve the deep system and perforators, the superficial venous system is most commonly involved.  The superficial venous system consists of the great saphenous vein (GSV), accessory saphenous veins (AASV), small saphenous vein (SSV), several tributary veins and junctions where they connect to the deep system which include the sapheno-femoral junction (SFJ) and the sapheno-popliteal (SPJ).  Additionally, common anatomical variations of the SSV can occur, such as the presence of the vein of Giacomini (VOG) and a thigh extension (TE).

GSV imaged

Normal GSV This is the GSV imaged on ultrasound in a longitudinal view. It is healthy without reflux.

GSV with reflux

GSV with reflux

Venous-valvular dysfunction within any of these veins may result in the appearance of varicose veins and can produce a range of symptoms.  Symptoms of venous insufficiency may include leg swelling, aching, heaviness, fatigue that is worse at the end of the day. Common nocturnal symptoms include restless legs and leg cramping. The GSV is most commonly affected, and is most frequently the source of varicose veins. Venous reflux can be determined by ultrasound.

Ultrasound Findings of Normal vs. Diseased Great Saphenous Vein2025-09-04T12:45:35-07:00

Get A Virtual Tour of La Jolla Vein Care

Get a virtual tour of La Jolla Vein Care. See how we maximize comfort, relax and watch Netflix during treatment, no lobby wait times.

See our vein treatment center San Diego. La Jolla Vein Care is located in the Scripps Ximed Building on the Scripps Memorial Campus. Established in 2010, we have helped thousands of San Diegans achieve lasting relief of varicose veins. We have two, state-of-the-art medical suites in Ximed, located in suite 410 and 530. Typically suite 410 is our ultrasound imaging center and 530 is our procedure suite, but during COVID all patients are seen in suite 530. Relax, sit back, and watch a netflix movie during your procedure. See how comfort is maximized at La Jolla Vein Care. La Jolla Vein Care, a San Diego Vein Clinic is one of the region’s only accredited vein treatment and vascular imaging center.

Get A Virtual Tour of La Jolla Vein Care2020-09-17T17:32:25-07:00

What are the adverse effects of vein treatment?

Adverse effects of vein treatment are uncommon.

Patients generally do very well with vein treatments, all of which have a low risk of complications. Most patients feel the benefits within a couple of weeks of treatment, for others it may take longer. With all treatments, the benefits need to be discussed along with the potential side effects or adverse events. The following are potential adverse effects from thermal vein ablations we tell our patients.

  • Aching over the treated veins is normal. This responds well to walking, ice packs, and anti-inflammatory medications such as ibuprofen (Advil, Motrin) or naproxen (Aleve).
  • Bruising over injection sites is also normal after vein treatment and resolves in about two weeks.
  • Hyperpigmentation over a vein can occur from blood pigments that are released as the vein is healing. It is more common in patients with large bulging veins and certain complexions. Hyperpigmentation tends to fade over many weeks if you stay out of direct sunlight.
  • Intravascular hematoma refers to a large varicose vein that becomes firm and tender days to weeks after treatment. This also responds well to ice packs and anti-inflammatory medications. We may also recommend a confirmatory ultrasound and/or offer needle drainage of the trapped blood to alleviate discomfort and minimize skin pigmentation.
  • Deep vein clots are very uncommon, and usually are limited to patients with poor mobility, advanced age, hormone treatment, and/or genetic tendency for clotting. We monitor all patients with ultrasound throughout treatment so we can detect clots at a very early stage before they cause a symptom. We may recommend surveillance ultrasounds, extra walking, and/or a short course of blood thinners.
  • Numb spot over a treated vein is another uncommon event after radiofrequency or laser vein ablation. This occurs when a branch of a skin nerve gets stunned during the heat treatment. It tends to improve over several weeks. The nerves that control the movement of the leg and foot are located far from the superficial veins.
What are the adverse effects of vein treatment?2020-10-23T15:44:39-07:00

La Jolla Vein Care Joins Health Excel IPA

La Jolla Vein Care has joined Health Excel IPA and will be contracted with some new insurances beginning today, July 1st. This is exciting news and means that more people will have access to our vein care services including ultrasound diagnostics, leading edge vein treatments,expert physicians, and concierge-style practice, and customer service.  The contracted plans with Health Excel IPA are below:

Blue Shield HMO

Golden State

Alignment

Imperial Health

Brand New Day

According to Health Excels website: ‘San Diego County-based independent physician associations (IPAs) have joined forces to create a new administrative organization with the goal of providing enhanced healthcare services to patients and payers. The new entity, called Health Excel, counts more than 1200 Healthcare Providers as members — over 300 Primary Care Physicians, and over 700 Specialists — making it one of the largest independent organizations in San Diego County. Virtually every medical specialty will be represented by Health Excel doctors.’ To read more about Health Excel, click here to go to their website.

La Jolla Vein Care Joins Health Excel IPA2020-09-17T17:41:53-07:00

Oh My! My Vein is Bleeding, What Now?

Spontaneous bleeding or Hemorrhage caused by rupture of a varicose vein is a hidden danger of varicose veins.  It usually occurs in the small blue veins around the ankle and shin (blue blebs), and the amount of bleeding and blood loss can be significant.

Untreated varicose veins

Untreated varicose veins are at a higher than usual risk of bleeding or spontaneous rupture.   Over time, varicose veins become larger, and the vein wall becomes weak and stretched out. These veins, which are already weak are also under high pressure (because of venous reflux, or the ‘backflow’ and pooling of blood in these veins). As a result, the high pressure can cause the veins to spontaneously burst and bleed heavily. Because they are under high pressure, they bleed like an arterial bleed and patients describe the bleeding as ‘blood shooting across the room.’  The varicose veins that are susceptible are veins closest to the surface of the skin

I have studied over 100 patients who have had an episode of spontaneous vein hemorrhage. Most patients describe that it occurs during or after a warm shower (warm water causes veins to relax and dilate, allowing more blood to pool within the veins) or during sleep. It is painless and patients report that they notice it because they feel something wet in bed or if awake, they describe it as bleeding that ‘shoots across the room.’  Patients who are on blood thinners can lose large amounts of blood, especially if it occurs while they are sleeping. Some people have required blood transfusions. The small blue spider veins around the ankle are equally at risk of rupture as are the larger bulging veins.

Spontaneous Vein Hemorrhage After Warm Shower
This is a patient who experienced spontaneous hemorrhage of their varicose veins. Notice the appearance of the blue, bulging veins that we describe as, ‘blue blebs.’ These veins are dilated, weak, and are close to the surface of the skin. The pooling blood within these veins causes high pressure, ultimately resulting in a spontaneous rupture or hemorrhage. The bleeding is rapid since varicose veins are under high pressure.  This is a common condition that we see at La Jolla Vein Care. If spontaneous vein hemorrhage occurs when you are home, immediately place pressure with towels and elevate your leg on several pillows. Standing will make it bleed more. If the bleeding does not stop with these measures, immediately seek medical attention.

If someone you know has experienced bleeding from their varicose veins, they should be seen by a doctor. Treatment will prevent the veins from bursting again.

 

Oh My! My Vein is Bleeding, What Now?2021-11-13T13:15:32-08:00
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Vista

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Privacy Policy

Hippa Privacy Practices
HIPAAOneTM Certified Seal 2

Use the search features below to find articles and insights for the diagnosis and treatment of vascular disease

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La Jolla/ UTC

North County San Diego/ Vista — Endovascular Center
Now Open! Call/Text for Appointments

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