Ugh. Varicose veins–the definition of which is, “A vein that is abnormally large, twisted, and bulging off the surface of the skin.” Something that I became all too familiar with during my second pregnancy. They hit me hard (think compression hose in full summer heat) and three years later, it looks as if they are here to stay. Painful and ugly, I wondered what could be done about my new “friends.” Breezy Mama asked Doctors Judy Hondo and Liz Foley of the Vein and Aesthetic Center of Boston in Dedham MA what could be done about the unsightly veins. Turns out that what used to be a painful procedure isn’t too bad, with a pretty fast recovery. Read on to learn more. . .
What exactly are varicose veins?
Varicose veins are dilated bulging veins that most commonly occur on the surface of the legs. While normal veins are not easily visible, varicose veins are unsightly and usually associated with leg symptoms such as aching, throbbing, heaviness and fatigue. Varicose veins are considered a medical condition and their treatment is usually covered by medical insurance. Varicose veins are caused by failure of one way valves within the vein walls. These valves normally allow blood to flow in only one direction, away from gravity and toward the heart. When these valves fail, backward flow of blood toward the ankle occurs. This increases the pressure within the veins causing them to dilate and bulge.
What is the difference between varicose and spider veins?
Spider veins are much smaller vessels that become dilated and often have the appearance of a spider. While they can sometimes cause mild symptoms such as itching or throbbing, they are of primary concern because of their unsightly appearance and are considered a cosmetic issue.
Why do varicose veins get worse during (and sometimes after) pregnancy?
Varicose veins often get worse during pregnancy for three reasons. First progesterone, the female hormone that rises significantly during the early stages of pregnancy and remains elevated until after delivery, has a major impact on veins. The progesterone weakens vein walls, making them more elastic and “stretchable”. These veins become more susceptible to dilation. During the second trimester of pregnancy (at about four months) there is a natural increase in blood volume. This can add insult to injury with the increased blood volume causing the more weakened vein walls to dilate (developing varicose veins). Finally, with the added weight and pressure from the pregnant uterus on the legs during the third trimester, there may be some resistance to blood return from the legs to the heart. This can further add to the increased pressure within the veins.
What can be done to fix varicose veins? Is this a painful process?
Luckily, there are many options to treat varicose veins today that our parents and grandparents did not have at their disposal. In the past, a woman with varicose veins would have to go through a painful surgery called vein stripping. This was performed in the hospital, under general anesthesia, and required a significant post-operative recuperation. Today, there are minimally invasive office procedures that typically take thirty minutes to perform that eradicate these veins. These procedures are performed under local anesthesia (simply numbing the area of the legs to be treated) and the patient immediately returns to her normal routine.
Can you explain the different ways to have them removed? Which is less invasive?
The different types of treatments performed depend on the type of vein being treated. Oftentimes varicose veins are the result of a dilated larger straight vein under the skin surface. This vein can be treated by closing it down with heat energy. This procedure, called Endovenous Ablation, involves simply placing an IV catheter into the vein, numbing the vein and then passing a heat source (either laser or radiofrequency) through the tip of the catheter and closing the vein (down with heat energy). The body then digests this newly closed vein over the ensuing months. To treat the bulging varicose veins, another office procedure called ambulatory phlebectomy can be performed. Here, the bulging veins are removed through tiny freckle sized incisions. These incisions are covered with tiny band-aids and heal within a few days. Sclerotherapy can also be performed on all size veins from the larger veins under the skin’s surface (with the help of ultrasound) to the bulging varicose veins, and finally to the tiny spider veins. Laser treatments are also available to treat spider veins, however, many varicose vein specialists prefer sclerotherapy to treat these veins.
Is removing spider veins different than varicose veins?
Spider veins are not technically removed. They are injected with liquid medications that cause the veins to close down and disappear. Larger varicose veins are more often removed by the Ambulatory Phlebectomy procedure.
What is the recovery period after having them removed?
Following ambulatory phlebectomy (removal of larger varicose veins), patients are able to return to their daily routine almost immediately. On the day of their office procedure, they leave the office with a gauze wrap under their support hose and are instructed to walk one mile that day. The following morning, we instruct patients to remove their stocking and dressing, take a shower, and then wear their fresh stocking during the day. For the next two weeks, we instruct patients to wear their support hose over the treated leg all of their active waking hours, walk a minimum of one to three miles per day, and take anti-inflammatories such as Ibuprofen for any mild discomfort and to aid in their healing process. We do recommend that patients avoid high impact exercise for two weeks and refrain from long car rides or airplane travel for three to four weeks following their procedure to avoid prolonged periods of inactivity.
Is this an expensive procedure? Does insurance cover it?
Most insurances cover varicose vein treatments. Symptomatic varicose veins are considered a medical condition and the treatments are covered by most insurance companies. For patients without insurance or whose insurance excludes varicose vein treatments, cost can vary from a few hundred dollars for a cosmetic sclerotherapy session to treat spider veins to a few thousand dollars for more extensive medical procedures.
Have you heard of the “VeinGogh” Treatment? What are your thoughts on this?
“VeinGogh” or “VeinWave” are the commercial names for electro-thermal coagulation, a technique that uses electricity to produce heat that coagulates small vessels. These procedures are especially useful in treating very small spider veins. A general rule of thumb for treating small veins is that if you can get a needle into the vein, sclerotherapy is the more appropriate treatment. If you can’t (usually in tiny veins less than 3mm), VeinWave or VeinGogh can be good alternative tools.
One reader asks, “I have spider veins that continue to pop up…How do I stop this from happening?
Unfortunately, you cannot completely prevent the occurrence of spider veins. They tend to be inherited. You can, however, protect your healthy veins by leading an active lifestyle. Walking and cycling are particularly good exercises for patients with spider or varicose veins. This is because the repetitive contraction of the calf muscle (known as the calf muscle pump) continuously pumps the blood out of these veins preventing build-up of pressure which can lead to more spider or varicose veins. Additionally, for people who are prone to vein problems or who have a family history of varicose veins and want to proactively protect their legs, compression hose can be worn during cooler weather. This, along with a regular exercise program will aid in maintaining healthy veins. For patients who decide to treat their spider veins, maintenance is more often than not required to touch up new spider veins as they occur before the veins get out of hand.
Does diet prevent varicose veins?
While diet alone has not been directly linked to varicose or spider veins, we all know how important a healthy lifestyle, including a healthy diet, is for our entire body. Taking in natural antioxidants helps to maintain good cellular health which directly can affect the integrity of our tissues. Additionally, maintaining a healthy weight keeps unnecessary pressure off of our legs and therefore our leg veins.
Anything to do when sleeping to prevent them (sleep with your legs elevated)?
While sleeping, your legs are typically elevated enough that the veins are being emptied and symptoms are usually relieved. For people with severe venous disease, elevating the legs slightly with pillows may further decrease their discomfort.
Are there any creams on the market that help?
There are some agents that may help protect vein integrity and lessen the discomfort associated with varicose veins. NSAID’s such as Ibuprofen help to relieve some of the symptoms of varicose veins which are due to inflammation. Horse chestnut seed extract (Venastat) may reduce aching and swelling. Pentoxifylline (Trental) and Daflon 500 reduce inflammation, diminish skin changes, and may help to prevent ulcers that can form in more severe cases of venous disease.
Is there truth to the wives tale that not crossing your legs prevents varicose veins?
There are no studies that have proven a correlation between crossing your legs and the development of varicose veins. While some have speculated that crossing your legs may cause increased pressure in the veins below the knee, this has never been verified by any scientific study. The top three causes of varicose veins are family history, being a female (due to the hormonal effects of progesterone), and leading a sedentary lifestyle; in that order.
If we get them fixed now, will they come back later in life?
We pride ourselves at the Vein & Aesthetic Center of Boston at getting to the root of the problem when it comes to treating varicose veins. Unless you eradicate the highest point of the problem, the varicose veins will likely return sooner than later. That being said, venous disease is an inheritable condition in the majority of cases and patient with varicose veins have an innate tendency for their vein valves to give way causing varicosities. We therefore counsel our patients that lifelong management is essential to maintain vein health. New varicose veins can always develop if a valve gives way and pressure increases within the vein, eventually giving way to new varicosities.
Anything you’d like to add?
Varicose veins can be unsightly and associated with marked discomfort affecting one’s ability to enjoy simple activities that require prolonged standing or even sitting. The good news is that today there are minimally invasive easy treatments with no down time that are available to varicose vein sufferers. These treatments result in a newfound energy and confidence, allowing you to enjoy life while “putting your best leg forward!”
Breezy Tip: Want a temporary solution of just camouflaging those spider veins? Try Dr.’s Remedy Enriched Instant Cover. Like foundation for your body, the cream comes in three skin tones and is easy to rub in. Not only will it cover unsightly spider veins, but i t can also provide temporary coverage of birthmarks, tattoos and sun spots. Containing tree tea oil, lavender,vitamins C and E and wheat protein, the formula is good for your skin as well. To order Dr.’s Remedy Enriched Instant Cover, $20.00. click here.
About Elizabeth A. Foley, MD: Dr. Elizabeth A. Foley received her medical degree from Albany Medical College of Union University. She subsequently completed her residency in Obstetrics and Gynecology at Tufts University School of Medicine. Following her residency training, Dr. Foley entered into a busy Ob/Gyn practice with Dr. Judith Hondo where she devoted the next 10 years to women’s health as an obstetrician and gynecologic surgeon. It was during this time that Dr. Foley encountered countless women suffering from venous disease with little state of the art treatment options available in the Boston area. While seeking alternative treatment options for her patients, Dr. Foley developed a keen interest in the field of Phlebology.
In 2000, Dr. Foley made a decision to redirect her medical practice and, along with Dr. Hondo, underwent extensive training in the field of phlebology and aesthetics. In 2002 Dr. Foley co-founded The Vein & Aesthetic Center of Boston. She, along with Dr. Hondo, was one of the first doctors to perform the EVLT procedure in the Boston area. Dr. Foley is board certified in phlebology and credentialed in the performance and interpretation of vascular ultrasound.
As a physician specializing in non-invasive aesthetic procedures, Dr. Foley is also highly skilled in the administration of Botox and dermal fillers. She received her initial training for Botox and fillers in 2001 and 2002 under the tutelage of Drs. Alastair and Jean Carruthers who together pioneered the cosmetic use of Botulism A exotoxin in 1987.
While devoted to her practice, Dr. Foley also takes great pride in her family and her role as a mother. She lives in Brookline, Massachusetts with her husband and their four children. In her free time Liz enjoys photography, painting, biking, and Pilates.
About Judith A. Hondo, MD: Dr. Hondo is a board-certified Phlebologist and Gynecologic surgeon. She attended UMass, Amherst where she graduated Magna Cum Laude, receiving a BS degree in MicroBiology. She obtained her medical degree from the University of Medicine and Dentistry of NJ and then completed her residency training at Tufts University School of Medicine in Obstetrics and Gynecology.
Dr. Hondo practiced OB/GYN at Newton Wellesley Hospital for many years. During that time she cared for many patients with venous disease, and she became interested in the field of Phlebology. Fellow OB/GYN and longtime friend and colleague from residency Dr. Foley expressed a similar interest in the field of Phlebology, and the pair decided to pursue this new career path together. Following extensive training in phlebology and aesthetics, Dr. Hondo and Dr. Foley co-founded The Vein & Aesthetic Center of Boston in 2002. They were among the first physicians in New England to perform the EVLT procedure after it was FDA approved in 2002. Since that time they have performed thousands of procedures. Dr. Hondo is also credentialed as a RVT (Registered Vascular Technologist) and RPVI (Registered Physician in Vascular Interpretation).
In addition, Dr. Hondo has extensive experience in the administration of noninvasive aesthetic treatments including Botox and dermal fillers (Juverderm, Restylane, Radiesse). Along with Dr. Foley she received her initial training for Botox and fillers in 2001 and 2002 with Drs. Alastair and Jean Carruthers.
Outside of work Dr. Hondo can be found on the sidelines watching her 3 daughters playing soccer, basketball, lacrosse, and water polo. Her two eldest daughters are in college and she lives in Walpole, Massachusetts with her husband and her youngest daughter. She enjoys running, spinning classes, reading, and walking her dog.
*For more information on Doctors Judy Hondo and Liz Foley of the Vein and Aesthetic Center of Boston, click here.