About Nisha Bunke

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So far Nisha Bunke has created 112 blog entries.

28, 4, 2021

Vein Care’s Dr. Foghi Interviewed in San Diego Voyager


We would like to share with you our very own Dr. Armin Foghi’s interview in San Diego Voyager Magazine. Dr. Foghi discusses his career path, obstacles and what makes him happy. This read gives you a personal take on one of San Diego’s best vein specialists- dedicated to the diagnosis and treatment of vein disorders.
You can find the link to the interview here

Vein Care’s Dr. Foghi Interviewed in San Diego Voyager2021-04-28T00:28:48-07:00

Medi-Cal Coverage for Varicose Veins and Leg Ulcers in San Diego


Medi-Cal Coverage for Varicose Veins and Leg Ulcers in San Diego
La Jolla Vein Care is pleased to announce that we’ve recently enrolled with Medi-Cal. This means that more people in San Diego and Southern California have access to world-class vein treatments. Most patients with Medi-Cal can now be seen by our award-winning vein experts, have a diagnostic ultrasound and help with:
-painful varicose veins, that interfere with work and lifestyle
-leg ulcers that do not heal
-leg swelling
-leg pain
-superficial thrombophlebitis
-blood clots

Does Medi-Cal pay for varicose vein treatment? Does Medi-Cal pay for leg vein treatments?
There are different types of Medi-Cal health coverage.
If you have Medi-Cal and would like to make an appointment, we recommend to call or text our office. We can take your insurance information and verify if the visit would be covered with your specific plan. Call us at 858-550-0330 or text us at 858-283-4099. You can also find more information about Medi-Cal insurance here.

Medi-Cal Coverage for Varicose Veins and Leg Ulcers in San Diego2021-04-25T00:47:37-07:00

Proudly Serving Veterans and Active Military for Vein Care Needs


Many veterans experience some form of venous disease in their live including leg pain, night cramps, Leg fatigue, Leg swelling, Skin discoloration, leg ulcers, and varicose veins. La Jolla Vein Care is proud to be partnered with Veterans Affairs to offer its vein treatment services to current and past members of the military and their families. A person may be eligible for CHAMPVA when they are no longer eligible for Tricare. Family members may also qualify. Read eligibility criteria here. La Jolla Vein Care offers a full range of diagnostic, minimally invasive and conservative options for venous disorders. Serving veterans is dear to our heart, as Medical Director, Dr. Nisha Bunke treated vein patients at La Jolla’s VA Health Care System for years. Most of our staff have spouses, parents or relatives to have served our country. We are proud to give back and serve San Diego’s Veterans.

Proudly Serving Veterans and Active Military for Vein Care Needs: When your VA facility cannot provide specialized medical services, including vascular care, in a timely manner, the Veterans Choice Program (VCP) allows U.S. veterans the opportunity to seek medical treatment outside of their regular VA clinic. La Jolla Vein Care gladly accepts Veterans Choice insurance as part of this program. We also are partnered with Tricare for active military.
Read more about insurance types accepted.

Many veterans experience some form of venous disease in their lives. Some common symptoms of vascular disease are:
Pain, cramping or discomfort in the legs including night cramps
Leg fatigue, that prevents long periods of standing
Need for leg elevation
Leg swelling
Skin discoloration around the ankles
Varicose Veins

Read more about our services: what is vein disease?
How is it diagnosed?
What are the treatments?

Call to schedule an appointment: 858-550-0330

Proudly Serving Veterans and Active Military for Vein Care Needs2021-11-03T23:25:26-07:00

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

13, 1, 2021

Dr. Bunke in Authority Magazine


Authority Magazine Logo

From an interview with Candice Georgiadis Candice Georgiadis 

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.

Thank you for these great insights!


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

2, 7, 2020

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 Vein2021-11-13T15:00:59-08:00

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


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
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