SCLEROTHERAPY

NATURE OF THE PROCEDURE

This procedure was first performed in the 1940’s, and very little has changed since. A sterile, fresh solution of highly concentrated salt water is injected into the spider veins using a tiny needle. No anesthesia is necessary. In most patients, most of the visible, larger spider veins can be treated in one visit. The Sclerotherapy session lasts about 20 minutes, and up to 3 cc’s of solution is injected. There is generally no down time, and you may quickly return to normal activities including work, school, and exercise. There is only mild discomfort, usually slight local cramping, and generally this passes quickly.

Because the salt water is highly concentrated, it will kill the lining of the veins. As these cells die, the body scavenger cells come in and carry the dead vein away and the vessel begins to fade. This may occur over a period of 4-6 weeks, although often you may see some early results the next day. The result in all patients is variable, and no percentage of improvement per vein, per session or overall is guaranteed. In many cases two treatment sessions will be necessary about a month apart, and then annual maintenance thereafter. There is a fee for each visit. After the veins die they simply begin to fade away and you may begin wearing shorts and bathing suits again without embarrassment.

ALTERNATIVES

Alternatives to Sclerotherapy can include surgical stripping of offending veins, radiofrequency heating of the inside of veins, and various other sclerosing solutions. Another alternative is laser treatment of certain spider veins, and Dr. Coverman has different lasers available for this purpose.

LASER VEIN TREATMENT

In 1983, Dr. Coverman became the first doctor in Austin to use lasers on the skin. Lasers can be used to treat spider veins, but certain caveats must be kept in mind: the laser treatment costs more, it is not faster, it is not less painful, and there are just as many potential side effects. Because of the inherent cost of the laser itself, the treatments are more expensive. There is a pinprick type of pain rather than a cramping pain, and each individual vein must be traced over. There are no shortcuts and this becomes more tedious. There is generally no advantage to using the laser unless one of the following conditions had been met:

Tiny veins too small for the needle or unresponsive to prior sclerotherapy.
The patient is hepatitis or HIV positive - the laser does not expose the doctor or staff to blood.
Past history of thrombophlebitis.

In general, Dr. Coverman has tried many lasers for leg veins and none of them seem to work well, despite enthusiastic advertising and hype. Dr. Coverman has found that either they don’t adequately eliminate the vein or they may leave pigmentary changes where the traced over vein is either darker (and worse than the original purple spider vein in the first place) or lighter and whiter. Unfortunately, these changes may be permanent. We have seen many patients at our office that went to "clinics" or "spas" for laser vein treatment, and unfortunately wound up with permanent pigmentary changes. For this reason, Dr. Coverman generally does not recommend any laser for any vein on the legs - in his opinion it just doesn’t work!

For small spider veins on the cheeks and face, particularly the chin and nose, lasers do work and work extremely well! Sclerotherapy or salt water injections is not recommended for the face and either FotoFacial and/or laser therapy works great in this area.

FEES

Each treatment session costs $275. There is no “lifetime guarantee.” Each session requires a separate fee. This is not covered by insurance and we ask you to please pay on the day of your treatment. This fee is for the entire treatment session, not necessarily just one site.

All fees are subject to change. The fee is always what is current at the time of your actual treatment. Old fee schedules, handouts, or web site fees do not apply. Any quoted fees must be in writing and are only good for six months. No "verbal" quotes are accepted.

SCHEDULING

Prior to your first treatment, you must have a visit with Dr. Coverman or Jennifer. There is a fee for this consultation. They will examine your legs, discuss any past treatments if appropriate, and discuss laser vs sclerotherapy for you. They will discuss risks, benefits, alternatives and fees. In general, you will NOT be treated that day unless previous arrangements were made. The actual treatment fee will be IN ADDITION to your consultation fee.

When you call to schedule your treatment session, please confirm that you have already had your consultation visit with Dr. Coverman or Jennifer. The procedure itself takes about 20 minutes, and plan on being here at least one hour.

There is a $150 non-refundable fee for missed appointments without a 24 hour notice.

PRETREATMENT

HOW TO PREPARE FOR SCLEROTHERAPY:

Medications - You may continue with all of your current medications.
Shaving your legs - This is up to you - it is a little easier to perform this procedure if your legs are shaved.
Skin creams - Please don't use any skin creams, oils, or emollients - it makes the procedure more difficult because your skin is slippery.
Aspirin - If you have no stomach or ulcer problems, and are not allergic, we recommend one adult (325 mg) aspirin per day with a meal the day before, the day of, and the day after the procedure. Do not take any other “NSAID’s” (Aleve, Celebrex, Motrin, etc.) while you take the aspirin.
Dress - BRING SHORTS WITH YOU - you will be wearing these during the procedure and you may wear them out or change back into whatever you wish.
Eat - Please try to eat a reasonable meal at least one hour before your treatment. It is best not to perform any in-office treatments on an empty stomach. Not to the point that you are stuffed and sick, but just to have something in your stomach.
Antihistamines - Sometimes this procedure can cause histamine release which can cause wheezing. The wheeze is not dangerous, but may be annoying. If you have any "asthma" inhalers at home, bring one with you. This may help prevent that. You MUST take an antihistamine with decongestant one hour before you come in - we prefer Claritin-D, Zyrtec D, or Allegra D. If you don’t have these, we will write a prescription.
Leaving the office - You may drive yourself home. You won't be sleepy or in any way incapacitated. You may even go back to work. We prefer that you walk vigorously as tolerated or as per your primary care doctor’s permission for about 1/2 hour right after the procedure. You could go to the gym and get on a treadmill or do whatever exercise you can normally tolerate. Bring socks and sneakers and plan on doing this.

TREATMENT DAY

WHAT YOU CAN EXPECT DURING YOUR OFFICE VISIT:

We will ask you to change into shorts at the time of your treatment.
Consent form - You should have already READ and SIGNED a consent form. If not, please mention this to Dr. Coverman or his staff.
Health history - We do not perform this procedure on anyone with a history of the following:

a. History of thrombophlebitis (blood clots)
b. Pregnant
c. Heart, blood pressure, or kidney problems
d. Any blood borne diseases such as hepatitis B or C, AIDS, or HIV positive, or syphilis.

You will be asked to fill out a form regarding the following:

a. Any symptoms you may have regarding your leg veins.
b. Any obvious signs of disease that you have noticed.

Veins - We will ask you to point out the veins that you would specifically like treated. Dr. Coverman or Jennifer may treat others at their discretion.
Position - You will be lying down, wide awake, and able to talk to Dr. Coverman or Jennifer at all times.
Skin preparation - Your legs will be prepped with simple rubbing alcohol.
Needle - All of our equipment is fresh out of the package, sterile, and discarded after use on you. No product is ever used on any other patient, and all of your products will be discarded at the end of the procedure including the needle, the syringe, and any leftover solution if not needed for your visit. Due to recent scares and concerns, let us reassure you that whenever we draw up solution for your treatment, a fresh needle and syringe is always used. If we decide that you or any one else needs more solution, we never use the same needle or syringe to draw that up: we throw the used syringe and needle away, and pull out a brand new needle and syringe to draw up more solution. There is never any chance of "cross-contamination!"
What you will feel during the procedure:

a. Cool alcohol swabs
b. Multiple brief needlesticks (our smallest needle)!
c. A brief warm sensation
d. Cramping or burning - This passes quickly. It only lasts a few minutes and by the time you leave the office, the cramping should be completely over with. Dr. Coverman can stop and give you a rest if you wish or can stop and massage the area that is cramping.

POST TREATMENT

We will do the following upon completing the procedure:

a. Clean your legs
b. Apply an antibiotic ointment

What you can expect when you go home:

a. First few days

1. Pinpoint bruising
2. Some swelling
3. Some aching
4. You may temporarily look worse

b. The first week or two, some swelling of the ankles due to:

1. Poor lymphatic drainage in that area
2. Gravity
3. Normal daily activities

c. First month - slow fading of the vessels
d. Second month - even more fading

What you should do at home:

a. Usually you may resume normal activities; sometimes you may prefer to have your legs elevated higher than your heart.
b. Exercise immediately - Brisk walking for 30 minutes or up to your normal exercise tolerance.
c. Take your aspirin.

If you have problems, call our office, or call the Medical Exchange at 458-1121 after hours.

a. If there is persistent or increasing pain, redness, or swelling.
b. If there is a sore or ulcer greater in size than a pencil eraser.
c. If you have unexplained cough, fever, chest pain, or shortness of breath.
d. If there is a red, tender streak anywhere on your legs.

COMPLICATIONS

There can be a sore, a scar, and/or ulcer if the solution leaks. Dr. Coverman has never had this happen with over 30 years of experience and thousands of treatment sessions. There can be light tan pigment over where the veins used to be - if it happens it would be more likely in older women and tends to fade and can be bleached. Sometimes there can be a blush of faint pink vessels where the old ones used to be - perhaps the body is sensing that those vessels have been destroyed and it is trying to make new ones. In general, the blush is always lighter than the original purple spider veins were in the first place, and this tends to fade. It can be reinjected.

There is some temporary cramping which only lasts minutes and should be fully clear by the time you leave the office.

A rare complication can be a deep vein thrombosis (clot). This may require special studies, hospitalization and anti-coagulants. This will be at your own expense.

CALL OUR OFFICE AT 345-9411 OR THE MEDICAL EXCHANGE AFTER HOURS/WEEKENDS 458-1121.

Please remember - do not expect dramatic results the first day or even the first week. What you may interpret as an unsuccessful procedure at the third week may have dramatically improved results by the sixth week. Please also remember that this is intended to gradually fade your vessels - no one treatment session is guaranteed to clear all of your vessels or any given percentage thereof. Certain areas may clear dramatically and other areas may clear less so or even not at all. Usually more than one treatment session is expected, and this will be always at additional full charge.

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