‘Are you done? Seriously? Seriously? Compared to my vein stripping 20 years ago…wow..why did I wait so long?’ This is what was heard in our procedure room on Monday. On Tuesday our patient came back for her second procedure and she was so casual about it she brought her coffee with her. 😄
Finally someone has made a cool medical animation movie to explain vein disease!
Varicose veins is a progressive disease, meaning it gets slowly worse over time. The good news is that you don’t have to get treated in an emergency fashion. It’s not like your appendix is going to rupture. Don’t let anyone pressure you into getting treated when you are not ready. We tell our patients they have time to plan and save for their treatment if they need. Plan for a year when you have good health insurance coverage. Or if you have a high deductible plan, just plan a year to knock out all of those other medical tests and treatments that you have been postponing in order to maximize meeting your deductible. Start at the beginning of the year to give yourself time to get all your medical appointments accomplished during that deductible period. If you are waiting a while, wear thigh high compression stockings strength 20-30 to support your legs and minimize your symptoms.
Is it possible to wait too long? It is possible to wait too long to get your veins treated. Once you have multiple other medical issues going on, are on lots of different medications and have reduced mobility, it’s sometimes too risky to treat your veins. Varicose veins increase in size and number over time, and these changes can increase the risks of treatment. You don’t want to suffer with vein problems and reduced quality of life for decades!
Varicose vein symptoms develop slowly over time, typically years. So basically this is a disease that allows you to control the timing of when you address it, you just have to make a plan! We are here to help.
There seems to be a lot of confusion on types of ultrasounds. People who have suspected a blood clot and visited the Emergency Department often say, ‘I already got an ultrasound!’ So really there are two different types of ultrasounds for veins, each which looks for a different vein disease.
If you go to the Emergency Department because you think you might have a blood clot, the ED is going to perform an ultrasound to rule out Deep Vein Thrombosis. They are looking to see if there is a blood clot or not.
The second kind of ultrasound is for patients who have varicose veins. Varicose veins are due to venous blood flowing the wrong way back down your leg. The flow problem causing varicose veins, however, is often more extensive than we can see just looking at your leg. During a venous insufficiency ultrasound, the ultrasonographer maps the flow in all the major veins in patient’s leg, marking where the blood is flowing in the wrong direction (reflux), noting how the veins connect with this specific patient, where the problem starts and stops, and noting vein diameters and presence or absence of reflux. We use this mapping as a road map to treat the patient, and we also use it to get approval from insurance. If the measurements don’t meet insurance criteria, then insurance does not consider treatment ‘medically necessary’. This venous insufficiency study takes about an hour to perform and is a different study looking for a different disease than the Deep Vein Thrombosis study.
Generally, if a patient has had a venous insufficiency study in the past but it has been over 12 months, then insurance will not accept the findings and will make the patient get a new study. This isn’t a bad idea, since varicose veins are a progressive disease and things often worsen over time. The picture may look worse a year or two later without treatment.
Woohoo! Dr. Larssen’s book chapters have been downloaded 24,957 times since it was published. This textbook is used by doctors who are training in vein medicine in order to pass the certification. Always ask whether your vein doctor is ABVLM certified.
Click here to order the medical textbook:
https://www.springer.com/us/book/9783319018119#otherversion=9783319018126
What causes varicose veins?
Some predisposing factors include aging, standing occupations, and leg injury or trauma.
Heredity is the number one contributing factor that causes varicose and spider veins. Women are more likely than men to suffer from abnormal leg veins. Up to 55% of American women may be affected in their lifetime. Hormonal factors seen during puberty, pregnancy, menopause, and the use of birth control pills affect the disease. It is common for varicose veins to become more prominent during pregnancy and worsen with successive pregnancies.
It’s so confusing, right? It seems like the insurance companies are changing the rules of the game as soon as we figure them out. Here are some basic concepts.
So here is an example of how this generally works:
Your deductible is $500, and you have not met any of your deductible expenses for this year yet. Your co-insurance is 20% after you meet your deductible. Your out of pocket is $3,000.
You need three cavities filled. The dentist says that it costs $1,200. In this situation, you would pay your $500 deductible, plus 20% co-insurance on the remaining $700, which is $140. So the total that you would pay is the $500 deductible plus $140 co-insurance for a total of $640.
Once you have met your deductible for the year, any other medical treatment that you may need after that will only be subject to that 20% co-insurance, and once you have spent all the way to your $3,000 out-of-pocket maximum, then insurance should cover the rest of your expenses. If you know that you need a few different medical treatments, and have been putting them off 1) don’t put off necessary medical treatment 2) but if you can plan them out, do it to maximize what you can get covered in that one year since you may be meeting your deductible and even out-of-pocket.
Every insurance plan is different, you should call your insurance provider to understand the details of your plan since they change every year.
When seeking medical care, sometimes it’s hard for the ordinary person to figure out which practitioner to pick. After all, there are fancy ads, promises of perfection, same day treatment and free initial visits. Who doesn’t love something perfect, immediate, and free? Here is the difference between a free initial visit versus a standard medical consultation with a specialist.
I like to think of it as thinking about buying a car. As soon as I go to my local car dealership, they aren’t charging me to be there, but they are going to be working hard to sell me one of their cars. It’s already a foregone conclusion that I need to buy a car if I am at the dealership.
But do I really need to buy a car? What if I go to a consultant who analyzes my driving history, habits, future plans, the public transportation options, and the viability, costs and value of the car I already have. Maybe that consultant tells me I don’t need a car, maybe he tells me that a car isn’t my real problem, maybe he tells me my current car is dangerous and I definitely need to replace it and here are the best options, maybe he tells me I will need a car in the future but could wait and save up money first.
A medical consultation by a physician normally means that you are consulting the physician to give you their unbiased medical judgement about your situation, advice on whether you need treatment, and best options for treatment. This kind of appointment takes time and specialty expertise, and is billed to insurance or the patient. You are not paying for a sales pitch, you are paying for expert advice.
A medical consultation should take into consideration the patient’s history, symptoms, physical examination. A few of the questions being evaluated are; is this even a vein problem, or something else entirely? Does the patient have other medical issues that would make it more complicated or inadvisable to treat their veins? Does the patient have the desire, informed consent, and realistic expectations to 
pursue treatment?
If a physician is working under a business model of offering free initial visits in order to obtain more treatment business, there is more pressure to sell the procedures, and to possibly oversell the results. Anyone promising perfect results can’t really know that they will manage to eliminate every single tiny visible vein.
Patients deserve excellent advice about their health and all of their treatment options. It’s a complex, confusing world out there and physicians need to be trusted advisors to their patients. You deserve it.
Spider veins are those little red or purple veins that you see close to the skin surface on your legs that are under 1 millimeter in diameter (in other words, really small). They drain into bigger veins deeper under the skin.
Cosmetic sclerotherapy is performed to close the visible abnormal spider veins. A sclerotherapy session lasts 15-30 minutes. To get good results, at least three sessions are needed. The main limitation is how much medicine we can give you in one day.
Before deciding on sclerotherapy treatment, your physician will need to do a history, physical examination and possibly an ultrasound. The purpose of this evaluation is to make sure that sclerotherapy is the best treatment for your specific situation. Some patients have an underlying vein flow problem which can only be seen on ultrasound, and which must be fixed before sclerotherapy can be effective. Other patients have a contraindication to treatment, in other words, some other medical issues that make it too risky to perform sclerotherapy.
Most people would describe a sclerotherapy session as irritating but not painful. Each person handles discomfort differently, however, so some patients would say sclerotherapy does not hurt at all and some patients would say sclerotherapy is painful.
After sclerotherapy, you need to wear your prescription compression stockings beginning immediately after treatment, for the next 7 days and including the first night. Wearing compression stockings improves the results of sclerotherapy. This is because sclerotherapy closes the vein, but keeping pressure on that closed vein keeps the body from trying to open it back up again. The body’s response to the closed vein is either to try to open it back up again, or to absorb it like the body heals a bruise.
Almost all patients see an improvement after sclerotherapy, but not all the veins we treated will likely clear after only one session. To get the best results, you will need at least three sessions. It usually takes around 6 weeks to see the results of your sclerotherapy session, so sessions are typically scheduled around 6-8 weeks apart.
Sclerotherapy, like any vein treatment, is not a cure for chronic vein disease, and you may get more abnormal veins. Occasionally a vein which closed may reopen, but abnormal veins which happen months or years later are usually just a progression of chronic vein disease.
The risk of a serious complication (something potentially dangerous) with sclerotherapy is low. Millions of sclerotherapy sessions are performed around the world every year, however, so multiple possible complications have been reported.
Alternatives to sclerotherapy include surface laser and phlebectomy. Surface laser is generally considered the backup treatment to sclerotherapy for leg spider veins because it is usually less effective and more painful than sclerotherapy. However, it is the best treatment if the spider veins are too small to get a needle into. Phlebectomy, the surgical removal of abnormal veins under local anesthesia, is generally reserved for large varicose veins because it is more painful than sclerotherapy.
We wanted to give an update on our humanitarian medical trip to Nicaragua, since we received a wonderful response to the write-up that Ivan Garcia did in the Monterey County Weekly a while back. Vein Specialists of Monterey was so honored to be part of this humanitarian medical trip to Nicaragua in July. Dr. Mowatt-Larssen and his team performed procedures to treat varicose veins on 170 patients in six days. It was crazy. Nicaragua is the second poorest country in the western hemisphere, after Haiti. The patients had severe vein disease and had been waiting a long time for treatment. We had patients who had traveled seven hours by horse and then bus to get to us. Patients were queued up outside the clinic at 4am. We really felt the pressure to try to treat as many patients as possible. They were so grateful, and they paid us in hugs, kisses, and benedictions. We really didn’t have time to process emotionally what we were hearing and seeing. We took all the medicine, supplies, medical devices, and equipment such as ultrasound machine and laser fibers. The drug companies didn’t cut us any breaks. It is expensive but in the end it’s more than worth it. We feel so lucky to be able to touch people’s lives in this way, in an extremely targeted, high impact fashion. There were a lot of people who responded to the Monterey County Weekly article and dropped off donations for us to take with us to Nicaragua. Thank you. We are sustained by the good will of this community and see that the circle of grace and gratitude stretches from the doctors at the Fara Clinic in Matagalpa Nicaragua who qualified and followed up on these patients, to our Nica patients who moved heaven and ear
th to get to us, to our community here in Monterey which has so many interested and compassionate people.
