Phantasmix

Originally published on July 1, 2004.Veins can be separated into 3 groups: varicose, spider, and reticular. I so far have not dealt with varicose veins (knock on wood), so I will only be talking about spider and reticular veins.

Spider veins
Small, thin veins that are close to the surface of the skin. They generally look like a web of purplish looking vessels, hence the name “spider”. They are connected to the major venous system but are not an essential part of it. Sometimes they itch, burn or ache, but most of the time they just don’t look pretty.

Reticular veins
These are flat blue veins. They are smaller than varicose, but larger than spider veins. Spider veins usually originate from these medium-sized bluish veins right under the skin. These can often be seen under your knees.

CausesThe reasons for veins showing up are numerous, most of course have to do with improper life style, such as lack of physical activity, obesity, bad diet that results in constipation etc. Genetics also play an important role.I got my spider veins when I was 15 from exercising too much. Yes, there is such a thing as “too much exercising”. Now looking back at that time, I believe I had an eating disorder. So when you add up not getting enough nutritious food with working out too much, you get spider veins at an early age.

Straining yourself in any way will do that to you (note to self: Hire movers next time!)ParticularsBoth my spider vein clusters were on my left leg. One on the outside of the upper thigh (about 2″ wide) and on the inside of the knee (about 1″ round). They didn’t bother me too much except for the fact that I didn’t like to wear anything short. Then, last year they started to itch and burn, especially after a long walk which I do quite often. Finally this year I went to the Vein Institute in Toronto and got an ultrasound done (on my both my legs just in case).

Ultrasound
It’s important that you get ultrasound check up, not just a doctor looking at your legs and then you checking off some points in a questionnaire. Ultrasound will find any underlying issues that may be causing your veins, while a simple visual test and your “opinions” will not.

Insurance Coverage
I live in Toronto, so the wonderful Canadian government provides health insurance coverage for all ultrasound procedures. If you just go in for a visual test, on the other hand, that consultation is not covered by OHIP. It will cost you $150 Cad or more depending on which clinic you go to.

Sorry, I have no idea how that works in the U.S.

Vein Institute
I chose the Vein Institute for 2 reasons: 1) First consultation OHIP coverage; 2) I figured since they specialize in veins only, it’s better than a general cosmetic doctor.

Test Results
Ok, so I had the test done. Got immediate results. It turned out all my veins were superficial, but in addition to spider veins I also had reticulars under my left knee. I can’t for the life of me figure out why all of the veins on my left leg. BUT… I have a feeling it has something to do with me sitting with my legs crossed. You know when you cross the legs, it’s usually one leg over another all the time, you don’t switch them much. I try to avoid crossing my legs now.

Therapy Options
I was given a sheet with therapy options. The best solution to get rid of both spider and reticular veins at the same time was a combination of laser/sclerotherapy.

Laser Therapy(this paragraph was copied from the Vein Institute site)The laser system produces a unique wavelength that safely passes through the skin and is selectively absorbed by the targeted blood vessel. The vein will gradually disappear, leaving the skin intact. Your skin is cooled with ice or a cold compress (in some cases topical anesthesia) to minimize the mild heat sensation. The length and number of procedures may vary, with an average procedure between 15 to 30 minutes.

Sclerotherapy (this paragraph was copied from the Vein Institute site)Sclerotherapy involves a series of injections using a very small needle to administer a medication into the vein. The medication irritates the lining of the vein causing it to collapse and ultimately disappear. In some cases, our physicians will perform sclerotherapy using ultrasound guidance to monitor the vein while injecting the sclerosing agent. Sclerotherapy requires no anesthesia, and causes only minimal, temporary discomfort. You can return to your normal daily activity immediately following sclerotherapy.They can only treat one leg at a time and only once a month. So if you have one leg “done” today they can only work on the other one in a month.

The ProcedureThe whole thing takes about 20 minutes in one session. Depending on the severity of your condition you may need more than one session (usually 3-6 at most). During the procedure the administering nurse/doctor is able to tell whether you’ll need more than one session. I only need one session for the entire leg.Ok, it’s not PAINLESS. It will hurt, not so much at first, but the more they poke you with the needle, the more tiresome and painful it becomes. And just when you’re breathing a sigh of relief that the sclero part of it is over, they start scratching you with a laser needle (that what it feels like, even though there’s no actual scratching OR needle).Just be prepared for unpleasant sensations and keep thinking that it’s going to end soon.

After the ProcedureDoctor will prescribe you a pair of support tights, with a compression rating of 20 to 30. The best result will be from a higher compression rating. It’s also best if you put them on right after the procedure.You can also buy them in your doctor’s office, and that’s exactly what I did. You still get a prescription receipt, so if you have a health insurance other than OHIP, it should cover the pantyhose/tights.

What You Can Expect AfterUgly bruising, really ugly. Swelling. And before the veins get better they will get MUCH worse, because they will be irritated by the whole thing for awhile. You will see below that it should take 1-2 weeks for the veins to resolve, mine however took about 3-4 weeks. And mine weren’t even that complicated. Just don’t get discouraged, there will be progress even if slow at first. In addition to ugly ultra-purple looking veins, I got a swollen bump where they poked my knee too close to the bone. This, too, is slowly but fading away and is almost perfectly normal (it’s been 4.5 weeks after I had the therapy done).

ConclusionAll in all, I’m very happy I had it done. My legs look great, nothing aches or itches anymore. I totally think it was worth the price.Vein Institute rate is $125 Canadian for one 20-minute session. This doesn’t include tax. Expect to pay $60-70 Canadian for the pantyhose. My total bill came to $203 Cad with tax and pantyhose included.This is a sheet I was given before the procedure. My comments are italicized.

WHAT SHOULD I DO BEFORE MY SCLEROTHERAPY/LASER TREATMENT?1. Do not shave your legs for one day prior to your appointment.2. Do not take aspirin or blood thinners 3-5 days prior to procedure.3. Eat a snack one hour prior to your treatment.4. Bring or wear slacks to wear out of the office.

WHAT SHOULD I DO AFTER MY SCLEROTHERAPY/LASER TREATMENT?
1. Keep stockings on until bedtime. If your toes turn blue or feel numb please call our office immediately. (This didn’t happen to me the first time around - yes, I did it more than once).

2. You can resume normal activities today.

3. You can resume exercising in 3 days.

4. You can shower in the morning but no hot baths for 1 week.

5. Wear your support hose for at least 5 days, from the first thing in the morning (ideally, take a quick 5 min shower and then put them on before doing the rest of your morning ritual), until last thing at night. (The nurse told me the longer I wear the hose, the quicker the veins will go away, so I wore it for about 8 days).

6. Bruising, local swelling and some tenderness are normal after treatment, but please feel free to call the office if you have any questions. The vessels should be completely resolved or greatly diminished 1-2 weeks after treatment.

7. Use sunscreen for at least 2 weeks following procedure. (Most likely you’ll be wearing pants until the bruising subsides, so this is not really necessary).

8. Apply Aloe Vera lotion or Vaseline to treatment area at night to prevent dehydration. (I ignored this for the first 2 nights because didn’t want to touch the bruises, but you should really apply some lotion, because in about 2 days the skin was really dry, and even started hurting and itching so I had to moisturize it throughout the day).

9. If there’s swelling, wrap ice in a cloth and apply to the affected area.

10. You will not notice an immediate improvement. Clearance usually occurs over a 2-week period and in some cases may take up to 6 weeks. Email me if you have any questions.