THIS PROGRAM IS MADE BY MPT TO ENRICH ALL OF OUR DIVERSE COMMUNITIES AND IS MADE POSSIBLE BY THE GENEROUS SUPPORT OF OUR MEMBERS.

THANK YOU.

LIVE FROM MARYLAND PUBLIC TELEVISION, THIS IS "DIRECT CONNECTION" WITH JEFF SALKIN.

♪♪] >> JEFF: GOOD EVENING AND WELCOME TO YOUR "DIRECT CONNECTION."

WE BEGIN TONIGHT WITH THE INFORMATION YOU NEED TO GET THE MOST OUT OF MEDICARE.

OPEN ENROLLMENT IS UNDERWAY.

YOU HAVE UNTIL DECEMBER THE 7TH TO MAKE ANY CHANGES.

JOINING US TONIGHT TO ANSWER YOUR QUESTIONS IS AYSE TOKBAY OF THE STATE HEALTH INSURANCE ASSISTANCE PROGRAM KNOWN AS SHIP.

WELCOME BACK TO MPT.

>> THANK YOU FOR HAVING ME, JEFF.

>> Jeff: WHAT IS NEW IN THE COMING YEARS, SOMETHING TO DO WITH MEDICARE ADVANTAGE?

>> I WOULD NOT SAY THERE'S SO MUCH CHANGE AS FAR AS MEDICARE IN ITSELF BUT THERE'S BEEN GROWING POPULARITY IN MEDICARE ADVANTAGE PLANS NATIONALLY.

THERE IS 54% OF THE COUNTRY ARE ON MEDICARE ADVANTAGE PLANS.

IF YOU WERE TO TELL ME 10 YEARS AGO THIS WOULD BE THE CASE I WOULD NOT HAVE BELIEVED YOU.

BUT IT'S MADE THINGS MORE CONFUSING FOR THE CONSUMER, RIGHT?

>> Jeff: MEDICARE WAS CONFUSING WITH PARTS A, B, C, D, WHATEVER.

>> RIGHT.

AND IT'S COMPLEX IT HAS A LOT OF NUANCE.

ANYTIME PEOPLE ASK ME A QUESTION ABOUT MEDICARE 99% OF THE TIME MY RESPONSE IS IT DEPENDS ON YOUR SITUATION, WHAT YOU WANT, YOUR INCOME A LOT OF VARIABLES ARE INVOLVED TOO.

WE HAVE TO DO A LOT OF QUESTION ASKING BEFORE WE CAN HELP PEOPLE NAVIGATE THAT.

>> Jeff: DID YOU TELL ME THE LAST TIME YOU WERE HERE THAT MEDICARE ADVANTAGE PLANS ARE LESS POPULAR IN MARYLAND THAN OTHER STATES?

>> I WOULDN'T SAY ALL OF MARYLAND BUT YOU ARE CORRECT THAT IS A GOOD MEMORY, JEFF.

54, MAYBE 56% OF THE COUNTRY ARE ON THE MEDICARE ADVANTAGE PLANS BUT BECAUSE WE LIVE IN A GOVERNMENT DENSE AREA WE HAVE FEDERAL RETIREES AND BECAUSE OF THE FEDS AND GOVERNMENT EMPLOYEES THEY DON'T HAVE TO WORRY ABOUT A SUPPLEMENT OR MEDICARE ADVANTAGE PLAN.

WHILE WE HAVE A LOT OF OPTIONS, IT IS LESS COMPETITIVE THAN OTHER MARKETS.

ABOUT 20% I LOOKED THIS UP LAST WEEK, 20% OF PEOPLE IN, I KNOW MY COUNTY, HOWARD COUNTY AND I'M NOT SURE IT'S FAR OFF IN THE SURROUNDING AREAS, 20%.

THAT IS A LOT LESS.

IT IS NOT THE SAME MARKET.

>> Jeff: PEOPLE SIGN UP FOR MEDICARE ADVANTAGE BECAUSE YOU GET STUFF?

YOU MIGHT GET VISION, YOU MIGHT GET DENTAL, BETTER PRESCRIPTION COVERAGE BUT WHAT YOU GIVE UP YOU ARE STUCK WITH A NETWORK?

>> IT IS A BIG TRADE OFF.

A LOT OF TIMES PEOPLE DON'T GET A MEDICARE ADVANTAGE PLAN BECAUSE THEY WANT TO.

THERE ARE PEOPLE WHO ARE ALL ABOUT THE SUPPLEMENTAL BENEFITS I WOULDN'T USE THAT AS A LEADING DECISION MAKING FACT FOR TO PICK YOUR INSURANCE.

TO YOUR POINT WHEN THE TIME COMES TO USE YOUR HEALTH INSURANCE, HEALTH INSURANCE IS CHEAPEST WHEN YOU ARE HEALTHY NO MATTER WHAT YOU ARE DOING.

BUT WHEN YOU START USING THE SERVICES EITHER WAY IN MEDICARE PAYING ON THE FRONT END ON THE BACK END YOU HAVE TO PAY SOMETHING.

MEDICARE ADVANTAGE PLANS OFTEN HAVE LOWER PREMIUMS NOT ALWAYS THE CASE BUT THERE ARE LOWER PREMIUM OPTIONS AND IT'S MORE WHEN YOU USE SERVICES.

BUT THE TRADE OFF WITH THAT IS YOU HAVE NO WAY TO SUPPLEMENT THOSE COSTS IF I AM ADMITTED INTO A HOSPITAL WITH AN ADVANTAGE PLAN FOR FIVE DAYS I COULD HAVE A BILL OF OVER $2,000.

AND NO WAY TO SUPPLEMENT THAT.

IF YOU ARE SOMEBODY WHO IS NOT PAYING ATTENTION TO THE DETAILS, OR IF YOU FEEL LIKE I GOT TO DO WHAT I GOT TO DO BECAUSE A LOT OF TIMES PEOPLE CANNOT AFFORD A SUPPLEMENT THERE'S DIFFERENT PREMIUMS TO MEDICARE AND AS SOMEBODY WHO TEACHES THIS IS FOR A LIVING PEOPLE COME IN TO RETIRE THINKING IT'S FREE OR ONE PREMIUM.

YOU HEAR POLITICIANS SAYING MEDICARE FOR ALL AND NOBODY UNDERSTANDS WHAT THAT MEANS.

NOT THAT MEDICARE IS BAD THERE IS A LOT OF FINANCIAL PLANNING THAT SHOULD TAKE MORE PLACE EARLY IN LIFE WHEN IT COMES TO IT.

>> Jeff: PEOPLE EXPECT IT'S GOING TO BE FREE BECAUSE WE HAVE BEEN PAYING INTO IT OUR WHOLE WORKING LIVES YOU SEE IT ON YOUR PAY STUB.

>> THAT PAYS FOR PART A. PART A YOUR HOSPITAL, YOUR INPATIENT HOSPITAL INSURANCE THAT IS WHAT YOU ARE BUYING INTO.

WHEN YOU TURN 65 WORKING OR NOT, A LOT OF PEOPLE TAKE IT BECAUSE IT'S PREMIUM FREE WHAT IS THE HARM?

THEN WHEN YOU ARE EXPLAINING TO PEOPLE, I OVERWHELM A LOT OF PEOPLE EVERYDAY FOR A LIVING.

BUT THEN YOU EXPLAIN THERE IS A PART B PREMIUM AND YOU EXPLAIN THERE IS WHAT YOU HAVE TO FIGURE OUT HOW YOU'RE GOING TO SUPPLEMENT THAT IF YOU CAN AFFORD TO DO SO AND YOU EXPLAIN THE TWO PATHS WHETHER ORIGINAL MEDICARE AND GET A SUPPLEMENTAL POLICY AND THERE'S CONFUSION WITH THAT, TOO AND NUANCE TO THAT, TOO.

ONCE YOU PICK A POLICY THERE -- THAT'S NOT PART OF THE OPEN ENROLLMENT.

THIS IS JUST FOR DRUG COVERAGE WHICH IS STAND ALONE DRUG PLANS OR ADVANTAGE PLAN.

SO PEOPLE CAN SWITCH PAUSE THEY CAN GO BACK TO ORIGINAL MEDICARE BUT YOU DON'T GET A PROTECTIVE WINDOW TO BUY A SUPPLEMENT AND THAT MEANS THERE COULD BE MEDICAL UNDERWRITING LIKE CAR INSURANCE THEY CAN ASK YOU ABOUT YOUR HISTORY TO ASSESS YOUR RISK OR DENY YOU OR CHARGE YOU MORE.

IF YOU ARE SOMEBODY WITH A LOT OF HEALTH ISSUES IT IS NOT SO EASY TO MOVE BACK AND FORTH BETWEEN THE PATHS.

>> Jeff: IF YOU HAVE A QUESTION ABOUT MEDICARE SEND US AN E-MAIL RIGHT NOW, LIVE QUESTIONS AT MPT.ORG.

IS THE ADDRESS.

SILLY STUPID QUESTION YOU ARE TALKING ABOUT SUPPLEMENTS AND TALKING ABOUT MEDICARE ADVANTAGE THOSE ARE TWO DIFFERENT THINGS.

>> TWO DIFFERENT THINGS AND PEOPLE GET CONFUSED WE GET A LOT OF CALLS I WANT AN APPOINTMENT FOR MY SUPPLEMENTAL POLICY AND THERE IS NO SUCH THING.

I SAY THAT BUT AS I SAID THERE IS AN IF, AND OR BUT.

THERE WAS A LAW PASSED IN MARYLAND TWO YEARS AGO CALLED THE MARYLAND BIRTHDAY RULE IT ALLOWS PEOPLE ON YOUR BIRTHDAY EVERY YEAR YOU GET A 30-DAY WINDOW TO SHOP FOR A POLICY WITHOUT UNDERWRITING BUT THERE IS A CATCH.

YOU CAN ONLY BUY A PLAN OF EQUAL OR LESSER VALUE YOU CANNOT MOVE UP.

IF YOU DECIDE I WANT MORE COVERAGE YOU HAVE TO GO THROUGH THE UNDERWRITING PROCESS AND FOR SOME PEOPLE IT MEANS NOTHING.

IF YOU ARE HEALTHY YOU ARE NOT WORRIED ABOUT IT AND DEPENDS ON COMPANY TO COMPANY.

SOME COMPANIES ARE MORE LENIENT AND SOME ARE STRICTER.

THERE IS A LOT OF OVERWHELMINGLY MOVING PIECES TO THIS.

>> Jeff: AND FOR PEOPLE AT A STAGE IN LIFE WHERE THEY MAY NOT FULLY ABLE TO DEAL WITH COMPLEXITY, DO I RECALL CORRECTLY THERE IS A TRAP IN MEDICARE ADVANTAGE PLANS HAVING TO DO WITH A PREEXISTING CONDITION AND YOU GET INTO ONE AND DEVELOP A PROBLEM YOU ARE LOCKED INTO IT?

>> NO, THAT IS OFTEN THE PLUS OF A PLAN.

A LOT OF TIMES IF YOU CANNOT GET A SUPPLEMENTAL POLICY BECAUSE OF YOUR HEALTH RISK AND SOMEBODY WHO DIDN'T DO DIDN'T HAVE THE FORESIGHT DIDN'T KNOW WHATEVER THE REASON IF YOU DIDN'T GET A SUPPLEMENTAL POLICY AND FIND YOURSELF SICK AND NOW YOU WANT ONE IT'S NOT LIKELY YOU WILL NOT GET ONE.

IT'S HARDER.

BUT ADVANTAGE PLANS THAT NOT THE CASE.

THEY TAKE YOU REGARDLESS OF ANY PREEXISTING CONDITION.

>> Jeff: CAN YOU LEAVE AT ANY TIME AND GO BACK TO REGULAR?

>> AS LONG YOU HAVE TO WAIT FOR A WINDOW BUT THERE'S NOTHING TYING YOU AS LONG AS YOU WAIT FOR OPEN ENROLLMENT.

IN THE MEDICARE ADVANTAGE ENROLLMENT THERE IS A FALL PROGRAM AND NEW MEDICARE ADVANTAGE ENROLLMENT PERIOD FROM JANUARY 1 TO THE END OF MARCH.

THAT ANOTHER OPPORTUNITY FOR PEOPLE TO NOT VERY POPULAR, I DON'T GET MORE CALLS ABOUT IT BUT IT'S THERE, TOO.

>> Jeff: ALL RIGHT.

WHAT IS OPEN FOR ENROLLMENT CHANGES NOW IS DRUG COVERAGE?

>> YES.

>> Jeff: WHAT SHOULD PEOPLE CONSIDER?

>> PEOPLE SHOULD AT MINIMUM LOOK AT THEIR EXISTING PLAN BECAUSE THINGS CHANGE.

THERE'S BEEN A LOT OF CALLS ABOUT CLOSING CERTAIN ADVANTAGE PLANS CLOSING.

THEY DO THAT FROM YEAR TO YEAR.

THEY CLOSE PLANS AND OPEN NEW PLANS THAT IS NORMAL.

BUT THERE IS A LOT OF CHANGES IN THE STAND ALONE DRUG WORLD AS WELL.

WE ARE SEEING FEWER PLANS BUT SEEING WIDER CHANGES ONE PLAN WENT FROM BEING $47 A MONTH TO $100 A MONTH FOR NEXT YEAR.

IF YOU ARE NOT LOOKING AT YOUR EXISTING PLAN YOU COULD BE IN FOR A SURPRISE JANUARY 1 WHEN WHETHER YOUR FORMULARIES CHANGE AND IT WON'T COVER A DRUG OR YOUR PHARMACY IS NO LONGER IN NETWORK AND JANUARY 1 THAT IS THE POSITION YOU ARE IN, UNLESS WE CAN FIND SOME SORT OF LOOPHOLE YOU ARE STUCK IN IT UNTIL NEXT OPEN ENROLLMENT.

>> Jeff: VIEWER QUESTION.

WAS THERE A GLITCH WHEN THE STATE ENDED PRESCRIPTION COVERAGE FOR STATE RETIREES AND FORCED THEM TO APPLY FOR MEDICARE PART D. I DON'T KNOW IF GLITCH IS THE RIGHT, THAT WAS A DECISION THAT WAS MADE.

>> I DO.

I OFTEN REFER SAY I HAVE PTSD FROM THAT SITUATION, THE STATE RETIREES WERE GOING TO DOUBLE OUR VOLUME AND IN THE 11TH HOUR THEY SUED THE STATE AND IT HELD IT BACK.

NOW, IT'S BEEN A COUPLE YEARS SINCE THEY HAVE TRANSITIONED TO IT BUT THE STATE IS USING THEIR OWN CONTRACTOR, STATE RETIREES IN GENERAL AREN'T COMING TO US UNLESS THEY ARE DECIDING THEY WANT TO OPT-OUT.

BECAUSE THERE ARE ADDITIONAL BENEFITS THEY ARE RECEIVING.

THEY HAVE A CONTRACTOR THEY HAVE BEEN GOING THROUGH.

UNLESS THERE'S SOMETHING SPECIFIC REFERRED TO I CAN'T THINK OF ANY GLITCHES.

>> Jeff: ARE THERE SCAMS OUT THERE?

I WONDER WHEN BIG MONEY IS INVOLVED, THESE ARE BIG COMPANIES WITH MEDICARE ADVANTAGE PLANS AND OTHER SUPPLEMENTAL PLANS THAT THEY COULD BE SOLD TOO AGGRESSIVELY.

SOMETHING WE SAW WHEN THE ELECTRICITY MARKET WAS DEREGULATED.

THERE WAS SOME SLAMMING WAS THE TERM FROM THE OLD TELEPHONE DAYS.

AND TALKING PEOPLE INTO SOMETHING WITHOUT FULLY DISCLOSING THE COMPLEXITIES OF IT.

>> THERE'S DEFINITELY ALWAYS SOME SORT OF SCAM GOING ON IN THE MEDICARE WORLD.

ONE OF THE MOST HISTORICALLY POPULAR ONES ARE PEOPLE RECEIVING A DURABLE MEDICAL EQUIPMENT IN THE MAIL LIKE BACK BRACES BUT DEPENDING WHAT IS GOING ON THERE'S ALWAYS SOMETHING HAPPENING.

AND I THINK ALSO, TOO, WITH THE MEDICARE ADVANTAGE PLAN IT IS OPENS UP THE DOOR TO MORE CONFUSION.

LAST YEAR THERE WAS A PLAN WITH A ZERO PREMIUM.

AND PEOPLE WEREN'T PAYING ATTENTION TO A HEALTH DEDUCTIBLE OF $800 AND GIVING UP SUPPLEMENTAL POLICIES HEY A ZERO PREMIUM AND IT IS A MUCH OLDER WOMAN AND WHENEVER THEY ARE CALLED THE NICE YOUNG MAN ON THE PHONE WAS HE A NICE YOUNG MAN, THOUGH?

BECAUSE THEY DON'T UNDERSTAND WHAT THEY ARE DOING.

SO I THINK THAT IT IS A LOT OF OPPORTUNITY FOR PEOPLE TO MAKE DECISIONS WITHOUT FULLY UNDERSTANDING WHERE I WISH THEY CALLED US FIRST SO WE COULD HAVE EMPOWERED THEM TO KNOW WHAT TO ASK.

>> Jeff: LET'S TALK ABOUT WHO CAN CALL YOU.

THE SHIP PROGRAM TALK ABOUT HOW THAT WORKS AND HOW SOMEBODY CAN GET ONE-ON-ONE TRUSTWORTHY AT VICE?

>> THERE IS A SHIP IN EVERY COUNTY ACROSS THE COUNTRY.

THERE IS A FEDERALLY OVERSEEN BUT AS I SAID THERE'S LOCAL OFFICES FOR IT BECAUSE THERE IS NO LOCAL MEDICARE CUSTOMER SERVICE OFFICE.

THAT IS WHERE SHIP COMES INTO PLAY WHEN METHODDY GAPS WERE CREATED WE CAME IN TO HELP.

YOU CAN CALL THERE IS A WEBSITE, WHERE YOU CAN FIND A SHIP LOCATER AND IT'S THE I WORK FOR IT AND I CAN'T REMEMBER IT.

>> Jeff: WE WILL HAVE IT ON THE SCREEN.

>> IF YOU GO TO THE WEBSITE THERE IS A LOCATER YOU PUT IN YOUR ZIP CODE AND IT WILL GIVE YOU THE SHIP FOR YOUR COUNTY AND I GIVE THEM A CALL.

EVERY SHIP IS RUN DIFFERENT SOME ARE SMALLER SOME ARE BIGGER.

BUT WE'RE ALWAYS HERE TO HELP PEOPLE AND ESPECIALLY DURING OPEN ENROLLMENT MOST OF OUR VOLUME DURING OPEN ENROLLMENT.

>> Jeff: VIEWER FRANK WANTS TO KNOW ARE THE PREMIUMS FOR MEDICARE ADVANTAGE PLANS TIERED TO ONE'S INCOME LEVEL AS IS THE CASE FOR MEDICARE PART B AND THE PRESCRIPTION PLANS PART D?

I DIDN'T KNOW PART D WAS TIERED.

CAN MEDICARE ADVANTAGE PLANS CHARGE YOU MORE BASED ON YOUR INCOME?

>> NO.

TECHNICALLY MEDICARE ADVANTAGE PLANS ARE NOT PART OF MEDICARE.

IT IS DIFFERENT.

SO THERE IS NO IRMA, THE INCREASE ACCORDING TO YOUR INCOME WHEN IT COMES TO MEDICARE ADVANTAGE PLANS.

>> Jeff: WHAT IS THE MOST EFFICIENT WAY TO APPLY FOR MEDICARE?

>> THROUGH SOCIAL SECURITY.

>> Jeff: AND YOU HAVE TO DO IT, THERE'S A DEADLINE THAT YOU DON'T WANT TO MISS, RIGHT?

65?

>> WHEN YOU -- IT DEPENDS.

IT DEPENDS.

>> Jeff: YOU SAID THAT ONCE OR TWICE.

>> THERE ARE CERTAIN WINDOWS THAT BECOME AVAILABLE ONE IS WHEN YOU TURN 65.

A LOT OF PEOPLE THINK THEY HAVE TO SIGN UP TO AVOID A PENALTY AS LONG AS YOU ARE WORKING AND HAVE INSURANCE FROM A LARGE GROUP EMPLOYER, YOU ARE FINE.

SO A LOT OF PEOPLE TAKE PART A AND WAIT UNTIL THEY RETIRE AND THEN WHEN YOU RETIRE THAT IS A DIFFERENT STORY.

YOU GET AN EIGHT-MONTH WINDOW ONCE YOU LOSE COVERAGE OR STOP WORKING.

BUT MOST PEOPLE SET THAT UP A COUPLE MONTHS AHEAD OF TIME TO AVOID A GAP.

>> Jeff: AYSE TOKBAY WITH THE SHIP PROGRAM AND HAS A LOT OF ANSWERS TO QUESTION COMPLICATED QUESTIONS, INCLUDING IT DEPENDS.

AYSE TOKBAY THANK YOU.

>> THANK YOU FOR HAVING ME.

>> Jeff: AND WE WILL BE RIGHT BACK.

[♪♪] [♪♪] >> Jeff: AND JOINING US TO TALK ABOUT YOUR HEALTH IS Dr.

KHANJAN NAGARSHETH, A VASCULAR SURGEON AT THE UNIVERSITY OF MARYLAND MEDICAL CENTER AND PROFESSOR OF SURGERY AT THE UNIVERSITY OF MARYLAND SCHOOL OF MEDICINE.

DOCTOR YOU THANK YOU FOR JOINING US.

PRESIDENT TRUMP WAS DIAGNOSED WITH SOMETHING CALLED CHRONIC VENUS INSUFFICIENCY.

THE NEWS COVERAGE WOULD SHOW PICTURES OF WHAT APPEAR TO BE SWOLLEN ANKLES.

WHAT IS THAT CONDITION?

>> THANKS FOR THE QUESTION.

CHRONIC AFFECTS ONE-HALF OF OUR CIRCUMSTANCE CUER TO SYSTEM IN OUR BODY.

THE VEINS BRING BLOOD BACK TO THE HEART THE VEINS OF THE LEG ARE NOT FUNCTIONING PROPERLY.

THE BLOOD IS NOT COMING BACK TO THE HEART LIKE IT'S SUPPOSED TO LEADING TO SWELLING AND VARICOSE VEINS.

>> Jeff: CAN IT CAUSE A CLOT?

>> IT DOESN'T TYPICALLY CAUSE A CLOT BUT IT COULD BE RESULTING FROM A CLOT.

IF YOU HAVE HAD A CLOT YOU CAN GET CHRONIC INSUFFICIENCY.

>> Jeff: HOW DO PEOPLE KNOW THEY HAVE THE CONDITION?

>> OFTEN TIME IT IS WILL AFFECT PEOPLE ON THEIR FEET OR PROLONGED SITTING FOR A GOOD PART OF THEIR LIFE.

ABOUT 40-50% OVER THE AGE OF 50 GET IT.

YOU WILL FIND SWELLING OF THE LEGS SOMETIMES FATIGUE AND HEAVINESS AT THE END OF THE DAY.

ITCHING AND DISCOLORATION OF THE SKIN AT THE ANKLES AND FEET.

>> Jeff: IS IT RELATED TO VARICOSE VEINS?

>> ON A SPECTRUM FROM PEOPLE WITH NO SYMPTOMS TO HAVING SORES IN THE ANKLES IT DOES OCCUR IN PEOPLE WITH VARICOSE VEINS.

>> Jeff: WHAT CAN YOU DO WITH SOMEBODY?

WHAT IS THE RANGE OF TREATMENTS?

>> THE RANGE OF TREATMENTS OFTENTIMES STARTS WITH CONSERVATIVE MEASURES LIKE ELEVATING YOUR LEGS AT THE END OF THE DAY IF SWEAR SWOLLEN.

KEEPING THE LEGS ABOVE YOUR HEART DECREASES THE SWELLING.

WEARING COMPRESSION STOCKINGS GETTING THE PROPER PRESCRIPTIONS STOCKINGS HELPS A LOT AND PROCEDURES TO CLOSE OFF VEINS NOT WORKING PROPERLY OR REPAIRING THE VALVES NOT WORKING OR REMOVING VARICOSE VEINS THAT CAN BE UNSIGHTLY.

>> Jeff: I WAS ON A LONG FLIGHT WHERE THE PERSON OPPOSITE ME WAS DOING THOSE LEG EXERCISES A LOT OF THE TIMES SORT OF FLEXING MOVING THE FEET UP AND DOWN.

AND I THINK THAT IS ABOUT PREVENTING YOUNG PERSON, SO I DON'T KNOW WHY THEY WOULD BE CONCERNED ABOUT CLOTS BUT MAYBE IS THAT RELATED AT ALL?

>> VENUS DISEASE OR DISEASE OF THE VEINS CAN AFFECT THE SUPERFICIAL VEINS, CHRONIC VEIN INSUFFICIENCY OR THE DEEP VEINS WHERE WE WORRY WITH BLOOD CLOTS FORMING AND GOING INTO THE HEARTS AND LUNGS.

THE EXERCISES WERE TO INCREASE THE CIRCULATION TO KEEP THE BLOOD PUMPING AS WE WALK WE'RE PUMPING THE BLOOD.

WHEN YOU ARE SITTING DOWN FOR A LONG PERIOD OF TIME YOUR BLOOD IS STAGNANT.

GETTING UP AND WALKING DURING THE FLIGHT OR PUMPING YOUR CALFS AT YOUR SEAT HELPS.

>> Jeff: REALLY?

SO, I MEAN, DID NATURE INTEND THAT?

IF WE DIDN'T HAVE CALF MUSCLES, THE BLOOD WOULD TEND TO SIT THERE FOR MORE PEOPLE?

>> ABSOLUTELY IF YOU DID NOT HAVE CALF MUSCLES YOUR BLOOD WOULD POOL AND YOUR LEGS WOULD GET SWOLLEN AND MORE PRONE TO GETTING BLOOD CLOTS.

>> Jeff: SO WE SHOULD ALL GO FOR A WALK.

>> THAT IS IMPORTANT.

>> Jeff: WHAT IS THE CUTTING EDGE OF THERAPY WHAT IS NEW?

>> THERE ARE A LOT OF THINGS UP-AND-COMING.

THERE IS A NEW TECHNOLOGY THAT HELPS RECONSTRUCT THE VALVES.

A LOT OF THE TIMES THE VALVES IN THE BLOOD VESSELS ARE NOT WORKING PROPERLY WHICH FORCES THE BLOOD TOWARDS THE HEART.

NOW WE'RE COMING UP WITH THERAPIES WHERE WE CAN RECONSTRUCT THE VALVES WITH A STINT.

OTHER THINGS LIKE STINTS FOR NARROWINGS IN THE VESSELS OR TREATING CLOTS THEY ARE ALL COMING OUT AND TRADITIONAL TREATMENTS LIKE REMOVING THE VEINS EXIST.

>> Jeff: WHAT HAPPENS TO YOUR BLOOD IF YOU TAKE THE VEIN OUT?

>> THE BODY FINDS A WAY.

WE ARE ONLY REMOVING THE ONES NOT WORKING.

>> Jeff: AND THE OTHER ONES CAN ABSORB.

>> THEY TAKE UP THE SLACK.

>> Jeff: CAN THEY GROW?

>> THEY DO GROW.

SOMETIMES WHEN THEY GROW THEY CAN FORM VARICOSE VEINS THAT WE'RE TRYING TO AVOID.

>> Jeff: LIFESTYLE CHANGES WHAT WORKS?

>> BEING AN ACTIVE PERSON WALKING A LOT.

A LOT OF US CAN STAND TO LOSE A LITTLE BIT OF WEIGHT THAT HELPS AND WEARING COMPRESSION IF YOU HAVE BEEN ON YOUR FEET A LOT.

>> Jeff: HOW DO YOU TEST?

SOME OF IT YOU CAN SEE I'VE HEARD THERE IS A MEDICAL CONDITION I'VE HEARD REFERRED TO AS THE WAITING ROOM DISEASE, THE DOCTOR COULD LOOK OUT IN THE WAITING ROOM AND SAYS THAT PERSON HAS IT.

IS THIS ONE OF THOSE?

>> SOMETIMES.

WITH THE RIGHT PERSON TRAINED IN THE RIGHT WAY YOU CAN IDENTIFY THIS.

A LOT OF TIMES PEOPLE THINK THEY HAVE RARYT AND GET SWELLING BECAUSE OF RARYT.

SOMETIMES THAT IS THE CASE.

OVER TIMES IT'S THE VEIN DISEASE.

GETTING SEEN BY A SPECIALIST IS IMPORTANT AND BEING PROACTIVE ABOUT YOUR HEALTH.

>> Jeff: IS THERE ANYTHING PRIMARY CARE CAN DO FOR THIS?

>> ABSOLUTELY.

SEEING YOUR PRIMARY CARE DOCTOR IF ANYTHING IS CHANGED IF YOU'RE GETTING MORE SWELLING, TALK YOUR TO YOUR PCP IS A GREAT IDEA AND THEY WILL DIRECT YOU IN THE RIGHT WAY.

>> Jeff: FAMILY HISTORY PLAY A ROLE?

>> 100%.

IF YOU HAVE A FAMILY HISTORY I HAVE PATIENTS TELL ME THAT THEIR MOTHERS HAD VARICOSE VEINS OR FATHERS HAD VARICOSE VEINS IT DOES GET PASSED DOWN.

IF YOU HAVE A FAMILY HISTORY YOU ARE MORE PRONE TO GET IT.

>> Jeff: FOOTWEAR.

IS THERE A TYPE OF SHOE THAT YOU TALKED ABOUT COMPRESSION SOCKS OR STOCKINGS IS THERE A SHOE THAT MIGHT HELP?

>> GOOD ARCH SUPPORT HELPS PEOPLE IN PEOPLE WITH HIGH BLOOD PRESSURE OR DIABETES IT CAN LEAD TO PROBLEMS WITH THE CIRCUMSTANCE CUER TO SYSTEM THROUGHOUT THE BODY.

>> IS THE EXERCISE POUNDING ONE AFEET ON THE GROUND TO PUMP THE BLOOD BACK TO THE HEART GOOD FOR FOLKS WITH SWOLLEN LEGS?

AND YOU ARE NOT TALKING ABOUT BANGING YOUR FEET ON THE FLOOR.

>> NO, NOTHING DRAMATIC OR TRAUMATIC.

>> Jeff: POUNDING THE PAVEMENT.

>> WALKING.

THAT IS A GREAT WAY TO DO IT.

BUT JUST A SIMPLE CALF PUMP OR HEEL LIFT HELPS A LOT.

>> Jeff: YOU MENTIONED LEG ULCERS.

HOW IS THAT RELATED?

>> THAT IS THE END STAGE OF THIS DISEASE.

IT GOES ON A SPECTRUM FROM HAVING NOTHING ALL THE WAY TO HAVING OPEN SORES.

THESE ULCERS ARE HARD TO HEAL WHY WE TRY TO TREAT THIS BEFORE THAT HAPPENS.

>> Jeff: YOU BELIEVE YOU CAN INTERCEPT THAT IF YOU GET TO SOMEBODY EARLY ENOUGH?

>> VERY OFTEN.

YOU CAN GET THE RIGHT CONSERVATIVE MEASURES AND NEVER NEED A PROCEDURE OR SURGERY.

>> Jeff: WHAT CAUSES THE ULCER?

IS THAT RELATED PEOPLE SOMETIMES HAVE A WOUND AND IT HEALS SLOWLY.

>> THAT IS WHAT WE'RE TALKING ABOUT IF YOUR LEGS ARE SWOLLEN OUR SKIN HEALS FROM THE EDGES IT WILL HEAL FROM THE EDGES IN.

IF YOU ARE SWOLLEN THAT SKIN IS OPEN OPEN FROM THAT SWELLING SO IT PREVENTS THE SKIN FROM GROWING TOGETHER.

>> Jeff: IF SOMEBODY HAS THIS AND YOU PROBABLY TALK ABOUT THIS ALL THE TIME AND DOESN'T TREAT IT WITH EXERCISE OR IS MEDICATION, IF SOMEBODY LEAVES THIS UNTREATED IS IT GUARANTEED TO WORSEN TO THE END STAGE CONDITION?

>> DEFINITELY NOT A GUARANTEE T PROGRESSES IN 20-30% OF PEOPLE.

MOST PEOPLE WILL STAY IN THE STAGE THEY ARE IN.

MOST PEOPLE WILL STAY WITH LEG SWELLING OR VARICOSE VEINS.

IF THE VEINS BECOME PAINFUL IF THEY VOCH SORES ON TOP OF THEM, OR BLEED, THAT IS A REASON TO SEEK TREATMENT ADDITIONALLY.

BUT MOST OF THE PEOPLE WILL PROGRESS IF THEY PUT ON MORE WEIGHT, IF THEY ARE BECOMING MORE INACTIVE OR JUST DOING OTHER THINGS THAT THEY SHOULDN'T BE DOING.

>> Jeff: IS IT RELATED TO PERIPHERAL NERVE ISSUES.

>> IT CAUSES YOU NOT SENSE YOU HAVE THE PROBLEMS GOING ON SO IT CAN.

>> Jeff: ALL RIGHT.

Dr.

KHANJAN NAGARSHETH IS A VASCULAR SURGEON AT THE UNIVERSITY OF MARYLAND MEDICAL CENTER AND PROFESSORS OF SURGERY AT THE UNIVERSITY OF MARYLAND SCHOOL OF MEDICINE.

DOCTOR WE APPRECIATE YOUR TIME.

>> THANK YOU VERY MUCH.

>> Jeff: AND THAT IS "DIRECT CONNECTION" FOR THIS WEEK WE'RE BACK FRIDAY WITH "STATE CIRCLE" THE LATEST ON MARYLAND POLITICS JOIN US FOR THAT FRIDAY EVENING AT 7:00 P.M.

YOU CAN SEE PAST EDITIONS OF OUR PROGRAMS ON-LINE AT VIDEO.MPT.TV.

AND ALSO ON THE FREE PBS APP.

AND YOU CAN FIND US ON SOCIAL MEDIA AT MPT NEWS.

FOR ALL OF US AT MPT THANK YOU FOR WATCHING.

AND HAVE A GOOD NIGHT.

[♪♪]