What is sclerotherapy, how does it work and what to expect ?
I always tell patients that compression hose are not supposed to fit like pajama bottoms, they have a job to do and they should fit like tight spandex. That's the best explanation I can give to family and friends. In my ten years of doing ultrasound I have seen patients in the ER at all hours who stopped wearing compression after having vein procedures and the symptoms are back and sometimes worse. I have many friends who are nurses and they usually will ask if they should wear them and my answer is always YES ! I feel like if patients are on their feet more than 7-8 hours a day compression is a benefit to the health of the legs. I try to practice what I preach but sometimes I am not going to fib; cuddling with my dogs in the morning sets me back and I don't have time BUT I should never have an excuse. I have had the procedure to ablate my superficial veins and I typically always wear compression. My legs feel better when I do and I know it's better for my health to continue doing so.
When we stand on our legs for long periods of time and sometimes even sitting, hydrostatic pressure can and typically does occur. What is hydrostatic pressure ? Well, in easy terms it has to do with the exertion of fluid (in our bodies that would be the blood) on a column (legs). When there is an increase in hydrostatic pressure and if there are damaged valves in the veins it can cause chronic venous insufficiceny. Typically, with every beat or ossilation of the heart the blood moves up in the veins to go back to the heart and lungs to be reoxygenated but when the valves are damaged they "pool" back to the calves and ankle areas. This can cause symptoms ranging from edema/swelling, brown discoloration to the inside of the ankle/calf area; also known as the medial malleolous, itchiness, heaviness, pain and sometimes ulcers. This is why people who stand for long periods of time for their jobs compression is a great leg saver :)
Next I'm going to touch on the differences between TED hose and compression hose, the benefits and some helpful hints that may make it a little easier and gives a little more incentive to wear them as they are intended.
TED hose are made with the intention of being worn only when a patient is not ambulatory or up walking around, to reduce the risk of deep vein thrombosis as bed rest is a risk factor. Typically TED hose are white and usually have a small opening in the toe/foot area. The compression in TED hose starts at the calf and moves up so as to not allow for blood to pool in the calf area potentially creating a blood clot in the lower extremities. The mmHg (millimeters of Mercury) in the TED hose are not medical grade and typically are between 8-18 mmHg. The shelf life of TED hose is also much shorter than that of compression, typically TED hose are only used for a duration of approximately 3-4 weeks give or take.
Compression hose are made for people who are on their feet or sitting for prolonged periods of time. Compression hose can come in many different colors, styles, compression levels and are closed or open toe depending on the preference of the patient. The compression begins in the ankle area where pressure is greatest and moves up from there. This assists blood to return to the heart and lungs to be reoxygenated without pooling back in the ankle area and causing symptoms related to chronic venous insufficiency. The mmHg range from 15-20 to 30-40. Really 15-20 is just a tight sock. I wouldn't recommend that to anyone I know nor would I wear it myself. 20-30 is medical grade and accepted by insurance companies for treatment of the veins and 30-40 is more for people with ulcers and/or having procedures. The shelf life of compression hose is typically anywhere from 9 months to a year and a half. It just depends on how often you wear them and how you take care of them.
I don't usually recommend anyone getting compression hose online as usually the fit is not appropriate. I tell friends, family and patients that it's best to be measured in the morning in case there is presence of swelling to get the best fit. If you are measured in the afternoon and there is swelling the compression is not going to fit properly, they will fit as to a swollen leg so it is not able to do the job it's meant to do which is control the swelling, itchiness, heaviness and/or pain associated with chronic venous insufficiency. I've heard many patients complain about wearing them in summer time because they are hot, but not wearing compression and being on your feet is contraindicated in providing the proper routing of blood back up to your heart and lungs. I had the procedure done on all of my veins in 2016 and I still wear compression hose. Just because the veins are ablated/removed does not mean that the venous hypertension is gone and if severe enough the blood will find different pathways to move, potentially creating new veins. I've never had a pair of compression hose that were "too hot" to wear even in the summer time.
Compression hose can be challenging to put on as they are tight and if people have back issues or arthritis that can be difficult. There are many suggestions and devices that can assist in getting them on without difficulty. There are donning devices, one that we have is the butler and we sell that at our cost to our patients. The Mediven bulter can be looked up online. These are really helpful in getting compression on in a timely manner. I have also suggested to patients to get the kitchen gloves for cleaning at the Dollar Tree, or even gardening gloves with the rubber material on the palm area as they provide a good grip on the compression to assist in putting them on. The most difficult part of the compression hose is typically the foot and ankle area as that is where the compression begins which makes it much tighter. We also have the ability to order what is called compression wraps. These are made like a wrap with compression marks so that they are pulled tight enough to provide the proper compression for the legs. There is velcro that is used to fasten the wraps at the proper compression levels suggested by your provider.
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What is sclerotherapy, how does it work and what to expect ?
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