One Patient’s Perspective

As the busy fall season kicks into high gear, we thought we'd take a minute to share a testimonial from one of our happy patients. Lucille used to do a lot of sitting because her legs felt so heavy and swollen. But now she walks at least 30 minutes every day!

"Dr. Asbjornsen is a rational, competent and caring physician. That's uncommon! From the first appointment, the doctor and her staff were very professional and continually demonstrated how much they care for their patients. Everyone was very thorough in educating me about each step of the process, from the evaluation to the follow-up—and they were pleasant too.

The group at the Vein Healthcare Center has restored my faith in the medical system. They are the cream of the crop. They're superlative!"

–      Lucille L., 69, Lewiston, ME

To read more about Lucille’s experience, check out the “One Patient’s Perspective” column in the latest issue of Vein Health News.

To see more of what our patients are saying, click here.

New alternatives in vein treatment

More and more people — doctors and the general public alike — know that so-called “vein stripping” is an antiquated treatment for varicose veins. Endovenous laser

therapy has been considered the gold standard in vein treatment for more than 20 years, but physicians in the field of phlebology are always seeking new, better techniques. The best vein specialists don’t stand still!

EVLA uses laser or radio frequency waves to create an intense localized thermal reaction in the incompetent vein. The thermal energy causes the vein to seal shut, stopping the healthy blood flow from entering the damaged vein, which keeps the blood flowing toward the heart properly.

In the latest issue of Vein Health News, we look at three non-thermal, non-tumescent vein treatments that are on the horizon. Simply put, “NTNT” modalities are newer procedures that do not require laser energy or radio waves, nor tumescent anesthesia.

To learn more about this and other current topics in vein healthcare, click here. And if you’re interested in a free subscription to Vein Health News, just click here.

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

Men, women and veins

Gender and age are two primary risk factors in the development of venous insufficiency. The U.S. estimate for varicose veins is 40% in females and 22% in males. 72% of American women and 42% of men will experience varicose veins symptoms by the time they reach their sixties (although vein problems can occur at almost any age).

While it’s true that women are more likely than men to have venous disease, including varicose veins and spider veins, men are more likely to suffer from the worst vein problems, such as ulcers. Why is this the case?

Dr. Cindy Asbjornsen has observed that women tend to get help for their vein issues right away, while men will often wait until the problem becomes too painful to ignore. Leg ulcers, or wounds that won’t heal, are often the result. Conditions like varicose veins get worse with time, so the longer someone waits, the more extensive the condition—and often, the treatment.

Even men who are athletic are susceptible to venous disease. The important thing is to seek help for vein issues as soon as symptoms present themselves.

Symptoms of venous disease include:

•     Leg fatigue or heaviness – It is an early warning sign when legs feel good upon waking but are intensely tired or heavy at the end of the day.
•     Swelling – This can be caused by many things but also serves as a very early warning sign for vein problems.
•     Skin changes – Redness, skin thickening or other color changes on the legs and/or ankles is a common (and commonly overlooked) symptom.
•     Other skin changes, such as dermatitis, cellulitis, dry or scaly skin, or brown “stains” on the skin can be signs of advanced venous disease, and should be evaluated by a physician.
•     Spider veins – Blue- or purple-colored veins that occur under the skin but are close enough to be seen on the surface can be the “tip of the iceberg.
•     Varicose veins – Another sign of early stage venous disease, varicose veins are visible veins in the leg that bulge, often protruding through the skin.
•     Ulcers – An open wound on the leg or ankle that fails to heal can be the result of ongoing venous disease, often an indication that venous disease has reached an advanced stage.

Remember, some people with venous disease present with no symptoms, only skin changes and/or bulging veins. The key for anyone, regardless of gender, is to get evaluated as soon as he or she suspects there’s a problem.

Sclerotherapy Q&A with Alison Scheib, PA-C – Part 3

In our two previous posts we spoke with Alison Scheib, PA-C and sclerotherapy specialist at the Vein Healthcare Center, about post-treatment issues with sclerotherapy. In our final installment, we ask her some of the most popular questions that arise about this procedure. 

What are the most common side effects after treatment?

The most common side effects are bruising and tenderness of the treated veins. The bruising is usually fully resolved within two weeks and the tenderness responds well to heat and elevation. I do want to add that patients who follow the post-procedure guidelines for care will help promote the most effective healing. After each sclerotherapy session, compression stockings should be worn for 10 days, in most cases.

How much does sclerotherapy cost and does insurance cover it?

Costs vary, but it’s usually about $300-$500 per session based on how the vein is visualized (light-assisted vs. ultrasound). Insurers describe sclerotherapy as an “adjunct” procedure and will cover it in part or in full if a bigger procedure has been done in the past, such as radiofrequency or laser ablation, or if there is an open ulcer. Patients should work with their treatment provider to understand their health insurance coverage.

What is the one question that patients ask you the most?

“Will it hurt?” Everyone’s experience is different, but most people describe it as very tolerable. It is always possible to stop the procedure or take a break if someone does find it very uncomfortable, but most patients say there is only minor discomfort. The medicine is pH balanced and vein access is with a 27-32g (very small) needle so it’s really just a very small perceivable pinch.

If you have any questions about sclerotherapy, or what to expect before, during or afterwards, feel free to contact us at the Vein Healthcare Center: email connect@veinhealthcare.com, or call (207) 221-7799.

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…

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!

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.