Dr. Mueller is the finest physician I have ever had. I have entrusted my life in his hands for over 15 years and he is the only Doc I would empower to be my medical team leader. His judgment and diagnostic & communication abilities are impeccable, as is his medical advocacy on my behalf. He actually listens, gives me full attention, and truly cares. He is always reachable immediately; I couldn’t be happier in the concierge program, which gives me extra security and confidence and I love the instant priority, no wait appointments, as well as the value, added tests that would not normally be covered.
Finally, conservative therapy entails using compression stockings and lifestyle changes (including exercise, avoiding high heels and prolonged standing, elevating legs during downtime, and weight loss) to control symptoms of vein disease, though they will not remove veins or directly treat the underlying condition. Some insurers require a variable period (6 weeks to 3 months) of documentation of use of conservative therapy, among other possible precondition to coverage of vein treatments. Conservative therapy is also recommended for 2 weeks after any vein procedure, and is essential for the healing of venous leg ulcers (along with other therapies), and is the only practical treatment for valve leaking and insufficiency of deep veins at this time, so many patients will benefit from lifelong conservative measures, even if they receive specific vein treatments. They should also be used long term for patients after a blood clot (deep venous thrombosis) and for vein patients with ongoing spider or varicose veins after any treatment.
Compression stockings are prescription only and differ from the much weaker support hose used in the hospital or available over the counter; support hose are much lower pressure, are ineffective for chronic vein disease, and are used solely to prevent blood clots; they are thus never an adequate substitute for the compression stockings we prescribe. Compression stockings come in various strengths based on the pressure they apply at the ankles (with gradually decreasing pressure higher up along the leg, leading to a milking effect of blood to flow from ankles up the leg toward the heart): 20-30 millimeters of mercury pressure, 30-40 mm Hg, and 40-50 mm Hg, and > 50 mm Hg. Athletes often use lower strength (15-20 mm Hg) support hose in the hopes of improved athletic performance, improved blood flow and venous return to the heart, faster healing time, and less muscle aching.
Compression stockings are fitted after measuring the legs so that the proper size stockings can be given to the patient. They come in knee high, thigh high, and pantyhose versions, open toe or closed toe, and in a variety of colors. They should be used daytime only and taken off before bedtime (except for the first 24-48 hours after a vein treatment procedure, after which we may advise round the clock use for the first 24-48 hours). Peripheral arterial disease (PAD) is often a contraindication to compression stockings, meaning they often should not be used when this condition is present. Patients having difficulty putting on and keeping on the stockings can try the following: rubber donning gloves, donning ‘butler’ frames, slide-on sleeves for open toe stockings, It Stays!® adhesive, stockings with a silicone upper holding band, garter belt, or using the Circ-Aid® velcro wrap-type compression garment instead of stockings.
Stocking prescriptions can be filled at a medical/surgical supply store, a few pharmacies, or measured and dispensed directly in our office. Insurance often does not cover compression stockings, and retailers often charge $100 – $200 or often more for the stockings. At Sutton Place Laser Vein Care we charge the lowest retail price we are aware of in the region, $75 per pair of brand-new, in the box stockings. This is a value added service convenience we offer patients and we do not bill insurance for this; it is an uncovered self-pay service. We never intended to be in the stocking retail business but our patients often turned to us in desperation when they were being asked to pay $200 or more, and asked for our help, and we then ordered a small supply from our wholesale supplier contacts. We also carry It Stays® liquid adhesive, which is useful to keep the top of the stockings from falling down.
Medications for venous disease have a very limited role, compared with the treatments highlighted on this page. The over the counter medications listed below are available for purchase in our office, or at vitamin stores.
- Arnica montana – an over the counter, homeopathic herbal medication available in oral or lotion form; it has been demonstrated to reduce pain and bruising after vein procedures, without significant risk of side effects. Active ingredients are Helenalin and Dihydrohelenalin.
- Diosmin complex / Vasculera – an over the counter, oral herbal medication. Active ingredients are primarily Diosmin and Hesperidin. Useful for chronic pain and swelling of venous disease, as well as for venous ulcers.
- Horse Chestnut Seed Extract – another over the counter oral herbal preparation. The active ingredient is Aescin. Useful for chronic pain and swelling of venous disease.
- Pentoxifylline – a prescription oral medication useful for helping to heal venous ulcers.
- Anticoagulants – Deep vein, and often superficial vein blood clots are usually treated with blood thinners. Given our background as cardiovascular specialists for close to 2 decades, we are extremely experienced in the use and management of the whole variety of blood thinner medications.