Following Your Procedure
Today you underwent a venous ablation of selected dysfunctional veins in your legs thought to be contributing to your symptoms and your visible surface veins. Your procedure went well. I expect an excellent result. This was performed with either endovenous laser ablation, ultrasound guided foam sclerotherapy, or with visually guided surface vein sclerotherapy. These are safe and successful procedures in the overwhelming majority of cases. To assure safety, the best possible symptomatic and the most durable cosmetic results please keep the following in mind.
Ask if you need to return in about three days for a short ultrasound to make sure you are not forming a blood clot in your veins. You should already be scheduled if I think you need one, however do ask just to be certain. The chance of forming a blood clot is very low (<1%) however, it is much better to intervene when early so that it remains a nuisance rather than too late when it has a higher chance of becoming a problem.
Please call with questions or concerns: I can be reached directly at +1.xxx.yyy.zzzz with any concerns regarding treatment, or symptoms you may be experiencing. Your discomfort should not require anything more than your usual over the counter pain remedy that you know you tolerate well taken per instructions in the included packaging. Discomfort usually peaks between three and seven days following your procedure and from that point should slowly and progressively improve. I expect the same for bruising. Decreased sensation, pins & needles in the treated leg can also occur. Sensation recovers more slowly, but in the vast majority of cases improves between one and eighteen months following the procedure. Local discolouration over the veins treated can also occur, but again in the vast majority of cases fades between one and eighteen months following the procedure. If you are not able to carry out your usual activities with only minor discomfort, or for any other reason, I want to know! It is much better to intervene when early so that it remains a nuisance rather than too late when it has a higher chance of becoming a problem.
If you are breast feeding; please refrain from doing so for the 24 hours following your procedure. You may “pump and dump” for these 24 hours. I will only perform laser ablations if you are breast feeding – only if you agree to “pump and dump” following the laser ablation. I will not perform ultrasound guided foam sclerotherapy injections until your newborn has been fully weaned. The laser ablations usually have the most impact on your venous insufficiency. With stockings, it is safer and better to wait until breast feeding has finished, your weight is trending back to your baseline and the hormonal influence of childbearing is subsiding.
As you know, I believe that stockings work! They certainly permit the treatment of dysfunctional veins to be more successful and more durable. Please (A) wear your stockings all day today, (B) wear your stockings tonight under your pyjamas, (C) tomorrow morning, remove your stockings, band-aids, shower/bathe as usual (not too hot), then put your stockings back on and resume your normal schedule of wearing your stockings six to eight hours a day during the most important awake, upright, standing and sitting hours of the day. After treatments, I want you to religiously wear your stockings for at least fourteen days during the initial healing/scarring period. After 14 days, you may be a bit more liberal and apply your own discretion with respect to wearing your stockings. Remember though, that I think stockings will help improve your symptoms and obtain the best cosmetic results over the long term.
Please walk leisurely for fifteen to thirty minutes two to four times a day for the first fourteen days. This is important. It reduces the already low (<1%) likelihood of forming dangerous blood clots, while helping the venous system return blood back to your heart while also encouraging the veins in your leg to establish healthy venous pathways towards your heart. Wear your stockings and comfortable shoes. Fresh air is good for the mind.
In the first three days following your procedure, please take a rest and avoid strenuous exercise such as running marathons, iron(wo)man competitions, triathlon and Olympic cycling. Don’t break a sweat. Aerobic exercises that demand higher blood flow to your legs may challenge the closure of the dysfunctional veins so soon after your ablation. The treated veins do need some time to irreversibly seal. Activities that cause blood to pool in your legs, or to become flush such as sitting in a hot tub, sauna, taking hot baths, or showers where you steam the windows will also challenge the treated veins. Activities such as heavy lifting, sit-ups, abdominal exercises, and sometimes unavoidably sneezing and coughing may transmit high venous pressures to your leg veins again challenging the success of your ablation. For laser ablations, I prefer to wait until after you have recovered from the flu, your cold, but that is not always avoidable. In summary, in the first three days, avoid activities physical activities that will send increase blood flow to your legs, reduce the venous flow of blood from your legs back to your heart, or activities that cause blood to pool in your legs. It is best to wait until after the sniffles have resolved to begin with laser ablations. Of course, wearing your stockings remain important while your treated veins are healing/scarring. Yoga, pilates, stretching exercises may be uncomfortable, so please use your discretion. Slowly walking through the deep end of a pool is perfect and provides compression much like wearing stockings without having to wear them.
Between the fourth day and the seventh day following your procedure, gradually build back up to you usual physical activity. Wear your stockings. I would avoid very strenuous long distance running/cycling and competition all together for the first seven days.
For the first fourteen days, please avoid prolonged periods of standing, sitting and extended inactivity. Certainly no long distance flying for the first seven days. When traveling, get up and walk around every hour be it by car, bus, train or plain. Wear your stockings during your travel.
For discomfort, you may use your usual over the counter pain remedies taken according to the accompanying packaged instructions. A cool ice pack or compress is best in the first three days. Following that, whichever is more comfortable/soothing, cold or warm compress, is best. Frozen peas in bag from the grocery store work very well.
Sun exposure: Please avoid sun tanning and direct exposure of the treated areas to sunlight. If you go out on a sunny day, SPF 30 or greater sunscreen on the legs is adequate. No need to wear your stockings out that day. Many patients report good results with the topical creams (Arnicare Gel, Hiruval 35, and Bio-Oil) that can be purchased on-line, or at your local pharmacy. I recommend that patients try these products in a small area to make sure they do not react to them. You may start to use these products on your legs 3 – 7 days before your first procedure. Continue using these products if they do not cause you a reaction and you are pleased with the results and costs. Patients report to me that staining, bruising and discolouration which we expect to occur following procedure is less prominent and fades more quickly. Patients with more pigmented skin usually experience more staining and also report the most benefit from especially a combination of Hiruval 35 and Bio-Oil.
Migraines: If you have, or do suffer from migraine headaches, please note that the primary medicine I use during ultrasound guided chemical ablation and that the your nurse will use during visually guided cosmetic sclerotherapy treatment can sometimes, but not always, provoke a migraine headache. When scheduled for these procedures, I recommend that you bring your usual migraine medications with you!!! Some patients know when they are getting a migraine and can abort a full migraine if they take their migraine medications in time. Secondly, I prefer to schedule these treatments when I know that you will not be forced to drive long distances, or work long shifts afterwards. If you do develop migraine headaches, it is best to not schedule these procedures when you know that a strenuous day awaits you. It is important to remember though, only a small percentage of patients with migraines suffer migraines following these procedures.
Call us: Please do not hesitate to call us with questions before or after treatments. I often like to schedule a time when we can talk on the telephone before your procedure to discuss any questions or concerns you may have. This is part of the consent and will make your visit to the office pass more quickly. Call us at +1.xxx.yyy.zzzz. We are happy to schedule a convenient time during the business day when I can spend 10-15 minutes on the telephone with you to be certain that you are fully informed.