The top 10 most important things you should know if you are considering vein treatment.
How to avoid disappointing results and wasting thousands of dollars!
1. Everyone should have a free screening ultrasound done as part of their initial consult.
All patients should expect to have a brief, limited-scope, screening ultrasound done at no charge before they begin any treatment whether they have varicose veins or spider veins.
Patients with spider veins may wonder why this is necessary, but research has demonstrated that approximately 30% of people who come in for spider vein treatment will actually have underlying larger vein problems which are not yet visible on the surface of their skin. If those patients begin treatment on the spider veins, without first taking care of the larger underlying broken veins, they are going to wastes hundreds if not thousands of dollars on a treatment that never had a chance in the first place, and may end up with twice the amount of spider veins they started with!
Additionally, for patients with large varicose veins, a screening ultrasound will allow their doctors to be able to better explain the treatment they are likely to need.
On the other hand, NOBODY should ever have to pay for a full ultrasound venous flow mapping before they even see a doctor for a consult! We are aware that some of the local hospital force their patients to have a full lower extremity ultrasound prior to allowing them to schedule a consult with one of their doctors. This is a huge waste of time, money, and resources and no patient should ever accept this.
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2. If you need a complete ultrasound evaluation, (not everyone does – see #1), it should always be done standing up.
Spider veins and varicose veins are a gravity dependent problem. This means your legs must be in a gravity dependent position to see the full effect of what is happening with the disease process.
Patients with vein disease are usually well-aware of this fact because their legs look and feel best in the morning, and look and feel the worst at the end of the day after gravity has been holding all that venous blood in their broken leg veins all day.
So why do so many hospitals and clinics do their ultrasound evaluations with their patients lying down?!? We don’t know, especially since a standing ultrasound has been established as the standard of care by all the major venous medical societies.
Not only is a standing ultrasound evaluation important to ensure complete treatment, it is also imperative to meet the arbitrary vein size criteria insurance companies use to determine medical necessity! If you allow yourself to be scanned lying down, you allow gravity to make ALL your veins smaller, and even a millimeter of difference can mean your claim gets approved or denied.
If your ultrasound venous flow mapping is not completed while you are STANDING, not only may you be wasting a lot of money on a useless scan, you may also have your case denied as NOT MEDICALLY NECESSARY, when in fact, you do have medically necessary disease and should have insurance benefits for treatment.
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3. Nobody needs surgery for their veins.
Unfortunately, many physicians still perform surgical ligation and stripping for their vein patients, even though it is a rough surgery with a long recovery period, has high recurrence rates, and carries a high risk of complications including but not limited to venous thromboembolism which can be life threatening. Most physicians who do this surgery tend to be older, and they were trained that way 20 or more years ago. Usually, they are part of a larger group practice, and they only offer vein treatment because they must in order to be part of that group. They are usually not interested in learning any of the newer minimally invasive vein procedures, as they realize that many patients will not proceed if they think their only option is surgery, and they tend to tell their patients things like “Your veins are too big for any other procedure.” To make matters worse, the hospitals they work at have no financial incentive to tell them to stop because vein stripping is a big money maker for the hospital!
The great news is almost nobody needs surgery for their veins! Newer options such as endovenous thermal ablation and ultrasound-guided sclerotherapy offer safer treatment and longer lasting results. If your doctor tells you that you need surgery, get a second opinion!
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4. If you have varicose veins and your doctor does not offer ultrasound-guided sclerotherapy you will probably be disappointed with your treatment.
Ultrasound-guided sclerotherapy is typically used to treat all the leftover branches after the main venous trunk has been treated. Because the large, blue, sometimes rope-like branches cause the majority of symptoms for patients, in addition to being what most patients find to be the most cosmetically unattractive, if these branches are not comprehensively treated, most people will feel that their treatment is incomplete.
There are only 2 options to treat the branches: phlebectomy and ultrasound-guided sclerotherapy. Phlebectomy, which is a minor surgery typically done under local anesthesia only (don’t let a doctor put you under general anesthesia for ANY vein treatment-see #4) is fine for a quick cosmetic fix on 1 or 2 bulgy veins, but is not a good option if you have symptoms related to your veins or if you have a lot of branches. Ultrasound-guided sclerotherapy on the other hand, can comprehensively, safely, and easily treat ALL the left-over branches, providing not only the best symptom relief, but also the best cosmetic improvement. Unfortunately, not many doctors offer ultrasound-guided sclerotherapy because it is time consuming and not as well reimbursed as some of the other procedures used to treat veins. It is very well worth the time for any patient to find a doctor who offers this procedure as part of their treatment process.
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5. Specialists are better, and one unified care team in the same location is best.
Many patients make the mistake of assuming that any hospital or clinic they choose will be able to provide the best care for their needs. They think that just because a doctor or nurse is affiliated with a large hospital or clinic that they will have access to all the best medical devices needed to treat their problem. They think that any provider they see will be familiar with the most recent treatment advances and adequately trained to provide those services. They may think that a single team of providers will provide, or at least oversee, all aspects of their treatment. They may even think that all providers are equally interested in every aspect of their specialty. Unfortunately, those assumptions are rarely true.
In many cases, doctors in large group practices (think of the large local hospitals and clinics) only treat veins because they are forced to, because their group has to offer that service. They often use outdated procedures like surgical vein stripping, and they will often be quick to refer their patients out for “cosmetic” treatment even if there are still larger vein problems left over after whatever procedure was done. This can create a terrible dynamic between 2 different doctors in 2 different locations, (most commonly a surgeon and a dermatologist) both saying that the other one needs to do more, and ultimately neither one helping the patient, who ends up caught in the middle.
At Madison Medispa, there is no need for guesswork — we only offer services that we are passionate about and which we a can provide at the very highest standard of care. All our providers are under one roof, and we all work together to ensure you are comprehensively treated and completely satisfied with your results. Come in for a free consultation and you will see the difference immediately.
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6. Quick fix “Spot treatment” including surface laser for leg veins is usually a waste of money, and if someone tells you that you only need a single treatment of any kind you should be skeptical.
Unless you are very young and only have the smallest of spider veins, most of the veins you see on the surface will have deeper feeder veins that need to be addressed as part of your treatment. If these feeder veins are not taken care of, most patients will have one of three things happen as a result: 1.) Their treatment looks good briefly, but everything comes back in a few months because the feeder veins eventually pop the treated veins back open. 2.) Nothing changes as a result of treatment because the feeder veins just keep forcing blood through the treated veins keeping them open. 3.) The treated veins look good initially, but the feeder veins find another pressure release and pop new spider veins right next to the ones that were just treated. Eventually the feeders also pop back open the treated veins, and patients feel they now have twice what they started with!
None of these three outcomes are good, but they are very commonly seen when clinics try to give their patient a “quick fix.”
At Madison Medispa, we always make sure we are addressing both the underlying feeder veins and surface vessels so that you have the most cosmetically attractive, longest lasting results possible.
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7. Your veins could be causing your leg pain…and more!
Because vein problems can be cosmetic in some cases, many people, including many doctors, are quick to dismiss broken veins as a cause of leg pain. This is unfortunate for those patients because veins can cause a wide variety of symptoms in the legs including aching, pain, heaviness, fatigue, itching, burning, swelling, and throbbing. Bed-time cramps and restlessness are also common, especially in patients with a large amount of spider veins! Because vein disease is gravity-dependent, symptoms are typically best in the morning and worse late in the day. Heat and humidity will often make things worse, as well as sitting or standing in one place for long periods of time. Leg elevation, anti-inflammatories, and graduated compression stockings can help you feel better, until you are able to proceed with treatment. Some patients wait too long to seek treatment and their leg veins end up causing end-stage problems like recurrent bleeding, recurrent blood clots, and even venous ulcers, large open wounds typically noted around the ankles!
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8. Spider Veins and Varicose Veins are part of the same spectrum.
Many patients mistakenly think spider veins and varicose veins are two completely different problems. Both varicose veins and spider veins result from the breakdown of the one-way valves in your leg veins that normally prevent gravity from pulling blood back down your leg veins in the wrong direction. This valve failure is caused by genetics in more than 80% of the cases, but other factors may also play a role, including female hormones and pregnancy, in addition to direct physical damage do a valve from a surgery or accident. Small veins have small valves and large veins have large valves, and when those valves break you get spider veins or varicose veins, and in many cases, both!
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9. All your out of pocket costs should be fully explained to you BEFORE you start treatment.
At many of the large hospitals and clinics, patients are never informed how much of their annual deductible is left, what percentage of total charges they will be responsible for, and what their maximum out of pocket cost will be for the plan or calendar year. This can result in large, unexpected out of pocket costs. This should never be the case and you should insist on knowing what your potential bill could be prior to starting any treatment.
At Madison Medispa, our staff will contact your insurance company for you, verify your benefits, and review expected out-of-pocket costs before you begin any treatment. We will also pre-authorize all treatment with your insurance and help you with scheduling to best ensure you maximize your insurance coverage for the procedures you require.
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10. Fall is often the best time to treat.
Not only because the cooler weather makes it more tolerable to wear the compression stockings you will need while you heal after treatment, but also because many people will have met their annual insurance deductible and therefore will have little to no out-of-pocket cost for their treatment! Treatment results take place slowly over several months, so if you want to have legs that look and feel great for next summer, Fall and Winter are the best time to get started on your treatment!
Learn more about everything you need to know about varicose vein treatment here.
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