Vein Treatment Information

Most cosmetic physicians in Arkansas now offer the latest treatment for spider veins. Spider veins, unfortunately, are quite common in women. They may appear as a maze with very fine lines resembling “tree branches”. They chiefly occur on the thigh area but can occur on the face, calves and ankles. Because of the blood they contain, they are quite prominent in light skinned individuals. Unlike varicose veins, spider veins are generally not associated with any symptoms. Some women may just have a few spider veins, whereas others may have multiple veins. No one is immune from spider veins and women of all cultures and ethnic background develop them. Why spider veins occur is not known but has been linked to increased pressure in the veins.

Can spider veins resolve on their own?

Spider veins in general do not disappear once they have formed. They are too minute to cause any pain or muscle aches. In all women, spider veins are only of a cosmetic nuisance.

How does one treat spider veins?

The available treatments for spider veins in Arkansas cosmetic clinics include:

- sclerotherapy
- laser

Can Spider veins be cured?

There is no permanent cure for spider veins. One can, however, prevent them from recurring (see below).

Are lasers used in cosmetic clinics in Arkansas?

Yes, Laser therapy is widely used by most cosmetic physicians in Arkansas. It is the most effective therapy to treat spider veins. Most of the health care workers in Arkansas believe that the results of laser therapy are second to none and highly recommend it. Laser treatment cuts down on the time to do the procedure, is less painful and does not involve taking time off work.

How does laser treatment work?

There are a variety of lasers but they all work in a similar fashion. The laser generates heat which permanently destroys the spider vein. The laser is very selective for the blood pigment and does not harm the surrounding tissues. Depending on the number of spider veins, you may require 2-3 sessions for the full benefit of the laser.

Can sclerotherapy be used to treat spider veins?

Yes, sclerotherapy is widely used by most cosmetic physicians in Arkansas. Sclerotherapy is a much older treatment of spider veins compared to lasers. The technique of sclerotherapy involves injection of an irritant chemical into each spider vein. The chemical causes the vein to collapse and eventually disappear. Unlike the laser, sclerotherapy takes a little longer and involves multiple injections- which can be mildly painful. After the procedure, a compression bandage is applied which must be worn for 5-7 days.

What is the best treatment for spider veins?

Most cosmetic physicians believe that the laser produces better and faster results. The laser is also less painful and does not involve the use of any injections. The laser causes less bruising and most people can return to work in 1-2 days. The only negative about laser is the cost- it is slightly more expensive than sclerotherapy.

Who treats spider veins?

Most cosmetic clinics in Arkansas have well trained physicians and other health care professionals who are well acquainted with the treatment of spider veins. Today, both sclerotherapy and laser are available in most cosmetic clinics in Arkansas. At your first visit, you will be examined and the merits of each therapy will be discussed with you.

Do spider veins need to be treated urgently?

No. spider veins are of only a cosmetic concern and the treatment can be done anytime when you are ready.

Can one have spider vein treatments during pregnancy?

No, it is highly recommended that you deliver the baby and wait a few months before treatment.

How can I prevent spider veins?

Prevention is the only cure for spider veins. Preventive measures should include:

- avoid standing for long periods
- get a pair of decent compression stockings
- be active and exercise daily
- if you are overweight, try and lose some weight

Does insurance cover spider vein treatments?

No. Spider veins are considered cosmetic in nature and the cost of treatment is not covered by any insurance carriers. The cost of treating spider veins ranges from $200-400. Most cosmetic clinics in Arkansas will, however, make all necessary financial arrangements to help you get your treatment.

Spider vein treatments in Atlanta are available in most spas and cosmetic clinics. The four most common treatments for spider veins include:

Camouflage: There are numerous creams available to hide the spider veins. There are no creams which can get rid of spider veins. Camouflage may be a good short term alternative in an individual who is undecided about treatment. In the long run, camouflage creams can be expensive.

Compression stockings: A decent pair of compression stockings can help prevent spider veins. The existing spider veins are not affected by stockings. The only disadvantage of compression stockings is the hot weather in Atlanta.

Sclerotherapy: This procedure requires the injection of each spider vein with an irritating chemical. The injections are performed with a very fine needle and do sting a little. Each spider vein must be injected to remove it. After the procedure, some type of compressive garment or stockings are worn for a few days. The compression prevents excessive bruising and swelling after the procedure. At most, 20-25 spider veins can be treated in each session and most individuals require a couple of session to completely eradicate the veins

Laser: The development of laser technology has been refined and now hand held probes are available for use in cosmetic surgery. The probe is aimed at the spider vein and fired. The heat from the laser coagulates (gels) the blood and causes collapse of the vein. Over time the vein shrivels up and disappears. The advantage of laser over sclerotherapy is that it is fast, less painful and does not require much time off work. However, the laser is also more expensive.

Is there a cure for spider veins?

No, neither laser nor sclerotherapy can permanently cure spider veins. All treatments are associated with recurrence of new spider veins sometime in the future. The best treatment for spider veins is prevention

What is the cost of spider vein treatments in Atlanta?

The cost of laser and sclerotherapy range from $ 200-400 per leg depending on the number of spider veins.

In the normal individual, there is a delicate balance in the blood system governing formation of blood clots. In simplicity, blood clots are a combination of some blood factors which in real life look like “jelly”. Blood clots are useful to stop bleeding and help healing. The body has mechanisms to dissolve the clots once they have provided their function. Sometimes these blood clots persist and can cause problems.

Where can blood clots occur?

Blood clots can occur in both arteries and veins. Blood clots can occur in any artery or vein. When it comes to the veins, only blood clots in the deeper veins are of medical significance. Blood clots in the superficial veins (varicose veins) are of little medical significance.

What are arteries?

Arteries are muscular blood vessels which supply oxygenated blood to the body. The largest of the artery is the aorta and it comes off the heart. Along its way, it gives off many branches, some of which go to the brain, arms, kidney, spinal cord, legs, groin, etc.

Can clots occur in arteries?

Yes, blood clots can and do occur in arteries. Because arteries supply oxygen to the body, blood clots can block the artery and hence disrupt oxygenated blood to the tissues. This is what happens in a heart attack. Blood clots in the arteries can block blood supply anywhere in the body and often occurs in the brain, legs and kidneys. In most cases, urgent treatment is required to remove the blood clot from the artery.

What are veins?

Veins are thin walled vessels which play a role in removing all the deoxygenated blood from the tissues and taking it back to the lungs for oxygenation. They are numerous veins all over the body; the largest vein is called the inferior vena cava.

Can blood clots occur in veins?

Most definitely, clots are far more common in veins than arteries. When clots occur in veins they have a tendency to break off and move to the lungs where they can compromise breathing. Clots can occur in both the arm and leg veins.

Where do blood clots in veins usually occur?

The majority of blood clots in the veins occur in the legs but they can occur in any veins in the body.

What happens when blood clots move to the lungs?

The lungs are important for gas exchange. When blood clots move into the lungs, they can block the airways and prevent this gas exchange. If the clots are large, one will have difficulty breathing and deaths are not uncommon.

Are blood clots in the veins common?

In the United States, about 2 million people per year develop blood clots. Most of them are aged 40 years or older. Statistics reveal that at least 200,000 patients die each year from blood clots in their lung.

How do I know if I have blood clots?

It depends where the blood clot has formed. In most cases, it is the legs, especially the calf area. You may have some of the following symptoms:

a. heaviness of the leg
b. tenderness in the calf area
c. swelling in the calf area
d. warmth near the calf
e. at least 30% will not have any symptoms

What causes blood clots in the veins?

There are many reasons why blood clots can form in the veins. These include

- Prolonged immobility (after surgery)
- Long airplane ride
- Taking the birth control pill
- Trauma or fractures of the legs
- Injury to the veins
- Cancer
- Stroke- which has caused one to be bed ridden
- After any surgery- especially hip and knee
- Obesity
- Congestive heart failure
- Pregnancy or just after delivery
- Inherited blood disorders
- Prior blood clot –there is increased chance of a second clot if one has had a previous blood clot

Are blood clots dangerous?

Most definitely. Any time you have one of the above symptoms; one should go and see a doctor. Blood clots in the veins have a high tendency to break off and migrate to the lungs where they can cause serious problem’s including death.

How can blood clots in veins be detected?

Your physician will first examine you and order the most appropriate tests. The first test to detect blood clots in all cases is:

Doppler ultrasound: This painless test takes a few minutes and can easily detect the presence of blood clots in the arm and leg veins. However, if blood clots are located in the chest, abdomen or pelvis, Ultrasound is not good enough.

MRI: This non invasive test is also excellent for evaluating the presence of blood clots. The test does not use radiation but is slightly more expensive. It is useful for detection of blood clots almost anywhere in the body, but is not the first test of choice.

Venogram: In the old days venogram was used to look for blood clots. However this test is rarely used to day because of the availability of US and MRI. Venogram requires the use of a dye and radiation.

CT scan: The newer CT scans can easily identify the presence of clots in the lungs. However, CT scans are not routinely used to detect for blood clots as the initial test. CT scan requires exposure to radiation and use of an iodinated dye.

What is the treatment of a blood clot?

If a blood clot is found, you will require admission to the hospital for at least 4-7 days. Following some blood work, you will be started on:

Heparin: This is a blood thinner which is given intravenously. It does not dissolve the clot but helps to stabilize the clot so that it does not move. After a few days, you will be started on an oral medication called warfarin and then discharged home. Anyone who receives warfarin needs their blood assessed on a weekly to monthly basis to ensure that the blood thinning is adequate.

How long do I need to take a blood thinner?

For a first time blood clot, you will need to take warfarin for at least 6-9 months. Those with recurrent blood clots will require warfarin for an indefinite time.

Are there any other medications one can take for blood clots?

Yes, the newer medications are called low molecular weight heparins (LMWH). These medications do not require monitoring and can be taken at home. Unfortunately they need to be injected daily and are more expensive.

Is there a risk from taking these medications?

Yes, all blood thinning medication can cause bleeding. Thus one should avoid activities that can lead to trauma to the body, otherwise severe bleeding can occur.

Are there any medications to dissolve the clot instantly?

Yes, there are medications (thrombolytics) which can rapidly dissolve the clots. However, there are specific indications for the use of these medications and they all carry a higher risk of complications. Their use is only limited to hospital patients.

Is surgery ever used to treat blood clots?

Yes, in the rare case surgery (thrombectomy/embolectomy) is sometimes used in the treatment of blood clots. However, this is done for life or limb threatening cases only. There is no role for surgery in the routine treatment of blood clots.

What happens if I am unable to tolerate a blood thinning medication?

There are devices (filters) which can be placed in the body to prevent the blood clot from moving to the lung. These devices have an umbrella like appearance and do not dissolve the clot but prevent it from going to the lungs. Filters are more commonly used in individuals who can not take blood thinners. They cost as much as a BMW and so their use is limited and they are only a temporary solution.

Can blood clots be removed from the lungs?

The first choice for treating blood clots is medication. However, in some individuals the blood clot may have completely blocked the lungs and cause severe breathing problems. In such cases, surgery (pulmonary thromboembolectomy) may be done to remove the clot from the lungs. This is life saving surgery and is of extremely high risk

How can I prevent blood clots?

The best methods of preventing blood clots include:

- Being active, walking on a daily basis
- If flying or driving a long distance, walk around every few hours
- Wear compression stockings
- Lose weight
- Avoid prolonged standing
- Avoid the birth control pill

Is there any home treatment for blood clots?

Yes, after you have been started on a blood thinner, one can relieve the symptoms by:
- elevating the leg which will decrease the swelling and pain
- Avoid standing for long periods
- One can apply a warm compress if there is a blood clot around the legs

Final advice

For those with a blood clot and taking blood thinning medications, one should wear a medical bracelet to alert all health care professionals.

Veins exist in all parts of the body. There are two sets of veins in the legs, superficial and deep. The superficial veins connect to the deep veins by small vessels (perforators). The deep veins are not involved in the formation of varicosities. The superficial veins are located just below the skin and may be slightly visible. All leg veins have valves which open and close. The function of all veins is to return the blood back to the lungs. However, occasionally the superficial veins in the leg develop varicosities.

In general, superficial veins in the legs are very thinned walled and have little muscle. They do not have much capacity to tolerate any type of high pressure in them. Varicosities can develop any time when the superficial veins are exposed to high pressures. The high pressures cause distension of the veins and thus the valves can no longer close snugly. This leads to engorgement of the veins with blood and hence to varicosities. If for some reason the small veins connecting the deep and superficial veins are damaged (usually from a blood clot), the superficial veins will then be exposed to slightly high pressures.

Any condition that either damages the valves or the superficial vein and/or causes high pressures will lead to the development of varicose veins.

The most common causes of varicose veins include:

Age: As we age our veins start to weaken and the valves start to wear down. The elasticity of the veins and the thin muscle layer around the vein starts to weaken and the veins can no longer push the blood out. The wear and tear of the veins with age, eventually leads to enlargement of the veins and development of varicose veins.

Trauma: Any trauma to the legs can injure the superficial veins and later on lead to development of varicose veins. Trauma may injure the valves or the veins itself. Most individuals who have had leg trauma usually have life-long swelling of their legs.

Estrogen: The female sex hormone, estrogen, is associated with an increase in the incidence of varicosities. Estrogen is thought to cause thinning of the veins and valves. This leads to collection of blood in the veins. This may be one reason why more women than men have varicose veins.

Obesity. In general, varicose veins are more common in obese individuals. The reason is believed to be due to the excess weight and fluid. The veins do not have a lot of capacity to endure the persistent high pressures and eventually varicosities result.

Pregnancy: Pregnancy is a very high risk for the formation of varicose veins. Women are particularly susceptible to varicose disease because the thin vein walls and valves get distended under the influence of fluid, weight gain and the sex hormones. Over time the sex hormones weaken the vein and soften the valves. Late in pregnancy, the enlarged uterus compresses the veins in the pelvis and exerts a significant pressure on the leg veins. All of this leads to development of varicose veins. Once varicose veins have formed during pregnancy, they never disappear. In fact, women with multiple pregnancies, usually develop the visible “rope like” varicosities along the entire leg.

Genetics: Varicose veins do tend to run in families. If one member of the family is affected, the chances are high that other members of the family may also develop varicose veins.
Idiopathic: Some individuals develop varicose veins despite having no risk factors or in the absence of any elevated venous pressure. This is what is known as “bad luck”.

Straining: There are some individuals who have constant high pressure in the lower abdomen. Conditions like chronic constipation and persistent coughing tend to increase the venous pressure in the groin area. This persistently increased abdominal pressure may be responsible for varicose veins. Hemorrhoids (type of varicosity) are a classic example of a disorder which is developed by constant straining.

Standing: Prolonged standing is known to be associated with development of varicose veins. When standing in one position, the leg muscles do not work and the veins are not able to push the blood back to the heart. The prolonged standing leads to increased venous pressure in the legs which slowly weakens the valves; leading to the development of varicose veins.

Blood clot: Anyone who has developed a prior blood clot in the leg veins is more susceptible to development of varicose veins. The blood clots may occur anywhere along the vein and they destroy the valves in the veins. The majority of individuals with a prior blood clot in the legs tend to have persistently enlarged legs with marked varicosities.

There are many companies which make compression stockings. The company is renowned for the numerous products it makes particularly in the field of blood clot prevention.

What is so particular about Jobst stockings?

Jobst makes both gradient compressions socks and stockings. The stockings are designed so that they deliver pressure at the ankle which decreases gradually along the leg. The graded pressure in the stockings allows for the blood to be moved along the leg back to the heart. The stockings mimic the muscles of the leg. When worn on a daily basis, these compression stockings prevent swelling of the feet and reduce the chance of clot formation.

Why do these stockings have a pressure gradient?

Most veins have little muscle and elasticity and are unable to actively push the blood back to the heart. Veins rely on the contraction of nearby muscles to squeeze them to drive the blood. When individuals are standing around for prolonged periods or when someone is bed ridden, the muscles remain inactive. This inactivity of the muscles leads to pooling of the blood in the legs. Compression stockings mimic muscle actions and by having a pressure gradient they slowly move the blood from the ankles up to the heart. Jobst was one of the first companies to design such compression stockings.

What is economy class syndrome?

Many individuals can not afford to fly first class and so the majority of us fly economy class in cramped seats. When flying for prolonged periods in these cramped positions, the blood starts to pool in the legs and can lead to formation of blood clots. Wearing compression stockings is an excellent method to not only prevent blood clot formation in the legs but also prevent the leg swelling and fatigue after a prolonged flight.

How are Jobst compression stockings fitted?

Some individuals who buy Jobst stockings are seen by a health care professional who will measure your ankle and calf size before recommending a pair of stockings. One should have a good fit to get the best comfort and function from these stockings. Never buy stockings based on how attractive they look. Properly fitted stockings deliver the most effective gradient to prevent blood clots.

Are Jobst compressions stockings attractive for daily wear?

Those days when compression stockings were made of thick fabric and appeared ugly are over. Jobst stockings are designed with sheer, thin and very attractive fabric to allow both men and women to wear these stockings, whether it be at home or office. Jobst stockings are attractive, come in various colors and styles.

What are uses of Jobst compression stockings?

The stocking may be worn in the management of:

Spider veins
Varicose veins
Leg swelling
Lymphedema
Post phlebitic syndrome
Long air travel

What gradients are Jobst stockings available in?

Jobst Gradient Compression Hosiery products are available at three ranges of gradient compression:

15-20 mmHg
20-30 mmHg
30-40 mmHg

The type of gradient will be based on the venous disorder you have.

Can Jobst stockings be used to treat lymphatic disorders?

Definitely yes, Jobst stockings can be worn to treat all types of lymphedema.

Are Jobst stockings only for females?

No. Jobst has a full array of compression socks and support stockings especially designed for Men. The stockings come in all compression ranges as well as a wide variety of colors and length. The Jobst men's support stockings have been designed for comfort wear and the newer varieties of the stockings also contain a chemical to prevent foul odor in the feet.

How long should compression stockings be worn?

For the best results, the stockings should be worn daily. Most physicians recommend that stockings should be worn during the day and can be taken off at night. For those individuals with lymphedema or venous ulcers, the stockings have to worn for life. It is highly recommended that whenever possible, you keep your legs elevated at night when not wearing the compression stockings.

What is so special about Jobst compression stockings?

They are attractive and function well
They are easy to wear
They do not compress the toes
The heel area is reinforced to make them durable
They contain an antibacterial product to eliminate foot odor
They are available for both knee and thigh wear

Does one need a prescription to buy the stockings?

A prescription is only necessary for some stockings, depending on the compression.

What is the major disadvantage of compression stockings?

All compression stockings are hard to get used to. They do feel warm and the hot weather may make wearing for prolonged periods intolerable. The best way to get used to these stockings is to start wearing them a few hours daily and gradually increasing the number of hours.

What is the cost of Jobst Stockings?

Depending on the size, gradient and style, Jobst compression stockings start from $ 45 and above. Some even cost about $100. Always buy one pair initially and see if this is what you like.

An estimated 40-60 million Americans are believed to be suffering from varicose veins. It is estimated that nearly 30-50% of women will have some degree of varicose veins after the age of 20. These varicose veins are more visible near the thigh area and sometimes occur just behind the knee. Even though not all individuals have symptoms from varicose veins, almost all of them complain about their unattractiveness.

California boasts of more Veins Clinic and Physicians who deal with varicose veins then any other State in the country. And most of these cosmetic physicians offer the latest in varicose vein treatment.

Why should varicose veins be treated?

Many individuals who have varicose veins have no symptoms. But there are also a fair number of individuals who do have symptoms. In most cases if the varicose veins are left untreated, symptoms will occur. The typical signs and symptoms of varicose veins include:

Cosmetic: Many individuals will complain that the varicose veins are ugly and unattractive. Many individuals also feel a sense of embarrassment at having unsightly varicose veins. The longer the veins are left untreated, the worse is the cosmesis.

Pain: Another very common complaint is pain and aches in the leg. The pain is all over the leg and is worse at the end of the day. Others will describe a feeling of a heavy leg or a sense of constant fatigue. Many individuals will describe other sensations such as a burning, throbbing, itching and cramping all over the leg.

Discoloration: If varicose veins are left untreated, a dark pigmentation around the ankles is a very common finding. This darkening is also associated with changes in skin texture and dryness. This does not reverse even after the varicose vein is removed.

Ulcers: Long standing varicose veins are notorious for causing ulcers which are painful. These ulcers tend to seep fluid constantly and are almost impossible to heal.

Phlebitis: When blood clot formation occurs in the varicose veins, it causes irritation of the vein. The irritation of the vein can lead to pain and tenderness along the entire leg. Some individuals may also develop a fever and have difficulty walking. The condition usually resolves in 2-4 weeks.

Swelling: Swelling of the leg especially around the foot and ankle is common; the swelling is worse after standing for prolonged periods. It usually resolves after elevating the leg.

What is the problem with varicose vein treatment?

Despite many years of experience, there are still many reports of varicose vein recurrences. This has been suggested to be due to inadequate investigations before treatment. In addition, we still do not have a cure for varicose veins.

How is diagnosis of varicose veins made?

The majority of Physicians in California use ultrasound to confirm the diagnosis of varicose veins. The test allows one to asses the valves in the veins and also for the presence of any blood clots

What options are available for treating varicose veins in California?

There are numerous options available for the treatment of varicose veins. The treatment is dependent on the presence of symptoms, the degree of varicose veins, available facilities and experience of the physician. The available treatments include:

Vein stripping: Vein stripping is one of the oldest procedures to treat varicose veins. Vein stripping is done under general anesthesia and requires 2-3 small incisions to remove the entire vein. After the procedure, a compression bandage is worn for a few days. The procedure is mildly painful and requires at least 5-7 days off work. The procedure is best for individuals with large varicose veins which are prominent and extend all the way from the groin to the ankle. When done well, the chance of recurrence is very low.

Ambulatory phlebectomy: Phlebectomy involves the removal of moderate to large varicose veins underneath the skin. The procedure does require anesthesia and numerous skin incisions. Specialized hooks help remove the varicose veins. A compression bandage is worn after the procedure. The procedure does leave numerous skin scars.

EVLT: This newer procedure called endovenous laser treatment (EVLT) is now widely used all over California. The procedure is fasting being accepted as an alternative to surgical stripping of the vein. A small laser probe is passed into the vein and the heat generated destroys the vein. The vein eventually collapses and shrinks. The procedure is done in a clinic setting and takes about 20-30 minutes. After the procedure, a compression bandage is worn for a few days; Short term results indicate that it is an effective procedure with good results.

Closure procedure: This is essential the same as EVLT but uses radiofrequency thermal heating to treat the varicose vein. The radiofrequency probe heats the inner lumen of the vein with subsequent scarring and closure of the treated vein. The procedure is performed in a clinic/office setting and does not require general anesthesia. The procedure usually takes 20-30 minutes. Possible side effects of the procedure include pain, redness or skin burns. The majority of these mild side effects resolve over a few weeks.

Trivex procedure: In this procedure, veins are visualized underneath the skin with a camera and removed with specialized instruments. The procedure does require anesthesia and multiple incisions. The potential advantages of the TriVex System over other methods have not been proven.

Compression stockings: In individuals who have no symptoms and are unsure about surgery, compression stockings may be the ideal treatment. The stockings come in various colors and sizes are effective in prevention of symptoms. However, the stockings must be worn daily to be effective.

Is there a role for herbs and nutrients in treating varicose veins?
Varicose veins are not affected by any specific diet or herbs. However, eating healthy is good for the entire body.

How can one prevent varicose veins?

Since there is no cure for varicose veins, most cosmetic physicians in California recommend preventive measures to help prevent worsening of the varicosities. The essential preventive measures include:

- Compression stocking
- Leg elevation is recommended whenever one is resting.
- One should avoid standing for prolonged periods
- Exercise regularly
- Control one’s weight

Does insurance cover surgery for varicose veins?

The majority of insurance carriers only cover varicose veins if one has symptoms and have failed a trial of compression stockings. In those individuals with no symptoms, surgery is not covered as it is believed to be a cosmetic deformity. The cost of varicose vein surgery is dependent on the procedure and ranges anywhere from $200-500.

What are spider veins?

Spider veins are small veins which are located just below the skin surface. They are called spider veins because on close observation they resemble a dark center with fine radiating lines in a circular fashion. Other names by which spider veins are often known as include “star” veins or telangiectasias. Spider veins are common and most individuals (especially females) have one or multiple spider veins somewhere on their body. Spider veins are generally more common on the legs, especially around the thigh and ankle area. Even though they occur in all ethnic populations, they are most obvious in fair skinned individuals. Because of their prominent bluish color, they are considered a cosmetic nuisance by most females.

What Causes Spider Veins?

No one really knows why spider veins occur but the incidence is definitely increased by the following factors:

Age: Spider veins are rarely seen in children and young teenagers. Most individuals develop spider veins after the 3rd decade of life. As people get older, the spider veins do increase.

Elderly individuals have very friable skin and easily develop bruising and spider veins.

Genetics: There is a higher incidence of spider veins in siblings if any one of the parents or other siblings has spider veins. The pattern of inheritance is not exactly known or understood. Spider veins have not been associated with any known medical disorder.

Pregnancy: Spider veins are very common during pregnancy. This is believed to be due to the increase in body weight and retention of fluids. The increased fluid retention leads to engorgement of the veins and which causes pressure on the smaller branch veins. These small branch veins with thin walls become distended and frequently rupture. Another factor related to increased incidence of spider veins during pregnancy is the female sex hormone- estrogen. Estrogen is known to soften the vein wall and the valves which control blood flow. The stretching of the veins is believed to cause an increase in blood engorgement- which eventually leads to spider vein formation.

During the last trimester of pregnancy, the fetus may put pressure on the leg veins by compressing the lower pelvis. For this reason it is highly recommended that pregnant females lie down on their left side to prevent the fetus from lying on top of the leg veins. Multiple pregnancies are often associated with numerous spider veins which rarely resolve.

Prolonged standing: Individuals who have occupations that involve prolonged standing are more prone to development of spider veins. This is believed to be due to the increased amount of venous pressure in the legs. The muscles of the leg do not become active and this further results in the pooling of blood in the leg. The increased pressure in the large veins is then transmitted to the smaller veins on the skin, which causes them to rupture and present as spider veins.

Prolonged sitting: Individuals who sit for prolonged times are also prone to spider veins. The sitting causes inactivity of the leg muscles and leads to pooling of blood in the leg; this also causes increased venous pressure. As soon as you start to walk the blood starts to circulate and the pressure drops.

Trauma: There are numerous small fine veins underneath the skin. Any type of trauma can cause these veins to rupture and present like spider veins.

Sun: Spider veins on the face are not related to increased venous pressure. Excessive sun exposure has been associated with spider veins on the face.

Tight clothing: Wearing tight clothes, girdles or underpants with firm elastic bands can also lead to spider veins. The tight clothing limits the flow of blood and leads to increase venous pressure. The increased venous pressure in the groins and pelvis is then transmitted to the legs- which eventually leads to the formation of spider veins.
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The retina of the eye is an extremely important structure for eye sight. If the eye is compared to a camera, the retina would be the film where the “picture” is formed. Without the retina, there is no vision. For the retina to function, adequate and proper blood circulation is a must. Fine blood vessels enter the retina and provide oxygen and nutrition. The blood then leaves the retina via the vein. The central retinal vein is located very close to the eye nerve (optic nerve).

What is Central Retinal Vein Occlusion?

Central Retinal Vein Occlusion (CRVO) is caused by a blood clot in the vein that drains the blood from the retina of the eye. The artery brings continuous blood to the retina but the blood can not leave the retina because of the block in the vein. Within a short time, the blood and its fluid start to back up in the retina and start to leak around (this is very similar to dropping a camera and exposing the sensitive film to water). There is immediate loss of vision.
This condition has 2 broad categories which may overlap:

Non ischemic: The milder form of the disease is not caused by a blood clot. This may resolve fully with good visual outcome, or progress to the ischemic type.

Ischemic: The severe form of the disease is due to a blood clot in the vein. These patients are often left with a painful eye with no vision.

How often is the condition diagnosed?

Some physicians indicate that about 60,000 people develop a CRVO each year in the United States. It is a common condition in individuals over the age of 60. CRVO does not have any particular racial preference but is slightly more common in males. Even though the disorder has been reported in all ages, the majority of affected individuals are older than 50 years.

What are risk factors for CRVO?

The majority of individuals who develop CRVO may have one of these conditions:

- Hypertension
- Diabetes mellitus
- Heart problems
- Bleeding or clotting disorders
- Some type of collagen vascular disorder
- Use of birth control pill
- Closed head trauma
- Excessive alcohol consumption
- Glaucoma

How do individuals with CRVO present?

At the initial stage, some may present with
- no symptoms
- decreased vision
- sudden or gradual vision loss
- eye pain when looking at bright lights
- painful blind eye
- redness of the eye
- watering of the eye

How is the diagnosis made?

Whenever vision is altered, you will be quickly referred to an eye doctor. Workup for all eye disorders may include:

- measurement of blood pressure
- blood work
- specialized eye studies

Can one die after developing CRVO?

No, the disorder may make you blind but it does not affect your long term survival.

What is prognosis of CRVO?

If the CRVO is not associated with a blood clot, it may resolve on its own in some patients. Those with a blood clot generally progress to blurred vision. In addition, some individuals with ischemic occlusion will also develop CRVO of the other eye. This usually occurs after 2-3 years.

What happens if the condition is allowed to progress?

As the condition progresses the visual loss continues. New vessels readily develop in the eye which decrease vision and also lead to development of glaucoma (high pressures in the eye).
After a diagnosis of CRVO has been made, many patients are advised by their doctors that the vision may return on its own if nothing is done to the eye. However, spontaneous recovery of vision in CRVO is very uncommon and when it does occur, the amount of recovery is usually very small.

What is treatment for CRVO?

Today, there is no reliable effective treatment to prevent the loss of vision or to improve vision once it is lost.

What are treatment options for CRVO?

Since there is no specific treatment available for CRVO, the thrust of management is geared towards identifying and treating any systemic medical problems to reduce further complications. Because the exact pathogenesis of the CRVO is not known, various medical modalities of treatment have been advocated by numerous physicians with varying success in preventing complications and preserving vision.

What types of medications have been used to treat CRVO?

The following is a list of those advocated treatments:
- Aspirin
- Anti-inflammatory agents
- Isovolumic hemodilution (hydrate the individual with fluids)
- Plasmapheresis (remove any bad antibodies)
- Blood thinners such as heparin, Warfarin
- Thrombolytic agents (agents to dissolve clot)
- Systemic corticosteroids
- Injection of blood thinner in the eye (intravitreal)
- Injection of steroids in the eye (intravitreal)

Surgical Care: Laser photocoagulation is the known treatment of choice in treatment of CRVO. This prevents new vessel formation and may prevent further vision loss.

Is there a special diet to help treat CRVO?

Diet should be tailored to systemic medical problems.

What is the role of physical activity when CRVO is diagnosed?

There are no specific restrictions. If you do develop some type of bleeding in the eye, you should avoid strenuous activities, sleep with the head elevated and avoid bending and lifting heavy objects (the grunt and groaning can increase the pressure in the eye).

How can one prevent CRVO?

The best way to prevent CRVO is to ensure that you control any systemic disease that you have (e.g. control your BP and diabetes)
Even though controversial, good control of your glaucoma may also be helpful

Which type of physician deals with CRVO?

In general disorders of the eye are dealt with eye physicians (ophthalmologists). Because the eye is a delicate structure and disorders of the eye can have a profound affect on life, it is imperative that you see an eye doctor anytime you have visual problems.

What is the cephalic vein?

The cephalic vein is a very superficial vein located in the arm. It runs all the way from the shoulder to the hand. It runs on the side of the thumb.

What is its function?

Like all other veins, the cephalic vein takes blood from the hand to the lungs.

What are uses of the cephalic vein?

The cephalic vein is excellent for starting an intravenous line. More than 95% of the population has this vein in a standard anatomical position. The cephalic vein is a frequently used vein to start IV in hospitalized patients.

The cephalic vein can also be used to withdraw blood for analysis.

The cephalic vein is also used for the creation of an AV fistula (a connection between and artery and a vein). An AV fistula is used to dialyze patients with kidney failure. The cephalic vein is connected to a nearby artery and a fistula is established. This is the most useful fistula in the body for dialysis and when done well, can last at least 4-6 years

What problems can occur with the cephalic vein?

Phlebitis: Sometimes when an IV is started in the cephalic vein, there may be irritation of the vein either from the chemicals in the IV solution or some solution may leak out on to the skin. This can cause irritation and pain at the site of the IV catheter. Most individuals will complain of pain at the site when this occurs. Phlebitis is a temporary disorder which usually resolves with warm compress and pain control. In all cases, the IV catheter has to be removed and placed elsewhere.

Blood clots: Sometimes a blood clot may form in the cephalic vein and cause mild pain. Unlike blood clots in the leg, cephalic vein blood clots do not migrate. The blood clots generally resolve on their own and do not require any specific medication.

Infection: Sometimes the IV catheter may cause an infection at the site. Often the catheter has to be removed and the infection will subside. However, in some cases, the infected portion of the vein may have to be cut out. In most cases, a short course of antibiotics will treat the infection.

Unlike the leg veins, the arm veins rarely develop varicosities.

Problems with the veins are now being increasingly recognized and a number of physicians in Colorado are offering the latest in vein treatments. There are two basic types of veins disorders which are quite prevalent in the American population.

Spider veins are bluish or reddish networks of small veins that often resemble a “Spider’s Legs” radiating from a central darkened area. They are less than 1-2 mm and may be multiple. They are most commonly found in the thigh and ankle area. They are frequently caused by excessive pressure in the small branches of the major superficial vein.

Varicose veins are enlarged, tortuous, superficial, often painful leg veins that may occur as a result of increased pressure in the veins. The most common conditions associated with varicose veins include:

- Prolonged standing
- Pregnancy
- Being over weight
- Injury to the leg
- Genetics- varicose veins do tend to run in families

In both cases, the basic cause is increased venous pressure in the legs. The veins have thin walls and very little muscular support. Any condition that increases pressure within the veins will destroy the elasticity/valves of the veins and lead to enlargement of the veins. The end result is pooling of the blood in the legs.

Both spider and varicose veins are chronic and progressive. They do not disappear on their own. When not treated, varicose veins can lead to a number of symptoms (see below). Unlike varicose veins, spider veins do not cause any symptoms- they only produce poor cosmesis.

What are symptoms of varicose veins?

Pain: Leg pain aching, itching, fatigue, burning and swelling are common after prolonged periods of standing. Most individuals complain that the symptoms are worse at the end of the day. This is chiefly due to the pooling of the blood in the legs.

Discoloration: When varicose veins are untreated, they tend to produce a brownish grey discoloration around the ankles (Dermastasis). This occurs because the blood in the veins leaks out into the tissues. The discoloration causes the skin to become very dry and appears unsightly. It is not reversible at this stage.

Ulcers are common with untreated varicose veins. The ulcers always occur around the ankle and are quite painful. These ulcers do not heal until the high pressure system in the veins is treated. In some cases, the ulcers are permanent.

What treatments for spider veins are available in Colorado?

Spider veins can be treated with either:

- sclerotherapy
- laser
- camouflage

Surgery is never used to treat spider veins.

What treatments are available for varicose veins in Colorado?

Most cosmetic and vascular surgeons in Colorado now have available several methods of treating varicose veins. Treatment depends on the physician, his/her experience and the degree of varicose veins. The methods of treatment include:

Vein ligation & stripping: In this procedure the entire vein is stripped. The procedure requires anesthesia. It is an excellent method to treat the very large tortuous and prominent veins which extend from the groin to the ankle. However, most individuals have to take at least 5-7 days off work.

Vein ligation & Stabs: In some cases, only the smaller branches of the vein become varicosed and are easily visible along the thigh. In such cases, the small varicosities can be excised under anesthesia. The major vein is preserved. The procedure does require numerous skin incisions which may not be appealing to all individuals.

Endovenous laser guided: This method utilizes ultrasound with laser or radiofrequency ablation. In both techniques, a small probe is inserted into the vein and the vein is burnt away. Both procedures are relatively painless and destroy the vein in the thigh. Only a small amount of local anesthesia is required. This is a good procedure for individuals with prominent varicose veins in the upper thigh. It has minimal downtime.

Can laser be used to treat varicose veins?

No, varicose veins are large and not suitable for laser. Laser therapy is only suitable for the more superficial spider veins.

Can Varicose & Spider veins recur?

Yes, despite the best treatment and technique, a few branches of the vein may persist and recur. These recurrences can be easily treated with any of the above methods.

How does one prevent spider & varicose veins?

Since there is no cure for spider or varicose veins, prevention is the key. Preventive measures should include:

- avoid prolonged standing
- wear compression stockings
- exercise daily
- keep your weight under control

Who can fix spider & varicose veins in Colorado?

Both spider and varicose veins can be treated by cosmetic surgeons, plastic surgeons, vascular surgeons and dermatologists in Colorado. There are numerous spas and clinics which are operated by non physicians and it is best to avoid them for safety reasons.

Does insurance cover spider & varicose vein treatments?

Unfortunately, because spider veins are considered cosmetic in nature, the cost of treatment is not covered by any insurance companies. For those individuals with varicose veins who have symptoms, the treatment may be partially or fully covered. The cost of treating both spider and varicose veins ranges from $200-400.

What are compression stockings?

Compressions stockings also known as TED stockings (thromboembolic deterrent stockings) are now widely prescribed for the prevention of blood clots. These specialized stockings are tighter at the heel and gradually get looser up the leg. This change in pressure gradient is designed to squeeze the lower muscles in the leg and push the blood up to the heart. This squeezing action helps prevent blood clots and maintains the circulation in the legs. Compression stockings also reduce the swelling in the legs which is so commonly seen after standing around at the end of a long day. Once used only in hospitals, compression stockings are now available for home use.

Are compression stockings only for women?

Graduated compression stockings are made for both men and women, and they come in various designs such as knee highs, thigh highs, and pantyhose.

What medical conditions are treated with compression stockings?

Compression stockings are a simple, non-mechanical method of treating conditions such as:

- spider veins
- varicose veins
- lymphedema
- venous ulcers
- post phlebitic syndrome (swelling and discoloration of the leg after an episode of a deep
venous thrombosis)
- deep vein thrombosis
- prevention of blood clots in the legs

Who needs to wear compression stockings?

There are certain risk factors for the development of blood clots in the legs. It is highly recommended that these individuals wear compression stockings. The risk factors for formation of blood clots include:

- obese individuals
- those who have had a previous blood clot
- those who are going for surgery
- those planning a long car or air trip
- those who have had a stroke
- those who are on the birth control pill
- those who have just given birth
- individuals with a prior clot in the leg
- pregnancy
- individuals with cancer
- those who are bed ridden

What should I know about my compression stockings?

The first thing you need to know is the size and strength of compression. You do not want to wear something too tight or too loose. Your health care worker will be responsible for selecting the appropriate gradient of pressure for your stockings.
Stockings also come in two basic lengths: knee-high (worn up to the knee) and thigh-high (worn above the knee). As to which one is the best is not really known. The knee-high is more convenient and easier to wear. The thigh-high is slightly more difficult to put on and needs a garter belt to hold it up (as it has a habit of rolling down the leg). For the majority of individuals, the knee-high is adequate.

How do I put on compression stockings?

Initially most individuals will have difficulty putting on the stocking because all compression stockings are tighter at the foot than higher up the leg. The following guidelines may help putting on the stockings:

1. Make sure both the stocking and your hands are dry. Wear gloves if you have
a pair.

2. Lie down in bed for at least 5-10 minutes with the legs elevated (this will help
decrease the swelling in your feet and legs)

3. Insert your fingers into the stocking as far as the heel pocket.

4. Turn the stocking inside out.

5. Carefully slip your foot into the sock and ease the stocking over your heel.
Make sure your heel fits perfectly into the heel pocket

6. Gently roll the rest of the stocking over the heel up around your ankle and calf.
Do not pull on the stocking as it does not help. Gently massage the stocking
upwards using the palms of your hands.

When should I wear my compression stockings?

For the best results, compression stockings must be worn religiously on a daily basis. One should put the stockings on first thing before getting out of bed. The swelling in the legs is minimal after a night's rest and the stockings are easy to put on.

What should I do if I find the stockings uncomfortable?

If in the beginning the stockings feel too tight, wear them for a few hours each day and then progressively increase the number of hours. Stockings must be worn constantly to be effective. Breaks can be taken in between. It is essential to wear the stockings during the daytime. Night time wearing of stockings is only recommended for completely bed ridden and patients undergoing surgery. Most individuals can take the stocking off before bedtime.

If my legs are swollen, when should I wear my stockings?

For those individuals who have severe swelling of the legs, it is best to stay in bed over the weekend (or at least 12-24 hours) and let the swelling subside. Once the swelling is decreased, the stockings should be put on first thing in the morning. By wearing the stockings all day and night, the swelling will gradually decrease. Then one can wear the stockings during the day and remove them at night.

When should I not wear my compression stockings?

There are some instances when compression stocking should not be worn. These conditions include:

Pain: when one has increasing pain in the leg or foot after wearing compression stockings, it is best to take them off and see a physician

Skin changes: anytime the toes go blue or the skin becomes discolored, stockings should not be worn

Ulcers: if there is skin breakdown, stockings should not be worn

Do compression stockings cause any complications?

In general the answer is NO. However, those individuals who already have decreased blood supply to the legs (severe diabetes, peripheral vascular disease) may not be able to tolerate the compression stockings.

What is the major complaint with wearing compression stockings?

The majority of individuals claim that the stockings feel hot and tight. And in the summer, most individuals are unable to wear them.

Compression stockings- Misconceptions

Compression stockings are only for sick people- False. Everyone can wear them. Besides preventing blood clots, these stockings provide support, comfort and help reduce fatigue.

Compression stockings weaken muscles in the leg. False. Muscles are not affected by the stockings. In fact, walking and wearing stockings tone the muscles and improve blood circulation in the leg.

Compression stockings can never be stopped once started. False. Stockings can be discontinued at any time. During the summer, if the weather is too hot to wear stockings, one can remove the stockings. If one has already recovered from surgery, one can stop wearing stockings. However, walking is recommended afterwards.

How should I take care of my stockings?

Compression stockings are sturdy but can be ruined by poor care. Stockings should be hand washed with soap. They should be gently rinsed and dried in open air. One should not wash or dry them in machines. Compression stockings should be as gently treated as one would treat their face. Most stockings are ruined during washing and drying.

Further, never allow the stockings to come in contact with creams, lotions, ointments, or oils containing acids, lanolin or petroleum. Any of these will ruin your stockings in no time.

How long does one usually wear compression stockings?

The stockings should be worn as long as you are at high risk for forming blood clots. For prevention of blood clots, daily wearing is recommended.

Compression Stockings: Tips

- you must wear them everyday
- compression stockings are easier to put on with rubber gloves
- initially compression stockings are hard to get used to, so start wearing them for a few
hours daily and gradually increase the number if hours
- to get the best results, put on the stockings on first thing in the morning
- remove the stockings out at night (the feeling is soothing)
- for those with dry skin, apply some baby oil at night
- never fold or roll your stockings
- never cut extra holes or snap off the elastic band in the stockings
- wash gently
- a pair will typically last 3-6 months
- if you have pain in the leg or bluish discoloration, remove the stockings

How are these stockings prescribed?

Compression stockings come in various pressure gradients. All compression stockings have the highest gradient at the ankle which gradually decreases up the leg. Your physician or healthcare provider will assess your condition and determine which is the best compression stocking for you. Measurements of your leg will be made and the best sized compression stocking will be prescribed for you. It is very important to have the correct size of compression stocking for the best results.

How and where can I get graduated compression stockings?

Once it is decided that you are a candidate for compression stockings, your health care provider will recommend the best places where you can buy these stockings. Most suppliers of stockings will measure your leg size for the best fit for you. You will also be provided with a leaflet to educate you further on the dos and don'ts about compression stockings. Never buy more than one pair initially to make sure you have the correct size and fit.

Are Compression Stockings covered by insurance?

Some insurance companies do cover the cost of compression stockings if you have are at a high risk for a blood clot. You can check up on your coverage by calling your insurance carrier.

How much do compression stockings cost?

Compression stockings can be purchased with a physician's prescription. They may cost anywhere from $ 60-$120/pair. Most need replacement in 3-6 months. Non prescriptions compression stockings are also available but they do not provide the level of compression required to prevent venous ulcers.

What is coronary thrombosis?

The heart receives blood via the coronary vessels. When a blood clot forms inside the coronary vessels, this is known as coronary thrombosis. In almost all cases, the blood clot is formed at a site of an already diseased coronary vessel. The heart is a very delicate organ and needs adequate amounts of blood to maintain its function. If the blood supply is blocked, a heart attack can occur.

Why does a thrombus occur in a coronary vessel?

In the majority of cases, the thrombosis occurs at a site where the coronary artery has already been narrowed or blocked. The coronary artery narrowing may be due to process of atherosclerosis or cholesterol plaque build up. Because the blood is unable to flow through the narrowed portion of the coronary artery, it slows down and starts to sticks to the vessel wall- eventually forming a blood clot.

What are symptoms of a coronary thrombus?

Most individuals with a coronary thrombus have symptoms which may include:

- chest pain
- sweating
- dizziness
- difficulty breathing or fast breathing
- chest palpitations (fast heart rate)
- nausea, vomiting

Who is at risk for a coronary thrombus?

Coronary thrombus is most common in individuals who:

- smoke
- are diabetic
- have uncontrolled blood pressure
- have high cholesterol levels
- have a family history of heart problems
- are obese
- who are inactive

How is a diagnosis of coronary thrombus made?

The features of chest pain may indicate a coronary thrombus but to confirm the diagnosis the physician will perform:

Blood work: Blood will be drawn at 8 hour intervals to detect the presence of a heart attack.

ECG: The electrocardiogram may reveal the presence of a new or old heart attack.

X ray: The chest x ray may reveal the presence of any heart failure.

ECHO: This ultrasound based test can assess the heart as it beats and determine not only the valve problems but also the force of contraction.

Cardiac catheterization: This test requires x rays and a dye which is injected into the heart vessels. It remains the gold standard for detection of a coronary thrombus and the presence of any coronary artery disease.

What is treatment of coronary thrombus?

Coronary thrombus can cause a heart attack so it is extremely important to get to a hospital as soon as possible. The immediate treatment of a coronary thrombus is:

- taking nitroglycerin tablets
- oxygen
- blood thinners
- Coronary artery angioplasty or stenting (essentially ballooning)
- open heart surgery

How can coronary thrombus be prevented?

The risks of coronary thrombus formation can be decreased by:

- being active, exercise regularly
- controlling blood sugar
- controlling blood pressure
- stop smoking
- avoid high fat diet
- control cholesterol levels
- take an aspirin every day

Which type of physician deals with coronary thrombus?

All heart problems are dealt by physicians who have added training in the field of cardiology. The physicians are known as cardiologists.

What is deep venous thrombosis (DVT)?

DVT is a blood clot (thrombus) that forms in the deep veins of the leg. The formation of the blood clot in the leg may be associated with pain and swelling. The major problem with DVT is that the clot may migrate to the lungs and cause difficulty in breathing and even death. Each year close to 200,000 people die from DVT which migrate to the lung (pulmonary embolism). Early recognition and appropriate treatment of DVT and PE can save many lives

Where are DVT most common?

DVT can occur in any vein in the body but are most common in the leg veins. It is the clots in the deep veins that are associated with complications. Clots in the superficial veins generally do not migrate and only cause localized pain.

What can cause deep venous thrombosis?

There are three essential elements that are required in the formation of a venous thrombosis. These are:

Prolonged stasis: Any condition that causes one to be in bed for prolonged periods (after surgery) or sitting in one place (flying in a plane) can lead to DVT
Vessel injury: Anytime a vein is injured, it is very prone to formation of blood clots
Hypercoaguability: There are some medical conditions (Protein C and S deficiency, lupus, etc) that can make one prone to formation of blood clots

What are common conditions associated with formation of venous thrombosis?

General:
Age
Immobilization > 3 days
During pregnancy and post delivery
After major surgery (especially hip fracture)
Long plane ride

Medical:
Anesthesia
Cancer
Stroke
Heart failure
Obesity
Use of birth control pill
Prior DVT
Trauma
Blood clotting problems

How may people develop DVT in North America?

Current data indicate that the true incidence of DVT suggest that about 80 cases per 100,000 persons occur annually (but this is an underestimate). DVT occurs in approximately 1 person per 20 over his or her lifetime, and 600,000 hospitalizations for DVT occur annually in the United States.

What are symptoms of DVT?

The signs and symptoms are related to the degree of obstruction and many individuals do not even know if they have a blood clot. In many cases, the body is able to break down the small clots but large clots may persist. The general features of a venous thrombus in the leg are:

Calf swelling
Pain in the calf (most prominent when moving the ankle)
Warmth of the skin around the calf
Shortness of breath (if clot has moved to lungs)

What are complications of a Deep venous thrombosis?

If a venous thrombosis is not adequately treated or missed, the following complication can result?

- Pulmonary embolism (blood clot moves into the lungs)
- Venous ulcer
- Swelling of the leg (post phlebitic syndrome)

How is diagnosis of DVT made?

The diagnosis of a deep vein thrombus is simple if it is suspected. The following are the most common tests:

Blood work: this involves routine blood work to ensure that your blood clotting parameters are normal. If you have had recurrent clots, then other special blood work will done.

Ultrasound: This is usually the first test done to look for a DVT. It is painless, fast and very effective in the diagnosis of DVT. It cannot look for blood clots which are underneath the groin. The test cannot differentiate between new and old clots either. Diagnostic accuracy varies depending on the technician performing the test.

MRI: This is never the first test of choice. It is useful if DVT is suspected and can look for DVT underneath the groin and in the major vein (Inferior vena cava) of the body. It can also visualize how far the clot has progressed from the legs into the abdomen. In pregnant females, it is the test of choice. However, is expensive and its use in pregnancy is questionable.

Venography: This is a rarely used test today because of the availability of ultrasound and MRI. It requires the use of a dye and exposure to radiation.

What is the treatment of deep venous thrombosis?

All individuals with a new diagnosis of a DVT need hospital admission and bed rest for at least 4-7 days.

Treatment is aimed to prevent:

- the thrombus from getting bigger
- prevent the clot from breaking loose and migrating to the lungs
- prevent the formation of new clots
- prevent the post phlebitic syndrome (DVT destroys the veins in the legs and even after
treatment, the leg remain swollen and tender)

Drugs: The initial drug treatment of a DVT is to immediately start a blood thinning medication called heparin. This medication is administered through an IV for about 2-4 days. The medication stabilizes the clots and prevents it from getting bigger. Once the blood clot is stabilized, you will be switched over to an oral medication (warfarin) and discharged home. These medications do not dissolve clots but do prevent the clot from increasing in size. Most individuals are maintained on warfarin for 6-9 months. Individuals who have recurrent DVT need life long anti coagulation therapy

What if I can not take warfarin?

In some individuals who are not able to take warfarin (pregnancy), a chemical similar to heparin, called low molecular weight heparin (LMWH), can be taken at home. LMWH are effective and have to be injected once or twice daily. They are slightly more expensive than warfarin.

Filters: There are some individuals who are not able to take anticoagulation medication because of the risk of bleeding or adverse side effects. In such cases, an umbrella-like device (inferior vena cava filter) can be placed. This device is placed under local anesthesia from either the veins in the groin in the neck. It captures the blood clots which may migrate to the lungs. These filters are viewed as a temporary solution.

Precautions

One should minimize activities that can cause injury while taking these blood thinners since bleeding and hemorrhage are a potential complication.

Prevention

Stockings: Elastic compression stockings should be worn if someone is going on a long flight or for surgery. Stockings relieve leg pain, swelling and prevent the post phlebitic syndrome. They must be worn everyday for at least 2-3 years after the DVT.

Activity: One should always remain active and ambulate on a daily basis. When traveling or flying, stretching and walking every few hours is highly recommended.

Hydration: Keep well hydrated

What is endovenous laser treatment?

EVLT is a new method devised to treat varicose veins. It requires insertion of a laser fiber through the vein in the thigh and then heating the vein with the laser. The entire procedure is visualized by ultrasound. The laser probe takes a few minutes to burn the vein with minimal complications. The procedure is fast, effective and has little or no pain. In addition, this novel procedure is done as an outpatient, involves a small incision and results in rapid recovery.

How does EVLT procedure work?

The laser probe is inserted into the vein and when the probe is activated it heats up the vein. The heat energy generated by the laser probe causes the vein to collapse. Once the vein is collapsed, it is replaced by a thin fibrous scar. This is a permanent procedure and there is no chance of varicosities occurring in the area. Once the vein is burnt, it has no more capacity to carry any blood.

Are there any preparations required for EVLT?

There are no special preparations required for EVLT. During the procedure, your eyes will be protected against the laser beam with special dark glasses. If you are taking Aspirin or any blood thinners, you will need to discuss this with your doctor. In most cases, blood thinners should be stopped at least 1 week prior to the procedure.

How is EVLT performed?

EVLT is done as an outpatient procedure and can even be done during a lunch break. Ultrasound is required to observe the vein during the entire procedure. Your leg will be exposed from the groin to the lower thigh. A small amount of local anesthetic will be injected in your thigh and the entire leg will be cleaned with a sterile solution. Following this a small needle will be inserted in the vein at the thigh and through the vein, a small laser probe will be inserted all the way to the origin of the vein in the groin. When the probe is in the correct place, the laser is fired. The energy generated from the probe slowly causes the vein to collapse. The catheter is then slowly withdrawn while heating the entire vein.
After the procedure, a small dressing is applied to the thigh incision and a compression dressing is applied around the thigh.

How long does EVLT procedure take?

The average time for the procedure is about 30-45 minutes. One can expect to be at the doctor’s office for about an hour.

Is EVLT painful?

There is some mild pain during the procedure. However, prior to the procedure, the doctor will inject some local anesthetic to numb the area. Once the procedure is over, there is minimal pain

When does one resume normal activities?

Most individuals return to work the following day. All individuals are encouraged to ambulate the first day. However, heavy exercise should be delayed for about a week,

When will I see the results of EVLT?

The vein takes about 2 weeks to shrivel up. The final cosmetic result is not seen for about 2 months.

What are side effects of the EVLT procedure?

Side effects are rare but may include:
- skin discoloration
- mild skin burns
- burning pain
- numbness
- bruising
- change in skin texture

The majority of these side effects disappear in 10-14 days.

What are the benefits of EVLT?

Compared to the usual varicose vein surgery, EVLT offers a number of benefits which include:

- it is relatively fast
- it is safe
- less extensive procedure
- there is minimal pain after the procedure
- there is less bruising
- there is only one very small incision
- there is little downtime, most individuals are able to return to work in 1-2 days
- there is no use of general anesthesia

Can EVLT be done during pregnancy?

No, it is best to wait until the pregnancy is over.

What are potential complications associated with the EVLT procedure?

Complications are rare but may include:

- vein perforation
- blood clot formation
- blood clot in lungs (pulmonary embolism)
- inflammation of the vein (phlebitis)
- blood collection (hematoma)
- infection
- paresthesia (numbness or tingling)
- Skin burn.
- Nerve damage
- bruising of the skin
- pain
- failure of the procedure to work

Is EVLT procedure suitable for everyone?

The EVLT procedure is only used to treat the large varicose veins. It is not suitable for spider veins. Normal veins should not be removed, because future open-heart surgery may require the use of these veins. EVLT is best for individuals with large varicose veins in the thigh area.

What are the limitations of EVLT procedure?

In those individuals with tortuous and small thrombosed varicose veins, the physician may not be able to pass the catheter through it. The procedure is only used to treat large varicose veins above the knee. Varicosities below the knee are not treated with EVLT.

How effective is EVLT procedure?

Most data indicate that EVLT is as good as surgery and most patients are satisfied with the results. There have been a few failures and these have mainly been due to inexperienced physicians and faulty technique.

What happens if the EVLT does not close my vein?

If endovenous laser treatment does not close a vein, you will need a second treatment. In some cases vein surgery is recommended.

How do I know that my vein has disappeared?

After 1-3 weeks, you will be seen by the physician who will perform an ultrasound to confirm that the vein has closed off.

What are other minimally invasive options for treating varicose veins?

Instead of using a laser, one can also use radiofrequency ablation as a probe. The entire procedure is the same except that radiofrequency ablation utilizes electrical heat instead of thermal heat. The treatment with radiofrequency ablation is only slightly longer by a few minutes.

IS EVLT used to treat spider veins?

No, spider veins are best treated with simple laser treatment or sclerotherapy

Is EVLT treatment covered by insurance?

If you have confirmed varicose veins and symptoms, most insurance carriers will cover the cost of EVLT. For those with no medical coverage, the average cost of EVLT ranges from $200-500.

What is Evista?
EVISTA (raloxifene HCl) is a prescription medication that prevents and treats osteoporosis in women who have just entered menopause.

What is osteoporosis?

Osteoporosis is a disorder characterized by weak bones which increases the risk of fractures. Osteoporosis means porous bone. The bones in osteoporosis have no mass or strength. The disorder frequently progresses slowly and is painless. In many individuals osteoporosis is not discovered until weakened bones have caused painful fractures usually in the back (spine) or hips. Unfortunately, those individuals who suffer one osteoporotic fracture are more than likely to suffer another fracture. The majority of these fractures are disabling and debilitating. Fortunately, today there are measures that one can take to prevent osteoporosis from ever occurring. The present day treatments can slow the rate of bone loss if you already have developed osteoporosis.

What are risk factors for osteoporosis?

A variety of factors promote osteoporosis. The more risk factors one has, the greater is the chance of developing the disorder. These factors include:

- Caucasian or Asian females
- thin or slender build
- Early menopause
- smokers
- those who consume excess alcohol
- low dietary intake of calcium. milk or vitamin D
- a sedentary lifestyle
- family history of osteoporosis

How Is Osteoporosis Related to Menopause?

It is well known that at menopause there is a drop in the female sex hormone, estrogen. Estrogen is very important for development and strengthening of bone. The estrogen drop during menopause has been directly linked to the development of osteoporosis. Early menopause, lack of dietary calcium, smoking and a sedentary life style all cause significant bone loss.

Can Evista relieve the symptoms of menopause?

Unfortunately No. Evista does not relieve any of the symptoms of menopause.

How does Evista help individuals with osteoporosis?

Evista is used both for the prevention and treatment of osteoporosis in postmenopausal women. It acts by mimicking the natural effects of estrogen on bone tissue. Over time, this slows down the rate of bone breakdown and increase the bone density, thus making the bones stronger and sturdy. Most clinical studies have shown that Evista can significantly reduce the risk of back (spinal) fractures. Its affect on the prevention of hip fractures are not as pronounced.

Does Evista increase the risk of Cancer?

Evista selectively mimics the effects of estrogen on bone tissue, but has no effect on breast or the uterus. This means that long-term use of Evista does not carry the increased risk of cancer of the lining of the womb (endometrial cancer) or breast cancer that is commonly associated with long-term use of estrogen-based hormone replacement therapy (HRT).

What is a major complication of Evista?

Evista is associated with an increased risk of developing blood clots in the veins (deep vein thrombus. This risk is similar to that associated with hormone replacement therapy (estrogen). The blood clots are known to occur in both the deep and superficial veins. The blood clots in the deep veins have the potential to migrate to the lungs (pulmonary embolism), which can result in death

What factors increasing risk of blood clots?

The risk of forming blood clots with Evista is much higher if you have the following risk factors: