It was mentioned in a previous blog that we would go into more detail on ADL’s; specifically what they are and how they are affected by your varicose vein pain?
What Are Activities of Daily Living?
To start with, ADL means “Activities of Daily Living”. Insurance companies are not in the business of paying for cosmetic treatments; therefore, an expectation is put in place before consideration of varicose vein treatment. One of those expectations is that your activities of daily living are affected. This tends to be hard for one to understand exactly what “affected” means; many of us will do our best to get through our responsibilities whether it is leg pain, headache, back ache or other ailments that come our way. Even though we are working through some of this pain there are times we are unable to complete some things or do some things on the timeframe needed because of the leg pain we’re experiencing. When asked, “how are your ADL’s affected?” some responses are as follows:
“At the end of a long day I am unable to do the dinner dishes before I have to sit and elevate my legs.”
“My job requires me to sit for long periods of time and makes it very difficult to do my work without standing and walking around.”
“After chasing my children around in the morning it takes some rest before taking them to the park or caring for them such as bathing or dressing.”
“I am unable to complete my chores around the house without sitting and elevating my legs.”
“I would like to do more yard work but after a short period of time I have to take a break.”
“My life could use more exercise but my leg pain limits how far I can walk before heading home.”
“My job requires me to stand for long periods of time; I am in a great deal of pain by the time break is called. The pain is effecting how I do my job.”
This list could go on and on in different ways of how your daily activities are being affected and from this list you may realize that you do experience heaviness, achiness or tired legs that limit what you do throughout your day. You may get cramps in your legs at the end of the day or at bed time that wakes your from your sleep, especially after a long day on your legs
Do You Relate?
If some of this is starting to resonate with you it’s time to schedule an appointment to assess your vein anatomy. At this appointment we will be able to evaluate your vein sizes for an appropriate treatment plan, which is also a requirement your insurance company will need. We will also be able to explain further insurance requirements which may include compression stockings, Nsaids and leg elevation. We are here to help you understand the process better and work directly with your insurance to help you overcome the pain.
Endovenous Thermal Ablation
The first procedure typically performed is the venous ablation. This is where the vein is burned with either laser or radio frequency catheters. During this procedure, the patient is sedated with valium, nitrous oxide, or both. The patient can choose the level of sedation they prefer.
During this procedure, the sonographer will map the vein to be ablated and mark a location that appears to be a good access point. What we look for is whether the vein is straight and has a large diameter, which makes accessing the vein easy. Veins will sometimes spasm or be a smaller diameter early in the morning when the patient hasn’t been standing or active all day, or when the leg is cold. In these cases, we use gravity, a Nitroglycerin patch, and a blanket to help warm up the leg and increase the diameter of the vein.
Once a location is marked, we prep the leg with a cleansing/sterilizing solution and set up the procedure using sterile technique. We ask that the patient not touch the sterile field, so to prevent infection. When the physician enters the room, he will also dress in a sterile gown and will don sterile gloves. We take every precaution to keep the patient safe and infection free.
At this point, the physician will access the vein and start the procedure. Once the vein is accessed, a “guide” wire is inserted and the sonographer will follow the wire up the vein to make sure we are in the vein and not in the surrounding tissue. After that, the catheter, with the heating element, is inserted and once again the sonographer follows the catheter with ultrasound to make sure it is in the vein to be treated.
Once the catheter is an acceptable distance from the deep venous system, we need to numb around the vein. This is two-fold: The first reason is to numb and protect the tissue surrounding the treated vein from being burned. The second is to compress the vein around the catheter so the walls of the vein will be treated.
Once this all complete, the catheter is slowly removed and the vein will be ablated. We close the access point with steri strips and the procedure is finished. The patient is then required to wear a compression stocking for one week.
Getting treatment for varicose veins can be daunting and sometimes frustrating. We hear you and want to help.
Does this scenario sound familiar:
Physician: How long have you suffered symptoms?
Patient: Explains reason for visit.
Physician: Well, I know we can help you with that. What insurance do you have?
Patient: Gives insurance information
Physician: Oh, I’m sorry to tell you that not all these procedures are covered by your insurance.
If this has happened to you then you are not alone. Most insurance companies have complex policies that are difficult for even their own employees to understand let alone the layman. So, what is it that you need to know about insurance coverage for varicose vein treatment and whether or not your insurance will pay? Three things: symptoms, anatomy and conservative measures.
Varicose Vein Symptoms
Insurance companies are not in the habit of paying for cosmetic procedures; therefore, if you simply do not like the way your legs look then you will have to dig deep into those pockets to pay for those treatments on your own. However, many of our patients are not aware they are experiencing symptoms from their varicose veins because they did not know what to look for. Most patients experience aches and pains in their legs, along with heaviness and sometimes swelling. Another symptom commonly associated with varicose veins is itching. The insurance companies like to quantify these symptoms by determining how they affect your life on a daily basis (Activities of Daily Living). Read about Activities of Daily Living.
We know you have no control over your vein anatomy but regardless the insurance companies have limitations on what they will and will not treat. When you come to an appointment at IVC, you will have a complete ultrasound that we call a “vein mapping”. This vein mapping allows us to determine which veins are healthy and which veins are not. It also allows us determine the diameter of the diseased veins and their shape so we know which modality we should use for treatment. You may hear us mention that a vein size is too small to be covered by your insurance. Most of the time, these smaller veins are not causing the symptoms you are experiencing; therefore, it is not detrimental to your health to not proceed with treating those veins.
Conservative Measures for Varicose Veins
Okay, now we have established that you are experiencing the symptoms the insurance wants for treatment and your vein anatomy meets their policy requirements. What are conservative measures and why do you need to do them? The majority of insurance companies are going to require a patient to have a trial period of wearing prescription strength compression stockings for at least three months prior to approving treatment. The styles really have come a long way from when our grandparents wore compression socks, but they still are tight and can be uncomfortable so the three months can sometimes feel like a lifetime. Insurances also like to see that you tried taking anti-inflammatories to alleviate symptoms. Some require these medications to be prescription strength and others require OTC. Either way, the insurance companies want to determine whether your symptoms can be managed by conservative treatment with medications and compression before they opt to pay for other forms of treatment.
Once you have completed your conservative measures trial period, then it is time to submit your clinical for prior authorization and move forward with treatment. Having insurance does not guarantee they will pay so it is very important to choose a clinic that will walk you through the process. Do not be afraid to ask questions to be informed as much as possible because ultimately the buck stops with you.
A nurse practitioner is a registered nurse with extra schooling and opportunities to provide health care, diagnose, and treat patients. There are different levels of nursing and they all have different amounts of schooling and opportunities for providing care. First you have a licensed practical nurse (LPN), second a registered nurse (RN) and third a nurse practitioner (APRN) and now a Doctor of nursing practice (DNP). I will discuss the schooling and the privileges of each of these nurses.
First Level – Licensed Practical Nurse
A licensed practical nurse (LPN) has the following job duties. They can care for patients basic needs with their normal daily activities such as bathing and dressing, and they can take vital signs. They can also obtain medical histories, draw blood, give injections and discuss health care with patients. There are other things they can do, it just depends on the facility they work in. They also report patient status to a registered nurse or a doctor. To obtain a degree as an LPN it will require one year of schooling. The classes will be in nursing, biology, pharmacology and supervise clinical experience. Many LPN’s work in Doctor’s offices or clinics and they help with patient flow and obtaining histories.
Second Level – Registered Nurse
A registered nurse (RN) has the ability to perform all of the duties of an LPN and they can also do many other things. They can administer oral and intravenous medication according to a medication administration record. They can administer treatments, perform diagnostic tests, coordinate care plans, and analyze results. They also instruct patients on illness management and they oversee the work of medical assistants, nursing aides, and LPN’s. Most RN’s work in hospitals and they can help assist doctors with minor procedures. RN’s have at least 2 years of schooling and some have 4. The privileges between the two are not any different. The 4 years of schooling lets you have the opportunity to work in management positions and to further your education and get a master’s degree.
Third Level – Nurse Practitioner
A nurse practitioner (APRN) can perform any of the things that an LPN or RN can do and they have many other responsibilities. A nurse practitioner can work side by side with a doctor and help them with seeing patients. They can perform physical exams and diagnosis and treat patients. They can prescribe medications, and perform many procedures on their own with some minimal supervision. A nurse practitioner can have their own office and see, diagnosis and treat patients. To become a nurse practitioner you need to have a bachelor’s degree in nursing and then get accepted into a program for nurse practitioner’s. There are many specialities you can go into as a nurse practitioner. These range from pediatrics, geriatrics, and family practice to acute care, women’s health and mental health practitioners.
In the past 10 years or so the nursing community has developed a Doctor of nursing practice (DNP) degree and they have an additional 2 years of schooling beyond the master’s prepared APRN. The rights and privileges are the same for the APRN and the DNP.
The differences between the levels of nursing depend on how much schooling you have and the privileges you get after obtaining the appropriate degree. It will take more schooling to have increased privileges and opportunities for growth and advancement.