Five ways to make the most of your vein treatment recovery

40871244_MCongratulations! You’ve chosen to seek treatment for your vein issues. At Precision Vein Therapeutics, we do our best to ensure a positive treatment experience for our patients. We keep wait times short, and we can answer any questions you may have about your treatment. One of the major concerns our patients often have is how long it will take to recover from a procedure. We make sure to thoroughly provide all the answers our patients need to prepare them for the recovery process.

Recovering from vein treatment typically doesn’t take long. Depending on the type of treatment you receive, it may even be just a few days. Our doctors will always do their best to ensure that you have all the proper aftercare instructions, and our office will be in touch to follow up on how you are feeling after treatment. Even though recovery is fast, it can still be uncomfortable, so we encourage our patients to do their best to relax and allow their bodies to heal. Here are five ways to ease the recovery process.

  1. Bring someone with you. After many of our treatments, you wouldn’t be able to drive for a day, at least. If you’ve had sedation, you may also feel nauseous or dizzy. Ask a friend or loved one to drive you to the clinic and stay with you after the procedure.
  2. Put your feet up. The best thing you can do to speed up the healing process is to rest your legs. Watch some movies, take a nap, and stay off your feet.
  3. Wear compression stockings. Compression stockings will help your body to heal faster. Wear them as much as possible, even at night if you can. Your doctor will outline the recommended wearing guidelines for your specific case.
  4. Make sure to stretch. Maintaining flexibility and blood flow will be a crucial part of your recovery process. Add light stretching, yoga, or other flexibility exercises to your workout in between treatments to keep your blood flowing.
  5. Stick with your treatment schedule. Many varicose and spider vein issues require multiple treatments. Your doctor will outline a treatment plan that will help you get the best results. Stick with your timeline, and you’ll see results in no time.

Recovering from a medical procedure is often uncomfortable, but that shouldn’t be a reason to put off treatment. Vein treatment has a speedy recovery time, especially if you follow aftercare instructions correctly. We want to help you feel and look your best, even during recovery. If you have any questions, ask us. We are here to help!

Compression hose can reduce the likelihood and severity of varicose veins

mother and daughter walking in the forestTrying to prevent spider and varicose veins? Ask us about the benefits of wearing compression hose. Compression hose can help you better manage venous insufficiency, a condition that can lead to a spectrum of vein-related issues, from spider veins to varicose veins to at worst, venous ulceration. That’s when a vein issue results in red and irritated skin and can progress to an open wound.

Chronic venous insufficiency occurs when the valves in your leg veins don’t permit blood to properly flow back up to your heart. This can cause blood to pool in your legs. By steadily squeezing your legs, compression stockings are designed to help your veins move blood more effectively.

It’s important to not only purchase quality compression hose, but to make sure you’re measured for the hose by someone trained in proper fit. Low-quality compression hose and hose that doesn’t fit properly can be difficult to wear, wear out quickly and/or not be as effective as quality hose. Don’t like the idea of wearing compression hose? Compression hose has come a long way in the last decades, and is not only more effective but easier and more pleasant to wear than ever before. If you receive treatment for vein problems, wearing compression hose after treatment as you’re instructed can make all the difference. They can help make your treatment more successful over the long term and can help prevent new issues from emerging.

Learn more about us and our treatment options by visiting our website: Questions about compression hose? Give us a call: (205) 258-0998

You’re So Vein

You probably think this blog is about you.  Don’t you? Don’t you?  And you would be absolutely right.  Okay I’m sure I’m not the first vein doctor to use Carly’s perfectly written breakup song about Warren Beatty for purposes of encouraging patients to get their varicose veins treated.  If you are old enough (like I am) to remember vividly when this song was released (1972) then you are also in the age group of the population with the highest incidence of venous disease of the legs.  These are problems that can affect both young and older people, but we know the incidence definitely increases with age.

I spend lots of time educating patients about what the symptoms of lower extremity venous disease are and how important it is to seek treatment for varicose and spider veins.   I grew up listening to Paul Harvey on the radio.    “The rest of the story” was always something different and deeper than what you were expecting.   Venous disease in the legs usually progresses and gets worse, involving more and more areas of the leg in the path of whatever vein has gone bad.  Early intervention is what I preach.

The rest of the story with venous disease is that there is such a wide variation in just how a patient will develop problems.  Most patients will have typical symptoms of aching, fatigued feeling legs that feel heavy towards the end of the day, usually with a bulging vein here or there.  Swelling that seems to go away overnight, only to return in the calves and ankles by quitting time is pretty typical.   Changes in the appearance of the skin over time are a big tip off.  This usually includes darkening, or an increase in pigmentation in the lower legs, a reddish itching rash on the skin of the lower calves and ankles, thickening or hardening of the skin in these areas, and the most advanced skin change is the appearance of a non-healing skin ulceration, a venous ulcer.  There are patients who will only have bulging veins or a covering of spider veins and no symptoms at all.   Wide variation.

Right lower calf venous ulceration before and after treatment.

The trick is heading all of this off at the pass.  Getting treatment for venous disease is more important than ever.  Bulging veins at the skin are at risk for lots of bad things.  Superficial blood clots can form in these surface veins that can progress to deep vein thrombosis (DVT).   Bulging veins just under the skin are often in vulnerable areas of the legs that are at risk for rupture and significant bleeding with even minor injuries.   Even more concerning is the tendency of these veins for spontaneous rupture due to the high pressures that develop from underlying veins that are allowing reverse blood flow into them.

The good news for most people is that treatment is not anything like it used to be.  There is an entire generation of people that still believe that “vein stripping” is still the only treatment.  This was invariably a very painful procedure that had a very long recovery period with serious risks.   Today, highly effective treatments are performed in an office-based setting in my clinic, extremely well tolerated under local anesthesia and mild sedation.   There is minimal down time with patients able to return to work on the second day and pain is easily managed typically with over the counter medications.

Don’t wait a minute longer.  Don’t daydream about getting something done.  Don’t be naive like Carly.  She had some dreams but apparently, they were clouds in her coffee.   Gulp that coffee down, grab your phone and give us a call at Precision Vein Therapeutics 205-710-3800 for an evaluation.  Two years after she released “You’re so Vein” she released my favorite song of all time, “I Haven’t Got Time for the Vein.”   You don’t either.

Michael R. Barlow MD, RPhS

All content copyright 2019


The Big Picture on Vein Disease and Leg Swelling

Vein Screening Form


“Why are my legs swollen?”  In this blurb I’m going to hopefully give you the big picture on a very common complaint, leg swelling (edema) that tends to go right along with venous disease.

When I give talks on venous disease of the legs, I emphasize that I believe one of the most important things I am trying to accomplish is educating patients on the importance of recognizing signs and symptoms of problems early when treatment can produce rapid recovery and return to function.  Doing this can prevent progression to advanced stages when recovery and improvement can be lengthy.   In addition to explaining the possible health consequences that could result from ignoring serious signs of developing vein disease in their legs, I like to focus on just how effective, well tolerated and elegant that modern vein procedures really are.

In most advertising for vein clinics (mine included!), you will see some version of “leg swelling?” being asked.   The typical pattern of swelling that is associated with what I treat (venous insufficiency) usually begins around the ankle and progresses up the leg.  Usually, this swelling tends to increase during the work day and decreases overnight or with simple maneuvers such as leg elevation.  Over time, swelling is noted to occur on top of the foot as well.

From here, keeping an eye on the big picture is challenging to say the least.  Figuring out the cause of swollen legs can be a complicated affair and frustrating for patients and physicians.   It’s very much like that scary forest right outside the Emerald City on the Wizard of Oz.  The second you walk into the trees it gets dark.  And thick.  So off we go.

First of all, when I see a patient for evaluation of a swollen leg, it is usually after studies searching for urgent situations such as acute deep venous thrombosis (DVT) have already been performed.  This is not always the case however.   Sudden swelling that occurs over hours to days is termed “acute” and if from a venous cause, is usually due to either a DVT in the leg or other obstruction higher up the venous circulation in the abdomen or pelvis.  These problems are usually managed in the hospital setting.

Leg swelling that occurs over a longer period of time, weeks to months, is termed “chronic” and when a patient comes for treatment, early investigation should start.  The most important thing to remember is that the longer swelling is allowed to continue without treatment, the more likely it will potentially become permanent.

My focus at Precision Vein Therapeutics is sorting out whether or not a swollen leg is the result of a vein that is not doing its job.  I perform a thorough venous ultrasound of both deep and superficial leg veins to determine this.  This exam is noninvasive and done right in our clinic on Watermelon Road.   The amount of information about the venous circulation that can be obtained from this elegant test is truly amazing.

In the setting of saphenous vein reflux, which I detail on the vein disorders and treatment pages of this website, mild to moderate swelling that follows the pattern I mentioned above, (gets better overnight), after treatment with endovenous laser ablation, typically resolves.  Longer standing or more extensive swelling that tends to remain unchanged over night on average may improve after correction of saphenous reflux, but in a percentage of patients, will need further management to deal with.   This is where the woods get dark and deep.   In medicine, we like to blame a set of conditions on one cause.  The swollen leg is a big ugly example of the situation where there can be multiple contributing causes.   It’s very important in cases of severe edema and venous insufficiency to help patients set realistic expectations.

The lymphatic system of the body is an extremely important little machine and it doesn’t get much air play.   For all practical purposes, it is microscopic, but it is the hardest working system in the body for its’ size.  It is responsible for collecting the plasma portion of the blood that is filtered out between arteries and veins at the cellular level.  Okay, there it is, we just lost the sun.  Walk with me in the dark for just a second.

There are many different medical and structural issues that can affect the load on the lymphatic system’s fluid transport ability and when it can’t keep up, you guessed it, edema happens.  The lymphatic system itself can have abnormalities that affect its ability to function correctly.  There’s even a little roundworm that is transmitted to humans by mosquitos mostly in tropical countries that has an appetite for human lymphatic vessels and basically destroys them.  Outside of developed countries, this is the #1 cause of lymphedema in the world.  120 million people have this.  120 million.  There are effective treatments but I’d still take some Deep Woods Off if you plan to go down there.  Here’s a classic example.




In developed countries, the #1 cause of lymphedema is obesity.   There are even some medications that can cause lymphedema.

I mention all of this mainly because of what I mentioned earlier.  Expectations. There is no question that venous insufficiency can cause or contribute to leg edema.  If I’m asking in my advertising if you have swollen legs then you might have venous disease, I better know what your next stop needs to be if you don’t.

The good news is that for patients clinically diagnosed with lymphedema, there are treatments available to help manage the disease.   There are lymphedema clinics that specialize in this very issue.

This brings us right back around to what I mentioned at the beginning of this.  Job #1 for me is providing education and awareness of the resource that Precision Vein Therapeutics can offer patients in terms of thorough evaluation for the presence of treatable venous disease, and then offering those definitive, effective outpatient treatments in the same office-based setting.  For those patients with a family history of venous disease, living with chronic leg and ankle edema, thinking it is just a sign of aging, working too hard or it’s something that just “runs in my family”, understand that waiting can be a very bad thing.   Make an appointment and get treatment.

That’s the big picture.

Michael R. Barlow MD, RPhS

Precision Vein Therapeutics

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Let’s Talk About Spider Veins

I was asked just recently to talk about the “state of the art” in treating spider veins.  As I was preparing that presentation, I happened to notice a big review article on that very topic in the current issue of Phlebology, a major vein practice related journal.   Being already in the groove, I thought that would be the perfect topic for my second post here.

You would think in 2018 that modern medical science would have spider veins all figured out.  A common complaint we hear from new patients is that they have had injections performed on their spider veins in the past, experienced some initial clearing, but then the problem returned within several months and seems to be even worse now.  Spider veins can be stubborn and although the causes and risk factors are still largely unknown, there are some basic principles that we follow at Precision Vein Therapeutics to maximize your chances of a fantastic, long lasting result.

“Telangiectasias” is the medical term for spider veins but it’s way too hard for me to type.   From now on out, I will refer to them as spiders.   Anyone that knows me understands how little I care for spiders.  I’m the guy that is perfectly willing to jump out of a moving vehicle if I find a spider on me.  I want them off of me.  I want them off of you.   Know that my heart is in this.

Patients have lots of choices when it comes to the treatment of spiders.   As a phlebologist, my approach is geared towards not just treating what’s on the surface but understanding what the underlying cause is and treating that as well.  Insurance companies consider spider veins, even those that cause symptoms, as a cosmetic concern and not a medical necessity, and therefore, not covered.  Knowing that patients are paying out of pocket, with their hard-earned money, motivates me to make darn sure that I am not just treating a problem that will come right back in short order because the real, underlying issue has not been addressed.

Although spiders can cause symptoms, prickly type pain and a burning sensation are common complaints, most patients seek treatment due to aesthetic concerns.   Often, the problem has existed for many years and patients have been simply too busy with LIFE to have anything done about it.  At a certain point, either folks just get fed up with only being able to wear long pants, or sometimes it’s other issues that develop, such as varicose veins.  Whatever reason brings patients to treatment, the first questions usually asked are, “What causes this?  Can we just laser these off? and What can I do to prevent these in the future?”.    The big three.  Here we go.

What causes this?

We don’t for sure.   It’s “still a mystery”.  I’m not kidding.  That’s an exact quote and the reference to the review I mentioned earlier is at the bottom of this.  Make no mistake though, we’ve got theories.  There is good evidence for all of them too.  The simple explanation is that not all spiders are the same.  You see these big hairy tarantulas that have names and birth certificates and ride around on the guy’s shoulder on YouTube.   I absolutely hate those angry little jumper spiders that look like crabs with their pinchers up and dare you to brush them off the couch.  There is nothing more terrifying to me than walking right into the web that those freakishly large wolf spiders around my house build right across the path to the outside faucet.  You knock them down.  They come right back the next day.  Annoying.

Different types of spiders can occur on your legs at the same time too.   We know that somewhere between 30 and 50% of spider veins are associated with reflux, or retrograde blood flow in the underlying saphenous veins.  Simply injecting the spiders with sclerosants (see my website for more on this), will set you up for failure because without treating the underlying source of venous pressure, recurrence is almost certain.   This is the exact reason that we make great effort to explain to patients why we perform a venous ultrasound examination on every leg affected by spiders.   You will hear us talk a lot about results and reputation.  Everything we do is focused on that.   We don’t deny the fact that vein disease tends to be progressive and that recurrence, even with the most meticulous techniques is possible and we mention that with all patients and in all printed materials.   What we are after is the clearest, longest lasting result we can attain for the investment our patients are making.

In those cases where spider veins do exist in areas of underlying saphenous vein reflux, effective treatment with endovenous laser ablation of the saphenous vein (see the treatment section of my website), greatly enhances the success of sclerotherapy of the spiders.

For the types of spiders not caused by underlying saphenous vein reflux, two possible explanations include the failure of valves within the tiny vessels called perforator veins which connect the veins on the surface to the deeper veins of the legs, and also actual direct connections to tiny vessels from the arterial side of the circulation called arterioles.  This is the reason that we discuss the small possibility of ulceration, or the formation of a sore at the site of sclerotherapy injection.   This is also precisely the reason that we use low concentrations of sclerosing agents and special injection techniques when we perform sclerotherapy of spider veins.  This risk of ulceration is very small (<1%) with our considerations.


Okay that’s scary, can we just laser these things off? 

There are areas of the body such as the face where the success of laser treatment of spider veins is widely known.  Lasers employ thermal destruction of vessels and most have very specific settings for a particular depth of tissue.   In the legs, the vessels that need to be treated exist at deeper and more varied locations, with thicker walls requiring higher laser energies and specific measures to decrease the risk of burning the epidermis.  As stated earlier, most spiders are associated with increased reverse pressure from larger deeper veins.  Most lasers will not treat these associated high-pressure veins.  Injection directly into a target vessel with spread of a sclerosing agent (sclerotherapy) into connected spiders is a much more efficient method to treat larger areas more quickly than laser.  As this latest review states that I keep referencing as well as most books on the subject, sclerotherapy remains the treatment of choice for spiders because it has the advantage of eliminating the larger feeding veins as well.

Okay, sign me up but what can I do in the future to prevent these ugly things? 

Some risk factors such as heredity, hormones, pregnancy (see my last blog entry), and age we can’t do much about.  Those things are why we have to live with a certain risk of recurrence of vein problems no matter what we do and how much we hate to admit that possibility.   With good, thoughtful sclerotherapy, most patients will need a touch up to maintain their results about once a year.

The other risk factors, we jump all over.



Sun exposure.

There is a direct correlation here.  Sunlight degrades collagen and elastic fibers and that is what you don’t want.   If you already have a familial tendency to have spider veins or think you might want to have a bunch of babies (which I highly recommend), don’t forget the sunscreen.   Lather up with a reasonable number SPF (at least 30) when you are outside starting early in life and during the day and reapply at lunchtime.   Your 55 and 65 and 75 and 85-year-old self will thank you.


Yes, there’s a study.   We know that obese and overweight patients have a higher prevalence of the underlying venous pressure problems that cause spiders.  Not all obese patients have spider veins though so this again comes back to other risk factors.  With a strong family history of severe venous problems, the appearance of spider veins can be a sign of deeper issues which may only worsen in the presence of unmanaged weight problems.


Patients often relate an episode of localized trauma to the appearance of an area of spider veins.   Damage to blood vessels in an area of trauma releases factors that we know stimulate blood vessel growth.  Can’t really avoid trauma.  You never know when or where it’s going to happen.  It’s like the lightning bolt that took out the clock tower on Back to the Future.

Other things we discuss with patients regarding spiders:

It always takes more than one treatment session.  With sclerotherapy, as I stated earlier, patients pay for this out of pocket per session.  We know that good sclerotherapy will take out 60-80% of the total burden.  Even patients with a small amount of spider veins usually require at least 2 sessions.  Most require 3 or 4 sessions for clearance.   This goes back to the different types of spiders.  Some spider veins are more resistant than others.  Most clinics that perform sclerotherapy charge between $200-$300+ per leg.

Expectations are important.  Long standing spider veins carry a risk of staining of the skin in many instances due to the presence of hemosiderin, the breakdown product of hemoglobin that has accumulated in the skin over the spider vein as a consequence of long term extravasation of red blood cells under the venous pressure that exists in the area.  The spider vein that is treated will be resorbed by the body but the stain above it may remain for some time.  This is another great reason for patients to have early treatment of spiders.

Recurrence.  Said it before and it bears saying again.   We tell patients that have had previous sclerotherapy and have experienced recurrence they may have an untreated underlying source.   We perform a complete venous ultrasound on every patient and we are completely upfront about the fact that most insurance carriers will refuse payment for ultrasound examinations in cases of pure cosmetic spiders when no underlying reflux is found.   The ultrasound examination fee would be an out of pocket expense but we absolutely believe it is well worth the expense in avoiding that situation of needless repeated sessions of expensive sclerotherapy that are doomed to failure.  To fully milk my spider analogies for this blog entry, it’s like killing the house spider but leaving behind that nice big egg sac.

On this website, I describe the treatments we have available at Precision Vein Therapeutics and in the evaluation and effective treatment of spiders, microphlebectomy is an extremely important weapon in our arsenal.  In certain clinical presentations, particularly involving the outside area of the thigh, actual removal of the superficial vein feeding the spider vein cluster is curative.  Microphlebectomy is performed under local anesthesia, however we do offer mild sedation in one of our treatment rooms on site.  We use tiny incisions at short intervals along the vein and remove it using micro surgical hooks.  The incisions typically heal without a scar and do not require suturing.

To wrap this up, as in most areas of medicine, there’s still a lot about spider veins that we’ve yet to figure out completely.   The good news is that there are incredibly effective treatment options available and well-known techniques to maximize results.  Be confident and get fed up with the spiders in your life and don’t wait another minute to do something about them.  Call us at Precision Vein Therapeutics, 205-710-3800 for an appointment and let us help you rediscover healthy legs that look great and feel even better!

Reference:  Pathophysiology of telangiectasias of the lower legs and its therapeutic implication:  A systematic review.   P Kern.  Phlebology 2018, Vol. 33(4) 225-233.