Patient Perspectives

Jane S. has worked in retail for more than 40 years. Now in her late sixties, she manages an upscale woman's clothing store. Being on her feet day after day for hours on end took its toll, and her legs needed help badly.

"I had very bulgy veins, particularly on my left leg," Jane explained. "They were almost rope-like, that's the only way I can describe them. They looked ropy and they weren't just little spider veins, these veins were big. On my right leg a very big vein started up in my thigh area and went down almost the full length of the leg."

Over the years, she sought treatment from three different vascular specialists. The first two attempts were unsuccessful. "One procedure was done long ago in the hospital," she said. "It was day surgery. I got no results or relief."

About eight years later Jane had outpatient surgery on her lower left leg. "I had been developing ulcers down in that area," she described. "It does happen from being in this kind of business. He treated it, but I still managed to get one or two ulcers after that."

Each time she developed an ulcer it took a long time to heal, hampered in part by standing on her feet all day. She also couldn't exercise, walk her daily couple of miles, ride her bike, or cross-country ski. And under the heavy, expensive and not terribly attractive compression stockings she'd worn for the past 14 years, were two legs that not only looked bad, they often felt heavy and tired.

Relief finally came when Jane visited Dr. Asbjornsen, a certified phlebologist, in the fall of 2010. She had a series of laser and ultrasound guided sclerotherapy treatments and almost immediately, both legs looked and felt better. The key, she discovered, is not to treat the noticeable bulges, but to find the leaky valves in the affected veins and plug them so they won't leak anymore. When the source is treated, the bulging vein goes away, usually over a period of about six months.

"I am walking or riding my bike everyday," she reported, "and I've had no ulcers in a year and a half. I am feeling fine." Not only do her legs feel better, they look better. Last summer she wore a skirt for the first time in decades. For her, it was more than a fashion statement; it was about how finally getting appropriate treatment for her varicose veins has made a significant difference in her life.

Hugely swollen. Wormy looking. Hot to the touch. These are some of the words that Shaye R., 44, used to describe how her legs have looked and felt for years.

When Shaye was 19, bulging ½-inch-wide veins began appearing on her right leg and got progressively worse throughout her twenties; five years ago they started appearing on her left leg too. "They were unattractive for sure, and they were uncomfortable," said Shaye. "But I was so used to living that way that I didn't know how uncomfortable I really was."

Over the years Shaye spoke to numerous primary care doctors about her legs, but they all said that her condition was merely cosmetic. Their dismissive attitude caused her to dismiss them too, despite the obvious physical discomfort she continued to feel.

By the time Shaye made an appointment with Dr. Cindy Asbjornsen at The Vein Healthcare Center, her legs were constantly achy and tired. During her evaluation, Dr. Asbjornsen took down Shaye's complete medical history. Although Shaye learned that venous disease is primarily hereditary, she doesn't know anyone else in her family who suffers from vein problems.

Shaye's legs were treated— first her right leg, then her left leg two weeks later— using endovenous laser ablation (EVLA), a minimally invasive treatment to resolve large varicose veins. The procedure involves threading a small laser fiber into the vein at the location of the "leaky" valve. The laser heats the lining of the vein, causing it to collapse and eventually become absorbed by the body. Blood is then diverted to the other healthy veins in the leg.

For Shaye, recovery time was quick. She wore waist-high gradient compression stockings for four weeks and walked at least 30 minutes every day, per doctor's instructions. Within a month, her legs looked smooth and no longer felt hot to the touch. "At first there was a ropy feeling, and then suddenly it disappeared and my legs felt amazing— that was the most unexpected outcome for me," said Shaye.

She no longer felt exhausted at the end of the day and even began looking forward to taking walks, an activity she used to loathe. Now, almost nine months after the procedure, her legs are no longer swollen and "wormy looking." This past summer was the first one in 25 years that she wore shorts and did not feel embarrassed.

Shaye is unreserved about recommending vein treatment to others. She even carries her before and after pictures in her wallet. "Do the research, ask a lot of questions, and then go for it," she said. "I can not get over the difference in how my body feels."

Joshua B. is a chef. Years in the restaurant business have kept him on his feet for extended periods of time, which— combined with a family history of varicose veins— was a recipe for unhealthy legs. "I started getting varicose veins in high school, but as unsightly as they were, they never really bothered me," said Joshua.

As the New Hampshire native got older, his veins got worse. They continued to get bigger and stay swollen for longer periods of time. Even crawling on the floor with his young kids was hard because of the varicose veins on his knees. But the self-proclaimed "tough guy" continued to live with the discomfort.

When he was about 27 years old, the skin covering Joshua's veins gradually got thinner and thinner, especially on the insides of his ankles. Eventually the skin got so thin on the inside of his right ankle that it ruptured and began spraying blood "like a squirt gun coming out of the side of his foot," as Joshua described it. "It was scary. I didn't know what to do, so I rushed to the emergency room where they gave me a Novocaine injection and stitches that stayed in for a week," he said.

That was the first emergency. Ten months later another bleeder opened up higher up on Joshua's right leg. He went to two different doctors for treatment. One physician encouraged vein stripping. The other physician advised against it but offered no alternatives. Joshua was confused: "I never really had a clear path of what to do."

Finally, Joshua found his way to The Vein Healthcare Center. An ultrasound revealed the source of the problem, and Joshua worked with Dr. Cindy Asbjornsen on a treatment plan. He proceeded to have endovenous laser ablation (EVLA) on his right leg first, followed by his left leg two months later. Dr. Asbjornsen followed both EVLA procedures with sclerotherapy. As Joshua put it, the EVLA "dams up the river," and then the sclerotherapy gets rid of the other streams leading up to it.

Joshua was nervous before the procedures, but found that it was a lot easier than he expected. The most difficult part of the experience has been the compression stockings required after any vein procedure — worn in a hot kitchen. He strongly suggests that anyone who has to wear compression get their garments professionally measured and tailored, because otherwise "you're battling with them all day."

"I'm not as apprehensive about wearing shorts and showing off my legs now, because before they were gnarly and bumpy," he said. "They're not Tom Brady's legs yet, but they look much better than they did." Overall, the experience has been an educational one for Joshua. In fact, he wishes a vein exam could be part of every general physical. "It's a quick thing to look at someone's legs to see if there are varicosities. There are a lot of possible treatments, and the earlier you start the better off you are."

Lisa F. has been dealing with blood clots and compression stockings since she was 17 years old. When her doctors discovered clots in both legs the first time, ultrasound sonography wasn't widely used, as it is now. Lisa had a venogram, in which x-rays were taken after a contrast dye was injected into the distal parts of her legs and tourniquets were placed at various spots on each leg. She described the process as "awful and archaic."

Lisa was given clot-dissolving medication and put on bed rest (outdated advice, since now patients are encouraged to get up and move, if they're able). She was discharged with a prescription for Coumadin, a blood thinning medicine, and compression stockings. While she took the medication faithfully as a college student, the stockings didn't "fit in with [her] routine or image."

After taking Coumadin for one year, Lisa stopped and was promptly hospitalized again with blood clots. Several years later, Lisa developed venous ulcers. That scared her enough so that she became "religious" about wearing compression. "Before I sought help for my veins, I would put on the knee-high stockings in the morning, even if I was just making breakfast before getting in the shower."

Now 45 years old and a medical-surgical nurse, Lisa is on her feet all day and continues to cope with her leg problems. It affects her endurance, so she can't work her 12-hour shift three days in a row.

About a year ago, Lisa went to a vein screening at the Vein Healthcare Center and came away surprised— and elated. "I had no idea that the symptoms I was experiencing, like itching and swelling, were related to venous insufficiency, and I didn't know there was anything you could do for veins," said Lisa.

Lisa spoke to Dr. Asbjornsen about her goals to increase endurance and relieve leg pain. They agreed on a plan to do endovenous laser ablation (EVLA) on her left leg and then, eventually, on her right leg. It has been about eight months since Lisa had the EVLA procedure on her left leg and she is on her way toward her goals of increased endurance and less pain. The vein treatment has had an added benefit: "You can see the shape of my leg again!"

During the 25 years she has dealt with blood clots, compression stockings and leg pain, Lisa had never been asked about her veins or how her venous issues affect her quality of life. "I never thought there was anything that people could do for veins, so to learn that there was a physician who specialized in it: suddenly there were options," she said. "Finding out your options is a great starting point."

In 1983, Brian G. and a friend took a bus trip from Maine to Florida. By the time they got to the Carolinas, Brian started noticing six lumps in his left leg, all in one vein. When they finally arrived at their vacation destination, he went straight to the hospital where he stayed for two weeks.

Six deep vein blood clots had developed. Fortunately, none of the DVTs had broken free, and treatments of Heparin and heat therapy reduced them enough for him to travel safely home, this time by airplane. Brian has a theory about what may have caused the clots: "I had been a toll collector at the turnpike for five years, and all that standing and sitting isn't good for my legs. Could that have contributed? Possibly."

Once Brian got back to Maine, his family doctor referred him to a local vascular surgeon who prescribed Coumadin to dissolve the clots, and then removed the entire vein. At that point, Brian started developing severe ulcers in his left leg. For the next twenty years he sought treatment from several vascular specialists in New England, including one doctor who gave him a vein valve transplant in the late 1990s, but nothing seemed to relieve his pain or heal his ulcers.

A few years ago, with encouragement from his wife, Brian went to a wound care clinic in southern Maine. At the clinic, he received excellent treatment, as well as a referral to Dr. Asbjornsen. She discovered the root of his problem: faulty perforator veins in his leg were causing his blood to flow backwards and pool in his legs, keeping his ulcers open.

The solution— after a thorough examination and detailed medical history— was to treat the troublesome veins at the source of the dysfunction, using ultrasound-guided sclerotherapy to seal the veins shut. "The ulcers are slowly closing, and the results I'm seeing are unbelievable," he said. "It's the best my leg has felt in years."

Brian continues to undergo sclerotherapy and will do so until his leg pain and ulcers are completely gone. Before sclerotherapy, Brian's pain was so bad he could barely walk. Now he says that he and his wife go for walks on the beach together. "My primary goal is no more pain, but my other goal is to go for a swim without any plastic bags or contraptions on my leg," he said. "I think we can make that happen."

Gary S. did not go to a vein specialist because his legs hurt, or to fix his foot issues, or even for cosmetic reasons. After being evaluated and treated by a vein specialist, however, both leg and foot problems were resolved— and his bumpy veins have disappeared, an unexpected side effect.

It all started when the 60-year-old engineering supervisor went to his family doctor for an annual physical. Gary had no leg pain, but the visible varicose veins on his legs gave him cause for concern. "For me it was all about prevention," he said. "I wanted to make sure that my legs were healthy."

Gary's doctor referred him to Dr. Cindy Asbjornsen who gave him a full venous evaluation, which included a physical exam and diagnostic ultrasound. Dr. Asbjornsen also collected a complete health history— and took note that both of Gary's parents had varicose veins, though they never sought treatment.

In addition to varicose veins, Gary had been experiencing "a fair amount of trouble with both feet." He suffered from plantar fasciitis and Achilles tendinitis. For the plantar fasciitis, he had been seeing a podiatrist annually for five years to get cortisone shots on the bottom of his feet. There were no effective treatments available for the tendinitis. Dr. Asbjornsen suspected that the build-up of fluid in his feet was the result of poor venous return.

In December 2012, Gary had endovenous laser ablation (EVLA) performed on both legs. In the months that followed, he was surprised to see that not only had his varicose veins diminished, but also that the pain in his feet were gone. "Fixing my foot problems wasn't the goal, but it's good when you fix one thing and the side benefit is you fix something else at the same time."

Gary admits that since the EVLA procedure, he's been "playing a bit more golf" than usual. His goal is to retire in a few years, and preventative care helps increase the odds that his body will be in "relatively decent shape" when retirement comes. "I think patients should be proactive with their health," Gary said. "If they have any concerns regarding anything, they should discuss it with their family doctor— and get answers to their questions!"

In the 1950s, most women wore dresses and skirts, but Priscilla F.'s mother always wore pants to cover up her bulging, unattractive veins. Her mother's legs were so swollen that her knees disappeared, her legs as wide at the bottom as at the top— what people used to refer to as "stump leg." "The worst thing was that when my mom got into her '70s and '80s, her varicose veins were so painful she could barely move," said Priscilla. "She was a very active woman who became so limited because of her legs."

Priscilla, who lives in New Hampshire, has had her own venous challenges. Shortly after her daughter Stacie was born, Priscilla sought treatment for her increasingly painful varicose veins. The only option available at the time was vein stripping, which she generously described as "quite a process." The treatment proved effective for about 18 years, but then Priscilla's legs and ankles began to swell again, and the heaviness and discomfort returned.

Priscilla knew she had to do something or risk ending up like her mother. After researching vein treatment online, she found The Vein Healthcare Center and made an appointment to be evaluated. "I was under the assumption that once veins are stripped you can't do anything else," she said. "I was elated to find out that I had other options and something more could be done!"

Priscilla determined that her main goal was relief from the pain and swelling. Together with Dr. Cindy Asbjornsen, she decided to have endovenous laser ablation (EVLA) for both legs, followed by sclerotherapy. Since then she goes to the local Y to exercise "every single day," something she would never have dreamed of just a few years ago.

Since vein disease tends to run in families, "bad veins" didn't end with Priscilla. Her 42-year-old daughter Stacie also has chronic venous reflux. Stacie began to see symptoms in her mid-twenties, and tried multiple treatments over the years— sclerotherapy, two rounds of radiofrequency (RF) ablation, and eventually a full removal of both saphenous veins from ankle to groin— but nothing gave her lasting relief. "It's disheartening when your veins are stripped and it's still not taken care of," shared Stacie. "There were nights I couldn't sleep, it was so painful."

Fortunately, Stacie's mom had already started treatment with Dr. Asbjornsen and recommended that Stacie pay her a visit. After an ultrasound evaluation, they found the root of the problem. Since then she's had EVLA on her left leg, along with a significant amount of sclerotherapy and light-assisted sclerotherapy. The treatment will be ongoing because of the past difficulties she's had with her veins.

Both Priscilla and Stacie agree that anyone seeking treatment for their veins should look for someone who is trained in vein care specifically. Stacie has some advice for younger women with vein problems: "I was in my mid-20s when I was first affected, so don't think it's just an 'old lady' kind of thing." She also suggests that those who have relatives with vein disease take special care. "Don't wait. It's not something to put off, because it does get progressively worse and it won't go away on its own," she said. "If you have a family history, you need to stay on top of it."