What can I do short of having a procedure?

By Dr. Cohen

For the vast majority of patients with symptomatic venous insufficiency, the first treatment should be a course of what we call “conservative therapy”. These are measures that you can do yourself, which might improve your symptoms (although they can’t make the problem go away or make your legs look any better).

Before authorizing coverage for definitive treatment of venous insufficiency and varicose veins, most insurance companies will require that you try these measures for a period of time and demonstrate a lack of improvement. (You can find out how long you need to do this by looking at your insurance company’s website or asking your vein doctor.)

The most important element of conservative therapy is compression stockings. The type of stocking should be a “graduated” compression stocking, which is tightest at the ankle and less tight as it goes up your leg. These require a prescription and can be purchased at your vein doctor’s office or at a surgical supply store.

They come in different sizes so your leg will need to be measured to be sure you get the right size. They also come in different strengths, typically described in millimeters of mercury such as 15-20mmHg or 20-30mmHg or 30-40mmHg. In my practice we usually use the 20-30mmHg thigh high stockings. A variety of brands and colors are available depending on your budget and taste. It doesn’t matter if it is closed toe or open toe, but the ones you buy over the counter in pharmacies just don’t work as well.

Graduated compression stockings work by compressing the abnormal skin veins and preventing the abnormal reversed flow and lowering the vein pressures in your leg. I usually recommend that stockings be worn during daytime hours when patients are up and about. Wearing them at night can be helpful to some patients but usually isn’t necessary. Ask your vein doctor how you should use your stockings. This may improve your symptoms like ankle swelling. (But don’t expect your veins to disappear when you take the stockings off!)

Another component of conservative therapy is developing practices that can reduce the pooling of blood in your legs. These include avoidance of prolonged stationary standing or sitting and elevating your legs when seated.

Exercise can also help. Walking activates your calf muscles, which helps to push blood up out of your legs and back to your heart. I recommend daily walking for as long as convenient. Intense weight lifting and abdominal exercise may aggravate your symptoms because any increase in abdominal pressure can also increase pressures in your leg veins.

Weight loss can go either way. Being overweight does increase your risk of varicose veins, but no one has shown that losing weight makes the veins better. In fact, I have observed that weight loss usually makes the veins more visible because of the loss of surrounding body fat. But of course weight loss can have other medical benefits if you are overweight.

Over the counter medications can help too. If you have a lot of discomfort, you can also try pain medication (analgesics). The best ones are the non-steroidal anti-inflammatory medications like ibuprofen. For itching from varicose veins, anti-histamines can be helpful. And a dietary supplement called “Horse Chestnut Seed Extract” may also provide some improvement in symptoms. Of course, don’t start any medication without checking with your doctor first!

If these measures don’t help you, check with your vein doctor about more definitive treatment. You can arrange for a quick and easy consultation right now by calling 201-265-5300.

About us: There are 20 million Americans with vein problems that can seriously affect the quality of their lives. And as we age, they just get worse. As one of the few New Jersey medical practices committed exclusively to vein care, Advanced Vascular Vein Care is uniquely capable of alleviating those problems, whether they are medical or cosmetic. All treatments are non-surgical, usually covered by insurance, and delivered in an office setting. And we do it as it should be done – with compassion, excellence, affordability, convenience, and the personal touch. Call 201-265-5300 or visit AdvancedVascular.com for a quick and easy consultation.

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