Put Spring in your step!

For most of our patients, their main goal is to make their legs feel better -- but after vein treatment, we’ve heard many folks say that their legs look better too.

As summer approaches (a.k.a. shorts and skirts season) it can be emotionally difficult for those with visible veins on their legs to enjoy their time out and about. At the Vein Healthcare Center, our philosophy is that patients who want to treat their problematic veins aren't being vain; they want to improve their health and quality of life. 

While the appearance of spider veins and varicose veins is a common concern, the physical symptoms often take the biggest toll. If you suffer from vein disease, you may already know the familiar aching, throbbing, heaviness, and swelling that can affect your legs by the end of the day. What you might not realize is that the summer heat can actually exacerbate these physical symptoms. As temperatures rise, our veins naturally dilate to help cool the body down. For compromised veins, this extra dilation leads to increased pooling of blood, making that heavy, achy feeling even more pronounced during the warmer months.

This is why addressing your venous health before the peak of summer can be beneficial. Timing your treatment in the spring offers a few advantages:

• Comfort During Recovery: Following most vein procedures, patients are advised to wear prescription compression stockings for a short period to aid in healing and healthy blood flow. That can be a bit more comfortable in the spring -- especially spring in Maine!
• Time for Results to Show: While today's minimally invasive treatments require virtually no downtime, it takes some time for minor bruising to fade. 
• A More Active Summer: By treating the root cause of your discomfort now, you can jump back into hiking, walking the beach, and traveling with renewed energy.

You don’t have to spend another summer hiding behind long pants, making excuses to stay out of the water, or skipping out on the activities you love. Modern vein treatments are safe and effective. All procedures are performed right in our office and allow you to return to your normal routine almost immediately.

Take the first step toward healthier, happier legs. Contact us at the Vein Healthcare Center today to schedule an evaluation, and let us help you step into summer with confidence!

Lipedema: Shedding Light on a Misunderstood Disease

 

In our latest issue of Vein Health News, we explore a condition called lipedema. Though it’s not venous in nature, there is often a co-occurrence with venous issues and sometimes lymphedema.

Lipedema is a loose connective tissue disorder that results in an abnormal buildup of adipose (fat) cells in the limbs. These cells settle into certain areas of the body, most often in the hips and legs—disproportionately more significantly than in the upper body (although lipedema sometimes affects the arms and lower trunk). 

 

Someone with lipedema may experience pain, tenderness, swelling, or easy bruising of the affected areas. The intensity and frequency of pain can vary. The condition may be accompanied by an unusual lumpy or fibrous texture within the fat tissue that can feel like peas or walnuts beneath the surface of the skin.

 

Lipedema is estimated to affect 10 to 17 million people in the United States, primarily women. The true prevalence is likely higher due to widespread underdiagnosis. The good news is that in 2021, a group of experts in the U.S. released a “consensus guideline” to standardize care for this diagnosis. Evolving scientific research is helping to increase knowledge of and about the condition.

 

There is currently no cure for lipedema. Current treatment means management, which includes dietary changes (to reduce inflammation), exercise, compression, weight loss (for management of comorbid metabolic disease), Manual Lymphatic Drainage (MLD), pain management, physical therapy, and in some cases, surgery.

 

Treatment for comorbidities can sometimes help. For example,
treating underlying venous insufficiency is appropriate if it is contributing to lower leg symptoms that impair functioning.

 

At the Vein Healthcare Center, we see a number of patients who have lipedema, and we do everything we can to provide knowledge to understand the condition. Having lipedema can be physically painful, not to mention difficult to cope with emotionally. That’s why psychological and social support are just as important as physical treatment.

Click here to read the Lipedema issue of Vein Health News!

Are graduated compression stockings the same as TED hose?

In a word: no. TED hose are not the same as graduated compression stockings. There are many people who do not realize there is a difference.

T.E.D. is an acronym for Thrombo Embolic Deterrent, so T.E.D. hose are "anti-embolic" stockings. They are often worn after surgery to help prevent Deep Vein Thrombosis -- also known as DVT. They work well for this purpose, but they are only 8-15mmHg of compression. As soon as someone is out of bed post surgery and is able to stand, there is more pressure on the veins and the TED hose become much less effective. 

TED hose do not help with the symptoms of venous disease, nor do they halt the progression of venous disease.   

A graduated compression stocking prescribed for chronic superficial venous insufficiency is generally 20-30 mmHg, which means there is approximately 30mmHg of pressure at the ankle, 25 mmHg in the mid-calf, 20 around the knee, 15mmHg in the lower thigh, 10 mmHg in the mid thigh, and 5 mmHg in the upper thigh. This graduation encourages good venous return. Another difference is that, in general, compression stockings are much more tolerable to wear on a daily basis. 

Though compression stockings are much easier to put on than TED hose, they can still be difficult to put on. So if you are prescribed to wear either compression stockings or TED hose, ask your provider for tips -- or even coaching -- for how to put them on and take them off. (That's called "donning" and "doffing" in the compression business.) There are lots of online resources to guide you.

If you have any questions about compression therapy or T.E.D. hose, contact us at the Vein Healthcare Center. We're here to help!

We love compression!

At the Vein Healthcare Center, we talk about graduated compression. A lot. 


In fact, Dr. Asbjornsen wears 20-30mmHg socks or stockings almost every day. Doctors are always on their feet, and graduated compression fights—and beats—gravity, keeping the blood circulating from the legs back up to the heart.


In our last issue of Vein Health News, the cover story was all about caring for your legs and feet when you’re constantly using them. Our colleague Tom Musone from the compression company Juzo gave us six tips about how to use compression to make your legs feel better:

1. Wearing compression every day can prevent edema (leg swelling), alleviate venous symptoms, and make your legs feel better overall.

2. Make sure you wear graduated compression stockings. That means the pressure is highest at the foot and ankle and gradually decreases as the garment rises up the leg. This pressure gradient makes it easier for the body to pump blood up towards the heart and more difficult for gravity to pull blood downward.

3. Compression also increases the pressure in the subcutaneous tissue, which helps to reduce and prevent swelling by moving excess fluid back into the capillaries.

4. Gradient compression is expressed in millimeters of mercury, or mmHg. Unless otherwise directed by a medical professional, look for 15-20 mmHg or 20-30 mmHg.

5. Current evidence supports wearing either knee-high or thigh-high style compression stockings when standing for prolonged periods. A good fit is the most important factor.

6. Get fitted by a certified fitter to find the brand, product, and style that’s right for you. These days there are dozens to choose from.


Dr. Asbjornsen swears that even if she weren’t a vein specialist prescribing compression stockings to patients, she would still tout the benefits of wearing it, because her legs feel so good at the end of the day!


If you have any questions about graduated compression for venous relief, prevention, or both, contact us at the Vein Healthcare Center. We’re happy to educate about the benefits of compression.

What is phlebitis?

Phlebitis happens when a vein in the superficial vein system becomes inflamed and swollen. (It is also referred to as superficial phlebitis.) Spontaneous phlebitis happens when there is a sudden onset of vein inflammation.

Three out of 10 patients may develop spontaneous phlebitis after endovenous laser ablation (EVLA) therapy, but it is very preventable, especially if patients follow the post-procedure guidelines closely.

Post-operative requirements include wearing prescribed graduated compression stockings and walking at least 30 minutes a day. If a patient does experience pain or swelling, he or she should apply heat to the area (NEVER ice), elevate the legs, and take a non-steroidal anti-inflammatory drug, such as ibuprofen or naproxen.

If phlebitis does occur and is not treated in its early stages, thrombophlebitis, or the formation of a blood clot associated with phlebitis, can develop. It is important to note that both phlebitis and thrombophlebitis are common conditions that both occur in the superficial vein system, not the deep vein system. (A blood clot in the deep vein system is called a deep vein thrombosis, or DVT.)

In our next post we will talk about how to prevent phlebitis. Contact us at the Vein Healthcare Center if you have any questions about phlebitis or would like to schedule an appointment.

Dr. Cindy Asbjornsen shares her wisdom on Successful Balanced Living

Get to know Dr. Cindy Asbjornsen a little bit better -- and hear some trustworthy, easy-to-understand advice. 

Dr. Asbjornsen was recently on the radio show Successful Balanced Living with Lynda Adams. She talks with Lynda about a variety of things, including:

• Why she decided to study phlebology (the study of vein disorders and treatment)
• Why sore legs and varicose veins are NOT a normal sign of aging.
• Who is at the greatest risk for getting vein disease
• Preventing blood clots on airplanes
• How she creates a successful, balanced life for herself

To learn about this and more, click here to listen.

And if you think you might have vein disease, schedule an appointment for a full evaluation of your vein health.

Happy National Nurses Week!

May 6-12 is National Nurses Week, sponsored by the American Nurses Foundation. This

year's theme is "Year of the Healthy Nurse."

To celebrate and support nurses everywhere, we offer some healthy leg tips for nurses who are on their feet all day.

Did you know that varicose veins can be an occupational hazard for nurses? One tried and true way to reduce the effects of vein disease -- and in some cases, prevent symptoms -- is graduated compression. 

Please note that so-called "support hose" does not have to be ugly! Not today, with the many styles and colors that are available. 

Another remedy for aching legs is to elevate them periodically and at the end of the day. This post explains how to properly elevate legs. Lastly, nurses should remember to care for their feet. Here are some tips from the blog RN Central.

Happy National Nurses Week to all of the nurses out there. Thank you for all you do!

Visit the Vein Healthcare Center in South Portland, Maine, or learn more about Dr. Cindy Asbjornsen.

Varicose veins during pregnancy—how to prevent them, how to treat them

In honor of Mothers Day, we’re discussing the topic of varicose veins during pregnancy, but with a focus on the positive: prevention and treatment. (We explore the effect of pregnancy on veins in greater depth in a previous blog post. Click here to read more.)

During pregnancy, the two most important preventative things to consider with vein care are periodically elevating the legs and compression. 

Maternity compression stockings come in a variety of styles and strengths, from knee-highs and thigh-highs, to full-length stockings. Many panty hose styles have more room in the belly and are specially designed to expand during pregnancy without restricting the abdomen. Maternity graduated compression stockings are specially designed to fit more snugly at the ankles and calves and less so toward the top. The gradual change in compression helps the weak valves in the veins to circulate the blood more effectively. Many women who wear maternity graduated compression report that it makes their legs feel great!

Though pregnancy compression stockings (and body garments) are available with a doctor’s prescription, many maternity stores also offer them. Accurate sizing is critical, so it is best to check with a doctor prior to purchasing any type of compression while pregnant.

In most cases, women can be safely treated for varicose veins 6-8 weeks after delivery. Hormonal levels are usually back to normal within that time (if the patient is not breastfeeding), and water retention and any clotting risks have usually returned to baseline.

           

Depending on the type of treatment, breastfeeding may be an issue for some patients. Treatments that require a local anesthetic, such as endovenous laser ablation (ELVA) or microphlebectomy, have been proven safe. Sclerotherapy is not recommended if the patient is breastfeeding, as certain medications used during this procedure have not been proven safe and may be excreted in breast milk. However, if the patient is willing to forgo breastfeeding for 24 hours, sclerotherapy is possible.

Another important preventive measure is knowledge. If someone in your family has had a history of vein issues, chances are you might too. Some vein specialists recommend that women seek evaluation, and possibly treatment, for problematic veins before their first pregnancy, especially if there is a strong family history of vein issues. Evaluation and education can be very important for preventing or controlling issues before you need treatment.

Running on all cylinders

This Saturday the Vein Healthcare Center is co-sponsoring the South Portland MAINEiacs first-ever 5K run, just around the corner from the VHC offices!

We’ve had running, exercise, and athletes on our mind lately, as our latest issue of Vein Health News is hot off the press. In our cover story package, we look at how exercise affects veins (and vice versa); whether athletic compression is worth considering; and how even athletes could be affected by DVT.

Click here to read more about athletes and veins. And get out and enjoy a walk or run in the increasingly crisp autumn air!

Vein Health News, a resource for patients and doctors

Dr. Cindy Asbjornsen of the Vein Healthcare Center in Portland, Maine is passionate about educating people about vein health. That’s why three years ago she started Vein Health News for primary care physicians in Maine and New England. Although the magazine was originally intended for physicians, we've found that patients really like it too.

Vein Health News covers such topics as: minimally invasive treatments for varicose veins, modern compression, leg ulcers, deep vein thrombosis, and more. Plus, the regular column “One Patient’s Perspective” explores vein care from a patient’s point of view. If you’re interested in a free subscription to Vein Health News, just click here.

Are you a Physician? 

Primary care doctors are on the front lines of reducing the growing number of people suffering with symptoms of venous disease. Vein Health News serves as a resource for well-researched meaningful information that you can pass on to your patients. If you would like the publication delivered to your office, click here to subscribe.

Education is an important first step toward better vein health and an improved quality of life.

Fashionable...compression?

Graduated compression stockings are ugly, beige, and only for “old people,” right?

Wrong. In the past several years, compression companies, such as Juzo, SIGVARIS, Carolon and Jobst, have been developing stockings and socks in styles, patterns, finishes, and colors that look more like fashion accessories than medical devices (while still being clinically effective when purchased and put on correctly.)

Newer brands like REJUVA and ITEM m6 (a spin-off of compression manufactuer medi) are also taking compression trends to the streets. Both companies were mentioned in an article about compression in the NYTimes Style section!

Read more about how compression has evolved in Healthy Style: Compression Steps Up, the latest cover story in Vein Health News. Just click here to read the story.

Preventing leg ulcers

It's not easy to live with leg ulcers. Open wounds can be painful, difficult to heal, and the likelihood of recurrence is significant. But prevention is possible.

One warning sign that you may be developing a venous ulcer is noticeable skin changes in the lower legs, such as dryness or thickening. Another sign of ulceration may be discoloration of the legs, typically dark red, purplish, or a brown, woody appearance. Other possible indications are aches or pains in the legs, especially when standing or sitting for prolonged periods.

Varicose veins are another possible warning sign. Varicose veins, as with any form of venous disease, are often hereditary. If you have varicose veins—or a family history of varicose veins— consider getting evaluated and treated for them before they lead to ulceration.

Risk factors for venous ulcers include older age, a history of deep vein thrombosis (DVT), venous insufficiency, and previous ulcers or leg injury. Though you can’t change your genetics, you can modify other things. If you have a job where you’re on your feet all day, wear graduated compression stockings.

There is often a misconception among patients and physicians alike that there is nothing you can do for venous ulcers. The fact is wound care specialists use a variety of modalities to heal patients’ wounds, including aggressive compression therapy, skin grafting and “low-tech” therapies like elevation.

It is important to remember that although wound care specialists can treat and even heal wounds, unless the underlying cause is addressed, it will only reoccur. If the wound is identified as a venous ulcer, then treating the incompetent vein valves that contribute to venous ulcers is key for lasting results.

Experts agree that the earlier the intervention and treatment, the better chance a wound has to heal and stay closed. And, of course, patients with venous ulcers are best managed by a multi-disciplinary team of primary care physicians, wound care centers, and professionals who specialize in venous care.

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.

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.

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. 

What can you expect at an EVLA appointment?

So you’ve met with a board certified vein specialist and learned about EVLA, made an appointment, and prepared for the procedure. What’s next? 

When you arrive for your EVLA appointment, you will change into exam shorts and photos of your leg will be taken. (Photos are used for your personal medical chart, in order to track improvement and recovery.) Your leg will be re-checked using ultrasound, and your doctor will write on your leg with a magic marker. Your vital signs will be checked, and you'll be asked to relax on a procedure table. There are often pillows and blankets available for your comfort, and if you bring a listening device, you can begin listening to music.

Your leg will be cleansed with an iodine solution to the groin— you should make the physician aware of any iodine or seafood allergies you may have. An IV will be placed in the problematic vein, usually at or around the level of your knee, or in the middle section of the back of your calf. You will feel a small pinch of local anesthetic during this part of the procedure.

Under ultrasound guidance, a laser fiber will then be threaded up to the highest point of venous insufficiency. There should be little or no discomfort. The area to be treated will then be fully anesthetized. Most physicians ask their patients to wear special safety glasses to protect eyes from the laser. The laser will then be turned on, and the ablation of the vein will begin, a process that usually takes approximately forty minutes.

The physician should provide you with post-operative requirements. Following guidelines for care after your treatment will help promote the most effective healing so you can return to your daily routine and start experiencing a comfortable, symptom-free life as soon as possible.

Life after DVT

The goal for treatment of DVT is to prevent the blood clot from getting bigger and breaking loose, as well as to reduce the chances of another DVT (about one-third of DVT patients will have a recurrence within 10 years). Treatment can include anticoagulation medications (blood thinners) and graduated compression stockings. 

Among people who have had a DVT, one-third experience something called post-thrombotic syndrome, or PTS. Symptoms of PTS include swelling, redness, chronic leg pain, and ulcers. PTS can be expensive to treat and the pain and discomfort it causes can make it extremely difficult for people to get around.

Those with DVT should wear graduated compression stockings on a daily basis, since several studies strongly suggest that they can significantly reduce the likelihood of developing PTS. In fact, according to the American College of Chest Physicians, wearing compression stockings for two years following DVT reduces the incidence of post-thrombotic syndrome by half.

Unlike insufficiency in the superficial venous system, there is no FDA-approved treatment for PTS besides compression stockings and supportive care. 

Of course the best way to prevent PTS is to never have a blood clot in the first place. If you think you might have a DVT, get to the emergency room as soon as you can. In most cases, the affected area— usually in the leg— will be painful, swollen or tender, with a redness or discoloration of the skin. Even a muscle cramp that feels especially sharp and painful can be an indication of DVT. Early detection can go a long way toward preserving your quality of life-- or even saving your life.

Education, of course, is key to preventing this very common disease. Here are a few resources where you can learn more:

• http://www.StopTheClot.org
• http://www.PreventDVT.org
• http://www.ThisIsSerious.org
• http://www.CDC.gov/features/thrombosis

How compression can help-- and help prevent-- DVT

In addition to managing both acute and chronic DVT, compression can be a tool for prevention. When there are risk factors for DVT, such as long distance car or plane travel, immobility, or pregnancy, wearing compression stockings can reduce its occurrence. 

What do we mean by compression? Graduated compression stockings provide a gradient of pressure against the leg. The pressure is highest at the foot and ankle and gradually decreases as the garment rises up the leg. This pressure gradient makes it easier for the body to pump blood up towards the heart (the normal direction) and more difficult for gravity to pull blood downward.

Compression stockings require a prescription and can be purchased at many pharmacies, most major medical supply stores, and specialty stores. Your doctor can tell you if you need knee-highs, thigh-highs, or a “pantyhose” style. 

These days, compression stockings are fashionable, comfortable, and come in a wide variety of styles and colors. Though modern compression stockings usually look like socks or tights, putting them on can be a challenge. 

It’s important to note that “TED hose”— the “anti-embolic" stockings that are often worn after surgery to help prevent DVT— are not the same as graduated compression stockings. TED hose work well for patients who are bed bound, but won’t offer much benefit to patients who are up and walking.

There are many benefits to using graduated compression therapy besides reduced risk factors for DVT, but be sure to consult your physician first. Compression is not appropriate for all patients and can actually have adverse affects on patients with peripheral arterial disease.

To learn more about DVT, read our previous posts.

Healthy Veins in the Winter

The winter tends to be a good time for people with vein issues, like varicose veins or venous ulcers. According to Dr. Cindy Asbjornsen of the Vein Healthcare Center, the heat of summer actually causes veins to dilate or stretch, and symptoms often become worse. She finds that people are more likely to pursue vein treatments in the winter months because of the need for compression stockings post treatment.

Compression stockings or socks are therapeutic hosiery designed to increase blood circulation by placing pressure on the lower leg, foot and, in some cases, the thigh. Graduated compression stockings have strong elastics that are tightest at the ankles and then gradually become less constrictive toward the knees and thighs. They can be used after vein treatment or, in some cases, as a supplement to treatment.

During wintertime, patients with vein problems are much more likely to wear their compression stockings, treating them like a welcome layer of insulation, like longjohns. Though compression stockings won't completely cure a vein problem, they can dramatically improve the symptoms and keep an existing issue from escalating.

One drawback of winter is that many people prefer to stay indoors to avoid the cold. But less walking and more sitting is the worst thing one can do to keep legs healthy— or to keep bad legs from getting worse. So what’s the answer?

Walk, even if it’s just around the house. Dr. Asbjornsen has one dedicated patient who walks for two minutes, 15 times a day— by taking a stroll around her house every half-hour! Of course, if you belong to a gym or fitness club, get in there and hop on a treadmill.

Another option is the mall. Walking around inside a mall, or even a grocery store or large department store, can go a long way toward venous disease recovery and prevention. Walking just thirty minutes every day keeps the muscles of the lower legs healthy.

Whatever the season, if you're experiencing symptoms of venous insufficiency, the sooner you address it, the better. Left untreated, the problem could get much worse. Treatment can stop the progression of the disease and its complications for those in its early stages, and for those struggling with late-stage symptoms, it can restore health and quality of life.