Thank you from all of us at the Vein Healthcare Center!

As another year comes to an end, I am counting my blessings for getting to do work that I love. I couldn’t do it without the Vein Healthcare Center team. What a pleasure it is to work with these skilled and thoughtful professionals every day!

I’m also grateful for all of our patients. Thank you for coming to us for better health and an improved quality of life. We’re always here to answer your questions.

Have a wonderful holiday season and start to the new year. And keep walking!

Sincerely,

Dr. Cindy Asbjornsen

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.

How exercise impacts veins (and vice versa)

In our last post we began discussing how physically active people experiencing leg pain are possibly experiencing the effects of vein insufficiency. In this post we take a closer look.

During exercise your muscles require more oxygen, so veins dilate to increase the volume of blood flowing through the circulatory system—but if your veins are not working properly, that means more blood can pool in your legs. On the other hand, exercise is beneficial from a venous standpoint because anything that improves the function of the foot and calf muscle pumps to get the blood back up to the heart is good.

Walking is the best exercise for improving the muscle-pump function, especially following vein treatment. Although walking can help manage the symptoms, it does not prevent vein problems. Neither does exercise cause vein problems, except in extreme cases. Physical activities that require your legs to support heavier weight over prolonged periods of time, such as weightlifting or backpacking can put someone at increased risk for developing venous issues. Repeated exposure to increased intra-abdominal pressure, or pressure that is transmitted to lower extremities, can cause the normal system of valves and veins to weaken over time and become incompetent.

Repetitive motion sports such as endurance running, cycling and tennis can also put a lot of stress on your leg veins and over time may overcome a normal venous system.

In general, exercise (and working out the muscle pumps) is not detrimental for the vast majority of athletes who are participating in a more typical spectrum of activity. In fact, maximizing the efficiency of that system is beneficial.

Depending on each individual’s degree of vein disease, he or she may become more symptomatic because the foot pump no longer counters the vein insufficiency. One person’s level of activity, for instance, may be associated with the progression of vein disease if they have some pre-existing risk factors, such as age or family history.

While exercise can influence vein dysfunction, it doesn’t necessarily prevent it or cause it. But can poorly performing veins affect athletic performance? The short answer is yes. If the venous system is not working correctly, then the “extra” de-oxygenated blood (and blood waste products like lactate) can cause discomfort, cramping, fatigue, or other conditions that diminish performance.

Even if legs feel great during training, vein issues can also cause legs to hurt after exertion and slow your recovery.

In our next post about athletes, exercise, and veins, we’ll turn to treatments to fix the problem. And be sure to visit the Vein Healthcare Center in South Portland, Maine to learn more about your options for treatment.

Sclerotherapy Q&A with Alison Scheib, PA-C – Part 2

In our last post, we discussed the basics of sclerotherapy with Alison Scheib, PA-C and sclerotherapy specialist at the Vein Healthcare Center. Now we talk with Ali about what to expect after a sclerotherapy procedure.

What should someone expect right after sclerotherapy?

Immediately following the procedure, there may be mild itching of your legs. It typically resolves within an hour. For the next few days, there may be some tenderness and bruising. About two weeks following the procedure, you may feel hard bumps in the area of the treated vein, which usually disappear over the course of several months.

How will the leg look or feel a week after sclerotherapy? A month?

Usually, the changes noticed in the first two months are improvement in symptoms. Patients have reported to me that their legs feel lighter, or without pain. The large, lumpy veins slowly disappear, usually 2-6 months after the procedure, and the smaller veins may disappear over the following six months. All veins clear up large to small, high to low. 

Are the results of treatment with sclerotherapy permanent?

Yes, once the vein has collapsed, it typically gets reabsorbed into the body and is permanently gone. Because that vein no longer exists, it cannot cause problems in the future. That said, all the veins in the body have the same genetic makeup and have generally been exposed to the same environmental stresses and, in theory, have the same risk of failing. In other words, if a patient has one bad vein, it is very likely that at some point they will have other bad veins. It’s important to note that healthy lifestyle changes can make a big difference in managing chronic venous issues and preventing future problems.

Can you go to work after treatment? What about exercise?

Yes, you can go to work after treatment. However, you should avoid heavy lifting and strenuous physical activity while standing for the first five days following sclerotherapy. Walking is great exercise after treatment. In fact, walking 30 minutes a day is a post-op requirement!

To read the conclusion of our conversation with Ali, click here. We ask some specific questions about common side effects and whether sclerotherapy is covered by insurance. Plus, the one question that patients ask most…

The calf pump

Is “the calf 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.  

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. 

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.