Preventing/Improving Deep System Reflux

Most patients with superficial system venous reflux also have deep system venous reflux. The deep venous system is responsible for 90% of the venous flow out of the leg. The superficial system is responsible for the other 10% of venous flow out of the leg. We do not treat the deep venous system for reflux because of the large volume of blood flow through this system. What can be done to prevent or improve deep system venous flow?

Compression

Using compression stockings can provide external pressure to the venous system encouraging blood flow out of the legs. Blood is moved through the veins when the muscles surrounding the veins squeezes and applies pressure to the vein walls forcing the blood to move upward. Compression stockings cannot apply this same amount of pressure as muscles do, but the pressure that is applied by the stocking works in the same manner. We recommend using 20-30 mmHg compression stockings.

Activity

Vein walls are much thinner than arterial walls and do not have the same smooth muscle composition as arteries. Veins are dependent on the muscles surrounding the vein to squeeze and force the venous blood up through the valves. If patients have regular activity then they have more muscle compression on the veins improving venous flow.

Elevation

When compression is not applied to the vein then fluid will always be gravity dependent. If you are standing or sitting the blood in your veins will naturally want to go to the lower leg. The fluid outside of the vein will do the same thing settling in the foot and ankles. By elevating your legs above the level of your heart you will encourage the blood/fluid to return towards the heart and out of the legs.

These three things will not cure vein disease or damaged valves. Damaged valves within the vein are not able to repair themselves, though by applying these principles you may be able to prevent worsening of venous insufficiency of the deep system.

Vein Center Accreditation

When trying to decide which vein center best suits you the choices can be overwhelming.  There are many different kinds of doctors doing the treatments, there are small stand-alone clinics to treatments within the hospital, there are offices close and there are offices far.  One could go crazy trying to compare facilities.  There is one easy way to narrow down your search of a great facility.

Accreditation is an important tool in determining the competence of a varicose vein facility. IAC Accreditation SealAccreditation is a series of checks and balances within the community to make sure certain standards are being met.  When applying for accreditation there can be evaluation of ultrasound images, checking appropriate certifications, maintaining continuing education, protocols set in place, and even a walk thru to make sure all things are in place.

As a patient, visiting an accredited facility should be important.  This can signify to you that the facility takes their job to the next level.  They are holding themselves to a higher standard.  The accredited maintains practices that you as a patient can have confidence that you are receiving the best treatment that is out there.  As a patient, you can rest assured you are receiving your ultrasound by technicians who have taken tests focusing on all imaging aspects of the vascular system.  You are also receiving consultations and treatments by doctors who have performed a certain number of exams each year as well maintaining current knowledge in their field.

As previously stated the varicose vein market has grown largely over the past few years.  There is a great way to pick out a facility for you by making sure that your choice is an accredited facility.  IVC is proudly accredited by two separate accreditation bodies.  We would love for you to come and visit us to show you why we stand out above the rest.  If our office does not work for you, do not hesitate to ask and make sure the facility you choose is accredited and held to a high standard for your best quality of care.

Everyday Mom Life

As the sun rises, so do I. Well, I’d like to wake up when the sun comes up, but being a busy mom and on the go, I’m up way before the sun most days. I find that as I have tossed and turned all night due to my legs cramping up and constantly feeling like I need to move them to get comfortable; it’s easier to wake up and get a start on the day.

I do enjoy feeling like I’m productive during the day due to an early start. I drop the kids off at school and head back to do the quick tidy up around the house.  However, I’ve noticed lately that as I start doing the dishes, laundry and cleaning I find that my legs start to swell or feel heavy. I push through it thinking that I’ll get a head start on dinner.  I sit down and look through the recipe book thinking of something new to cook, I notice that the pressure from my legs feels a little more relaxed and even more so if I prop them up on the chair beside me. Creamy chicken over rice sounds good, but I need a fresh vegetable to go along with it and I’m fresh out.

Grocery shopping, I have gotten to where I don’t even go much anymore. I find that the lines are horrible and standing on my feet so long, tends to make my legs look like the spaghetti squashes that I’ve purchased for dinner. I stand in line looking like a weird lady with consistent itching because of the swelling. People probably look in my cart just to make sure I’ve got some sort of lotion or anti-flee cream because the itching gets so out of hand.

I feel much better as I’ve gotten home and dinner is in the oven and I can get off my feet.  I might even try that new “personal time” idea that people keep raving about, maybe I can get a few minutes in before the kids get home. I still want to try to be productive and so gardening has become quite the therapeutic activity for me lately. I enjoy the flowerbeds looking nice and doing something so monotonous helps me to relax and focus on the simple things in life, well that is before my legs start to cramp up. As I stretch them out, I realize that my ankles look about the color of the red and purple flowers I’ve purchased earlier this morning on my distracted grocery errand,  too bad It’s time to go pick up the kids from school and I won’t be able to elevate them to help the new color changes.

As I go pick up the kids, I find myself having to resituate in the car several times due to the uncomfortable aches I feel in my legs. Maybe I should have them checked out at the Vein Center that my friend went to; I mean after all she was thrilled with the treatment and their polite staff.

It’s part of the natural anatomy for women’s bodies to change and not work as they did in the earlier years. In fact, most busy women experience the symptoms talked about above, even if they aren’t in that specific stage of life. Taking time to notice what your body is trying to tell, is critical in helping you to live the quality of life that you want to. If you notice any of these symptoms above, you may want to think about getting set up for one of our free screenings here at IVC.

What To Expect During Your Ultrasound

Some very common questions new patients have when they come in for their first appointment are “What are you looking for? How can you tell if I have varicose veins?” Ultrasound is excellent for diagnosing varicose veins and is used throughout the treatment plan. Patients can expect to have an ultrasound at all of their appointments.

When the exam is started, the sonographer adjusts the bed to what’s referred as the Reverse Trendelenburg position, which is with the foot of the bed much lower than the head of the bed. This simulates standing, which increases venous pressure on the legs, and the blood flow patterns can be evaluated more accurately than laying down flat on a bed, which creates 0% hydrostatic pressure and the flow patterns would be minimalized. The patient does stand for part of the ultrasound when the back of the legs are being evaluated.

The sonographer evaluates all the deep and superficial veins in the legs. The legs are checked for any superficial or deep blood clots. The starting and ending point of all the veins are evaluated, and the flow checked for reflux. Reflux in the veins is when blood is going in the wrong direction (towards the feet) when it should be flowing up towards the heart. The heart pumps the blood from the arteries to the

Reflux in a vein identified using color doppler.

extremities, and the veins take the blood back to the heart. The amount of blood returning to the heart varies at any moment, as this is achieved by breathing. When there is increased abdominal pressure, for instance, taking a deep breath, the diaphragm presses down on the lower venous system, decreasing flow, just for a moment, and when breath is exhaled, the pressure is released from the lower venous system, and the blood rushes back to the heart. This happens over and over.
There are valves throughout the veins, and when there is increased pressure on the veins, the valves will stop the blood from going back to the feet. When you have Chronic Venous Insufficiency Syndrome, the valves have stopped working and every time there is increased abdominal pressure, the valves won’t hold the blood where it is, and it all rushes towards the feet. This phenomenon can be visualized on ultrasound by using Doppler, which can tell what direction the blood is flowing. The sonographer has the patient reproduce this through the Valsalva movement (bearing down) multiple times throughout the procedure. This is how venous disease is diagnosed.

A week or so after the procedures another ultrasound is performed, this time to check for vein closure and to make sure there are no complications or blood clots. After several months the body has absorbed the vein and it is not visible on ultrasound anymore.

Ultrasound is a very useful modality in the diagnosis of varicose veins and has revolutionized the treatment and management of Venous Insufficiency Syndrome.

Summer Is Here!

For this blog I would like to get away from posting about insurance and the issues we find such as high deductibles, insurance requirements, and the struggles that may be found with treatment of painful varicose veins. Instead, I would like to focus on summer fun and have you refer back to my past posts that may help you with some insurance questions. I am ready for any questions you may have with insurance and treatment of your varicose veins. If you find your veins have affected your summer fun, come see us so next summer will be even better!

Summer brings shorts, swim suits, boating, pool time, parks and many more fun activities. Along with the fun in the sun with family and friend comes food, I would like to share a recipe that I had at a barbeque a couple years ago. It’s a little different than the usual picnic dish. I hope you all enjoy it as much as I have.

Frito Salad

1 chopped red onion
1 chopped red pepper
1 chopped green pepper
1 chopped orange or yellow pepper
1 can kidney beans
1 can black beans (all canned product drained)
1 can black eyed peas
2 cans corn
1 ½ – 2 cups may
2 bags Chili Cheese Fritos – don’t add until serving time

What is Pelvic Congestion Syndrome?

Pelvic Congestion Syndrome is a condition where there are varicose veins in the lower abdomen and pelvis. Many women are affected by this condition, but may not know that their pelvic pain, heaviness and pressure are caused by varicose veins.

Symptoms

Symptoms of Pelvic Congestion Syndrome (PCS) are: heavy, achy, (anywhere from a dull ache to significant achiness), and/or pressure in the pelvis, pelvic pain that gets worse during a woman’s cycle, leg pain that accompanies the pelvic pain, back pain, and pain after intercourse.

Diagnosis

In our office, a Nurse Practitioner, Physician’s Assistant, or Physician will discuss pelvic symptoms with you. They will determine whether you present with pelvic congestion syndrome symptoms and order an ultrasound to look for varicose veins in the pelvis, labial area and upper thigh. This gives information regarding the sizes of the varicose veins in the pelvis and whether they have propagated to other parts of the body. Once these veins are found, they will also order a CT scan to show the origin of the varicose veins.

Treatment

For treatment of pelvic varices, the doctor will perform a pelvic venogram.
Embolization of a vein: After using an anesthetic to numb a small area of the neck, doctors make a small incision there. Then, they insert a thin, flexible tube (catheter) through the incision into a vein and thread it to the varicose veins. They insert tiny coils, into the vein to block the flow of blood into these varicose veins.

Sclerotherapy: Occasionally, due to the size or position of the veins, the doctor may need to inject the veins with a chemical to close the varicose veins along with the embolization.

Follow Up

We always follow-up with the patient approximately one month post venogram to see if some you the patient’s symptoms have resolved. It may take 1-2 menstrual cycles before significant relief is noticed. Most women we have seen in the office for their post venogram follow-up have described some cramping for the first few days post procedure, and with significant relief in the weeks and months after.

Read More: Pelvic Congestion Syndrome

How Do I Talk To My Doctor About Varicose Veins?

As an ultrasound technician, I have the opportunity to spend a good amount of time with our patients. Something I hear over and over again from our patients is they have been suffering from varicose veins for some time and they are frustrated their doctors did not send them to seek treatment sooner.
I have seen so many patients who have been amazed by the relief they receive after vein treatment. Another common thing that I hear is I wish I would have known about this sooner. With that in mind I have decided to share some ways in which you can talk to your doctor about varicose veins.

Discuss Your Varicose Vein Symptoms

First thing that you need to do is speak up! Your doctor wants to know about your symptoms. Before you visit your doctor take some notes on how your feeling. Make notes on how your legs or pelvis feel (tired, achy, heavy, etc) and if there is anything that you do that makes it feel worse or better (standing, sitting, exercise, etc). Always remember you can never give too much information when you are trying to diagnose a reason for symptoms.

Explore Treatment Options

Second step is to discuss treatment options. When it comes to varicose veins there are treatment options. If you have pelvic varicose veins you could do treatment through hysterectomy or you could have a procedure done where varicose veins are closed in the pelvis. Within the leg there are a few treatments ranging from injections or laser on spider veins to heating and closing the vein and potentially removing varicose veins. Sometimes varicose veins are connected to open ulcerations on legs. When there are open ulcerations on the leg sometimes treatment with wound care needs to be part of the discussion.

Lifestyle

Third and final suggestion is discussing lifestyle changes. Sometimes you are not ready for treatment of varicose veins and you would like to treat conservatively. This can be accomplished thru suggestions for low impact exercises, prescriptions for compression socks, ideas to alternate standing and sitting at work, or similar conservative actions.

In the end the best suggestion I can give is to never be afraid to begin an honest conversation with your doctor. Never hesitate, a doctor can not treat what they do not know as a problem.

What is Superficial Venous Thrombosis (SVT)?

Superficial venous thrombosis (SVT) is an attack of blood clots in the veins that are just under the skin surface within the fat layers. SVT is something that can reoccur and is a common medical issue. The percentage of patients affected by SVT is unknown and it affects both women and men equally. SVT produces an area of redness and warmth on the skin surface with associated pain and firm lumpiness under the skin. Swelling can be seen but is not always present. Ultrasound and physical findings are used to diagnose SVT.

Etiology

The cause of SVT is not always known or easy to find. A common cause is recent injury or trauma to the area affected. There is a large number of patients who have a hypercoagulable state or a clotting problem. Identifying the clotting problem may change how your physician may treat the SVT.

Treatment

Mild pain medications such as Tylenol and Ibuprofen will help with the discomfort from the SVT. Warm compresses over the affected area and the use of compression stockings will also help. If the SVT is in the upper thigh or near the deep veins more aggressive treatment may be needed such as anticoagulation.

Conclusion

Most cases of SVT go unnoticed or are not taken seriously and resolve on their own within in few weeks. Treatment is most often conservative if found by your physician and the SVT will eventually resolve with time.

Insurance Terms and Coverage Explained

Insurances can be very confusing when it comes to healthcare, but don’t worry. At IVC, we go over your insurance coverage to help you understand what they will cover for your medical procedures in our office. So when you leave our office, you will have a better understanding of the cost for treatment as well as budgeting and financing for your health.

Do I pay monthly, or yearly?

Premiums, those are set amounts that individuals pay each month, to have insurance coverage. Think of it like your electric bill, you need to pay the bill each month to have electricity in your house. A premium works the same way; it’s a set amount of what you pay each month.

Deductibles –whatever that means

Next is your deductible. Deductibles are amounts that an individual will have to pay before their insurance will even start to pay. Sometimes depending on the benefit plan, insurances will waive the deductible and just make you pay coinsurance. Deductibles can be tricky, because oftentimes insurance plans can have a family deductible, individual deductible or even both. Deductibles range in amounts and oftentimes people think that once they have met this amount they will be covered at 100%, but it is often not the case.

Insurance Plans

Coinsurance is usually the amount you have contracted with the insurance to pay for your visits. Insurances pay a certain amount and leave the patient with their contracted or co-insurance amount. Let’s look at the 80/20 plan, insurances would pay 80% of the bill and the individual would be left with 20% of the bill. Coinsurance seems pretty self-explanatory, but there are more small facts inside of a plan. Insurance plans can range all over- from a non-covered benefit, meaning the patient would be most likely left with the full amount, to having 100% of their treatment or plan covered.

Out of Pocket Max, or Max out of Pocket?

The Out of Pocket Max is another limit that you have worked towards throughout the year before the insurance will pay 100% of your procedure costs. Out of Pocket Maximums can range in the amount you will pay per year. A maximum is typically the most money you would pay for your health care per year. Just think that if you’ve maxed out, you’ve reached your limit.

Out of network benefits or in-network?

Going to the doctors contracted with your insurance is always a smart idea. To have benefits in-network means that your insurance is contracted with a provider and both parties have agreed to negotiated rates. Oftentimes you will end up paying less to go to the contracted provider. To have an Out of network rate, means that your insurance will allow you to go to providers that aren’t contracted with them. However, the provider is not obligated to take that negotiated rate and the patient can be left with their out-of-network percentage and the adjustment amount that typically is written off by a contracted provider. Most of the time, insurances will pay a lower percentage of your visit, as compared to a visit paid at a higher rate with a provider that is in network.

March is DVT Awareness Month

What is DVT?

DVT or deep vein thrombosis is a blood clot that develops, usually in the legs. Blood clots impede blood from flowing back to the heart, they can be dangerous if part of it breaks loose and travels to the lungs, where it blocks one or more arteries in the lungs. Approximately 1 in 1000 people will develop DVT in their lifetime.

Risk Factors

There are 3 main factors to consider when DVT is in question. Venous stasis (stagnant/sluggish flow), hypercoagulability (thick blood), and damage to the lining of the blood vessel wall (trauma, surgery). These 3 factors are collectively called Virchow’s triad, named after a German pathologist Rudolf Virchow. Various medical conditions put you more at risk for developing a blood clot; they include but are not limited to, recent surgery, pregnancy, cancer, and trauma.

Signs

Signs of a DVT include swelling of the leg, pain, and redness. Many people don’t show any signs or symptoms.

Diagnosis

Ultrasound is the gold standard for diagnosis of DVT. Using real time imaging, the deep veins are evaluated, flow is assessed using Doppler, and a diagnosis is made. Ultrasound is inexpensive, relatively painless, portable, and does not use ionizing radiation. Ultrasound has dramatically improved the diagnosis, treatment, and outcome of DVT.

Prevention

Compression socks help people who are at risk of DVT, they help with the return of blood flow to the heart. Walking and being active also help prevent DVT because exercise uses the muscles of the legs to help force blood back to the heart and keep it circulating. This is why medical professionals want patients up and moving as soon as possible after surgery, this way the blood does not stay stagnant in the veins, increasing the risk of clotting.

Treatment

The most common treatment of DVT is anticoagulation therapy and the use of compression socks. In some cases, thrombolysis is the best treatment option. This is where the radiologist accesses the vein, and mechanically removes the clot. For high risk patients, or patients with multiple episodes of DVT, there is also the option of an IVC filter, basically a filter that is put in the inferior vena cava, the vein that returns blood to the heart in the abdomen. This filter will catch any clots that come loose, and this prevents pulmonary embolism.