1445 - How to Get Rid of Varicose & Spider Veins w/Dr. Goldman

When life gets hectic, energy ups and downs are all you need. If you're seeking energy reassurance, Eonnext can help. From regularly updating our tariffs to get you our best value, to SmartTech that helps you take control of your energy future, we're here for whatever's next. Just one of the reasons why we're rated excellent on TrustPilot by our customers. Find out more about how we can help at eonnext.com. Allegibility and T's and C's apply. TrustPilot February 2026. Welcome to the Strictly Anonymous Podcast. Strictly Anonymous Podcast. Conversations with online strangers. We place ads online. The Craigslist is definitely like the gift that keeps on giving. Real people respond. You go to Singapore or Thailand. You can't not do it. The temptation is just too much. Real followers. Your friend know that you're begging her? No. No, he has no idea. And anything goes. The motto of the show, let your freak flag fly. Probably the only good advice I'll ever give you is to re-hide your whips and chain. Here is your host, Kathy. Hey, welcome to the Strictly Anonymous Podcast with Kathy. If you want to follow the Strictly Anonymous Podcast on Instagram or Twitter, follow me at Strict Anonymous. If you want to be on the show, it's called Strictly Anonymous because I change everybody's voices and everyone's name. So, if you have an interesting naughty secret life or even just regular not-so-naughty life that you want to talk about while remaining anonymous or not anonymous, if you're out and proud, that's cool too, you can be on the show. I also look for like health related stories now. I have a sexual health Saturdays. So, if you have any kind of interesting health story, I love stuff like that health and fitness story, you could send me an email at StrictlyAnonymousPodcast at gmail.com or just go to my website StrictlyAnonymousPodcast.com and click on be on the show. If you have a naughty confession that you want to leave on my Confessions Hotline, you could do that 24-7, the number's 347-420-3579. That's 347-420-3579. Some of those confessions make it onto a Confessions episode and I talk about them. The rest of them all go up on my Patreon. My Patreon is a great place. Listen, if you're annoyed with these beginning intros and you don't want to hear f-ing ads and you want to see hot picks of all the females who have called into my show, plus take part in all of the polls and questions and contests we have over on my Patreon, join my Patreon for just $7 a month. That's like super cheap. I also throw in a complimentary link to my private Discord. My Discord is great. I do throw in complimentary access to my private Discord if you join my Patreon. Like I said, it's just $7 a month and you can cancel it anytime or you could buy my book. I have a book. It's called StrictlyAnonymous Confessions, Secret Sex Lives of Total Streets. It's now available not only in paperback and ebook, but you can pre-order the audiobook. It's still not going to be out till August 25th, but you can pre-order it. The book is basically 17 different stories taken from my show. Told in the third person. They're quick short stories. Think like Penthouse Forum letters or Naughty True stories. All in one book. If you get my book on Amazon or wherever you buy books, you could get it. Give me a screenshot of your order and I'll also give you complimentary access to my private Discord. My Discord is f-ing great. That's where you could go in and post your own stuff. My Discord is super fun. People get very naughty on there. We have lots of contests, tons of different channels with all kinds of content, but it is private and I only give links to either my guests if you call into the show. You get a link to my Discord or get my book or join my Patreon. You get it from all that. Last thing I want to tell you about is if you are looking to get into the lifestyle, the site I recommend to everybody is SDC.com. SDC.com is like the world's largest online adult dating site, but it's so much more than a dating site. It's more than a pickup place. You go on there. You're going to learn everything about the lifestyle. They have live events. They have educational stuff that you can learn on there. They also will tell you where all the gang bangs and swinger clubs and orgies and parties that are going on in your area and your neighborhood or if you're traveling, you can find out what's going on there too. That's what's great about SDC. It's like a one-stop shop for the lifestyle. If you use my code 37712, you're going to get a free trial so you could check it out. Go to SDC.com, use code 37712, or just go to the description and click on the link. All the links, everything I told you about including my Patreon is in the description. Okay, listen. Today, I'm talking about veins, varicose veins, spider veins, leg shit, because I wanted to know this information. I happen to have a friend, Dr. Guy. He has been on my show before, but he's a legit doctor. He was a cardiologist. Now he owns vein centers. That's what he does. I was having this conversation with him about varicose veins and spider veins. Then I was like, why don't I do an episode about this? If I have these kinds of questions when it comes to varicose veins and spider veins and what the treatment is like to get rid of them and all that kind of good stuff, I was like, there's probably other people that want this information. It's my podcast and I have a Sexual Health Saturday series. I get to do whatever I want. I'm doing a whole episode on veins. Varicose veins, spider veins. We get into that treatment and he talks all about it. I ask every question you would want to know if you were somebody that maybe thinks you have varicose veins or spider veins and want treatment and don't know anything about it from whether insurance covers it, how much it is out of pocket, if it doesn't. The consultation, what happens, what happens with the treatment, what happens after. He talks about everything. I asked, like I said, every question that you would want to ask if you were sitting down in his office. The good news about Dr. Guys, he is in the New York Metro area. He has two vein centers. He gives a shout out to those. The information to his centers will be in the description because he's very reasonable when it comes to this because he's very reasonable when it comes to vein treatment, his centers. He's like a legit, like I said, he was a cardiologist. We talk a little bit about his past and how he got into doing vein treatment. He started out though as a cardiologist and this is what he's been doing for many, many years. If you want to see him, you could go to the description and click there. Tell him I sent you or you heard my podcast because I'm hooking him up. I don't know. Anyway, I'm going to get right to it and be right back on with his name is, I used to call him Dr. Guy on my episodes, but he's Dr. Adam Goldman. He's going to be right back on with Adam. Hi, Dr. Goldman. Adam Goldman. You're kind of like my friend, but you're a doctor, right? Yeah. Yeah. I love doctors. I like Dr. Friends because don't I call you up for shit? You started out as a cardiologist, right? You were like, had a cardiology someplace. And then now you do really interesting things. I do get Botox from you. You do injections and stuff, but you also the biggest part of your business right now is you own a lot of vein centers, right? Like Varico's, what is it called? What would be the, it's not vein centers. What would you say? I could talk to you very unprofessional because you're my friend. Yeah. No, no. You could call it a vein center. In case you were treating Varico's veins and venous insufficiency. Yeah. I love all that. Yeah. Because I feel like, and I was like, listen, I have talked to you about coming in and doing some Varico's veins on my legs. Like I dated you a long time ago and remember, I don't remember, no, if you remember you and your guy from your office looking at one on my leg and being like, oh, that's a blah, blah, blah one. Like that's really bad. You should get that off. I was like, oh, what the fuck? It's like something that I've needed to do when I've asked you a lot of questions that I'm like, you know what? If I want to know these kinds of things, I feel like there's people out there that would have had it. And now that I have a sexual health Saturdays episode, I'm like, I'm going to do a whole episode on this. Right? Now we're going to promote the Fed. Anyone wants to go and see you because your centers, I mean, you have more than one are in the New York City area. So why don't you give a shout out to that real quick and then we'll talk about that at the end and I'll put the stuff in the, you know, in the description in case anyone does want to use one of your centers. Just want you to give a shout out to the name of them and where they're located. Sure. Sure. So it's metropole and vein and the Stedix Center and we're on the web. It's NY Metro vein. There is a competitor called Metro vein. So but we're NY Metro vein. We have two locations. One is in Queens and Corona. And then the second one is in Manhattan, but upper Manhattan in Inwood and the address there is 4915 Broadway. So if you are in the area or you have questions and you can travel to us and we'd love to see you. There's my plug. Yeah. No, I like it. I'll link to your website in the description. The first question I think I always ask is like, is this procedure right covered by insurance? Cause like, I don't know. Is it like cosmetic that you want your varicose veins to go away or is it like a medical issue that you can get it covered by your insurance? And then I have like real questions, but like that would have been my first question. Yeah. That's a good question. So, you know, it all depends on the clinical scenario and the anatomy. So in general, you know, if someone has larger veins and they have other evidence of problems, you know, so it's both basically affecting the skin. So you get swelling, edema, you get ulcerations in very severe cases. You get a inflammation of the skin that doesn't go away unless you treat the underlying disorder and can lead to ulcers. And then there's just symptoms. So pain, cramping, heaviness. So as far as insurance is concerned, you have basically one of like, say three criteria. So one, you have to have the correct anatomy. So when we evaluate a patient, obviously we're looking at the external to the, you know, the physical exam and we're looking to see that they have swelling or they have significant varicose veins. And then inside there's an ultrasound we do to look at the feeding veins. We can talk a little bit later about the pathology. But we're basically looking to see that the anatomy is causing these veins. So if you have those two problems, then you can go on to the third, which is either symptoms or other complications of venous disease. And that's the only way insurance will pay for it if you can either prove symptoms or and that's obviously a subjective experience. So we have to take with the patient's opinions about what they're feeling and what's going on. And then obviously, objectively, they have other complications or bleeding varicose. That's another indication. Insurance will cover it. It usually needs to be authorized. Very few insurances will just cover it. You know, when you go see the doctor and they put the bill in, but if you've been properly documented your problem, it often will be covered by insurance. Yeah, that's interesting. And like is varicose veins like a genetic thing, something physical that maybe you've done? Like do people that work out hardcore at the gym have more compared to people that don't? Is it sometimes, like I said, genetic or is it something that everyone gets them at a certain point because of age or all of the above maybe? Yeah, I think it's all the above. So it's very ubiquitous. There's about, let's say that 30% of the population in the world that experiences venous disease. That's it? Only 30%? So that's a lot. No, you know, but I do notice when I go to the beach, I look at my sister, she doesn't have legs with like the stuff that I have on it. And then I'm like, I don't see anyone else with those. So you're kind of right. It's not like every single person has them. No, you know, it's also what you may not realize is the people who have venous disease aren't showing their legs. So, yeah, so, so often the people with venous disease, you don't see their legs. So you're not aware that they have a problem. Because they're covering it up. Oh, yeah. If you had significant venous disease, you wouldn't be showing your legs either. I'm looking at it correctly, right? So that's problem number one. That's why you're not aware of it. Yeah. Um, and then, you know, it's, it's a large proportion of the problem is genetic. Yeah. So in general, if one parent has had venous disease, the chance that you will get is about 50%. If both parents have it, um, it's probably about 90%. And then there's environmental. So obviously obesity, um, lack of exercise, uh, you know, a job or a vocation or a lifestyle where you're standing in place or sitting in place for long periods of time. Um, so these are things that, that will, you know, make it more likely to develop. And then there's, it's really a wear and tear problem. So the reality is the people, as people, we are standing upright and gravity is always bringing things down. So, uh, the blood is kind of pooling in the legs when you walk, it's being pumped up. Yeah. And basically the problem with venous insufficiency is the valves that are preventing the water from going back down are incompetent. They're not working and, or it's just smaller venous pressure. We can cause these very small veins. And really there's no specific treatment for those because it's not really one vein or a series of veins that are feeding it, but just a wear and tear and gravity problem. So it's a combination of those factors basically that cause it. And now is it like not a stretch that a cardiologist would be doing, you know, you know, honing into something like this because it's like blood flow and it's related. Is that, would that be correct to say? Yeah. I mean, basically, you know, we are trained as cardiovascular and in fact, uh, my job before I focused on veins, I was interventional cardiologist. So I did most of my work in the hospital doing, uh, cardiac catheterization, angioplasty, I also treated peripheral vascular disease with the same kind of methods. So basically what changed, uh, in the last, I'd say the first discovery was in 1998 and then around 2005, it really became mainstream, uh, because one company did a study to show that doing endovascular treatment of the veins was possible and was, uh, effective with long-term benefits. So basically what went from a invasive procedure where they would strip out the feeding veins went to a very, uh, minor endovastor. So you mean you just do it with ultrasound in this case and you basically do it with catheters and wires. It's very similar to, uh, angioplasty in that sense. So really my training and my work for many years before that really was involving very similar techniques. Yeah. And then also it really, uh, revolutionized you with the advent of better ultrasound. So nowadays, as you may or may not know, you can have a 3D ultrasound of your baby and see almost a, you know, a picture of that child in the uterus. Yeah, totally. Really advanced. So now we now have, you know, 2D and 3D ultrasound that's highly effective and very clear. You can really see what you're doing. You know, in the old days when we started, I started doing veins, we didn't have as good imaging equipment. Right. I would say it's a much more difficult procedure. And now that we have such excellent imaging, it's become very easy to diagnose and treat these problems. So the treatment has evolved from a very invasive and, and, you know, a long recovery to a very simple procedure. And that really advanced the treatments for many more people who are eligible or interested in getting treatments. That's what, you know, what changed in time. Hey, this is Dan Savage, deviant of the highest order, according to the Daily Caller. And I'm here to talk with you about my show, the Savage Lovecast. Each week I answer questions like, is it normal to come 60 or 70 times during one session? Or what should I do when my two doms give me conflicting orders? If you subscribe to the magnum version of the show, you will also hear amazing guests like Esther Perrell and Ezra Klein. But you know what you don't have to listen to if you become one of my subs? Ads. There are no ads on the Magnum Savage Lovecast. And if you're a Magnum sub, you get invites to hang out with me at Savage Love Live. And you can listen to my Sex and Politics and Occasional Sex and Television Podcasts. It is a whole thing. And right now get 30% off a Magnum subscription simply by using the code strictly at savage.love slash subscribe. That's strictly at savage.love slash subscribe. Okay, guys, I want to totally impress your girl the next time you're with her by like shooting the biggest load you've ever shot in your life and have it actually taste really good. Well, then you need to check out VB Health's Load Boost. Okay. I swear by load boost. I'm a check. I can't use it, but let me tell you, I have gotten so many DMs from my listeners raving about the fact that it totally works. If you don't believe me, email me. Okay, listen, load boost is not some sketchy supplement. Okay. It is doctor formulated to not only improve the volume of your load and make it taste better. Now, listen, there's a reason why it's a favorite with elite athletes, porn stars. Okay. As well as my listeners because it f-ing works and it works super fast. Some people see results in just one to two days of daily use with most people seeing results in just one to two weeks of daily use. And that's because VB Health makes products that work. Okay. And they just dropped a new product energy boost that I'm excited to tell you about that also works great. Energy boost is a pre workout powder that you drink with effective ingredients for blood flow, energy and focus. The blue raspberry is delicious. It's my personal fave. Okay. So what are you waiting for? Go get yourself some load boost by VB Health. They believe so much in their products that they offer a hundred day money back guarantee. So you really have nothing to lose. All you got to do is go to loadboost.com and use my code strictly and you're going to get 10% off. That's loadboost.com. Use code strictly for 10% off or just go to the description and click on the link and use my code strictly. Yeah, for sure. That's, that's a kind of amazing. And that happened over like your lifetime, right? While you were in school and out of school and now doing it. And that's why, right? Or while you were doing it. Uh, actually it was really out of school. I mean, I graduated my fellowship in 1998. Right. And really there was very little information about, uh, very close things, even though it's something that's been, it's an ancient, it's actually described back in a papyrus in Egypt. Oh, you're kidding. No, no. And in fact, they lived long enough to have them. Yeah. Yeah. No, no. And then there was documentation that one of the, uh, emperors of Rome, uh, had Barracose vein procedure done one of his legs, but it's before they had anesthesia and he, and it was written that he refused to do the other leg because the treatment was worse than the disease. So, yeah. So, but, but, and then really, uh, the understanding of Barracose veins has been going, it goes way back. Yeah. Uh, but there wasn't much you did about it. And so people didn't really seek treatment. Uh, and there wasn't a lot of, it wasn't as widespread. Yeah. And then as things evolved and became easier, and it just happened way after my chair, I said, really the first landmark trial was in 2005. So before that, it wasn't really widespread. And then after that, it started gaining traction now. So that was a big change. Quick question. This is like my paranoid hypochondria. I mean, I only care about things I could die from. Sometimes I wonder like, Oh, because I have Barracose veins. If I'm going on a 10 hour plane ride, am I like somebody that's going to be more prone to getting a blood clot and die and I should wear compression, you know, the things on my legs compared to someone else? Or does one have nothing to do with it? Does that have nothing to do with it? You know, because really the clot that occurs that's dangerous is in the deep system. Oh, okay. Good to know. Yeah. There are post veins are really relative to this, the superficial. The venous system. Yeah. And so what happens is, yeah, on a plane ride, you're more likely to swell. And obviously it's good to wear compression stockings, do, you know, cafes, other, you know, uh, kind of, you know, movements that would keep the blood flowing. Yeah. Um, you know, and obviously the reason people usually who develop clots are usually people who have a underlying clotting disorder. And so they go to a long plane ride. They're not aware, but they may never been diagnosed. He never had a complication and they develop a clock on that plane ride, but it's not really applicable to people with superficial venous disease. It's a different problem. Okay. What is the, like the worst thing that could happen if like your, uh, varicose veins go untreated? Like what are the negative symptoms that maybe people could be having that they don't know are the stuff, the warning signs and then like the worst case scenario. So symptoms, you know, are symptoms. So if you can live with the symptoms and a fact, right, um, when you try to get authorized, you have to document that the patient tried conservative, uh, measures and was unsuccessful to relieve their symptoms. Uh, but it's not really dangerous. Right. Okay. That's good to know. Yeah. Yeah. The main problem occurs that over time, the venous pressure causes a destruction of the skin. Uh huh. So it starts out with, you know, the swelling, uh, then you have actually atrophy of the skin, uh, where it becomes thin and sort of shiny. You know, if there's hair loss associated with that, you know, and a woman doesn't matter, but a guy may notice that. And then eventually it can lead to this kind of, uh, bad inflammation, dermatitis, where it's, the skin gets very red and irritated. And, uh, then she, that can lead to ulcerations. And so, you know, we don't see it, I'd say every day, but there are definitely patients come in with recurrent ulcers. Yeah. And so this is a very important thing to treat that obviously. Yeah. Um, besides that the symptoms probably can go on for a long time and not really be a problem and obviously the cosmetic issues. Uh, but if you have skin changes, you know, then you are at high risk for ulcers. And once it also develop, it takes months to heal. You know, it's obviously, you know, it's painful. It's something you want to treat, you know, proactively if you can. And then finally they do bleed. Um, so what happens is if you have very large veins, you know, under a lot of pressure because it's engorging the vein and the skin is thin. So sometimes with minor trauma, you bump into something or something minor happens. And suddenly it starts bleeding and the bleeding can look very profuse. You can actually need transfusion. Somebody at the emergency room. Oh wow. Uh, it'll certainly look like there was like, you know, like it was American psycho. Oh my God. Yeah. So that's happening. You know, the same thing. It should be treated. Don't want to, you know, you're not to worry. You're on a plane and when your unconscious is bleeding, oh my God. You know, they got to get a LAN emergently. So they don't want that to happen. Yeah. Now, and don't they all, aren't there like different looking types of varicose veins? Veins. Yeah. They're not just the bulging ones, right? Sometimes they're the bulging ones. Sometimes they're like the flat, like spider looking ones, correct? Or are those not, are there's one, not varicose and the other one is? So one's not varicose. One's really spider veins or tilanes, like tages. Okay. Like I said, that's not really, it can be related to a deeper problem. Okay. Um, you know, so sometimes when you treat the underlying venous insufficiency, the spider veins, uh, get better. Just a usually, yeah, you, but usually it's, it's a separate problem. And like I said, it's wear and tear. So gravity causes pooling and some, it's a very, you know, micro level. So in other words, at the smaller vein level, um, and your bite kind of relieve that pressure, starts to grow these small veins, um, outside. Yeah. And the, and they can be treated with sclerotherapy where we inject and close the veins. Uh, but that's a certainly cause any symptoms that could cause a little bit irritation or itching, it will not cause a more serious problem. So there's not a medical indication. In fact, that's all you have. The insurance won't cover that. Oh, interesting. Okay. But it's the bulging ones that look a little weird and sometimes they're not like so straight, right? So generally we classify a varicose vein greater than four millimeters. Um, so, you know, about the head of a pencil. So if it's smaller than that, it's probably not being, um, exacerbated by any kind of internal problem and it can be treated or it can be left alone. It doesn't matter, you know, it won't go away if you don't treat it, but it'll get worse, you'll get more, but it's not something that you have to do. Yeah. You can live with it. Right. What are the other classifications? I mean, so we have a, a classification that we use based on symptoms, the amount of varicose, if you've had any kind of ulcer or healed ulcer, damage to the skin. So, so when we kind of classify, so for example, it goes two through six is the common, the gold CEAP classification. So someone has just varicose veins, no swelling, no skin damage. So, so, so as you worsen, uh, and we give it a score based on symptoms, the amount of varicose, uh, the size and there's a calculation you do. Uh, so we have a way of kind of grading it. Uh-huh. The other day, you know, you don't, in terms of, will not pay for class one. It has to be class two or worse. Yeah. Class two with symptoms or something else. And question, I'm just using my life as a, as a, as a, as a, as a, as a a, as a, as a, as a, as a, as a, as a, as a, as a, as a, as a, as a, as a, as a, as a, as a life as like, you know, if I'm like sitting in the office with you, but I feel like if I have these questions, other people do. Like, so like, I know I had one when I went to the beach with you, like 10 years ago, 12 years ago, whenever that was, you know, it's like, where is it kind of like where there's one, there will be many kind of like if my body did that once 10 years ago, like I'm going to be more prone to having more. Is that the way it kind of typically works? I mean, you see all kinds of patterns. You see patterns where people have a few and their whole life. They never multiply. Uh-huh. people that we treat and then it keeps coming back every year or two years to have retreats and do veins come out. I myself did my veins, my father had varicose veins and what really got me in was I was having some symptoms but literally in the two week period it started growing like crazy on my leg. I said, oh my god, I need to get my veins treated. You're kidding. Wait, what did it go from? What size to what size? So it went like it was like just isolated to my calf and then it started creeping up my thigh. You're kidding. I'm like, no, I said, wow, this looks terrible. I beg at the street. So you know, you know, so then you can see cases where nothing happens. I've had, and I think genetics plays a big part in obviously some lifestyle issues, but I've had families behind this one family from Mexico and you know, you see it in men obviously, but not so much in younger men. So it was a several family members, cousins and you know, other relatives. These guys are like 21, 23 years old and they came in with massive veins and ulcerations and really, really bad disease, you know, and so they obviously have a very bad gene and you can have cases where none of the parents have it and you spontaneously, you know, the genetics happen. Yeah. So, but there's definitely, you can see all those patterns and you'll declare yourself. In other words, so if you have had stable venous pattern for 20 years, you know, probably that's what's going to happen in the future. And then that's also when people come and get treated. Finally, you know, I kind of get an assessment of how bad the problem is and how recurrent it is. Yeah. So someone has a lot of recurrences and has really bad disease. Yeah. They probably should be wearing prophylactic, uh, compression stockings to prevent the next, uh, problem. Uh, people will have a need to treat once and nothing comes back in 20 years, you know, to wear compression stocking on a daily basis, which is uncomfortable. Yeah, totally. It's probably not the best strategy. And they don't need it. You can do it. Right. Yeah. Do men, is it something that like more men suffer from than women or vice versa or not? There's no like difference. Well, no, women definitely have more incidents. So I would say they're more aware of the veins because cosmetically it's an issue for them. Yeah. Yeah. Of course. So even if men have it, men will often live with it. You know, it's really bad. Yeah. So usually, uh, you know, I'd say we're probably three to four to one women and men that we treat. Uh-huh. So that's the problem. Number one, number two is women. So part of the factors are pregnancy, hormones, you know, so people who are, you know, you know, menopausal, premenopausal or, you know, we got their period. I've seen even young women, it started when they first had the onset of their menstruation. Uh-huh. So, so women has a hormonal milieu that tends to make it worse. So it's, but it does happen to both sexes. Yeah. Definitely there's a predominance for women. And now does work because I was always like, I'm very vascular in that, like, I always say I have like zombie hands, you know, there's like no skin on my hands. So like, I look like I was a 6D my hands when I was like a 25, you know what I mean? And because I've always been a hardcore working out person, like, veins will pop out like I'm on my, in places, right? But the legs is a different thing. Like, does like working out hardcore or anything like that? Because I know that you said not working out is a problem, but like, can actual heavy weights and stuff and squatting and everything actually make something like this worse or no? I mean, I guess if you're really, really hardcore and putting a lot of pressure on your veins, you know, generally when you work out, you're not just doing, you know, you're not just doing legs or, of course, of course. Yeah. So it's, so the short period of time where you did 10 reps, even with a heavy weight, you know, it's probably not going to make a difference. Exercise in general is preventive because you're keeping the blood flow. You know, when you're very sedentary, you know, you have more chance for venous pooling and that the veins can, you know, expand or dilate. And that causes part of the problem with the valves. Yeah. So, you know, you definitely want to be active. Yeah, of course. So it's not hurting most likely. Yeah, but I would say that that's probably less of a problem. Right. Okay. So let's get to the point where like I've come to your office, you know that I have them, my insurance has covered it. Like what's like the process next? Like, you know, I come in like what's the procedure like, and then let's go to like aftercare and how long you can't work out and all that kind of gets up. But start like at the beginning when I maybe I come in for my actual treatment. How, how it all goes down. So the first, so if we've got an authorization. Well, let's go down like the actual first time I come in to just get, you know, looked at. So they do an ultrasound. How long does that take and what does that entail? Ultrasonic takes like 15 minutes. Okay. That's not long. And, and in general, you know, you need it done at a vein center or people who are experienced because what happens is, you know, if you just go to a radiologist or choose some kind of imaging center, they're really going to make sure you don't have a deep vein thrombosis. Whereas with your diagnosing being this insufficiency, it's more of a proactive study. You know, you're actually measuring the flow of blood in relation to, you know, basically squeezing a calf or thigh to make it go up and you're measuring how much is stops when it goes back down. So really you want to see a certain amount of, of we call reflux in order to diagnose the problem and know which of the veins that you have are causing it. And general, there's, there's basically four main veins or two in each leg. So the greater saphenous vein and the lesser saphenous vein are the most common causes of insufficiency because they are larger veins that are basically peripheral veins, but they kind of feed out through the muscle sheath. So they've lost some of the protection that the deep system has. And that's where you get the incompetence in general. So we know where to look and we are proactively trying to figure out if these veins are leaking. That's kind of interesting. So it's not like if you see like four different places, it could just be coming from like one vein or something. So you're not doing like four different places. Like they're catheterizing that one vein, the one, right? Yeah. So it all depends. So some people have all four veins leaking. Some people actually have another branch. So for my, in my case, I did two major branches of the greater saphenous vein. I did the anterior accessory because that was leaking as well. So every, every anatomy is different. But if you have probably one leg, it's probably only one vein. If there's one area that's being affected. It's probably just that one vein. But often people come in, they've got a lot of veins coming out. So both in both legs. And they just, they do the ultrasound on the calves, right? Of both legs. Is that where they go? It's up to the thigh. So it's the groin down to the calf basically. And then on the, you know, it depends on where the veins are sometimes the backside. The lesser saphenous vein runs from the, let's say around the, just above the knee down to the ankle. So that's being a value of that case. And the greater saphenous vein, we really don't treat with the ablation above the knee. We do treat the lower part with what's called an injection called the arithena. So, you know, but we do evaluate more interested from the groin on to about the knees, the most important area to evaluate to the greater saphenous vein. Okay. Peak of Vibe, the sex toy company who makes one of my favorite toys, the flora pro licking rose toy. They've just dropped a whole new collection of super cute and powerful toys. They have a kitty, which is a magic wand. That's super powerful and rumbly. There's Lulu, which is a buddy shape vibrator that's small, but packs serious power. Okay. There's also bubbles, which is a suction toy that uses air pulses and vibrations. So it gives you like that. I can't tell if it's a tongue sensation. And they also have a new toy called the Fuji, which is also a suction toy, but it's sleeker and more sophisticated. Listen, all of their toys are super quiet, silky silicone, waterproof, and you're not going to believe me, but they all look like something you could just like literally leave on a bookshelf or your nightstand and nobody would know that it's a sex toy. Like I said, you're not going to believe me. You just need to go to peak of Vibe to check it out. And if you head over to peak of Vibe.com slash strictly, you're going to get $15 off your order. Peak of Vibe.com slash strictly, P-I-K-A-V-I-B-E.com slash strictly $15 is going to be automatically applied at checkout or just go to the description and click on the link. The world moves fast. You work day, even faster. Pitching products, drafting reports, analyzing data. Microsoft 365 Copilot is your AI assistant for work built into Word, Excel, PowerPoint, and other Microsoft 365 apps you use, helping you quickly write, analyze, create, and summarize. So you can cut through clutter and clear a path to your best work. Learn more at microsoft.com slash m365 copilot. Right. So I come in, I get the ultrasound. Do you call me later with the results saying, okay, this is like your deal, and then you go to your doctor and they try to put it through insurance? So usually the people doing a venous insufficiency ultrasound are also the people doing the treatments. Okay. So in our clinic, you've come in, you've been evaluated, the ultrasound is done, and we know what's going on, and we will usually come in and give you the results right away. Oh, that's cool. Yeah. And then let you know what the odds are depending on your insurance or the odds of getting authorized, what is involved in the treatment. So you have an idea, what to expect. So usually it's done at the point of initial evaluation. Okay. So let's get to the point where I've been, did my ultrasound, so I go into the office, they tell me I got some issues, you know, and let's pretend insurance is going to cover it. Now it happens in regards to treatment. Like, what am I looking at? So it depends on the insurance and the problem, but in general, you want to treat the larger veins first. So if someone has insufficiency in the greater sapiens vein, less sapiens vein, the first step is to do an ablation. So there are different ways to do that. There's energy like radio frequency and laser. And then there's a glue, which some insurance pay for some don't called angiocel, which can be used as well. And there's different advantages and disadvantages to each one. But basically you want to close that vein. So the vein is open and we don't clot off because it's a living organism. There's a lining there that produces proteins and anticoagulants, because the blood is very slow moving. So you imagine you cut yourself and the blood's coming out, you know, pretty much it clots fairly quickly. That's because all those factors are basically not present outside the vein or artery system. So in the vein, in order to make it close, so the old days, they stripped them out. They literally took out the vein. So now we realize you don't have to take it out. You can leave it in. It's much less traumatic. Of course. And just use energy inside to basically eliminate that lining. So the vein stays closed. Interesting. That's all done in local anesthesia. There are no cuts or marks really. It's just a basically a small needle hole where we pass all the equipment we need in through that. So if you're doing real frequency, put a real frequency catheter, if you're doing laser, put a laser catheter, and then we do something called to mesa anesthesia. So basically inside the vein, there's no nerve endings. Oh, okay. Interesting. But if you burn with a laser RF, it will be painful. And so what we do is we basically put numbing through into the muscle layer or into the superficial layer. And that allows you to do the procedure. And then the other way with the glue. Yeah. Yeah. That was a major add that also that happened in the 90s. So they figured that out. Yeah. So then the glue, because there's no energy, you don't need anesthesia, you know, you're able to deliver the glue inside. So it's a little less dramatic. Yeah, it's a catheter. So the catheter goes in. So once you've gotten through with the needle, you put that needle. Yeah. And then you pass the catheter. And then from that catheter now, as you're drawing back, you're delivering the glue basically. And that's how that works. Right. So and the anesthesia into the muscle, that's like a through a needle as well, right? Like a regular kind of thing. Yeah. So, so we numb the skin. So as we're moving along, so go to the bottom to the top. So I'm going to, you know, give you a little bit of anesthesia to numb the skin. And then we put the needle into it. You just feel pressure. Yeah. And then as we're advancing, we're numbing the skin. So you don't feel the next needle. So you just feel pressure. So it's pretty, it's not painless. But I would say it's, you know, uncomfortable, but not, you know, very tolerable. And that's anesthesia in your muscle. What does that feel like when you get up to walk? You may feel little, you know, it feels tight. Oh, okay. Or you feel, yeah, you feel like a pressure and then once, once you get wrapped in some kind of bandage, ACE bandage afterwards, it kind of feels okay. And, you know, you're able to function, you know, you can drive afterwards. No problem. You don't lose any muscle function. You know, just, you know, it may be kind of, you know, if you go to the dentist and they put lidocaine in, for couple hours, two, three hours, you feel a little off or you can't eat. So same thing here. I mean, you know, you don't feel little numb and kind of, you know, full, but it's not really uncomfortable. I mean, I, I, I did my things. I went right back to work and most of my patients do it's a problem. Oh, okay. That's good to know. But now what is the typical time it takes and now, of course, I know it varies. Like, what is the, like, you know, for a very normal, not so hard case, you know, how long does it typically take for the lighter cases and the, you know, the worst cases? Like, what's the range? So after we've done the ablation, usually, oh, you have to go back? Yes, more to the outplay the second part. So generally, how long does the ablation take? But say 15 minutes. Oh, okay. All right. That's great. It was five. It could be as much as 30. Okay. So the average about it doesn't take long at all. Okay, cool. That, but that's in one time. And then you go home. So you go home and you're wearing an ace bandage. So when we do our clinic, we do an ace bandage and the next day, you take it off shower and put the compression stocking on. So you want to wear the compression stocking, we recommend at least three days. Okay. And if the leg feels absolutely fine after three days, you can take it off and leave it off for now. If you're still feeling sore or still swollen, you want to wear that stocking for a few more days, you know, so it's a four days, five days. And the larger the vein, the more superficial, the more likely it's going to be kind of achy and sore afterwards because you can imagine it's more inflamed and it's better to wear the stocking while it happens. It feels better because it holds the vein in place. So you're more comfortable with the stocking on as well as it's helping the healing process and making sure the vein doesn't reopen. Because that can happen. The blood can force its way back through. So you want to keep the pressure on it in the short term so that it stays closed. Okay. So what happens next? So then it depends on the insurance, on the patient. So if someone has a lot of superficial varicose, they have a lot of big, giant bulging veins. Often after we close the feeding vein, we will wait a couple of weeks before doing the second part. The reason being that by waiting, and you wear the compression stock also, if you have that problem, like, you know, that bad, we're trying to make, so if you can imagine if you have this blood constantly flowing into these superficial veins, they're going to get bigger and bigger and bigger and they're not going to go away. So sometimes if it's not too far gone, after we close the feeding vein, because we eliminate the blood supply to those superficial veins, they will decrease in number and size, which makes the second part much easier. You'll have less complications, much easier to treat. So the next step once, so depending if it's not that bad, we have to come back the following week. So if it's very bad, we may say we have to wait a month. And then you want to either pull out those superficial veins or you want to inject them with varicose, which is the polydokenol. So injection is good because basically it gets into every nook and cranny. So all the communications, all the veins that are under the surface that are part of the process will be closed with that injection. The problem is that the injection afterwards, sometimes you can develop blood that has re-infiltrated the vein. And so if that happens, the iron is very caustic inflammatory. So first of all, you'll be uncomfortable. Number two is it can cause discoloration of the skin. So it's very important after the injection of the varicina, that you wear the stockings. We actually use a two-layer compression. We'll put a stocking on and above that we'll put an ACE bandage that actually compresses the veins even more to prevent that blood from getting in. The other way, if it's very large veins, often that will not work well or you have a lot of retained clot. So in those cases, we will often pull out those superficial veins. So basically, we use the same numbing and then each place that we mark, where the veins are kind of popping out on the surface. And then we make a hole with a needle, an 18 gauge needle, basically go on this little hook and we hook the vein, we pull it out. And then we can sometimes get out a long segment, sometimes a short segment. It all depends, depends on how big the vein and how finaceous. But we try to get as much of the vein as possible. So you end up with these little tiny dots where we went in, those will often fade over time, but you'll definitely have a better result than if we used the varicina, the injections. So yeah, depending on the anatomy. Yeah, the vein isn't even there anymore. So you don't have that bulge. I mean, it's totally gone. You end up leaving some communications. Sometimes we even do both procedures. We'll treat one area where they're very large, we'll pull them out. And then we have another chain that's not as prominent that will come back and we'll inject because we inject it. You can say you could really eliminate all the communications. So it helps. I'm pretty sure it helps with the recurrences that you're being more thorough in your treatments. Okay, so after that, is that all done after the two treatments? So basically, if you have one area that is affected and you've closed the vein and you see the superficial varicostates, you're pretty much done. So then people often will come back and get their spider veins injected as well because cosmetically they want that treated often. Oh, and you can get those treated? Yeah, those two problems coexist. That's not covered by insurance, but if someone is not happy with, so yeah, my big veins are gone, but look at all these little veins I have. How much is that out of pocket? So it depends on the clinic. I mean, we're pretty reasonable. We charge $250 a session and it's not how many injections we do. It's a time base, so it's a half an hour. Other places charge $500. Interesting. So it depends. I mean, it's fairly, you know, of all the things, that's the one thing that's uncomfortable. So, you know, you use a 30 gauge needle and so you're going to have, usually you have many spider veins, so they're all over. So there's no way for me to numb the whole leg. It's impossible. So number two is the injection for the anesthesia, the same as the needle for sclerotherapy. So if you inject one point, it'll hurt and then you go back, it doesn't hurt, but you didn't gain anything. That doesn't help you. And then finally, you know, once you, if you put anesthesia everywhere you want to go in, you'll cause swelling, you won't be able to see the veins, very small. So you need to really be precise when you do this. You need to get a little needle. Sometimes I use only the very end of the bevel because it's like a smaller than a hair. Yeah, of course. And so, and you'll literally see when you're doing sclerotherapy, you know, you're doing a good job because you'll see the veins actually disappear. Oh, interesting. Push the two medicine, you know, it's been, the serotonin has pushed the blood out of it. So basically it disappears. Then it comes back because now it's a heart in vain and the body removes it. So, you know, it's more of an, we've ever had a tattoo, it's kind of a similar kind of experience. The worst. Yeah. Yeah. But you can, we do sell a numbing cream that you could put on, but you need to have it on for a good half hour before you do the injections. Right. I come real early. It doesn't completely numb it. And to be honest, you know, most people go through it without that, you know, necessary. So, but it is an option. You can use a lot of king cream. Yeah. I mean, listen, I feel like I'd be, I'm happy. I don't really have spider veins. I have the varicose one. I'd rather have varicose veins. They're the ones that hurt less to get rid of, I think. Spider bounce, spider bounce, spider veins sound worse. Yeah. Yeah. They're a little more uncomfortable. Yeah. So that's, that's usually where you run into people being very squeamish, you know, and a lot of people have foggies of needles, you know, that doesn't help matters. Yeah. So you deal with emotional states. I used to be that way. And I explained this recently on an episode, we're talking about a GLP one, because when I would start doing IVF, I was one of those needle phobic people. When I had to go once a year for my blood test, I would like have a panic attack for that one stupid needle, you know, and then when I did IVF, I was like, you know, I did 10,000 needles probably with all this shit I did, you know. So, I got so used to it. And now I realize it's really not that big of a deal. Plus, I do my hormones now with like, you know, the little diabetic needles, and you don't really feel anything. And the ones that go into the veins, if the person does what they're doing, you shouldn't feel anything, you know, it's like when the person doesn't know, you kind of feel it. But, you know, I kind of like tell people like I went from being petrified of needles to like, they don't, you know, especially when you're not going into a vein, you know, a lot of times I don't feel it at all, you know. And if I do kind of feel it, I move the needle because I'm like, Oh, I have a lot of nerves in that one area, you know, I don't know, you don't feel it at all. Yeah. Yeah. We just started gauging us exactly that. That's the one that I use. Yeah. Yeah. But there's pain, you know, there's parts of the body where it's obviously so when you treat the ankle, right around the knee. Oh, yeah. Oh, no, no, no, I can't even think of that. Yeah. Because you got the bone. But it's like, it's a, but it's an emotional experience too. And like you said, you got accustomed to it, you got over your fear. You're following. Yeah. Yeah. So people have a fear of heights. Yeah. They keep on climbing on a ladder. Yeah, they get over it. Yeah. Yeah. Yeah. I got to keep going in elevators and all like elevators. But I live in New York, so I'm a psychopath. Okay, wait, let's get to the point where, okay, so after it's done, right, like pretend I'm a simple case, I had a couple of Veracruz veins, I'm all done. You know, I always, for me, because I'm like a gym person, and I got to take my kid to school every day. And you know, I have to, I can't be laid out, you know, is it the type of thing where you're fine the next day, but maybe you can't work out? Like what is the aftercare as well as like the instructions of what you can and cannot do? Yeah. So basically, as I said before, the compression stock is going to be used. Of course, yeah. And for me, you know, it's not the force of the activity. So the gym doesn't, you know, really not only can affect what we did. Okay. However, the problem is the skin has been basically interrupted. So it's swollen, it's irritated, we've made a bunch of holes in it. Oh, sounds terrible. And bacteria, yeah, I mean, well, but the good news is that heals very quickly. Bacteria naturally live in our skin. We're all colonized with staff and strep, you know, we basically we're walking peachy dishes and we're in our body, our mouth, or anus, whatever, but the skin is covered. And so part of your body why we don't all get infected is because the skin is intact. Right. So what I generally recommend to people is that for the first three days, no sweaty activities, right? So no exercise, no baths, sorrows, not going on a mursing water, because there's a greater chance that the bacteria will now enter and cause infections. Absolutely. To prevent infection, they want to keep it clean. But within three days, even if we did a lot of work, all the swelling will go away, those little tiny holes will close up, and it's perfectly safe to start any activities, no problem. But in between, you can work, you can cook, you can clean, you can drive, you can open it upstairs. There's no restrictions. I just tell you, please don't get all sweaty. Yeah, that makes sense. I love a good reason not to have to go to the gym and I don't have to feel guilty about it. Like it wasn't my choice. I'm not allowed. Like when I get Botox, I don't go for a couple days, you know what I mean? Not allowed. Now, is it because like you said, I think with the spider veins, you said like they pop back up and then your skin absorbs them. Is it the same thing with the varicose? Like say the three days is over, you take off the compression socks and everything. Like what am I going to see? Am I going to see my legs like totally perfect? Nothing there? Am I going to see like the vein there before my, you know, because you didn't take those veins out, right? They're like catheterized or something like that. They'll just be like gotten like I won't see them anymore. Like is it immediate? So, you know, the legs in general heal very slowly. Oh, interesting. From the heart. Oh yeah, makes sense. Yeah. And there's a lot of, you know, kind of wear and tear on it because we, I said we're obviously upright in our posture and gravity. Yeah. And if you have ever had a bruise or if you had a cut in your leg, you'll see it takes a long time to heal. It's very, yeah, it's very lengthy time period. So it depends on what we're doing. So we're just closing the vein inside and we're not really dealing with anything outside. You're really not going to have a lot going on from that. You may have some bruising, you may have a little bit of redness over the vein, it may be a little sore, but in general things will progress. Although the symptoms may not go away for a couple of weeks. So everything kind of restores back to normal. Right. And then for the larger veins, same thing, you know, there's going to be some bruising or overlying irritation, even if we did varicine or if we did a microfiber back to me, when you're pulling out those veins, I told you that we're pulling out a piece of it. There's a piece inside that's going to basically clot off because it's lost its flow and that's going to become an alum, then it's going to become kind of irritated and could be swollen. So, you know, minimum, you need a couple of weeks to kind of see the final result. And then any of that hyperpigmentation that you made. So what happens with hyperpigmentation is it takes a long time for that to go away. And I, in fact, I myself had a cut on my leg, I scraped a bunch of skin off and I watched it took almost three months to heal. And then I was left with like a black kind of scar afterwards. That looks terrible. But whatever. And I died. And then literally like took almost two years and it faded completely and you can't see it at all. So a lot of this little stuff. And I've seen patients many years after their initial procedure with that terrible looking legs. And then if you wait long enough, a lot of this stuff will fade. Having lighter skin, unless melatonin obviously is a better and you're the fading of all those little marks will be more significant or much better. Yeah. Very dark skin in general people with dark skin, cheloid, they have a lot of problems, you know, with hyperpigmentation. You know, so you have to be realistic when we have a patient with very dark skin. We explain, look, this is what you have now. This is what could end up. And that patient said, black, black veins with dark, dark skin and treated it. And it came out absolutely perfect. You couldn't tell anything was there. Interesting. And the patients that the dark spots don't go away. So yeah, yeah, I understand. And something just takes a long time. But the final thing I'd say is for the spider veins, what we're doing is we're closing them. So now we're depending on the body to take them away. Yeah. And it takes at least four weeks to see results. Now on top of that, even if you inject it perfectly, and I'm pretty, I'd say I'm pretty good at this for years and I'm not experienced and I really will inject that vein till I see it like turn black or purple. So I know it's closed in thrombose. Some of these veins will reopen. The body wants these veins there and spontaneously even doing a perfect job. So it's a probably about 70 to 75% effective, the first round of injections for spider veins. So some of them will persist. And on top of that, the body sometimes wants these veins. That's it's a we're in. So so it'll actually grow a vein in right next to where we just injected that vein. And you know, it's what we call the ovasperization because it actually looks a little different. Sometimes literally, it could look like a bruise. It looked like black or brown. And you know, it's not a bruise because you press on it and it blanches. It goes clear. You let go and it comes right back. So you know, that's not a bruise. Yeah, yeah, totally. And then there's some of these veins that kind of look like almost like thin little red hairs, you know, like a spider vein, spider web, and as opposed to the initial vein that we treated, which was like a straighter, more purplish color, and was very defined. These are much more kind of hazy. So the good news is a lot of these, if you re-inject them, you can get them to go away. There are sometimes spots that no matter how many times you inject it, the body re-growsed it. And I had patients that I came back like five times. I know I got in the veins, I could see it clearing. And the body just re-grew it. So you know, there's some spots that no matter what you do, you can't get rid of them or they keep coming back. Right. That's so interesting. So now, and then you're done. And then like you said, some people, they will grow back. Some people, they won't, right? I mean, that's just something that you won't know until time goes by. It'll happen. Yeah. Your patients will obviously help. Not so far. I mean, I've only done, I did the worst like the right line was the worst side. And still, and actually now my left leg is supposed to be treated. And it's not as bad, but you know, initially, it took a few months for my swelling, my red light to go away completely. Oh, and now my, my, my right calf is much thinner than my left. I can see my left is swollen. You know, it's not like always formed, but I can see there's quite a big difference. And so, you know, mine had been okay. There are other people, I told you all the time, I said, look, when you die, you'll have no more varicose veins. No blood moving. It's over. Yeah. So before that, there's a chance it's going to come back. And you can retreat the veins a hundred times if you need to. So if they are bad enough. And I tell you also, if you have a few that came out, just wait, you know, if it's not bad, why, you know, because you're paying and thinks it's painful, you're getting this pressure stockings, I wait till it's enough that's worth it, start to bother you. So I tell people, I said, don't focus on little stuff, you know, wait till it's significant enough. So it makes it worthwhile. And you do it all at once. Last question. So when I come into your office, that consultation, is that free or do you have to pay for that? Because at that point, you don't know whether you're going to be covered by insurance or not. Does that go to like a deductible if you're covered by the through insurance that you could like that visit? Like how does it work? Yeah, it really depends on your insurance. So most insurances will pay for a consultancy. You see any other doctor. Yeah. You may have a copay, you may have, you know, deductible for buying any of those issues is generally covered to do the evaluation. You don't know what the problem is. So you're allowed to have it, you know, imaged and to see a qualified professional. That's perfectly legitimate. There are people who have no insurance and they come in and generally those people have pretty bad varicose veins, recharge them a fee for cash paying patients, you know, pretty reasonable, but you know, they pay for the ultrasound. But usually most people insurance it's covered. So what are the people that you give a good deal for that don't have insurance that come in for that? How much is that? So generally we charge 150 for the initial consultation consultation. And then depending on what you need done, you know, it can cost anywhere from 2000 to 2500 for out of pocket procedure, you know, that's including veins. So we're giving you a lot of stuff to follow up everything. Right. You know, we should probably budget that amount is that's reasonable. Right. Listen, I love all this information. I find all kinds of medical things interesting. That's why I started my sexual Saturday series, because I do like talking about it. You know what I mean? Like, I don't know. It's interesting to me always, especially because I have some varicose veins and need them. Oh my God, it's always like on the back of my mind. I don't have any symptoms from them except that they look bad. You know what I mean? And so I just, I guess I have to do it at some point. So listen, why don't you give a shout out again to all your places? I will put the link anyone driving that's listening to put the link because you are all over and have plenty of people listen on the East Coast, you know, they could come check you out because I do like the fact that you guys are like half the price for, you know, that you said to some people cause to charge 250 guys cost, most people cost 500. Right. So like you're very reasonable is what you're saying as far as like a, you know, a vein treatment center. Yeah. So I'm aware that often people need multiple injections. So I'm kind of being very kind because you know, it's usually not just one. Yeah. Usually it's at least two, maybe four. So I'm going to give you a little bit of a break, but we're metropolitan vein and aesthetic center on the web. It is nymetrovane.com and also on Instagram. It's at nymetrovane. That's NY, you know, it's letters. We're located in Corona Queens and in Manhattan in the Inwood section. So please check us out on the web or Instagram. And if you want to have your veins evaluated, if you want to just check by your insurance, your eligibility, please call us or come in for consultation. Yeah. Let them know you got, you heard them on a podcast. You don't have to say the name if you, if you want to be on the DL, but I'm not Dr. Guy to know I have a lot of listeners, but wait a second. I wanted to, oh yeah, what? I wanted to ask a quick question because you have been on my show. Anyone that does my show, I'm not going to give it up, but you know, Dr. Guy is Dr. Guy. But like, you know, which one do you work out of? Are you at all different ones? And do you actually do procedures anymore? Are you just like back end? Yeah, no, no, no, I'm still very involved. I do procedures. I have patients who have recurrences. They, they, I did their procedure 10 years ago, 15 years ago. They usually want, they usually want me to do it. I'm in both offices. Okay. That's not every day. Yeah. So, you know, it depends on the day. So if you could always, if you want to see me or you just, you know, I mean, I'm on, I do a lot of advertising on Hispanic television for the Dominican Republic, Tel Amicro. So people see me on that show. Want you. They want to see me in person. They get a big thrill out of that. So they think. You're kind of handsome. Do you get like women coming in and like hitting on you still? Yeah, I have patients who are, you know, a little, you know, they insist and they say things to me, you know. So they bring me a little presents, you know, they bring food, they'll bring cookies or empanadas, you know. Well, one thing I'm going to say about you, like not about, it doesn't have to do with that, but why I would like to request you, I gotta say out of like, I mean, for me, like when it comes to boyfriends, like the only thing someone needs to bring to the table at this point in my life is like, they have to be like interesting to talk to, you know what I mean? And I always say like about you, behind your back, like one thing I really liked about you is like talking to you. Like you're very interesting. Like I could have great conversations with you. Do you know what I mean? Like some people you just can't, most people you can't, I'm just saying, you know what I mean? Like you out of anyone, I always have like, you know, really when I was dating you, when we were hanging out, you know, it's like good conversation. So like I would want you to do it because I'm going to sit there and rap with you. Like you're fun to talk to. So I'm giving you a shout out for that. So you want Adam because you're fun to talk to. You're down. I don't know if they're sexy, but I guess that's sexy because you're cute. No, listen, I have a lot of guys that are not going to go to you for because you're fucking sexy, but you know, they could like, you know, you're going to like rap with them. And maybe I don't know, are you the type of doctor that when you're doing it, you don't even fucking talk? I don't know. Yeah, no, no, I, I, you know, you'd be amazed if people talk to me about like, you know, one woman, one woman asked me, Dr, are you married? I'm like, what? And, and, but she wasn't asking because she said, you should treat, she said, oh, it's hurting me a little bit. I said, you should treat me like you treat your wife. I said, my wife complains when I injected with something too. Oh, yeah. Yeah, that's, yeah, no, fans. Yeah, you were really, you were terrible when you injected me. And then she's like, goes on. So I found out a whole bunch of like, she, her son and her having a little bit of a, you know, not inappropriate, but she's a little too addicted. She hasn't been with a man for 15 years. The father was the last guy. And like, my dear, attractive, I said, you need to find the guy. Her son told her that too. She said, mom, get a boyfriend. Oh my God, wait, you know, maybe you need to give one of the, like, you, she should, you should have given her like my calendar link to book a type to call. Yeah, she could use your help. Oh my God. Well, anyone, okay, so listen, I'm going to put the link in the description. Thanks for doing this. This was fun. I found it very interesting. Like I said, I feel like, you know, if I wanted this information and I had these questions, I always like treat it like the questions I would ask you, even if we weren't taping, you know, I feel like I'm the regular person asking questions, you know, there's got to be so many other people that want this information. So why not? I thought this was kind of fun. Thanks for coming on. No problem. My pleasure. It was a lot of fun. Thanks, Adam. Bye. Bye, Adam. Bye. Okay, I just want to tell you before you go that my book, it's called Strictly Anonymous Confession, Secret Sex Lives of Total Strangers is now available not only in paperback and ebook, but you can pre-order the audiobook. It's still not going to be out till August 25th, but you can pre-order it. The book is basically 17 different stories taken from my show. I kind of picked one story from each category that I talk about on my show. Like there's a hot wife story, there's a cuck queen story, there's a cuck story, there's a gang bang girl story, like I said, 17 stories and they're all told in the third person and they're all true. I took the interview and rewrote it in the third person and I wouldn't really call it like a total erotica book, think like penthouse letters. It's more direct. It's not so over the top like erotica. I don't really like that kind of vibe, right? But these are true stories, 17 of them, they're really short chapters, easy read. You could read one or two and then skip around. You could read the whole book. It's available in eback format, paperback format and finally the audiobook is available coming out August 25th, but you could pre-order it now. And if you buy my book in any format or pre-order it, I will throw in a complimentary link to my discord. My discord does not disapoint. There's no way you'd get into my discord any other way than getting the link from me. I give it to people who buy my book. There's tons of people in there. Everybody shares content with each other and that's what you get to do there. You could post your own pictures and videos. There's tons of channels. We have lots of contests where you could win a lot of money. It's a super fun place to be. It's a total strictly anonymous community and you will love it. I will be giving anyone who buys my book access to my discord. It's private. Like I said, all you got to do is email me a screenshot of your purchase, whether you did the audiobook, the ebook or the paperback. Send it to me at strictlyanonymouspodcastatgmail.com. That's strictlyanonymouspodcastatgmail.com and I will send you the link to discord. So anyway, thanks so much for tuning in. Just one tasty tablet kills fleas and ticks for a whole month. No mess, no stress. Just one tasty chew. Advantage chewable. Flea and tick protection made easy. Find out more at advantagechewable.co.uk. Easy to love, easy to protect. Advantage chewable. Okay, I just want to tell you before you go that my book, it's called Strictly Anonymous Confession, Secret Sex Lives of Total Strangers, is now available not only in paperback and ebook, but you can pre-order the audiobook. It's still not going to be out till August 25th, but you can pre-order it. The book is basically 17 different stories taken from my show. I kind of picked one story from each category that I talk about on my show. Like there's a hot wife story, there's a cook queen story, there's a cook story, there's a gang bang girl story. Like I said, 17 stories and they're all told in the third person and they're all true. I took the interview and rewrote it in the third person and I wouldn't really call it like a total erotica book. Think like penthouse letters. It's more direct. It's not so over the top like erotica. I don't really like that kind of vibe, right? But these are true stories. 17 of them, they're really short chapters, easy read. You could read one or two and then skip around. You could read the whole book. It's available in eback format, paperback format. And finally, the audiobook is available coming out August 25th, but you could pre-order it now. And if you buy my book in any format or pre-order it, I will throw in a complimentary link to my discord. My discord does not disappoint. There's no way you'd get into my discord any other way than getting the link from me. I give it to people who buy my book. There's tons of people in there. Everybody shares content with each other and that's what you get to do there. You could post your own pictures and videos. There's tons of channels. We have lots of contests where you could win a lot of money. It's a super fun place to be. It's a total strictly anonymous community and you will love it. I will be giving anyone who buys my book access to my discord. It's private. Like I said, all you got to do is email me a screenshot of your purchase, whether you did the audiobook, the ebook, or the paperback. Send it to me at strictlyanonymouspodcastatgmail.com. That's strictlyanonymouspodcastatgmail.com and I will send you the link to discord. So anyway, thanks so much for tuning in.