Meet the Vein Healthcare Center team!

Dr. Cindy Asbjornsen, the founder and fearless leader of the Vein Healthcare Center, relies on the entire staff at VHC to ensure that our patients feel safe, comfortable, and cared for. 

You may remember our interview with Physician Assistant Alison Scheib, but we thought you'd be interested to see who else makes up our team!

Our ultrasound departMent is second to none. Emanuel "Manny" Papadakis is our Technical Director and a registered diagnostic cardiac sonographer (RDCS) and registered vascular technologist (RVT). Brad Thomas, RVT, RDMS, is our Vascular Ultrasound Technician. 


Both Manny and Brad work with patients in two ways: they produce vein mappings that help the physician create a treatment plan, and they provide ultrasound guidance for ablations and sclerotherapy treatments.

Both sonographers also care for patients in other ways. Brad does his best to make patients as comfortable as possible, treating each person as though they are a member of his own family. Similarly, Manny tries to connect with patients and get to know them a bit more on a personal level, making for a more comfortable and less intimidating visit.

In our next post, we'll meet a few more people who make up the VHC family!

If you'd like to find out more about treatments for varicose veins, spider veins, or other venous issues, please contact us at the Vein Healthcare Center.

Fixing the problem

In our last two posts, we looked at the problem of leg pain in athletes, and how veins and exercise can possibly affect each other.

If vein problems keep someone from doing activities that aggravate his or her vein symptoms, then choosing alternate activities is one way to cope. Some people may find that swimming, for example, does not produce the same discomfort that running does.

Athletes can live with the problem, but they don’t have to. There are so many options for treatment so that people can continue doing their favorite sports or whatever activity they're passionate about. They might even see an improvement in their performance.

Modern treatments have excellent initial and long-term success rates when performed by an experienced phlebologist (vein specialist). Endovenous approaches are minimally invasive treatments used to address specific large varicose veins in the legs.

Endovenous ablation (EVLA) is considered the gold standard in the treatment of venous symptoms, with success rates between 90% and 98% after five years. It has largely replaced previous, more invasive standards of care, such as vein stripping.

Another option for treatment is sclerotherapy, performed either with ultrasound-guidance, or with a light-assist, which seals the vein wall of small varicose veins allowing them to fade away.

With both EVLA and sclerotherapy, patients can walk the day of the procedure and return to normal activity, including moderate exercise, within a few days.

The key to safe, effective vein treatment is to consult with a board certified vein specialist who can evaluate the entire venous system so that poorly functioning veins can be treated at the source.

Hidden signs of vein disease

Sometimes vein disease is unmistakable. Large, bulging varicose veins are a sure sign, as are bluish spider veins. But sometimes vein issues are harder to detect.

The 65-year-old woman in the picture to the right sought help because of veins in her right leg, but in her initial evaluation it became apparent through skilled ultrasound mapping that both legs were affected. Even she didn’t realize the disease was actually worse in her left leg than her right.

Other symptoms that may indicate vein problems are heaviness or aching in the legs. Swelling, throbbing, cramping, or burning sensations in the leg are other signs, as are restless legs. If you think you might be suffering from one or more symptoms of vein disease, ask yourself these 12 questions to find out more.

As for the patient in the picture, she had EVLA treatment on both legs, followed by ultrasound-guided sclerotherapy. Both of her legs – and her quality of life – have distinctly improved.

Sclerotherapy Q&A with Alison Scheib, PA-C – Part 1

Patients often have common questions about sclerotherapy, a minimally invasive procedure used to treat spider veins and varicose veins. To shed some light on the topic, here is a Q&A with Alison Scheib, PA-C, who specializes in sclerotherapy at the Vein Healthcare Center.

What is sclerotherapy?

Sclerotherapy is a medical procedure involving a series of injections into a dysfunctioning vein. The provider uses tiny needles to inject a medicine called a sclerosing agent into the vein's interior wall. This causes the vein to become sticky and seal shut, causing the troublesome vein to disappear. Blood then finds a healthy path back to the heart. “Ultrasound guided” or “light assisted” defines how the vein is visualized during these injections.

Can you explain the difference?

Ultrasound-guided sclerotherapy uses ultrasound echoes to locate veins that are not readily visible and cannot be seen with a light. This procedure is often used to treat perforator veins, or veins that connect the superficial system (above the muscles in your leg) to the deep system (veins under and between the muscles of the leg). During light-assisted sclerotherapy, a small, hand-held light illuminates the veins directly below the skin, which allows the sclerotherapist to clearly identify the source of the dysfunction.

Who is sclerotherapy best for?

Sclerotherapy works best for those with superficial veins that are not directly connected to deep veins by junctions and have a diameter less than 5 mm. It can also be highly effective in patients who have leg symptoms such as heaviness, aching, pain, itching, swelling, throbbing, or skin discoloration or breakdown.

How long does the treatment take? How many treatments do most patients need?

Number and length of each treatment varies from patient to patient. Each session can take between 15 minutes and one hour, depending on the complexity of vein patterns and reflux. Most patients need multiple treatments, 3-6 sessions, on average.

To read part two of our interview with Ali, click here!

Leg ulcers, an advanced stage of vein disease

Leg ulcers can occur at any stage of life and, without treatment, can cause overwhelming problems. 

When blood pools in the lower leg over a long period of time, the condition is referred to as venous stasis. When blood leaks into the tissue of the skin it can cause swelling and damage to the tissue. Tissue damage can result in wounds, or ulcers, that are chronic and do not heal if the condition is left untreated. Ulcers may be painful or itchy and often require constant care and dressing.

There are three large classes of ulcers: diabetic, arterial, and venous. Of the three types, venous, or vein-related, is the most common. In fact, venous disease is thought to account for approximately 80% of chronic leg ulcers. Venous ulcers can be caused by venous insufficiency or by a wound that has been exacerbated by venous insufficiency. 

Leg ulcers are often an indication that vein disease has reached an advanced stage. However, the key to properly treating and managing them is to first get them diagnosed. Though ulcers may appear similar, each one has a different cause and thus, very different treatments.

Clinical appearance is the first clue to distinguishing between venous and arterial ulcers. Typically, venous ulcers can appear anywhere between the knee and the ankle, while arterial ulcers are usually found between, or on the tips of, toes.

Another sign is discoloration. Venous-related wounds tend to be ruddy, and the surrounding tissue may be red or hyper-pigmented due to hemosiderin (a pigment formed by the breakdown of hemoglobin). In contrast, the wound bed of an arterial ulcer tends to be black, grayish, or yellow.

The most effective way to diagnose a venous ulcer is with a duplex Doppler ultrasound, which reveals whether or not the blood is flowing in the proper direction, or if there is any pooling occurring.

Ulcers do not heal on their own, but even those who are already experiencing this late-stage symptom can have excellent success with treatment. If you have skin breakdown or infection due to ulceration, you should visit your doctor immediately.

Using ultrasound for vein treatment

Ultrasound is an essential tool in vein care, as well as non-invasive and comfortable for the patient. In addition to mapping a patient’s veins and diagnosing vein disorders, ultrasound is used throughout the treatment of veins, acting like the physician’s “eyes inside the leg.”

After a diagnostic ultrasound is performed and the doctor establishes a treatment plan to fix the problem, ultrasound may be used. In endovenous laser ablation for example, seeing where the healthy vein connects with the unhealthy vein is very important; ultrasound is the best modality to visualize this area.

Another example is ultrasound-guided sclerotherapy, which uses the guidance of ultrasound to find leaking veins that are not visible and can’t be seen with a hand-held light used to view veins near the surface (transcutaneous illumination). Ultrasound-guided sclerotherapy is often used to treat perforator veins, or veins that connect the superficial system (above the muscles in the leg) to the deep system (veins under and between the muscles of the leg).     

After the vein treatment and a designated amount of time for healing, the physician will use ultrasound again to assess the effectiveness of the treatment plan.

What is ultrasound mapping?

Vein disease, which often manifests as varicose veins, is defined as the impairment of blood flow towards your heart. Oxygenated blood is constantly being pumped from the heart to the rest of our bodies through arteries. It is the job of our veins to carry deoxygenated blood back up to the heart.

Healthy veins have valves that open and close to assist the return of blood to the heart. Vein disease occurs when these valves become damaged, allowing the backward flow of blood in the legs where it can pool, leading to a feeling of heaviness and fatigue and causing varicose veins or other skin changes.

Ultrasound is a tool used to diagnose if and where a vein valve (or multiple valves) in the legs is damaged. High-frequency sound waves are used to create images that allow the doctor to see which veins have flow going in which direction—like a road map for the venous system.

A healthy vein will only allow flow from the feet towards the heart. Faulty veins are often connected, so finding the “source” of the problem is a complicated, but critical, step in establishing where exactly treatment should start.

Ultrasound is the gold standard for evaluation of chronic venous disease, and it is important to have a qualified sonographer perform the mapping in order to have accurate diagnostic results. To learn more about what to expect at a vein evaluation, visit our previous post on the topic.