Prologue

I am a runner who is currently being treated for venous insufficiency through the removal of my Great and Lesser Saphenous veins in both of my legs. 

I have decided to blog about my experience because I cannot find much, if any information about how runners or any other sport enthusiast do after such procedures.  I have looked on message boards and through Medline in an attempt to better inform myself as to what I should expect, but have only seen a few random post claiming improvement in times of about 5%.  However, these claims seem to be founded on one study that focused on venous return due to compression hose use, not invasive treatment options such as ablation, stripping, or sclerotherapy.  In addition I have an opportunity to share my experience, almost as a science project as I am having my ablation in between two equal caliber marathons with an obvious lack of training for the second as the only unequal variable.

Background: (2010-2012)

I am an almost 36 y.o. male who has been running steadily for about 7 years, but who has been more or less dedicated for 2-3 years.  I have been tracking my running through NikePlus and now Garmin for the last 3 years.  In the last 12-18 months, I have attempted to average 30+ miles per week and improving times on all of my distances.  Currently I have ran 5 marathons, 15 halfs and countless 10/5Ks along with my weekly runs.  PRs are 3:47(26.2), 1:46(13.1), 1:11(9.3), 43:30(6.2) and 20flat(3.1); most of which have come in the past 12 months.  I am a pharmacist and work 10 hour days, 4 days a week; the pertinence of which will become clear as the discussion evolves.

Over the past several years I had developed small spider veins in my abdomen.  The veins were an aesthetic problem at best and apparently weren't even visible to anybody but myself.  Nonetheless, I sought treatment, first with a plastic surgeon, who promptly sent me away.  The reason I was given for this reaction, is that my varicosities were in a very unusual location and he was concerned that my symptoms might be related to a hepatic portal vein issue.  He also said that if I could get a hepatic specialist to sign off on that issue he would look further at possible treatment with sclerotherapy.  I told him thanks and then promptly saw the vascular surgeon instead, whom I currently still use.  Upon meeting the vascular surgeon he examined me and I told him about the previous encounter with the plastic surgeon.  At this point his demeanor changed and he had me lay down.  He did a physical examination and said that possibly my liver was larger than average then promptly sent me to a gastroenterologist.  I went through the entire previous two conversations with the gastroenterologist and he also gave me a physical exam.  Upon completion, he recommend a CT scan with contrast.  The scan came out fine and he then sent me back to the vascular surgeon.  At this point the vascular surgeon recommended Veinwave treatment because the veins were so small.  Now a few points about this methodology; first it is painful, second it is expensive, and third it just doesn't work all that well.  I think that I am not alone in my opinion about this procedure because the vascular lab I use discontinued this methodology within a year.  However, I did go through two round of this and endured over 300 painful sticks and spent over $1000.  About a  year went by and I really liked the vascular surgeon, but didn't like this technique, so I decided to show my varicosities to my dermatologist, thinking that a simple laser treatment would be a better option for these seemingly minor and almost topical veins.  He agreed and I set up an appointment with the technician.  This methodology is great for spider veins.  It is still painful, maybe slightly less so than Veinwave and cost about the same, but the results are far and away better.

Now here is where this discussion becomes interesting to anyone who might unknowingly have venous insufficiency/reflux, especially runners or anybody else who keeps up a decent amount of physical activities, i.e. cyclist.

In late November of 2012 I went to my scheduled appointment with the laser technician.  The appointment went well and the results with the spider veins almost seemed instant.  However, and just as an aside on my way out, the technician said that I had something on the back of one of my legs that I should have checked out with a vascular surgeon.  I didn't really pay much thought to it, but after several more months and the appearance of a large bulging vein on the inside of my right knee I made an appointment to see my vascular surgeon, once again.   

Current ordeal (First Half 2013)

In early 2013 I entered the vascular lab, once again, but this time with something that really seemed to warrant a vascular surgeon.  I had a large branch off the GSV that had started to varicose and I started having pain and burning in the area after standing or sitting for extended periods of time.  At this point I was scheduled for an ultrasound on both legs.  After getting the results I met, once again, with the vascular surgeon who told me that all my valves were basically nonfunctional in both the GSV and LSV of my right leg.  He then asked me about my left leg and I told him that my left leg was my good leg.  He then told me it was my worse diseased leg. 

Now as an aside I have had leg cramps since I guess birth and I don't know if this has anything to do with what I am dealing with now, but as long as I can remember I have been woken up in the middle of the night with terrible leg cramps for which extremely hot baths and ibuprofen have been my treatment.  My only reason for mentioning this, is that I assume I am not alone here either and I don't know if my problem is a purely genetic one that would have occurred regardless or if I have caused or at least worsened it with such behavior over the past 30+ years.  The vascular guy tends to blame my condition on poor genetics and career choice, but I don't think I helped myself with scalding hot baths and excessive use of ibuprofen.

Radiofrequency ablation (VNUS system) was recommend with concomitant use of 20-30mm thigh high compression hoses to be worn while working.  I was already using knee high compression hoses for marathons.  I agreed with his recommendations as this condition will do nothing but worsen and only cause further issues and treatment more complicated as time passes.

Current ordeal (Insurance)

My insurance required me to wear my compression hoses for 3 months before I could even request ablation treatment.  The hoses cost $95 per pair with insurance and I purchased two pair.  I have access to wholesale cost of these and they are just high, I wasn't simply getting ripped off.  Also, at this point I can tell you that you will get 5-6 months out of a pair and that is all that can be expected.  I had an additional ultrasound after the three month period and then the doctor submitted my prior authorization to the insurance for which I was promptly denied.  My valves were shot, but the veins themselves were about 0.5mm too small.  I asked the doctor about this, but he said not to worry and appeared to have expected for this kind of rigmarole.  I did ask him if after the next ultrasound if I were denied again could I just pay for the procedure; he told me sure, but that they charged $8000 per leg for cash paying customers.  I have yet to see what the contracted price with my insurance company is, but expect it to be 25-50% of that.  After my third and final ultrasound I was approved with valve failure >10 times the norm and vein circumference twice of what they required.  The difference was I didn't wear my stockings the day of the final ultrasound which shows that they help possibly stop progression, but don't reverse or resolve the condition. 

Right leg ablation (11/7/13)

I had my first leg treated on Thursday, the treatment lasted about an hour and I would say that there is basically no pain associated with it, or at least I didn't have any pain during the procedure.  They gave me a 0.1mg clonidine and 1mg lorazepam about 30 minutes prior to procedure, but no oral pain medications either before, during, or after. 

They do recommend the use of over the counter NSAIDs if need be while you heal, but I haven't had any pain and today is Sunday.  There are two stitches in my leg and the leg was placed in a compression hose and remained that way for 72 hours.  I have now removed the hose and the leg looks fine.  There is a small amount of bruising and a lot of dried betadine and marks from their paint pens, markers, .... etc.  I did work yesterday, just 48 hours after the procedure, but that isn't recommended.  I will go for an ultrasound on Monday morning, then I am scheduled to have my left leg operated on this coming Thursday.  I am running the Rocket City Marathon on 12/14/13.  I will update the blog after each step along the way and hope for an improved life/running experience.  I hope this information helps somebody out there and look forward to any comments and/or questions.