24, 6, 2020

How To Wear Compression Stockings
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How To Wear Compression Stockings

Nisha Bunke2021-11-15T12:48:33-08:00

How to put them on, tips, and troubleshooting common issues with compression stockings.

Compression stockings are an important part of conservative management and after-treatment care of venous reflux disease. It is important to wear compression stockings correctly and obtain a proper fit to make sure they are as comfortable as possible.

Applying stockings with ease:

Turn your stocking completely inside out
Locate the smaller foot hole of the stocking and tuck the foot in until you reach the heel
Place your thumbs on either side of the tucked in foot hole, with the heel located on the bottom
Put your foot in the stocking until the heel of the stocking has met your heel
Grab the larger hole or top of the stocking (it should be hanging off your foot) and pull the stocking up onto your leg
Inch and pull the stocking until it has reached either below the crease of your knee for knee highs, or the highest portion of your thigh for thigh highs.

Cant keep your stockings up? Try these tips!

1. When someone’s stocking is falling down, their first instinct is to tug at the top band to pull them back up. This is mistake #1! By tugging and pulling at the top band, it is stretching out the top of the stocking which will make it fall down faster and more often. Instead of tugging at the top, simply inch and pull the stocking up by the fabric that is at the ankle. This will allow for the stocking’s extra fabric to be moved to the thigh or calf and will keep the stocking up better.

2. Wash and DRY the stocking! Stockings are very durable and can handle a washing machine and dryer. Putting a wet stocking in the dryer will bring it back to its original compression which will make the stocking stay in its rightful spot for longer. Just don’t use fabric softener when cleaning the stocking.

3. Is your skin dry? The silicone top band on most thigh-high stockings won’t stick to dry skin which will make the stocking slip down. Moisten skin with lotion, skin cream or even water to allow the stocking to stick to your skin.

4. Be in the correct size! Stocking that is too small on the thigh will roll at the top making it nearly impossible to keep them up. Be sure to be sized properly to ensure proper fitting. There are even stockings that are made with larger calf and thigh ranges which may help those who have a “rolling” issue. Alternatively, to too small of stockings, stockings that are too big will fall right down! Don’t borrow stockings from friends to prevent being in the wrong size. Be sure to be fitted correctly to ensure the stocking is the correct size.

5. If none of the tips above help, be creative! You can use Spanx, suspenders to even safety pins to keep stockings from falling down.

Is the foot too tight? Some stocking brands run narrow. Signs the foot is too tight is toe numbness or foot pain. Talk to your doctor if you feel the foot is too tight.

How To Wear Compression StockingsNisha Bunke2021-11-15T12:48:33-08:00

Understanding Insurance Coverage for Varicose Veins
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Understanding Insurance Coverage for Varicose Veins

Nisha Bunke2021-11-13T14:15:50-08:00

Does Insurance Pay for Varicose Vein Treatment? Here are the criteria that determine if insurance pays for varicose vein treatment

Most insurance types (including Medicare and Molina) will cover varicose vein treatments that are considered “medically necessary care” but not for “cosmetic care”. Varicose veins (bulging leg veins) have to cause symptoms such as leg pain to be covered by insurance. Spider veins (tiny clusters of blood vessels at the skins surface) are considered a cosmetic treatment and are not covered by any type of insurance.

4 Main Criteria for medically necessary vein treatment

Varicose veins must cause leg pain or other symptoms.

Medically necessary vein treatment means that the varicose veins must cause symptoms such as leg pain, heaviness, persistent swelling, night-time cramping, or burning. Complications of varicose veins that may indicate treatment include leg ulcer (open wound) from the vein problem, recurrent blood clots or phlebitis, ruptured bleeding vein, or skin discoloration around the ankle.

Symptoms affect daily life.

The symptoms must be severe enough to affect a person’s ability to do their daily routines or work. For example, a teacher may have varicose veins that prevent them from standing and doing their job, because they have to take frequent breaks to elevate their legs. A server at a restaurant may no longer be able to work long shifts, due to leg pain after a few hours. Symptoms can interfere with lifestyle by limiting the amount of exercise one hopes to achieve, or the inability to cook or do house chores due to leg pain.

Conservative treatment must be tried for 6-12 weeks.

In most cases, insurance requires that conservative measures have been tried for several weeks. Conservative measures include compression stockings, leg elevation, exercise, weight loss, anti-inflammatory medication such as ibuprofen or vasoactive agents such as horse chestnut or Vascular, and hot/cold packs. Many insurance types REQUIRE 6 to 12 weeks of wearing medical-grade compression stockings prior to being approved for treatment. You should have your consultation as soon as possible and begin implementing conservative management into your lifestyle. You should begin keeping a daily log documenting that you are using conservative treatments. If your primary care physician has already prescribed compression stockings, it is helpful if you have a note, you’re your doctor or the prescription, as this counts toward your conservative management time period.

Venous reflux must be demonstrated on ultrasound.

Underlying venous insufficiency must be documented by ultrasound examination. The ultrasound study to determine the treatment and the physician visits are covered benefits with most insurance types.

Treatments that are not covered by insurance because they are considered to be ‘cosmetic services’ include:

Varicose veins that do not cause any symptoms
Spider veins

Does Your Vein Condition Qualify for Medical Necessity?

If you have answered ‘yes’ to each of the 4 categories, then you are likely to meet medical necessity criteria for vein treatment. Disclaimer: this is a simplified questionnaire for patient convenience and understanding.

Do your varicose veins cause at least one of the following symptoms?

Leg pain
Heaviness
Persistent swelling
Aching, heaviness, or throbbing

And/ Or have you suffered from one of the following complications of varicose veins?

Leg ulceration
Ruptured bleeding vein
recurrent blood clots or phlebitis

Do your symptoms (leg pain, etc.) affect your daily life?

Yes, it affects my job
Yes, it affects my home
Yes, it affects my daily routine or leisure

Have you already tried conservative management and the conservative management has not completely resolved your vein condition?

Yes, I have tried compression socks/stockings/ AND two or more of the following:
Leg elevation
Exercise
Weight loss
Ibuprofen or other NSAID
Ice or heat packs
Venoactive medication such as Vascular or OTC supplements like horse chestnut or grapeseed extract

Did you have an ultrasound examination that demonstrated underlying venous reflux disease?

Yes, my ultrasound demonstrated and documented backward flow in my veins (venous reflux)
No, the ultrasound examination concluded my veins have normal function.

However, some individual insurance policies exclude varicose vein treatment- this is usually a result of employer exclusion. Sometimes in this case, one may ask the employer to include varicose vein treatments on the policy. You may call the number on the back of your insurance card to ask specifically if they cover vein treatments. When you start a vein treatment process with us, we will help you to understand what your insurance will cover. Our prior authorization specialist will obtain preauthorization (approval) for your treatment and can answer questions.

For a list of insurance types we accept at La Jolla Vein Care, click here.

Understanding Insurance Coverage for Varicose VeinsNisha Bunke2021-11-13T14:15:50-08:00

Varicose Vein Sclerotherapy Treatment: What to Expect
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Varicose Vein Sclerotherapy Treatment: What to Expect

Nisha Bunke2021-11-13T13:29:56-08:00

Ultrasound-Guided Foam Sclerotherapy

Ultrasound-guided foam sclerotherapy allows your doctor to treat backward flow (or “Venous reflux“) in superficial veins that are not visible to the naked eye but are causing symptoms including pain, swelling, and varicose veins. Ultrasound allows us to localize the unhealthy veins, inject the medication precisely, and guide the medication towards areas of varicose veins. This minimally invasive treatment will be done in our office and does not require any anesthesia. A fine needle is placed into the vein and a sclerosant foam medication (polidocanol) is injected. The brand names are Asclera and Varithena. The medication irritates the vein wall, which causes it to stop flowing, then eventually close down completely. The blood continues to return to the heart through other healthy veins.

Preparing for your procedure:

Bring your prescribed thigh-high compression stockings to every appointment. Please try on your stockings prior to your first appointment to ensure proper fit. We do not recommend shaving your legs beforehand because the compression stockings may cause ingrown hairs.
On the morning of the procedure, shower and use antibacterial soap to cleanse the leg.
We recommend you eat a light meal before you arrive.
Our procedure rooms are equipped with TVs and Netflix, but you are welcome to bring a book or iPad to use during the procedure if you prefer.
Please notify our office if you are scheduled to have any type of medical procedure or surgery 2 weeks prior to or after your treatment.
If you become pregnant or are breastfeeding, please notify your La Jolla Vein Care provider as your treatment will need to be postponed.

Medications

If you have asthma, please bring your inhaler to your appointment.
If your La Jolla Vein Care provider recommended a prophylactic blood thinner (e.g. Xarelto, Eliquis, or Lovenox) or an antihistamine (e.g. Zyrtec or Claritin), please take your first dose at least two hours prior to your procedure
If you were prescribed a blood thinner during treatment, continue to take it until your final ultrasound 3-7 days after the last treatment unless instructed otherwise.
If you already take aspirin or another blood thinner, you will continue it during treatment unless instructed otherwise.

The ultrasound-guided foam sclerotherapy procedure:

You will check-in 10-15 minutes prior to your appointment, then change into disposable shorts supplied by our office.
We will clean your leg(s) with alcohol. We will then use ultrasound to “map” the veins to be treated. Each vein will be accessed with a tiny needle through which the foam medication is injected.
You will flex the foot prior to each injection and then do calf exercises (pointing and flexing the foot) between injections.
After the treatment is complete, we will elevate your legs on a wedge pillow for 10-15 minutes while you continue 20 calf exercises per minute.
We will then help you in to your thigh-high compression stocking, then you will walk around the medical campus for 30 minutes before getting in the car.

Medical Compression Stockings

Wearing compression stockings is a part of your vein treatment. Your veins will not only heal faster, but compression stockings reduce the risk of complications
You will wear compression stockings continuously for 72 hours (3 days). You can remove them to take a quick cool shower the day after treatment or you can shower in the stockings.
After the 72 hours, you will wear the stocking for an additional week during the day (for a total of 10 days after each procedure). The 10 days will start over after each treatment session.
For comfort, you can fold down the silicone band at the top of the stocking at night.
If your stockings are slipping down, try wiping down the silicone beads with rubbing alcohol to make them tacky again. We also have glue available for purchase at our office to help them stay up.
If you experience numbness, tingling, or discomfort on the foot, you can remove the stocking at night, then put it back on first thing in the morning. Sometimes the stocking has to be cut to relieve pressure. Be sure to NOT cut the toe band of your stocking as this will cause the toes of your stocking to roll. Instead, cut a 1/2 to 1-inch long slit on the side and in the middle of the foot area. First, make a small cut; you can make it bigger if needed.

Activity

You can resume your usual activities on the day of treatment. You can return to work the same day as long as you are able to walk and/or do calf exercises every hour.
Walk at least 30 minutes twice daily for 2 weeks after each treatment session. There is no limit to how much walking you can do and inclines are okay.
Avoid pooling of blood in the legs by keeping the calf muscles active with heel raises, pointing/flexing the feet, and walking. Avoid high heels.
When you are sitting, the more you elevate your legs the better.
Avoid running, spinning, other strenuous exercises, and exercise in hot environments for 2 weeks after each treatment session
Avoid hot tubs and leg massages for 2-3 weeks after treatment.

Travel

Avoid long trips for the next 3 weeks. For car rides over 1 hour, get out every 45 minutes and walk for 10 minutes.
On a long airplane trip, get up to walk around frequently, and flex your ankles every few minutes.
Wear your compression stockings during travel.

What to Expect Following Treatment

After treatment of dilated veins close to the skin (spider veins), it is normal for those veins to itch for a few hours.
Bruising at the injection sites is normal and will fade over about two weeks. You may apply arnica or Recova cream to those areas.
Varicose veins may become firm and blue after treatment, then fade over a period of weeks. The skin overlying larger varicose veins may develop brown “hyperpigmentation” as the blood pigments within those veins are absorbed by the body. This can take up to a year to fade. Avoid exposing that skin to the sun until the pigmentation fades, so that it does not become permanent.
Aching and slight swelling is normal in the legs for several days after treatment, and generally improve with the following:
- Walking 10-30 minutes is the most effective treatment.
- Ice packs (or a bag of frozen peas or ice) over the sore veins, 15 minutes at a time, several times a day. Protect your skin by placing a thin washcloth under the ice pack.
- Anti-inflammatory medication such as ibuprofen (Motrin, Advil) or naproxen sodium (Aleve), taken as directed on the bottle. If you cannot take those medications, acetaminophen (Tylenol) can be used.
- For severe pain or pain that worsens with walking, promptly call the office.
Treated veins will look worse before they look better. Initially, large veins may feel tender, firm, and/or lumpy. Please point out any lumpy and/or tender areas to the doctor. The whole healing process may take several weeks to months.

Adverse Effects

Although rare, sclerotherapy can be accompanied by unwanted effects including trapped blood (a small amount of blood becomes trapped within the closed vein), hyperpigmentation of the skin (darkening of the skin), allergic reaction (rash, hives, or anaphylaxis), or infection.

Injection of the foam bubbles can be irritating to the body and cause symptoms including chest pain and headache. We minimize this risk by giving you only a small amount of foam medication per day and by elevating your legs for 10-15 minutes after treatment.
Some patients develop “trapped blood” within larger varicose veins days to weeks after treatment. This usually presents as a tender, possibly red, firm area. It can generally be managed with ice packs and anti-inflammatory medication but we may offer needle drainage of the blood to alleviate pain and minimize the risk of hyperpigmentation.
Some patients develop new, tiny spider veins near areas of treated veins, which is also called “telangiectatic matting”. This usually occurs 2-4 weeks after treatment and fades within 4-6 months but can take up to a year. It is more common in women who take estrogen supplements.
There is a small risk of clot formation within the deep veins of the legs. This risk is minimized by using ultrasound guidance throughout treatment to monitor the foam and to avoid injections near areas where the deep and superficial veins are connected through “perforating veins”. We will ask you to do flex your foot during injections and to do calf exercises afterward to circulate the medication away from the deep veins. Walking after treatment is also crucial to avoid the pooling of blood in the deep veins, which can predispose to blood clots.

Follow-up Ultrasounds and Clinic Appointments

We will schedule an ultrasound 2-7 days after your final treatment to make sure veins are responding appropriately. We will do the formal ultrasound of your superficial veins for backward flow (or “reflux”) at one month. At that point, we will re-evaluate your symptoms and anatomy and decide if additional treatment is indicated. Be sure to come to all of your scheduled follow-up appointments to ensure that your veins are healing properly.

It is important to come to all follow-up appointments so your provider may follow your progress and address any adverse effects promptly.

Varicose Vein Sclerotherapy Treatment: What to ExpectNisha Bunke2021-11-13T13:29:56-08:00

Foam Treatment for Varicose Veins Is Not New
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Foam Treatment for Varicose Veins Is Not New

Nisha Bunke2020-09-18T01:53:21-07:00

Foam treatment of varicose veins is not as new as people think. It was originally described as early as 1944. Foam sclerotherapy is a method for treating varicose veins. It involves injecting a foamed sclerosant medication into unhealthy varicose veins, causing them to eventually dissolve.

Foam Sclerosant Medication used for foam treatment of varicose veins has a ‘frothy’ foam appearance.

In 1944, E.J. Orbach introduced the concept of a macro bubble air-block technique to enhance the properties of sclerosant in performing macrosclerotherapy. Apparently, few vascular surgeons were interested in the subject and the technique languished. The work of Juan Cabrera and colleagues in Spain attracted attention of some vein specialists and interest in the use of foam technology in treating venous insufficiency was reawakened. Administration of foamed sclerosant was reintroduced in the early 1990s by Cabrerra, who summarized a broad experience in 1997. By the 1990’s, broad use of diagnostic ultrasound imaging made it possible to monitor foam distribution with ultrasound scanning. Some 40 years earlier, and before the development of ultrasound scanning, foam had been used in Germany to treat varicose veins. At that time, foam was made by special syringes and its distribution was assessed by touch, instead of ultrasound scanning.

Tessari , prior to the year 2000 developed an easy way of making liquid sclerosant into foam using two syringes and a three-way stop cock.

Foamed sclerosant inside a vein: Once foam is introduced into the vein, it is hyperechogenic on ultrasound. In this picture taken in 2009, Dr. Bunke points to the foamed medication inside the vein. Notice it appears ‘white

By 2000, Sica was able to report a three-year experience using foamed sclerosant in treating saphenous varices. Since that time, foam has appeared increasingly in general use. Around 2000, Dr. John Bergan began describing the utility and success of foam treatment to physicians in the United States and can be attributed to bringing its awareness to North America. Over the past decade foam has gained world-wide popularity for the treatment of varicose vein tributaries in place of surgery. In 2013, Varithena foam was FDA approved to treat the great saphenous vein and its accessories with foam sclerotherapy. Dr. Bergan predicted that microfoam sclerotherapy will eventually replace all other methods. Presently, it is most commonly used as an adjunct to endovenous ablation of the great and small saphenous veins or as a sole treatment for surface varicose veins. Since Dr. Bunke was trained by Dr. John Bergan, thousands of patients have been treated successfully with foam sclerotherapy at La Jolla Vein Care. Additionally, our office manager Anna, spent time in Spain with Cabrera’s team in observation of how varicose veins were treated with foam.

Foam Treatment for Varicose Veins Is Not NewNisha Bunke2020-09-18T01:53:21-07:00

COVID Precautions at La Jolla Vein Care
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COVID Precautions at La Jolla Vein Care

Nisha Bunke2020-09-18T02:11:40-07:00

While we offer telemedicine visits and in-home ultrasound diagnostics, if you prefer or need to come to our office, we want you to know about the extensive COVID precautions we have taken to ensure our office is one of the safest places you can be.

We want you to know that our first concern has always been the safety and care of our patients and our team. Although the coronavirus pandemic is new to many of us, infection control is not new to healthcare. For decades, OSHA has mandated that medical practices follow the strictest guidelines in infection control. In order to put your mind at ease we at La Jolla Vein Care want to share with you some of the practices we employ to ensure our patients that our office is one of the safest places you can be.

La Jolla Vein Care Staff wearing masks during procedures

Less appointments will be scheduled throughout the day so that there will be minimal people in the lobby, with little or no wait time.
We’re extending our hours and offering after-hours appointments to minimize the number of patients in office at a given time.
Park and Wait check in. If you prefer, you can wait in your car and we will text you when we are ready to room you. We recommend this for patients checking in prior to procedures.
Prior to every visit, we will ask you screening questions, to ensure symptomatic or at-risk patients reschedule their appointments to avoid community spread.
You must wear a mask or cloth facial covering to be permitted into the building. You will be provided with a mask and asked to wear it while in our office. You also will be asked to disinfect your hands with hand sanitizer. Please note only the front entrance is open at the Scripps XiMED building. There is currently no third-floor access via the parking structure.
Our staff are required to wear masks for your protection.
We are seeing all patients in suite 530. When you enter our waiting room you will notice that some chairs have been removed in accordance with national social-distancing recommendations.
We are eliminating coffee service, snacks and water coolersfrom our waiting area to reduce chance of community transmission.
Daily, we are screening our staff and following CDC guidelines regarding staff members who are ill or may have been potentially exposed to COVID-19
As a medical facility, we have always had a policy of sanitizing any surface after each patient encounter – but we are increasing our vigilance and frequency of disinfecting during this time.
Please fill out any forms electronically if able and return them prior to your appointment.
If you need to fill out any forms or sign consents, we have single use pens.
We encourage Virtual options and mobile ultrasound at-home visits when possible.

COVID Precautions at La Jolla Vein CareNisha Bunke2020-09-18T02:11:40-07:00

What to Expect After Saphenous Vein Ablation
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What to Expect After Saphenous Vein Ablation

Nisha Bunke2021-11-05T10:57:18-07:00

After a vein ablation procedure, such as radiofrequency or laser ablation, it is normal for your leg to feel swollen. The swelling is the fluid that was placed around the vein called a tumescent anesthetic. You will feel the swelling in the location where the vein was treated. If the vein in the thigh was treated, your thigh will feel swollen. If the vein on the back of your calf was treated, the calf will feel swollen. The tumescent will slowly be absorbed by the evening or the next morning.

Applying gauze inside of your stocking

Sometimes, the tumescent will leak out from the tiny needle puncture sites. For this reason, we will apply gauze inside of your stocking. At night before going to bed, reach in and pull out the gauze and throw it away. It only takes one drop of blood to make the gauze look blood-tinged. This is also normal and nothing to worry about.

Before going to bed, remove the ace bandage that overlies your stocking. You will wear the stockings overnight (for 72 hours to be exact). If your stocking causes foot pain or leg pain, or numbness in the toes, please remove your stocking during the night and sleep without it. It may be too tight. Call us in the morning so we can further advise.

What to do when the leg feels sore and achy?

On the evening of the procedure, your leg may also feel sore and achy. When it starts to throb, get up and walk. This usually helps it to feel better. Ibuprofen or Tylenol are helpful to reduce discomfort. You can also apply ice, by placing ice in a zip lock bag and applying the cold to the sore areas on the leg. You do not need to sleep with your legs elevated, but may do so if this is more comfortable.

When you are sitting for longer periods, such as watching a movie at night, elevate your legs.

To avoid blood clots, walk frequently throughout the day. A rule of thumb is to walk at least 30 minutes, twice a day. There is no limit to walking. After your procedure, you will be asked to walk 30 minutes around campus prior to getting into your car. This will help get the blood circulating and stimulate the tumescent to be absorbed.

What to Expect After Saphenous Vein AblationNisha Bunke2021-11-05T10:57:18-07:00

31, 5, 2020

Approach to Vein Treatment
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Approach to Vein Treatment

Nisha Bunke2020-09-18T18:51:19-07:00

Venous Reflux Disease is Treated By a Staged Approach

Step 1: The Underlying Problem

The first step is to treat the underlying problem, the venous reflux. The specific pattern of venous reflux was detected by ultrasound. Venous reflux usually starts in the saphenous veins. The saphenous veins are most effectively treated with vein ablation procedures. This involves placing a small catheter within page2image34774576

the vein and using heat or a solution to produce injury and eventual closure of
the vein. The most commonly used treatments for the saphenous veins are radiofrequency ablation (RFA), laser ablation, mechanico-chemical ablation
(MOCA or Clarivein), and in some cases Varithena Foam. The treatment Step recommendation is customized, based on where reflux is present and other clinical factors.

Step 2: Varicose Veins

After the underlying saphenous vein reflux is corrected, the bulging veins (varicose veins) can be treated by injecting a foamed medication that will cause them to scar and eventually dissolve (foam sclerotherapy), or to remove them using tiny incisions. The most common method is foam sclerotherapy. This is also known as ultrasound-guided foam sclerotherapy (UGFS).

Step 3: Spider Veins

Spider vein treatment is always considered a cosmetic procedure. If improved cosmesis is a goal of treatment, make sure to discuss this with your doctor and plan on having cosmetic treatment as the last step. Spider vein treatment is accomplished by sclerotherapy, which is an injection of a liquid medication into the spider veins. Ask your provider for an estimate about how many treatment sessions/ vials are necessary to get the results you want.

close up photo of spider veins

page2image66292544

Approach to Vein TreatmentNisha Bunke2020-09-18T18:51:19-07:00

Vein Treatment During COVID-19
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Vein Treatment During COVID-19

Nisha Bunke2020-09-18T18:57:42-07:00

The International Union of Phlebology (UIP) Published a Consensus Document in the Journal of Vascular Surgery regarding the treatment of patients with vein disorders during COVID: Triage of Patients with Venous and Lymphatic Diseases during the COVID-19 pandemic- the Venous and Lymphatic Triage and Acuity Scale (VELTAS).

We are pleased to report that our own practice guidelines are entirely consistent with the recent UIP recommendations; and we are excelling at allowing urgent as well as semi-urgent (patients who are highly symptomatic) to be seen typically within one week.

The purpose of the triage scale developed by International Union of Phlebology (UIP) is to ensure that patients with venous and lymphatic disorders receive care in a timely fashion without compromising healthcare resources needed for the pandemic and without imposing undue risks to patients and health care providers.

Triage urgency was categorised into four groups and individual conditions were allocated to each class of triage. These included 1) Medical Emergencies (requiring immediate attendance), example massive pulmonary embolism; 2) Urgent (to be seen as soon as possible), example deep vein thrombosis ; 3) Semi-urgent (to be attended to within 30-90 days), example highly symptomatic CVD, and 4) Discretionary/Non-urgent- (to be seen within 6-12 months).

La Jolla Vein Care’s statement is as follows:

‘While we continue to encourage virtual visits and at-home mobile ultrasound diagnostics, our office has re-opened for medical necessity treatments and for those who require in-office visits. Medical necessity conditions include complications from venous reflux disease and varicose veins such as thrombophlebitis (blood clots), vein hemorrhages, venous leg ulcerations (open leg wounds), and symptoms that interfere with one’s ability to work or maintain daily activities such as leg pain, heaviness, throbbing, swelling and night symptoms that interfere with rest such as restlessness and night cramps.’ Cosmetic spider vein treatments are postponed until a future date.

This means that patients who suffer from symptoms of varicose veins and CVI, and those with complications do not have to put off their vein care. We continue to be committed on a daily basis to helping our patients. If you have a vein condition you would like to have addressed, please call us at 858-550-0330.

Vein Treatment During COVID-19Nisha Bunke2020-09-18T18:57:42-07:00

How to Treat Leg Spider Veins
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How to Treat Leg Spider Veins

Nisha Bunke2020-09-18T19:01:10-07:00

Spider veins and reticular veins of the legs are most commonly treated with sclerotherapy. Sclerotherapy involves an injection of a medication into the vein. This will cause the vein to collapse and gradually fade away. Sclerotherapy has been used to treat spider veins for decades, but modern solutions such as Asclera, allow for spider veins to be treated with minimal discomfort and immediate return to activities. Saline solutions are rarely used these days by vein specialists, because alternatives solutions are less painful and better tolerated. Sclerotherapy is the preferred over laser in most cases of spider veins on the legs, because spider veins often have underlying ‘feeder veins’ that can easily be treated with sclerotherapy, but are not addressed by laser. Laser may be used for the fine thread like veins, most common on the face. Many people will require more than one treatment session for optimal results. The national average is 2 to 5 treatment sessions. Wearing compression stockings after treatment will improve results.

How to Treat Leg Spider VeinsNisha Bunke2020-09-18T19:01:10-07:00

How to make compression stocking application a cinch!
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How to make compression stocking application a cinch!

Nisha Bunke2022-01-04T04:40:52-08:00

Stocking Troubles? Tips, tricks, and an easy guide to living in harmony with compression stockings

Applying stockings with ease:

Turn your stocking completely inside out
Locate the smaller foot hole of the stocking and tuck the foot in until you reach the heel
Place your thumbs on either side of the tucked in foot hole, with the heel located on the bottom
Put your foot in the stocking until the heel of the stocking has met your heel
Grab the larger hole or top of the stocking (it should be hanging off your foot) and pull the stocking up onto your leg
Inch and pull the stocking until it has reached either below the crease of your knee for knee highs, or the highest portion of your thigh for thigh highs.
If your stockings slide or have trouble staying up, there is stocking glue that can be applied to the skin.

How to make compression stocking application a cinch!Nisha Bunke2022-01-04T04:40:52-08:00

24, 6, 2020

How To Wear Compression Stockings

How to put them on, tips, and troubleshooting common issues with compression stockings.

Applying stockings with ease:

Cant keep your stockings up? Try these tips!

Understanding Insurance Coverage for Varicose Veins

Varicose Vein Sclerotherapy Treatment: What to Expect