The Vein Game
Everything you need to know about Varicose Veins in the one, fun to read book!
By Eric Davis, PA-C, MPAS
Smashwords Edition Copyright © 2011 by Eric Davis PA-C, MPAS
All rights reserved.
Smashwords Edition License Notes
This ebook is licensed for your personal enjoyment only. This ebook may not be re-sold or given away to other people. If you would like to share this book with another person, please purchase an additional copy for each recipient. If you’re reading this book and did not purchase it, or it was not purchased for your use only, then please return to Smashwords.com and purchase your own copy. Thank you for respecting the hard work of this author.
Published by Full Circle Ventures, LLC
Full Circle Ventures, LLC
62806 Baskin Ct.
Bend, Oregon 97701
USA
http://www.fullcircleventures.com
Virtual Consultation ebook Series, a division of Full Circle Ventures, LLC.
http://www.fullcircleventures.com
http://www.thevaricosevein.com
This publication is written to provide general information regarding varicose veins and the other subject matter included herein. However, due to the fact that every medical situation is different from and every medical practice differs in how it operates and deals with medical issues, actual real-world experiences may vary. For this reason the reader is encouraged to seek out medical consultation with his or her own medical provider regarding their particular degree of health and medical problem.
The author has taken reasonable precautions in the research, writing, and preparation of this book and believes that the facts and statements made herein are accurate as of the date of its writing. The author does not assume any responsibility for the medical wellbeing or health of his readers or for any errors or omissions. The author specifically disclaims any and all liability from the use or application of the information contained in this book. This book is for informational purposes only and is not to be used in place of or in exclusion of the medical advice of a trained medical professional.
Contents
Varicose Veins are like Thumbprints
The Anatomy “How your veins are put together”
The Physiology “How normal veins work”
Veins versus Arteries: Score 2 to 1
It’s a tough job, but someone’s go to do it
The Pathophysiology “When veins go bad”
Will the real Varicose Vein please stand up?
Causes of Varicose Veins “Why me? ”
The Symptoms “What varicose veins can do to you”
Cosmetics “Nobody likes a blue leg”
So you want to be a Supermodel
Social Comfort is a legitimate goal
The Worst Case Scenario “How bad can it get?”
Choosing the right vein Doctor “Be a smart shopper”
The Consultation “It’s a 2-way street”
The importance of the Ultrasound
Varicose Veins and Insurance “Dirty Rotten Scoundrels”
Necessary vs. Non-necessary treatment
Jumping through the insurance hoops
Treatment Options for Varicose and Spider Veins
Traditional Vein Stripping “The old way of doing it”
Endoluminal Catheter Ablation “The new way of doing it!”
Ambulatory Phlebectomy “Removal of large ropy veins”
Sclerotherapy Injections “Tidying up the loose ends”
Transcutaneous Laser Ablation “Taking care of those pesky spider veins”
Pulsed Light Therapy “Another way to treat spider veins”
A word about Lasers “Magic or Myth?”
Naturopathic Remedies “Do it yourself guide”
Manufactured Creams and Ointments
Which Treatment is Right for Me?
To Treat or Not to Treat? “That is the question”
Compression Socks “Putting the squeeze on Varicose Veins”
Spider Veins on the Face “Are your cheeks too rosy?”
Blood Clots “Don’t be frightened”
Varicose Veins and the Media “Can you trust the tube?”
ABCNews “Cutting Edge: Removing Varicose Veins”
“A New Procedure can Remove the Veins in 15 minutes.”
Fox News: “Zapping Varicose Veins”
“Taking the pain out of varicose veins”
Dr. Oz: “The Fix: Plastic Surgery”
My Personal Experience “I’m not only the president of the club, I’m also a member!”
Common Questions (and the answers)
Online Resource Quick Reference “Websites that I trust!”
Glossary of Terms “Goofy words your medical provider may use”
This book would not exist without the incredibly valuable influence and input from some truly amazing people that I have had the pleasure of knowing. Their support and encouragement has not only raised the quality of this book to much higher levels than I could have imagined but has opened a well of creativity in me that I did not even know existed. Thank you to everyone who had a hand in the creation of this important work, especially my peers in medicine.
My wife Melissa is far and away the most supportive and understanding person in my life. Projects like The Vein Game would not exist without her standing along side of me and my sometimes crazy, ideas. Her patience rivals that of a Tibetan Monk. This book is dedicated to her.
Thank you also to my parents Ken and Lynn for their complete and total support of me and for instilling in me the belief that I, combined with the power that God gives, can do anything.
G. R. Buzzas MD, FACS has been not only my mentor and a source of my growth in medicine and surgery, but a truly great friend. It was his dedication to patient care and education that brought my own evolution from a brand new medical provider to a true student of surgical practice. Working with Dr. Buzzas for the last eight years has been a blessing and a pleasure.
Also to my “partners in crime”, Becky Baker-Green and Mary Philo, for their constant unwavering expertise and support as we continue to improve on our abilities to help the people who show up on our doorstep with varicose veins. I appreciate you more than you can possibly know.
And finally to all of my patients, especially those of you that have taken time out of your busy lives to read The Vein Game and supply valuable feedback. This book is really for you and all those like you.
Sincerely,
Eric Davis PA-C, MPAS
Welcome to the Vein Game! In the pages of this book you will learn if you are a player in the game of varicose veins or not. You will understand the rules that apply to varicose veins, their diagnosis, their treatment, and how all of this comes together inside the worlds of medicine and insurance. You will find out how to tell if your medical provider partner even plays the “vein game”, if they know the rules, and if they can help you win. You will understand who the players are including the insurance companies and how to take advantage of this knowledge. You will understand how to maximize your chances of winning the game and coming out the other side with the results that you had hoped for. All of this and so much more are waiting for you in the pages that follow, so let’s get started.
Simply put, because there are millions of people just like you who are plagued by varicose veins and/or spider veins and simply don’t know what to do. In fact, it is estimated that around 1 in every 20 Americans has the disease. This translates to an estimated 20 million people in the United States who are affected by varicose veins, yet it largely goes undiagnosed and rarely discussed. I see it all the time and it frustrates me that much of the medical community has yet to embrace this as a real disease. Now I won’t argue that in life there are far more concerning diseases that affect us as humans, cancer for example, and that these demand the majority of our attentions and research, but that does not mean that lesser diseases such as varicose veins should be overlooked and ignored completely.
Personally, I have developed a passion for the problem of varicose veins that is the result of my exposure to the people that suffer with them and the experiences that I have had while helping these people. I now know that the old days of being told, “You should just live with them”, are over…or at least should be. Some people have large varicose veins that are painful or causing them significant problems. Others have nothing more than a few spider veins, but are completely self-conscious about them. Whatever the case, varicose veins are a slow and insidious disease that can cause severe medical problems in later life and can result in significant issues that could have been avoided had they been treated earlier. The risks associated with this disease are often times overlooked by patient and provider alike simply because neither of them fully understand the implications. I further believe that cosmetic improvement is a worthwhile goal in our society and this alone is reason enough to pursue treatment. It is due to these reasons and more that I have made it a priority in my life to try and better educate folks about vein disease and to help start a new way of thinking when it comes to the need to treat varicose and spider veins.
Let me share a story about a patient of mine that will help to demonstrate why I think dealing with this problem is so important.
I met a very nice elderly woman a few years ago that had a lifelong struggle with varicose veins and spider veins. I will refer to her as Mrs. Smiley since I never once saw here with a frown on her face. Mrs. Smiley had what I refer to as “a complete mess” of blue and purple varicose and spider veins nearly covering her legs from top to bottom. Sure, she had noticed them and had recognized that her legs ached, hurt, and swelled nearly every day and she had often wondered why her legs wore out so much faster than those of her similarly aged friends when they went out on one of their regular walks. She had even brought it up to several medical providers in the past only to be told that unless she was developing ulcers or having pain that kept her from getting around at all, it simply wasn’t worth doing anything about. “Try some compression hose”, one Doctor had told her, but what that provider didn’t consider was that the arthritis in her hands was so bad that she was unable to get the tight socks on over her feet and had no help at home since her husband’s passing several years prior. So, she simply went on living with them. That is until she had a truly life changing event.
You see, this wonderful older woman loved to swim. Well, it wasn’t really swimming, but she would go to the public pool several times a week and do water aerobics and “lane walking” in the water for exercise. She loved doing this and absolutely glowed when she talked about it. It made her feel young, energetic, and refreshed (not to mention that her health was great due to the benefits of regular workouts). One day Mrs. Smiley was in the pool with several other people enjoying her usual activities when unbeknownst to her one of the other patrons approached the pool manager and asked if the “skin disease” that this older lady had on her legs was contagious and if other people in the pool might be able to “catch” it. Well, in the classic ignorance of someone lacking even basic knowledge or personal skills, the pool manager cornered Mrs. Smiley and asked her if the ‘leg disease’ she had could transmit to the other patrons of the pool!
Needless to say Mrs. Smiley was mortified. She remembers stammering out some half-backed explanation to the manager and then removing herself from the scene as quickly as possible. She never returned. She simply felt too embarrassed and could not face that kind of scrutiny again. While the way she was approached is completely unacceptable, the real tragedy is that she lost the one form of exercise that she could actually take part in to maintain her health.
It was at this time that I met her. Mrs. Smiley came to me with tears in her eyes (not smiling now) and shyly asked if there was anything that could be done even though she expected the same answers that she had been given before. You could not believe the relief that flooded her face when she heard the truth about her problem and that there was not only a treatment, but one that would eventually allow her to return to her swimming with confidence and even more importantly eliminate her pain and swelling (something she had assumed was hers for life).
Long story short, after only 6 months she was back swimming, the varicose veins were gone, the swelling and pain were gone, and I was sure to tell her to sock that pool manager right in the kisser if she saw him again!
It is for people just like Mrs. Smiley that I write this book. I hope that you find the stories entertaining, the information educational, and the call to action inspiring.
Varicose Veins are like Thumbprints
You might be thinking, “My legs aren’t as bad as Mrs. Smiley’s, do I really have varicose veins?” Whoa, don’t worry. Mrs. Smiley is an extreme example. The truth is that out of thousands of patients, I have never seen two legs with varicose veins that looked the same. While the veins that we have in our legs are generally put together the same person to person, the ones that turn into varicose veins are different every time leaving a unique pattern on each individual, like a thumbprint.
Some people develop only the large ropy, twisted veins that look like a line of marbles running all over the place. Other people get only the really fine, ‘hair like’, red spider veins here and there. Still others have some combination of both of these. The truth is this. Big or small, red or blue, all over or just a spot, symptoms or no symptoms they are all varicose veins. You see the process that causes varicose veins affects all the different kinds of veins in our legs resulting in a wide variety of visible differences when they pop out. Even though a large lumpy vein looks very different from a small red spider vein, essentially the same thing has happened to both…they have stretched out and become dilated. I will be going into more detail about this process later, but for now understand that the large ropy varicose vein started out as a vein the size of a spaghetti noodle and the small, red spider vein started out as a microscopic vein no bigger than a hair. But both have distended or stretched up to 5 or 10 times their original diameter.
Vein Game Tip #1: Don’t fall into the trap of comparing your legs to the legs of other people. Your legs are unique and your varicose veins are like a thumbprint, very different from anyone else’s and should be evaluated without bias.
Where on the leg that this occurs is determined by myriad factors including the body type of the person, fitness level, prior injuries to the legs, risk factors, ethnicity, and genetics. There are lots of reasons, but the point here is that no two legs develop varicose veins in the same way and so for a medical provider to tell you that “yours don’t look very bad and probably don’t need treatment” is really ignoring this fact. Not to mention that only you as the patient can decide what is tolerable or intolerable in your own life.
We are not entirely sure why, but it does seem as though severe varicose vein disease is occurring at younger and younger ages. This could be related to the increase in obesity or possibly an overall decrease in exercise in society. Whatever the cause, I am hearing more and more people say, “I can’t believe that I am getting veins like my grandmother already.” “Aren’t I too young for this?”
Unfortunately no. I have seen both spider veins and extensive vein disease show up in every decade of life. Including the teens, believe it or not. Now, one thing that is true is that if left untreated, varicose veins will likely progress over time ultimately resulting in the really bad looking legs and many of the medical problems that go along with them. So typically the legs of the elderly are far worse then those that are younger. The unfortunate thing is that most of our older (or should I say “seasoned”) folks out there never had good treatment options for dealing with there veins when they were younger, so it progressed unchecked and now they have to play catch-up if they hope to have any improvement. The latest technology for treating these vein issues has only been around and readily available for about ten years or so and most of you in your later years really only had the option of a stripping procedure. That was a pretty tough decision to make for sure. “Hmm, do I live with my veins and hope not to get ulcers later in my life or do I undergo a painful treatment that requires me to be off my feet for up to 6 weeks?” Tough call. Fortunately, as you will see in later chapters, the decision now is “Well, I can live with the pain and swelling and run the risk of complications later or I can undergo an office procedure and take it easy for a few days.” Now that is almost a no brainer, right?
Whoa, not so fast. Remember, I am a big fan of patients making informed decisions. So don’t get up and run off to the nearest vein specialist quite yet. Finish this book first. Then make an educated decision, and when you do meet with a vein specialist you will gain much more from that visit and be able to better understand the treatments proposed.
“How your veins are put together”
Yea it is! So instead of having you apply for the next admission year, why don’t I just walk you through the science of our veins? We are going to go over the anatomy, the physiology (normal function), and the pathophysiology (abnormal function) of the vein system of the leg.
Some of you are really going to like this part (maybe even a little too much), while others of you might already be getting a little queasy. Don’t worry! I promise, no gross pictures or drawings of a pickled leg. Instead I will use the same descriptions and analogies that I use every day in the clinic to describe it. These descriptions have been fine-tuned through thousands of patient encounters and should make this relatively complicated information much easier to grasp. Ready? Here we go.
No, really. Go dig up a plant of some kind. When you do, take a hose and rinse all of the dirt of the roots and take a close look. As it turns out the root system of a plant is very similar to the vein anatomy of the human leg.
If you have ever noticed on a plant root, there are main, large, central stems of the root system and off of these primary stems there are secondary, smaller branches. Now follow one of these branches carefully and you will see that it branches and splits dozens of times until finally there is nothing but tiny, hair like fibers at the end. Now if we could look at these small hairs under a microscope we would see that there are even smaller root branches coming off of these hairs. Our veins are put together basically the same way. The only difference is that we have several “root” systems working together, rather than just one.
In the leg there are two distinct vein or ‘root’ systems. One is called the deep vein system, which is located in the center of the leg, near the bones and encased in muscle. The other is known as the superficial vein system, which is located near the skin. This is the vein system that is affected by varicose veins. The deep system is completely surrounded by muscle and really does not develop varicose veins because it is so well supported. There are bad things that can happen to the deep vein system such as blood clots but we will cover this later on.
OK, now imagine that root system again. The superficial (near the skin) root system has a central vein called the great saphenous (pronounced s-a-f e-n-u-s) vein as its center, main vein. This vein runs from your groin all the way to your ankle just like the inside seam of a pair of pants. And just like the plant root, there are main branches that come off of this central vein and run out to the front and the back of your leg, off of these main branches come smaller branches and off of these come the hair-like veins at the very end.
See, not so complicated right?
Next there is a very similar main vein or root that starts just above the back of your knee and runs down the back of your calf into your ankle. This one is called the small saphenous or lesser saphenous vein. Again, there are branches and then smaller branches, and then the “hairs” wrapping around the inside and outside of your calf.
Vein Game Tip #2: The veins in your leg are built exactly like a root on a plant. Large veins branch into smaller and smaller veins until they are microscopic. Blood flows in the direction from the smallest to the largest.
That’s pretty much it, at least for the purposes of this book. There are actually all kinds of other veins and smaller systems mixed in, but in most varicose vein issues these are the two main systems that fail.
So now take a look at your legs. You likely can see most of the varicose veins in your leg and based on the anatomy that we just discussed, you can probably already make a good guess as to which of the two vein systems is responsible. You can also probably determine if the veins that are bothering you are near to the main stem or are farther away based on the size or diameter of them. For example, a patch of spider veins has at least one or two larger veins between them and the main stem veins, whereas a large ropy vein is probably a branch directly off of the main, central vein. Make sense? OK. Let’s move on to the function of veins.
“How normal veins work”
Veins versus Arteries: Score 2 to 1
I am constantly amazed at how many of my patients don’t understand the difference between an artery and a vein. It’s most of them. So don’t feel bad if you aren’t clear on it either. Let’s start by imagining the nearest freeway. There are two sides to the road with traffic traveling in opposite directions and separated by a thick concrete divider wall. On one side we have delivery trucks carrying loads of brand new products from the city to the outlying areas for distribution and use. On the other side we have the same kind of trucks driving from the outlying areas into the city carrying loads of broken and used up products to be recycled into new ones and then sent back out again.
Our vascular system is exactly the same. Arteries carry fresh blood from the heart down to the legs. This blood is clean and full of oxygen to deliver to the cells of the leg and foot. Veins on the other hand are carrying old, used up blood back up to the liver, heart, and lungs so that it can be cleansed and more oxygen can be put in. Then the process happens all over again.
Remember the plant root analogy. Well, the small, hair-like veins are the first ones to pick up the used blood and transport it to the next largest vein, which in turn transports it to the next largest, and so on until it reaches the main stem vein of the leg and can move up and out of the leg. Another interesting point is that there is one main artery system in the leg and 2 main vein systems. Why is this? Simply put, veins have the tougher job. You see, arteries have the benefit of the heart. When the heart pumps, blood is forced through the arteries out to their destination. Veins on the other hand don’t have much help from the heart. Plus veins are working against gravity, against pressure that we create in our bellies when we lift or strain, against babies taking up room in the belly, and against extra weight that we carry. Whew! It makes me sweat just thinking about it. All of these veins working in tandem have the ability to overcome all of these opposing forces. That is until some of them decide to give up and become varicose veins.
It’s a tough job, but someone’s got to do it
So how do the veins get the job done? Mostly by two means, one-way valves and muscle contraction. Our veins are equipped with one-way valves that only allow blood to move uphill, but then close to keep blood from running back down. Pretty neat, huh? We move blood from valve to valve by using muscle tone. Even a slight increase in muscle tension will compress the veins and force blood up hill against gravity, through the next valve. Think of it like one of those fancy straws that have a little flap valve at the top. This valve opens and allows your favorite soft drink to flow out when you suck on it, but then closes when you stop. It won’t work in reverse, which means that you can’t blow down the straw and make bubbles in your soda. Hopefully you aren’t still doing that anyway, but you get the point.
Admittedly there are many other factors at play in moving blood through our vein system. But understanding the valves is really the key. This is how our veins were designed to work.
“When veins go bad”
Will the real Varicose Vein please stand up?
Varicose veins come in all kinds of shapes and sizes ranging from huge rope-like veins down to small purple and red spider veins. Even though we have different names for these varicose veins depending on their size, they are all having essentially the same problem.
Basically a varicose vein is a vein that has valves that are no longer working and/or has become distended or stretched and cannot move blood efficiently toward the heart.
We are going to go over all the reasons for why veins “go bad” in a later chapter, but for now lets review what happens when they do “go bad”.
Floppy Valves: This is where the valve actually flops backward. Now blood can move up the vein when pressure from your muscles is applied, but just turns and runs back down the leg when the pressure stops. The one-way valve is broken and blood flow is actually reversed.
Vein Distention: This is where the vein walls stretch out. When this happens valves are even less functional because the leaflets of the valve are being pulled apart or separated. Plus the stretched vein now holds more blood then it should and there is extra “weight” pushing downward in the direction of gravity.
Vein Game Tip #3: Varicose Veins and Spider veins are basically the same thing. One was just a larger vein to begin with then the other.
Vein twisting (tortuous veins): As a vein stretches, its walls become thinner and don’t have the same strength that they once had and begin to twist and bulge out. It is just like a water balloon. Have you ever noticed when you inflate a water balloon several times that the rubber becomes thinner each time? It also tends to lose its shape. The same thing is happening in the case of varicose veins and this is why some veins seem to be twisted and lumpy. Even spider veins are nothing more then small veins that are distended and stretched and therefore more visible.
Spider veins: The really small normal veins in our legs don’t have valves. But they do rely on being the correct diameter. Spider veins are microscopic or slightly larger veins in our legs that have stretched out and are holding blood without moving efficiently and are therefore more visible. See? It is the same process as with larger veins, but on a smaller scale.