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. 

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.

How to prepare for an EVLA

In a previous post we described the outpatient procedure called EVLA, or endovenous laser ablation. Now we’ll discuss what to do to prepare for an EVLA appointment. Being fully prepared for your appointment and following recommendations for care before your appointment will help ensure successful, comfortable treatment.

Most vein specialists offer patients pre-operative instructions. Read— and heed— all of the guidelines as part of preparing for the appointment. Common EVLA preparations include:

1. Compression stockings should be purchased and worn prior to your appointment to be sure they are comfortable. You should bring them with you the day of the procedure, as you will use them immediately following treatment and during the following two weeks.

2. Refrain from shaving your legs the morning of the procedure. This will reduce the risk of razor burn irritation from the sterilizing wash.

2. Take all regular medications the day of the procedure.

3. You will be prescribed a muscle relaxer to help keep the muscles in your leg loose, and a pain medicine. Take both medications 1 hour before the procedure or as directed by your physician.

4. Fasting is not required— eat a normal breakfast or lunch.

5. Prepare to bring or wear high-cut underwear that you are willing to have stained by iodine solution. You will likely want a second pair to change into after the procedure is over.

6. Bring an iPod or headset if you'd like to listen to music during the procedure.

It’s important to remember that while endovenous laser ablation (EVLA) is the gold standard for venous care, you and your vein doctor, together, may decide on a different course. Call the Vein Healthcare Center to schedule an educational visit and learn about what options may be right for you.