A Patient Testimonial

We're ending the year on a positive note, with this testimonial of a patient whose health--and quality of life--has improved since seeking treatment for her vein problems.

“My legs were a mess. I had varicose veins on the front of my left leg that started in the back, upper part of my thigh and wound around toward my shin. My lower legs often felt heavy and sore. Dr. Asbjornsen evaluated my legs and recommended a treatment plan. Now my legs look great, and I don’t have any more achiness, throbbing, or tightness.  

I chose Dr. Asbjornsen because she listened to what I wanted and gave me other options like compression stockings and tips to alleviate my discomfort. I felt like she was looking out for me, not just pushing to have a procedure done. I thought everyone at Vein Healthcare Center was exceptional. Every time I called the office with a question, they knew who I was and made me feel like I was important.”– Christina J., 40, Lisbon Falls, ME

Read more patient testimonials. See if you may have symptoms of venous disease. Consider making an appointment with Dr. Cindy Asbjornsen, a board certified vein specialist.

And, of course, have a healthy, happy and peaceful holiday season!

Veins and Feet

When people think about varicose veins, they usually think about the veins in the leg— but that’s only part of the picture. Lots of patients experience aching, heaviness, or even bulging veins in their feet. Below is just one example of a patient who found great relief after visiting Dr. Cindy Asbjornsen at the Vein Healthcare Center.

 Here’s an explanation of the process in Dr. Asbjornsen’s own words:

This 45 year-old patient came to see me complaining of aching, cramping, pain, heaviness and numbness in her legs on both sides. All of her symptoms worsened with prolonged standing, and she felt self-conscious about wearing clothes that showed her legs. She would often have difficulty falling asleep because her legs bothered her so much.

The onset of her vein issues was about 23 years ago when she was pregnant with her son. After an initial exam, including ultrasound mapping, I diagnosed her with insufficiency of the great saphenous veins bilaterally (on both sides).

I treated her with several bilateral endovenous laser ablations (EVLA) to her great saphenous veins, as well as multiple sessions of sclerotherapy to clean up the surrounding veins.

           

As you can see by the picture, the outcome for this patient was a full resolution for all her symptoms, including the bulging veins. And she enjoyed wearing shorts and skirts this summer.

To learn more about the close connection between veins and feet, read the cover story about it in Vein Health News. Just click here to read the story.

What is Lymphedema?

In a previous post we discussed the problem of edema, as well as some tips for relief. Here we'll introduce the condition of lymphedema, a related--but different--condition.

To review briefly, edema is swelling that happens because of the accumulation of excess tissue fluid that had not yet returned to the circulatory system. The excess fluid eventually leaves the area as it heals and the swelling goes down.

Lymphedema, on the other hand, occurs when the lymphatic system is damaged or blocked and protein-rich fluid builds up in soft body tissues causing swelling. Primary lymphedema is caused by the abnormal development of the lymph system, before birth.

Secondary lymphedema, a more common condition, is caused by damage to the lymph system any time after birth, or by the removal of lymph nodes because of injury, trauma, infection of the lymphatics, or cancer biopsy. In fact, lymphedema is a common problem that may be caused by cancer and cancer treatment, although the patient may not notice any swelling until months or years after treatment.           

Lymphedema usually affects the arm or leg, but it can also affect other parts of the body. Swelling ranges from mild, hardly noticeable changes in the size of the arm or leg to extreme swelling that can make it impossible to use the affected limb.

Unfortunately, there is no cure for this chronic condition, only treatment and management. 

To learn more about lymphedema--and its close cousin phlebolymphedema--read the cover story in Vein Health News. Just click here to read "Mutually Interdependent: the Venous and Lymphatic Systems."

Treating venous symptoms, naturally

We've discussed alternative options for preventing, treating, and stopping the progression of venous disease before, including a cursory look at several herbal remedies, as well as graduated compression therapy.

In the October 2014 issue of Essential Living Maine magazine, Dr. Cindy Asbjornsen delves further into the use of herbal medications to ease venous symptoms. Just click here and turn to pages 24-25. 

Of course, everyone is different, and those who think they may be at risk of vein disease are urged to obtain an evaluation by a vein specialist to understand their options for treating the underlying cause of their symptoms. It's important to ensure that symptoms are not an indication of a more serious medical condition, such as phlebitis or thrombosis.

World Thrombosis Day

October 13, 2014 is the first-ever World Thrombosis Day, a chance for people around the world to learn a little about what's more commonly known as "blood clots."

For a quick review on blood clots--what they are, how to spot them, and how to stop them--check out this article in the Bangor Daily News by Dr. Cindy Asbjornsen, founder of the Vein Healthcare Center.

Dr. Asbjornsen also wrote a guest post for Diane Atwood's popular health blog Catching Health. There, you can learn about this man:

And listen to this conversation with Dr. Asbjornsen and two of her colleagues, on an episode of Maine Calling from earlier this year: "Advances in Treating and Detecting Blood Clots."

Finally, go to the World Thrombosis Day website to get all the facts. Reducing your risk begins by educating yourself.

How to properly elevate your legs

There are a variety of vein treatments for varicose veins and other venous diseases. Board certified vein specialist Dr. Cindy Asbjornsen supports the minimum intervention that will meet each patient's goals for treatment. In some cases, elevation of the legs can alleviate the pain or swelling that is the result of early stage vein disease.

Leg elevation means raising the legs above heart level. The ideal position is to lie on a couch with the back on the cushions and feet up on the armrest, so feet are at a slight angle higher than the heart. Lying down with the legs resting on three or four pillows also works well.

Here are more tips on how to get the most out of this accessible therapy:

• Elevating at intervals throughout the day can encourage blood flow from the legs and decrease the pooling of blood.

• Legs should be elevated as often as possible, for as long as 30 minutes or as briefly as three minutes.

• The morning is a good time to elevate.

• The best time to elevate is after a hot shower, or after standing for a long time. 

• A good way to remember to elevate is to pair it with your meals or snacks.

Elevation is a simple, yet powerful, tool that can help improve blood circulation in the veins and provide some relief to venous symptoms. Dr. Asbjornsen believes that elevation is so important for someone with venous disease that at the Vein Healthcare Center recliners and ottomans are provided in the reception area, so that patients can elevate while they wait.

Tips for swelling legs

Swelling of the feet, ankles or legs is a common problem that affects men and women alike. Edema, as it is known in the medical community, is swelling due to a buildup of extra fluid.

According to Dr. Cindy Asbjornsen of the Vein Healthcare Center in Maine, there are many possible causes for edema, including venous insufficiency. She said that the treatment of leg edema depends upon a proper diagnosis of the cause— and that if the swelling is caused by venous insufficiency, there are treatments available.

Those who experience leg swelling should visit his or her primary care physician or specialist to determine the cause. A variety of tests will likely be checked, possibly including a venous ultrasound test to look for faulty valves in the leg veins.

If leg swelling is due to venous insufficiency, here are some things to consider:
   • Elevate your legs above your heart periodically throughout the day, especially after you have been standing for a long time.
   • Wear graduated compression stockings to help promote the flow of blood back up to the heart. They are available at many pharmacies and medical supply stores.
   • Protect the skin over the swollen area from cuts, scrapes or extreme temperatures. The skin becomes more fragile over time and any injuries can take much longer heal.
   • Contact a board certified phlebologist for an evaluation. Minimally invasive office procedures, such as endovenous laser ablation, can fix the underlying problem of venous insufficiency.

Chronic swelling also puts people at risk for cellulitis, a potentially serious bacterial infection that can affect the skin’s surface and its underlying tissue and cause the skin to become swollen and tender. Those with venous symptoms can also be at increased risk for superficial thrombophlebitis, which are clots within the superficial veins that can be extremely painful.

In our next post, we’ll introduce a condition called lymphedema— and what happens when the venous system becomes involved.

The foot pump

Is “the foot pump” a new dance all the kids are doing? No, it has something to do with veins, of course! Namely, making sure the circulation in your legs is working properly.

As summer draws to a close, many people are returning from vacation, driving in their cars, or hopping a long flight home. In order to prevent deep vein thrombosis (known as DVT), try the foot pump, in the car or on the plane.

It’s a simple toe-tap exercise: tap your feet for a minute or two, going back and forth between heels and toes. This squeezes the deep veins in the legs and forces the blood to circulate through the leg. It also feels good after sitting for a long period of time. Do the foot pump (on each foot) every half-hour or so.

Also, don’t forget to stay hydrated, preferably with water. And try to take a brief walk in the airplane aisles (or at the rest stop) occasionally to keep the blood flowing.  

Meet Dr. Cindy Asbjornsen

As the Vein Healthcare Center approaches another anniversary of serving patients in Maine and New England, we thought we’d revisit this interview with VHC founder Dr. Cindy Asbjornsen:

Q: What were your most important needs in getting started?

A: I think my most important need was building a team of business advisers. Although I had a strong grasp of the medical side of the practice, the business side remained a bit of a mystery. While I have a general understanding of the business, there’s no reason for me to have expertise in everything, not when there are people on my team who do that. Assembling a strong team, including bookkeepers and legal and financial experts, was critical in getting my practice off the ground, and they remain very important in running the practice, so I can focus on caring for patients.

Since this interview was published, Dr. Asbjornsen has been named a Fellow by the American College of Phlebology, contributed to two respected books about phlebology, and moved back to Peaks Island!

To read more of the Maine Women article, click here. To learn more about Dr. Asbjornsen, click here.

What women can do about varicose veins (and free eArticle)

It is a common misconception that only women experience troublesome veins. In the U.S. one in three people— including men— has some form of venous disease. Still, gender does make a difference. Why?

A woman has three potential “high risk” times in her life that men do not. Significant hormonal fluctuations typically happen during menarche (menstruation), pregnancy, and menopause. Surges in the hormone progesterone, in particular, can cause veins to stretch, sometimes enough for vein valves to tear and fail to do their job. Women who have venous insufficiency may notice that their symptoms worsen during menstruation.

Even after menopause, when most hormone fluctuations have stopped, a woman’s risk of vein disease continues to increase with age. There is a higher incidence of varicose veins in older women, because as the body ages, it produces less collagen, which causes the veins (and vein valves) to become weaker.

With the right information, women have the ability to reduce their risk of developing venous disease and/or decrease its severity. Preventative measures include: wearing graduated compression stockings; living an active lifestyle; and maintaining a healthy weight.

There are also a number of effective, minimally invasive treatments available for varicose veins and other symptoms of vein disease. If you’d like to learn more about how women can improve their vein health, read our latest eArticle “Women and Vein Treatments.” Click here to download your free copy.

Welcome back, snowbirds!

For years, New Englanders have spent the winter months in warmer climates and then travel north when the snow stops flying. Summer can be a good time for people with vein problems — including “snowbirds”— to think about treatment.

During the warmer summer months, the heat can dilate veins and cause symptoms to worsen— which can inspire people to seek treatment. All venous procedures require compression stockings post-treatment, and because many seniors already wear compression stockings regularly, this may be less of a barrier.

Most snowbirds check in with their primary care doctor when they get to Maine or before they leave. If this is something you do, this doctor visit is a good time to discuss any achiness or pain in your legs, or ask about vein disease, such as varicose veins or venous ulcers.

In any case, vein evaluations can take place in either the patient’s summer or winter home. Phlebologists who are certified by the American Board of Phlebology (ABPh) can be found on the ABPh web page: www.americanboardofphlebology.org.

Finally, good communication between primary care physicans and specialists is essential to receiving good patient care. Phlebologists, too, should keep every patient’s family doctor abreast of all vein procedures and interventions, even if one doctor is in Florida and the other is in Maine. 

Varicose vein treatment in the summer, Part 2

In our last post we discussed some of the treatments available for venous disease, including varicose veins. Now we frankly discuss one possible drawback to seeking treatment for vein problems in the summer.

Following every vein procedure, patients must wear graduated compression stockings. The length of time that patients are prescribed compression stockings is highly variable, depending upon the patient and the procedure. It could be as short as three days for some light-assisted sclerotherapy, or as long as two weeks for endovenous laser ablations or ambulatory phlebectomies. The lighter, sheerer stockings are better tolerated during the summer months, but tend to be less durable than some of the thicker options often work in the winter.

Although some people choose to delay treatment until after summer is over, others prefer to seek treatment as soon as possible. For those who choose not to undergo a vein procedure during the summer, it is still a good time to think about vein health.

It can take several months or more for the complete resolution of veins that have undergone treatments, so people can plan for next summer by scheduling an evaluation now. Whether or not one decides to pursue intervention for varicose veins or other venous issues, here are tips for vein relief in the summer.

No matter what the season, finding a qualified vein specialist can lead to an improved quality of life and better overall health. 

Varicose vein treatment in the summer, Part 1

Mainers love their state in the summer— and so, it seems, does everyone else! Every year hundreds of people flock to Maine beaches and lakes for sailing, swimming and all manner of fun in the sun. But those with vein problems can be acutely affected in the summer, both physically and psychologically.

From a physiological perspective, most varicose veins worsen during the summer months because the heat dilates veins. Due to warmer temperatures, a “leaky” vein will leak even more, causing increased pain for people with existing vein problems.

For some people, just as bad as physical pain is the discomfort of feeling self-conscious about wearing shorts, skirts or swimsuits because of unsightly leg veins. That kind of unease shouldn’t be ignored, especially when there are treatments available.

The treatments for venous insufficiency are the same in summer as the rest of the year, though the post-procedure considerations may be different. Minimally invasive treatments include: light-assisted sclerotherapy for small veins; ultrasound-guided therapy for larger veins; and endovenous laser ablations (EVLA) for the veins in between, known as junctional veins.

After treatment, patients who have undergone any type of sclerotherapy can go out in the sun almost immediately, although wearing sunblock for six months after any vein procedure is recommended, to decrease the possibility of hyperpigmentation.

Patients can usually swim twenty-four hours after any vein treatment. Generally, there will be some bruising at the site of the procedure, but the bruises are fairly small. There are also many affordable self-tanners and cosmetics that effectively cover up bruises— short-term options that are generally preferred over a bulging varicose vein.

After EVLA

As with any medical procedure, if you’ve undergone Endovenous Laser Ablation Therapy, or EVLA, it is important to know what to expect after the procedure— and to understand any recommendations or restrictions the doctor gives you.

Because EVLA is minimally invasive and almost always performed in an outpatient setting, there is usually minimal down time, if any. In most cases, those who undergo EVLA treatment can return to their regular daily activities immediately. In fact, many patients may return to work the day after your appointment, provided the job is not physically strenuous.

Recommendations

Immediately after the EVLA is performed, your leg will be washed and you will be asked to put on your compression stockings. Compression stockings should be worn for the first two weeks following treatment any time you are on your feet. (They do not need to be worn during sleep.) This is an important requirement and can make a big difference in your recovery.

Following EVLA, the treated leg may drain fluid for the first 24 hours, making the compression stocking feel damp. Patients can expect a moderate amount of bruising, swelling, and discomfort. Post-procedure discomfort is highly variable from patient to patient, and while some patients may experience pain, some may feel no discomfort at all following the procedure. Elevating your legs as much as possible, applying heat, and taking ibuprofen as needed are all effective ways to ease most post-operative pain.

Another important recommendation is to walk for 30 minutes each day for the first two weeks after your procedure. Walking can be done in short increments throughout the day adding up to 30 minutes, or it can be done all at once, whatever works best for your schedule.

Restrictions 

Post-procedure restrictions include no heavy lifting and no strenuous physical activity while standing. However, patients should feel free to exercise as long as their feet remain at, or above, the level of their heart (e.g. swimming or floor exercises, ideally with feet on an exercise ball).

The main reason for these restrictions is that those activities increase pressure by tightening the core or abdominal muscles— which then increases pressure downward into the legs. That pressure can cause irritation of the treated vein, which may lead to swelling. It's possile that the swelling could develop into phleblitis. The closed vein likely won’t open, but phlebitis can be quite uncomfortable.

Hot tubs are also restricted while you are healing. Even though doctors sometimes suggest patients use heating pads post-procedure, in a hot tub all of the veins in the legs above and below the treated area become dilated. This can actually cause pain.

           

Follow up

Finally, and most importantly: schedule a follow-up visit to the phlebologist within a week following the procedure to ensure that everything is healing properly.