Expert advice for painful varicose veins during your child bearing years
When the 27-year-old mother of four first walked into my office, she was beside herself. She had been told by her primary doctor that addressing her extremely painful varicose veins might mean not having more children.
When my patient left, she was relieved – if not ecstatic. Her varicose veins could be dealt with almost immediately, through out-patient treatment, and without surgery. She could quickly recover and then get back to growing her family.
But it was a path and an outcome not available to women in another era. Worse, a lack of understanding of medical advances by some OB-GYNs, family doctors and even patients themselves (usually based on the experiences and memories of older relatives) means some women seeking varicose vein treatment might as well be living in 1959.
First, a bit of a history lesson.
Back in the 1950s, varicose vein treatment was limited to painful and invasive ligation and stripping. It was a major surgery, so it was often delayed as long as possible – and women were regularly told to wait until after they were done having children. If women wanted to continue having kids, it often meant they had to struggle through the pain, making the simplest tasks (e.g., picking up an infant) horribly difficult.
Things have gotten considerably brighter in recent years. But the news sure hasn’t traveled fast — or fast enough.
Ligation and stripping is now rare, and a host of less invasive surgical techniques have become available through the decades. Ultrasounds can identify malfunctioning valves within veins, sometimes preventing problems that are years away from happening.
But the most exciting development is Varithena – the one that caused my 27-year-old patient to leave my office smiling. She’s fortunate because even though her provider didn’t have all the answers, she knew enough ask the right questions of a vein specialist.
Recently approved by the FDA, Varithena is an injectable that I’ve used on about 60 patients since last March. The treatment takes about an hour (we often describe it as a fancy IV) and can be performed as soon as six weeks after pregnancy. Then, after just two weeks of wearing compression hose – a relatively short period for women who have likely worn them throughout the pregnancy – the veins should be gone. For my 27-year-old patient, her legs now look like they did when she was 22.
Varicose veins, of course, occur when veins become enlarged, dilated and overfilled with blood. Blood goes from major deep veins to superficial veins, which get bigger and bigger. One of the previous treatments was thermal ablation using either laser or radiofrequency energy, in which a catheter is placed in the long part of the vein. That closed the straight segment of the vein but not those curving, ropey branches. Varithena, though, gets everywhere – helping the superficial veins as well as their tributaries or branches.
In addition to helping with general awareness, part of my goal in writing this post was to let women know that they should act quickly to get treatment. Oklahoma’s Medicaid program, SoonerCare, provides coverage for women for up to three months post-pregnancy — well within the recommended treatment window. As noted above, women can receive Varithena safely six weeks after giving birth.
Some doctors will tell patients (wrongly) that taking care of varicose veins is cosmetic and not covered by insurance. But chronic venous disease is actually more common than cardiovascular disease and it can lead to chronic ulceration. Patients struggling with that face a quality of life similar to someone who’s had congestive heart failure. In other words, we’re not just talking about blue ropes on your legs.
In addition to helping women still in their child-bearing years, Varithena can help those who previously put off treatment. A 60-year-old patient in my office recently was stunned when she learned what we could do for her.
“I can’t believe this,” she said. “This is just light years away from where it all was.”