Treatment #2 is much better

I took a picture of my leg 24 hours after the second treatment. I was able to pull down the stockings to remove the large bandages. I amazed by the pretty bruises. I don't know for sure, but I believe the bruise on the inside of my thigh above my knee was caused by the infection that made me yelp. I saw only a tiny bruise on my calf where the catheter was inserted.

The pain this since treatment is night and day from my 1st treatment. I have taken the pain medication and it helped. My leg feels a little sore, but walking is not uncomfortable and I don't have a limp. With that being said, I was still conservative with my activity over the weekend. The Tramadol makes me drowsy (I took lots of naps). The post operative instructions suggests walking and using the stairs, but nothing strenuous. We took a family walk around the neighborhood after dinner. It felt great and I would have liked to go longer, but I don't want to over do it.

I can take the stocking off tomorrow morning to shower (yeah!). Two more weeks of wearing the stockings during the day only and I hope to be done with them for a while. If the past 3 days are any indicator of how I will heal over the next 2 weeks, I am optimistic that I will survive without any unplanned ultrasounds (or additional pain killer prescriptions).

I went back again.... and again...and again

I apologize for lack of recent posts. My family has taken priority over my little vein stories. I experienced a birthday sleepover, double ear infections, and guys weekend and I lived to tell about it.

Recap of stockings during the day:

Since my last post, the pain level got increasingly worse. Not only was the pain getting worse everyday, the section by my knee was slightly red and felt a little warm. After some prodding by my husband, I called the doctor. An ultrasound did not show any blood clots. The doctor thought that my pain and leg condition was abnormal, but not a problem. He reminded me that my procedure was more involved than most. In that one ablation procedure, he treated 4 large veins. The nasty twisted rope vein was knee was causing me extra pain because it was the spot were 2 larges veins were meeting close to the service of the skin. I received a prescription for Celebrex to help manage the pain while I was at work since the Tramadol makes me feel drunk. The Celebrex was great.

Recap of post-stockings:

I was looking forward to August 13th to be my first day with wearing stockings. I took on the challenge of grocery shopping with my leg free from stockings. It was a little sore, but I wasn't surprised since I didn't have the support of the stocking. The weekend got away from me before I was about to write. Monday morning, the 15th, I noticed that my ankle and foot were swollen. Tuesday night it was still swollen so I wore my stockings to bed. I didn't see any improvement even after wearing my stocking Wednesday so I took my husband's advice and called the doctor.

I went in and had another ultrasound. Swelling is common symptom of blood clots. Thank God, I didn't have any clots, but no one had a solid answer for my swelling. (take a look at the picture). I iced my ankle, wore my stockings, and kept my feet elevated the best I could while staying home with the baby who was dealing with the norovirus.

I was wearing my stockings for an extra week and I noticed improvement. I was happy to take my stockings off. I was looking forward to finally writing the post about how fantastic life was without stockings but odd work and family schedules interfered with my spare time. Before I had time to write, the swelling came back. I couldn't believe it. The top of my foot was so swollen that any shoes that covered the top of my foot were uncomfortable. I sucked it up and didn't even mention it to my husband.

Treatment #2

Can I you believe that I went back for more? The financial aspect was a huge motivator in getting back to the doctor today. I have meet my insurance deductible for the year and my remaining EVCA procedures this year will be covered.

The plan for today's procedure was very similar to the 1st. I was more aware of what the doctor was doing today when he was inserting catheter into my veins. The long vein going from the groin to my ankle was quite twisted and the catheter was not easily moving through. (Quote of the day: "when you get to groin, you're almost done.") My husband was in the procedure room with me and he was able to see the doctor inject the catheter and move it through my veins. The vein in the middle of my thigh was not as bad as originally thought so the doctor was about to use the sclerosant to threat the area. Sclerosant was also was used on the veins at my ankle and foot. Those areas are problem some, but too small for the catheter.

My husband counted at least 22 injections in my leg. He thinks they may been more judging by my facial responses. The doctor normally gives a heads up that he is going to stab me with a needle, but a few were surprises. My husband noticed 8-9 syringes for the sclerosant, plus the injections to insert the catheter and the injections for the lidocaine.

When my head was tipped down to begin the ablation, I became dizzy. My heart was beating so fast. I had uncontrollable shaking. The cold compress on my head and a mint helped. The nurse told us that the lidocaine also included epinephrine. That helped explain why I had to take medication to lower my blood pressure when I took the Valium.

After the procedure, the doctor took a look at the swelling on my right leg. The veins that are over my ankle bone and foot are trying to heal and are irritated every time I move my ankle. He is not concerned about the swelling.

I took my Tramadol as soon as I go home today. I sat down to watch to movie and was out cold. An hour later, I woke up when my daughter gave me a kiss. I was shocked because somehow my husband had fixed dinner and picked up both girls from daycare. He said that he tried to talk to me multiple times, but I was in a drug induced nap.

I'm feeling another drug induced nap coming on.

A whole week of stockings

What a difference one week makes! The pictures this morning look so much different from the pictures last Wednesday. I don't feel like I am walking with a limp anymore. I can still see my varicose veins and fell them when I run my finger across my legs. The large swollen vein at my ankle is much smaller.

The pain level today is higher than yesterday. My postoperative care instructions state that tightness is an "expectation of a successful procedure". I can also expect to have bruising and tenderness up to a month after the treatment date.

This may sound crazy, but I was looking forward to putting my stocking back on this morning after my shower. I despise compression stockings yet I cannot argue with their benefits. Air on my leg is refreshing and relaxing. Too much relaxing means that my veins are not receiving the proper amount of support and pressure.

I forgot to mention an annoying downside of compression stockings. When I wore my compression stockings for the first 3 days straight I had no issues for the stockings falling down or bunching behind my knees. Putting stockings on and removing them daily stretches them causing them to gradually fall down during the day. After 1 1/2 days, I have to start pulling the stockings up from the back of my knee. It is driving me crazy.

7 Days In

I'm feeling much better today. I have some pain when walking. The top of my thigh that is not covered by compression stockings is finally beginning to bruise. That area is healing at a much slower pace. The spot of my above my knee that I feared was getting red and swollen last night looked great this morning. The slight redness turned into a bruise. Bruises I can handle. Symptoms of blood clots I can not.

I haven't taken any pain medication today. I don't even plan to take any before bed. A can of beer is my only medication today. I think I deserve one after the week I've had.

I took my stockings off!

It was fantastic to take my compression stockings off yesterday morning. As the first two pictures show (on the brown rug), my large varicose vein is still visible on the inside part of my leg. There is a slightly swollen red patch above my knee where the vein stuck out the most. If I would not have had errands to run yesterday morning, I probably would have stayed in the shower all day just so I didn't have to put my stockings back on. I waited until noon before I took any pain medication.

The picture on the right (green background) was taken this morning. The bruising became quite yellow since yesterday morning. I was able to sleep without my stockings last night. I waited until 7 pm to take any pain medication today. The pain today is quite different from the pain on Tuesday and Wednesday. My ankle and knee feel painfully swollen, but no swelling is visible (maybe because my stocking is restricting some it).

I am embarrassed of how white my legs look in these pictures. My doctor advised against tanning (or any sun exposure) one month before and after the procedures. I don't fully understand the month before. The no-sun one month after has something to how the sun can discolor the veins as they are closing. I'll ask for a better an explanation when I go in for the next procedure. In two weeks when I no longer have to wear my stockings during the day I plan to get a spray tan.

If my leg still feels swollen and if the stop above my knee if still red in the morning, I plan to call the doctor. My postoperative instructions say to call the doctor if I experience any of the following symptoms: redness, warmth, pain, swelling, temperature of 101 or higher, or abnormal drainage.

On Sunday nights I normally get sad when a new episode of Entourage is over. I am excited for it to be over tonight because it means time to take my stocking off again for bed.

How to Take a "Bird Bath"

My Thoughts of Day 4

• I still have pain in my leg, but I am confident it will be better soon. I can tolerate the pain (with some ibuprofen) although it is exhausting. Walking from my desk to the printer is a daunting task.
• The parts of my leg where the varicose veins were collapsed is quite tender to the touch. Sleeping on my side last night was difficult since my untreated leg was applying pressure to the recently treated large vein. Today, someone suggested that I sleep with a pillow between my legs like I during my pregnancy.
• I was bummed to realize that lidocaine is still leaking out of some of the injections sites today. My "no khaki pants" recommendation is still in effect for day 4 of EVCA.

I took my final "bird bath" of treatment 1 this morning. I was tired and groggy when got up this morning and wanted nothing more than to stand in the shower and feel the warm water hit my back. Oh, tomorrow morning will be glorious. These past 3 mornings have made me appreciate my tiny little 1968-sized shower.

My only saving grace during my "bird bath" experience has been the spray nozzle in the jacuzzi tab. I had my left leg in the tub and rested my right leg on a towel over the side of the tub. Leaning over the side of the tub to wash my hair made me dizzy. Maybe I will dry shampoo the next time. I would still have the awkwardness of getting clean without getting my stocking wet, but I wouldn't get lightheaded.

I can't wait to wake up in the morning and take off my stocking! I will be sure to take some pictures of how my leg is looking.

Compression Stockings are Fun

Day 3 is going well. My leg did not feel as numb today. It appears that the lidocaine induced swelling has gone down. The ibuprofen I took before work definitely wore off before the end of the day. Even though I took the prescription pain killer 2 hours ago, I still have some discomfort. The varicose veins that were treated are tender to the touch. When I stand up to walk, there is twinge of pain down my leg. It feels better once I get going, but it hurts a little to put all my pressure on it. I am forcing myself to walk on the stairs (since the doctor told me to) because the twisted rope vein by my knee tightens every time I bend it.

I wanted to take the opportunity tonight to tell everyone about compression stockings. I hate wearing them, but I know that add value so I tough it out. As I mentioned before, I wore compression stockings during my last pregnancy from 8-41 weeks. Why couldn't she be born early? Until this week I didn't know an option for toeless compression stockings existed (see picture). Compression stockings are made by multiple vendors and come with "variety" of options: knee high, thigh high, full pantyhose, different compression strengths, and I believe only 3 colors (nude, black, and suntan).

I broke a sweat the first time I had to put compression stockings on. I laid the stocking out in front of me and put my right arm through it to grab the heal. I used my left hand to pull the stocking off my right arm. The leg portion was now instead out. The goal was to get my toes in the stockings and get it over my heal in one motion. Easier said than done some days. Once my foot was in stocking, it was a slow and steady process to pull the stockings up to my thighs. The compression stockings, by design, are tight. My husband laughed the first time he saw me put my stockings on. It wasn't until he helped me remove them that he realized how difficult it was for me to put them on.

Putting compression stockings on is only one piece in the puzzle of my disgust for them. In the summer when it is 90 degrees outside, the compression stockings make me feel like it is 110 degrees. I am self-conscious about the physical appearance of the stockings and I always cover them with pants or long dresses. I find it terribly annoying when the stockings start to bunch be my knee. Patience is required when slowly readjusting the stockings.

I am very excited about my new toeless stockings. I probably would not have selected them in the winter. The toeless option allows me to wear sandals or flip-flops with pants and feel like I am some what normal.

During my current 3 straight day stint of not removing my stockings, I wear socks when I am at home. I am only wearing a stocking on the leg that was treated. Since I obviously can't change the stocking yet, I don't want them to get it dirty by stepping on food that a cute baby has thrown on the floor. I am looking forward to Saturday when I can remove this stocking and put on a clean one. Stockings are sold in pairs. I was advised to hand wash compression stockings in regular detergent, not Woolite, to retain the tightness. Of course, I then have to hang them to dry.

For the postoperative treatment of EVCA, compression stockings must be worn for 3 straight days (treatment was Tuesday afternoon- so Wednesday, Thursday, and Friday). Saturday morning I can begin removing my stocking to shower and sleep. That will be my new routine for 2 additional weeks.

Time for bed. The drowsiness side effect is starting to kick in.

Day 2- Treatment 1

I took my 50 mg of Ultram for pain last night as recommended. I took a cat nap, but I was not out cold. The pain narcotic made me feel buzzed but I still had discomfort in my leg. My husband has researched on-line and found that it was common for the lidocaine to discolor the skin. The nurse explained to me this morning that the large white spot above my stocking was a result of having so much fluid pumped in me the day before.

As directed, I took my "bird bath" this morning. It is not easy to get clean while half hanging in the bath tub using the spray hose. I can't take the stocking off to shower nor can I get it wet.

After my "bath", I was able to pull the stocking back to remove the large pads of gauze. The twisted rope vein by my knee wasn't even visible. I was concerned about the red marks on my leg, but the nurse today told me that was not a problem. The large reddish/purple mark above the compression stocking line is the beginning of my bruising. I didn't have the courage, or the time, to count the injections marks in my leg, but I know that I have 6 injections in the reddish/purple area above the compression stockings.

I didn't take the Ultram before work today. The bottle warns that it could cause drowsiness and it is not recommended to operate a vehicle. I did take the maximum dosage of ibuprofen. I felt much better when I got home and took the Ultram.

Lesson of the Day: Don't wear khaki pants the day after this procedure. One of the injections above my stockings started to bleed through my pants. The lidocaine was oozing out all day. Once I identified which injection was oozing, I could control the mess without a band-aid that I changed multiple times through out the day. It was too late for my pants though.

Myth:"Rarely does bruising occur" according to the marketing material
Fact: See the picture. "Bruising and tenderness for a few weeks to a month"- Expectations of a successful procedure according to my "Postoperative Instructions for Endovascular Catheter Ablation"

Treatment #1- Day 1

Once again: I am not a doctor. This is simply my account.
Treatment of my right leg begin on Tuesday, July 21st. I arrived at the doctor's office 30 minutes before the procedure was scheduled to begin. The nurse administered 20 mg of Valium and .1 mg of Clonidine. Clonidine is used for high blood pressure and is supposed to help the Valium work faster. I was advised to put on the gown and remove my underwear. What!?! Since my leg had to be cleaned it was suggested that I may not want my underwear to get soaked. I sat in the changing room for 30 minutes waiting for the Valium to kick in fuming the whole time that I was without my underwear.

I was taken back to the procedure room at 2:45. The nurses were as sweet as can be and helped protect my modestly as they draped blue sterile paper under right leg. My leg was scrubbed clean from my foot up to my hip. My legs rested on a warming pillow to help with blood circulation. The room was set at 68 degrees so a blanket was placed over my arms. I still didn't feel "high" from the Valium, but I was relaxed.

The bed was tilted with my legs down when the doctor arrived. I could not see what was going on, so I apologize that I not have the account of all the details. I'll try to pay better attention next time. The doctor began with the sclerosant (known as cpt 36471 to the insurance company). The goal was to "dry" up the blood in the smaller superficial veins first. The next step was to insert the laser. The doctor watched on the portable ultrasound machine to ensure that the laser reached all the way though. He tell me that he has a semi-difficult time since many of veins were twisted around.

I think at this point the bed was tilted allowing the blood to rush to my head. It was time to inject the lidocaine. The lidocaine, like Novocaine at the dentist, numbed my leg so I didn't feel the laser procedure. The lidocaine injections were not what I would call a pleasant experience. I would feel a pick and then a machine would turn on to inject the lidocaine. The process was repeated numerous times going from my ankle to my groin. I had to ask if a needle was still sticking in my leg around my knee because it felt so uncomfortable. All I could think was "why would anyone do acupuncture?" The injections in the groin area were brutal. I practiced the deep breathing that helped my deliver 2 babies without epidurals, but I still had tears coming down my face.

After the lidocaine was in the large bad vein, the laser process began. I could see on the ultrasound where the laser heated the vein causing it to bubble and collapse. I don't fully understand this point, but the heat was released into my lungs. I was given a mint for the old charcoal burnt taste. I could stop coughing when I left the office. The lidocaine/laser process was repeated 3 more times on much smaller veins. The doctor accurately warned me that the injection near my calf would feel like a charlie house. Man, was he right. A few times during the procedure I asked if it was normal that I didn't think I could move my leg. I was successfully able to wiggle my toes and peace was restored. I also asked on more than one occasion if I could have extra Valium next time.

The nurse put band-aids over what I believe were the laser injections sites. Gauze pads were placed along the large vein to absorb some of the fluids that could leak out. They had injected the max dosage of 600 mL lidocaine and 8 cc sclerosant. The nurse put on my new $90 30-40mmHg thigh stockings. I was excited that I had upgraded to the toeless type. I could still wear flip-flops and jeans.

I was escorted back to the changing room where my husband waited for me. It was 4:30 by the time we left.

Total cost: Just over $4,000. Yippy, I have meet my insurance deductible for the year.

Myth: Pain level for procedure is a 1-2
Fact: I could not have tears over pain of 1-2.
Myth:"You will feel very little if any pain"
Fact: Then why did I have tears coming down my face?
Myth: You only have to wear the compression stockings for 3 days after the procedure
Fact: After 3 days, I can remove stockings to shower and sleep. I have to continue wearing then during the days for 2 more weeks

Time to Make a Change

My husband and I had decided during my 2nd pregnancy that this would be my last pregnancy. After she was born, I dreamed about having my veins treated and having my boobs lifted. (Ooh, that is a great a idea for a future Real Girls Guide entry.) When she was about 7 months old I saw a commercial on TV for a vein removal clinic in town. The commercial advertised for an extended video On Demand. I watched the video and called for my consultation.

The first part of my consultation was an ultrasound to determine the extent of my varicose veins. I got a little light headed attempting to stand still during the hour long ultrasound. The ultrasound tech kindly told me that this is not uncommon. She gave me a mint and had me sit down with my head between my legs. I felt like a wimp.

Disclosure: I am not doctor nor do I work in the medical profession. The doctor met with me to go over the results of my ultrasound. Veins have flaps that open to allow the blood to return to the heart. These healthy veins should be about .30 cm wide and the flaps should close in about 1 second. I have veins 6 times the healthy size. Some of the flaps took over 5 seconds to close allowing all the blood to rush back down. The ultrasound machine stops reading closure time at 5 seconds. I was off the charts. My mom should be so proud.

I was concerned about closing the veins. Where would the blood go? The doctor assured me that the blood would safely be routed to go good veins. The doctor would use CoolTouch CTEV to treat the veins. The method of laser ablation (endovascular)is safer and more effective than the old-fashioned vein striping. The doctor was patient and kind and answered every question I could think of. The plan would to be my legs in 4 different appointments. The fronts of my left and right legs would require the full dosage of medication allowed. The back of my legs would be easier, but the doctor would not treat different legs at the same time. The doctor was also in support of sclerotherapy to treatment some on the smaller veins.

Total cost: Close to $800 for the ultrasound and office visit. It counted towards my insurance deductible.

Background Story

I noticed my first symptom of varicose veins when I was 20. I looked down at my ankle one day and noticed a large bruise, but I didn't recall hitting my leg. The bruise, as I called it, never went away. Based on my family history, I should have known what it was. The problem was that I associated varicose veins with the twisted ropes that protrude from your legs.

When I was pregnant was first daughter, I saw my first twisted rope varicose vein. I was only 21. The OB/GYN suggested I elevate my feet and wear stockings. I was naive and thought maternity pantyhose would help. The twisted rope was on my right leg on the inside of my knee. I complained to my French doctor that the protruding vein made it difficult to shave my legs. His suggestion was not to shave. I wanted to tell him to go back to France. A different doctor in that office called a intern into the room during my physical exam to see how high up the varicose veins went. Could I get paid to be in a medical journal?

I thought that getting down to my ideal weight would help my veins. At 136 (I'm 5'6") my ankle was still bruised and I had a nasty vein sticky out by my knee. Keeping a tan lessened the visibility of the bruising and growing spider veins on my ankle.

Six years later I was pregnant again. When my midwife saw my legs at my 8 weeks appointment (on Valentine's Day), she immediately prescribed compression stockings. Oh, maybe that is what the French doctor has intended. My husband and I left the appointment was went to go get my first pair of compression stockings. The medical supply store smelled "like death" according to my husband. They sold craft-matic adjustable chairs and electric scooters. The woman escorted me into a room where the stockings huge on the wall. She pulled the curtains closed and told me to take my pants off. My jaw must have hit the floor because she then explained me she needed to measure my legs to get the right fit. My color options were nude or nude. I tried to make the best of the situation. I joked that most couples pick out sexy black thigh highs with garter belts on Valentine's Day. I went home with 20-30mmHg nude thigh compression stockings. It was a huge turn on.

As I had been warned, the varicose veins were getting worse this pregnancy. About half-way through the pregnancy, I started have plan in my leg left. I noticed discoloration above my heel and a vein was starting to stick out across my calf. The vein on my right leg was now sticking on on the inside of leg. The compression stockings helped with some of pain, but I then I notice veins sticking out of my thigh above the stockings. The final straw was when I got varicose veins "down there". That's right. Every vein below my pelvic bones was swollen. I upgraded my thigh high stockings to 30-40mmHg full maternity belly hose. It took me over 5 minutes just to pull down my stockings and get then back up plus pee time.

This picture does not show the full extent of problems. For obvious reasons, I don't like to take pictures of legs. If my legs are shown at work, I use make up to cover up the bruising. Make-up doesn't hide twisting rope veins though.