Dr. Nabili received his undergraduate degree from the University of California, San Diego (UCSD), majoring in chemistry and biochemistry. He then completed his graduate degree at the University of California, Los Angeles (UCLA). His graduate training included a specialized fellowship in public health where his research focused on environmental health and health-care delivery and management.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
How can compression stockings help with varicose veins?
Compression stockings work simply by reducing the amount of blood and pressure in the veins. There are various types of stockings available, and some
may apply more pressure than others.
The main problem with compression stockings is that the blood will return to
the veins soon after the stockings are taken off. They also may be uncomfortable
for some people, and therefore, they may not worn for long enough to have any
benefit.
These stockings typically lose their pressure if washed a few times, so they
may need to be replaced from time to time.
What is sclerotherapy?
"Sclerotherapy" uses a fine needle to inject a solution directly into the
vein. This solution irritates the lining of the vein, causing the vein to swell
and the blood to clot. The vein turns into scar tissue that may eventually fade
from view. Sclerotherapy is typically used for spider veins and varicose veins
that are less than 6 millimeters in length. This is generally offered to
patients who have tried compression stockings and leg elevation without much
success.
Today, the substances most commonly used in the United States for
sclerotherapy are hypertonic saline and sodium tetradecyl sulfate (Sotradecol).
Aethoxyskerol (Polidocanol) is undergoing FDA testing but has not yet been
approved in the U.S. for sclerotherapy. Sclerosing agent or solution is the
general term for the substances used for sclerotherapy.
In sclerotherapy, after the solution is injected, the vein's surrounding
tissue is generally wrapped in compression bandages for several days, causing
the vein walls to stick together. Patients whose legs have been treated are put
on walking regimens, which forces the blood to flow into other veins and
prevents the development of blood clots. This method and variations of it have
been used since the 1920's. In most cases, more than one treatment session will
be required.
Picture of Varicose Veins Being Treated with Sclerotherapy
Picture of Spider Veins Being Treated with Sclerotherapy
What are potential side effects and complications of sclerotherapy?
In about 10-%30% of patients treated with sclerotherapy, dark discoloration of
the injected area may occur (hyperpigmentation). This usually happens because of
disintegration of the red blood cells in the
treated blood vessel. In majority
of cases, this discoloration will completely go away within 6 months.
Another problem may be the formation of new spider veins near the area that
was treated with sclerotherapy. This can happen in about 20% of patients, but
these new vessels also typically disappear within 6 months.
More rare complications may include the formation of an ulcer around the
injection site and the formation of small blood clots in the small surface veins
(superficial thrombophlebitis).
Is sclerotherapy safe for everyone with varicose and spider veins?
Sclerotherapy is generally safe for most people for
treatment of varicose veins and spider veins. However, in certain groups of
people, sclerotherapy needs to be avoided, including non-ambulatory people
(those unable to walk). Other contraindications for sclerotherapy include
obesity, blood clots in the deeper veins, allergy to the sclerosing agent, pregnancy, and arterial
obstruction (blocked blood flow in the artery near the varicose vein).
There are many symptoms involved in the 1st, 2nd and 3rd trimesters of pregnancy. The first early pregnancy symptom is typically a missed period, but others include breast swelling and tenderness, nausea and sometimes vomiting, fatigue and bloating. Second trimester symptoms include backache, weight gain, itching, and possible stretch marks. Third trimester symptoms are additional weight gain, heartburn, hemorrhoids, swelling of the ankles, fingers, and face, breast tenderness, and trouble sleeping. Read more to learn about recommended procedures and tests for each stage of a healthy pregnancy.
Deep vein thrombosis (DVT) is a blood clot in a vein located deep in the muscles of the legs, thighs, pelvis (lower torso), or arms. The most common symptoms of a deep vein thrombosis are swelling and pain in the leg that has the blood clot. A DVT is difficult to diagnose without specific tests in which the deep vein system can be examined.
Edema is the swelling of tissues as a result of excess water accumulations. Peripheral edema occurs in the feet and legs. There are two types of edema, non-pitting edema and pitting edema. Causes of pitting edema is caused by systemic diseases, most commonly involving the heart, liver, and kidneys. Local conditions that cause edema are thrombophlebitis and varicose veins. Edema is generally treated with medication.
Itching can be a common problem. Itches can be localized or generalized. There are many causes of itching to include: infection (jock itch, vaginal itch), disease (hyperthyroidism, liver or kidney), reactions to drugs, and skin infestations (pubic or body lice). Treatment for itching varies depending on the cause of the itch.
Restless leg syndrome (RLS or restless legs syndrome) is a common cause for painful legs that typically eases with motion, and becomes worse and more noticeable at rest. This characteristic nighttime worsening can frequently lead to insomnia. Treatment of the symptoms of restless leg syndrome is generally with medication as well as treating any underlying condition causing restless leg syndrome.
Obesity is the state of being well above one's normal weight. A person has traditionally been
considered to be obese if they are more than 20 percent over their ideal weight.
That ideal weight must take into account the person's height, age, sex, and
build.
Phlebitis is the inflammation of a vein. Thrombophlebitis is when a blood clot causes the inflammation. Phlebitis can be superficial or deeper in the veins. A blood clot deep in a vein is deep vein thrombosis (DVT). Some of the common causes of phlebitis include prolonged inactivity, varicose veins, trauma to a vein, underlying cancers, clotting disorders, etc. Symptoms of phlebitis may be mild (pain, tenderness, redness, or bulging of a vein. Treatment of phlebitis depends on the cause.
Birthmarks and other abnormal skin pigmentation is caused by the body's inability to produce enough melanin. Abnormal skin pigmentation can cause conditions such as vitiligo, pigmentation loss, melasma, albinism, port wine stains, macular stains and hemangioma.
Pregnancy planning is important to help prevent exposure of the mother and fetus to potentially harmful medications and substances during the early days, and throughout the pregnancy. Nutritional planning, prevention of birth defects, conditions such as high blood pressure, heart disease, diabetes, and kidney disease need careful monitoring. Gestational diabetes, preeclampsia, and pregnancy induced hypertension are conditions that may arise during pregnancy. Immunizations, inherited disorders, exercise, air travel, intercourse, and birth control are important factors to consider when planning a pregnancy.
Lymphedema is a condition in which one or more extremities become swollen as the result of an impaired flow of the lymphatic system. There are two types of lymphedema; primary, secondary. Filariasis is the most common cause of lymphedema worldwide; however, in the U.S. breast cancer surgery is the most common cause. Symptoms include swelling of one or more limbs, thickening, cracked, and secondary bacterial or fungal infections of the skin. There is no cure for lymphedema.
Regular physical activity can reduce the risk of disease. Regular exercise can also reduce the symptoms of stress and anxiety. There are fitness programs that fit any age or lifestyle.
Women's health is an important topic area to guide a woman through the stages of her life, as well as knowing the conditions and diseases that may occur. Educating yourself so that the transitions into different phases of life is key to a healthy, happy, and productive life.
Pregnancy can bring challenges like weight gain, stretch marks, varicose veins, heartburn, constipation, hemorrhoids, problems sleeping, and wondering if it is safe to have sex while pregnant. Learn how to manage and move through these challenges during pregnancy.
Klippel-Trènaunay-Weber (KTW) syndrome is a condition characterized by port-wine stains or birthmark malformations in the skin, soft tissue and bony growths (generally involving a limb), and vascular anomalies (varicose veins). The cause of Klippel-Trènaunay-Weber syndrome is not known, however, recently, there have been some cases that run in families. There is no significant treatment for Klippel-Trènaunay-Weber syndrome.
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