On Wednesday, Sept. 14, dailypress.com held a live web chat, "Ask the Experts: Everything you wanted to know about varicose veins, spider veins, and more." Susan Hancock, M.D., an independent practitioner with the Hancock Vein & Surgical Center in Newport News, answered your questions about vein-related diseases. Her practice covers the spectrum of medical and cosmetic venous disease. For transcripts of previous chats, go to www.dailypress.com/health.



 Ask the Experts: Everything you wanted to know about varicose veins, spider veins, and mor(09/14/2011) 
11:59
Prue: 
Readers: Today's health chat topic is on veins -- varicose and spider and more.
Wednesday September 14, 2011 11:59 Prue
12:00
Prue: 
Our expert today is Susan Hancock, of the Hancock Vein and Surgical Center in Newport News. She can answer your questions about vein problems and how to treat them.
Susan -- Please let our readers know when you're online and ready.
Wednesday September 14, 2011 12:00 Prue
12:01
Prue: 
For all your health news -- local and national -- go to dailypress.com/health and to our daily blog, dailypress.com/healthnotes.
Wednesday September 14, 2011 12:01 Prue
12:02
Prue: 
We're just waiting for our expert, Dr. Susan Hancock, to finish up with a patient and then she'll be with us.
Wednesday September 14, 2011 12:02 Prue
12:02
[Comment From JaniceJanice: ] 
I have very pale skin & you can see the blue veins along the front of my legs - they do not protrude but make my legs unsightly. Is tthere a procedure that can address this?
Wednesday September 14, 2011 12:02 Janice
12:02
Dr. Hancock: 
hello i am here
Wednesday September 14, 2011 12:02 Dr. Hancock
12:03
Prue: 
Today's topic is on VEINS -- ask your questions now.
Wednesday September 14, 2011 12:03 Prue
12:04
Dr. Hancock: 
do they cause you any pain or discomfort?
Wednesday September 14, 2011 12:04 Dr. Hancock
12:04
Prue: 
Let's assume that they don't cause her pain but she just wants to look good.
Wednesday September 14, 2011 12:04 Prue
12:05
[Comment From JaniceJanice: ] 
No pain no discomfort - just unattractive. I'm 60 & would like to dress with bare legs instead of hose.
Wednesday September 14, 2011 12:05 Janice
12:05
Prue: 
I'll bet that there are lots of people like Janice.
Wednesday September 14, 2011 12:05 Prue
12:07
Dr. Hancock: 
Yes, often the blue or purple lines represent spider veins that viewed as a cosmetic problem by most. If you don't have aching legs, you likely don't have a deeper problem.... although people ofte dismiss tired and heavy legs as part of older age, so I often review this with patients when talking about spider veins.
Wednesday September 14, 2011 12:07 Dr. Hancock
12:08
Prue: 
So, what can you do for spider veins?
Wednesday September 14, 2011 12:08 Prue
12:09
Dr. Hancock: 
Spider veins without an underlying problem are typically addressed with sclerotherapy, a technique whereby a chemical is injected into the spider veins that over times causes them to collapse. The process takes weeks to months and often more than one treatment is necessary determined by the extent of the problem. It is important to realize that wearing compression stockings after sclerotherapy helps ensure the best outcome.
Wednesday September 14, 2011 12:09 Dr. Hancock
12:09
Prue: 
Also, before you answer other questions, could you tell our readers what causes spider veins and also varicose veins. What are they? Are they dangerous to your health?
Wednesday September 14, 2011 12:09 Prue
12:09
[Comment From JaniceJanice: ] 
I have spider veins & have had them treated in the past. These are larger veins so I don't imagine collapsing them with saline (assumption on my part).
Wednesday September 14, 2011 12:09 Janice
12:10
Prue: 
Is it saline that's injected or something else?
Wednesday September 14, 2011 12:10 Prue
12:11
Dr. Hancock: 
The short answer is.... varicose veins and spider veins both have a significant hereditary component. They are both caused by increased venous pressure in the legs. Longterm, venous disease can cause health problems due to skin changes such as ulcerations, infections, and chronic leg swelling.
Wednesday September 14, 2011 12:11 Dr. Hancock
12:11
Prue: 
Readers: We are talking with Dr. Susan Hancock of the Hancock Vein and Surgical Center in Newport News. She can answer all your questions about vein-related problems.
Wednesday September 14, 2011 12:11 Prue
12:11
[Comment From MarcMarc: ] 
Has there been a link between high blood pressure and venous insufficiency? Does having high blood pressure increse the risk of varicose veins or is it the other way around
Wednesday September 14, 2011 12:11 Marc
12:13
Dr. Hancock: 
Large varicose veins do not do well with sclerotherapy and generally require phlebectomy or local stripping after reflux has been addressed.
Wednesday September 14, 2011 12:13 Dr. Hancock
12:13
Prue: 
What do you mean by "increased venous pressure"?
Wednesday September 14, 2011 12:13 Prue
12:13
Dr. Hancock: 
Sclerotherapy in the past has been performed with hypertonic saline which can be painful. There are newer FDA approved agents that are more effective now.
Wednesday September 14, 2011 12:13 Dr. Hancock
12:14
Prue: 
Can you answer Marc's question about high blood pressure?
Wednesday September 14, 2011 12:14 Prue
12:14
Dr. Hancock: 
Venous pressure=venous reflux or pooling of venous blood in the legs due to dysfunctional valves.
Wednesday September 14, 2011 12:14 Dr. Hancock
12:14
Dr. Hancock: 
High blood pressure is a risk factor for venous reflux disease, yes.
Wednesday September 14, 2011 12:14 Dr. Hancock
12:15
[Comment From lutoshlutosh: ] 
I have spider veins that look like a starburst and are red, sometimes they itch really bad. What causes this to happen.
Wednesday September 14, 2011 12:15 lutosh
12:15
Prue: 
Readers, Dr. Hancock is here until 12:30 p.m. to answer your vein-related questions.
For more health news, go to www.dailypress.com/health
Wednesday September 14, 2011 12:15 Prue
12:16
Dr. Hancock: 
Marc,

Just because your young does not mean you should not address your varicose veins. I have treated numerous young people with varicose veins and the key is to treat them before they become complicated!
Wednesday September 14, 2011 12:16 Dr. Hancock
12:17
Dr. Hancock: 
Spider veins do have symptoms of itching, burning, and throbbing. There is an inlammatory compenent to all venous disease that causes these symptoms.
Wednesday September 14, 2011 12:17 Dr. Hancock
12:17
[Comment From MarcMarc: ] 
I'm young - 25 - and doctor suggested I should wait until my varicose veins get worse before I get them removed. Won't keeping them damage other veins or is it the other way around?
Wednesday September 14, 2011 12:17 Marc
12:18
Prue: 
Dr. Hancock -- I think you already answered Marc's question, but you mentioned possible complications by leaving varicose veins untreated. What would those complications be?
Wednesday September 14, 2011 12:18 Prue
12:19
Dr. Hancock: 
Varicose veins get progressively worse with time and cause the skin changes I mentioned above. Compression stockings can help but do not provide a definitive fix. Unaddressed venous reflux disease will over time will result in enlarging varicose veins.
Wednesday September 14, 2011 12:19 Dr. Hancock
12:19
Prue: 
Is the difference between spider veins and varicose veins just the size?
Wednesday September 14, 2011 12:19 Prue
12:20
Dr. Hancock: 
Longterm, venous disease can cause health problems due to skin changes such as ulcerations, infections, and chronic leg swelling. Also, advanced venous reflux disease that cause swelling and skin changes can lead to something even more problematic called lymphedema.
Wednesday September 14, 2011 12:20 Dr. Hancock
12:20
Prue: 
Earlier you mentioned a phlebectomy for larger varicose veins. What does this involve?
Wednesday September 14, 2011 12:20 Prue
12:21
Dr. Hancock: 
Spider veins are the tiny superficial veins that are less than 1mm. As they get bigger, you have venulectasia, then varicose veins up above 3mm. It is a size difference which also dictates best methods of treatment.
Wednesday September 14, 2011 12:21 Dr. Hancock
12:22
[Comment From GuestGuest: ] 
Is leg exercise a preventative measure to stave off varicose veins?
Wednesday September 14, 2011 12:22 Guest
12:22
Dr. Hancock: 
Phlebectomy means local vein stripping through small 2mm incisions.
Wednesday September 14, 2011 12:22 Dr. Hancock
12:22
Prue: 
Good question from guest. Is there anything else you can do to PREVENT varicose veins.
Wednesday September 14, 2011 12:22 Prue
12:23
Prue: 
I'm not sure I understand what you mean by "vein stripping" ...please clarify.
Wednesday September 14, 2011 12:23 Prue
12:23
Dr. Hancock: 
Yes, exercise help to prevent venous reflux disease by building the calf muscle pump which helps keep the venous circulation efficient.
Wednesday September 14, 2011 12:23 Dr. Hancock
12:23
Dr. Hancock: 
Vein stripping simply means local removal of veins.
Wednesday September 14, 2011 12:23 Dr. Hancock
12:24
Prue: 
Readers - ask your questions about veins now. We have a couple more minutes with Dr. Hancock.
Wednesday September 14, 2011 12:24 Prue
12:25
Prue: 
I have a question -- years ago I had blood vessels on my face "zapped" with some electrical device I think. (It hurt.) Is this still practiced to shrink burst vessels?
Wednesday September 14, 2011 12:25 Prue
12:25
Dr. Hancock: 
Preventative measure include other things considered helpful to your general health.... exercise, maintaining proper weight, managing other issues such as hypertension, and wearing compression stockings if you see early signs, have family members with venous problems, or have an occupation that requires long periods of standing or sitting.
Wednesday September 14, 2011 12:25 Dr. Hancock
12:25
[Comment From JamesJames: ] 
If venous reflux disease is the underlying cause of varicose veins, how is the disease treated be fore the veins become a problem?
Wednesday September 14, 2011 12:25 James
12:26
Dr. Hancock: 
Facial spider veins or telangiectasia to respond well to Veinwave which is a device used to 'zap' these veins. It's not considered laser. It does sting a bit, but is fairly effective in treating facial veins.
Wednesday September 14, 2011 12:26 Dr. Hancock
12:28
Prue: 
Susan Hancock practices at the Hancock Vein and Surgical Center in Newport News; www.hancockvein.com.
Wednesday September 14, 2011 12:28 Prue
12:28
Dr. Hancock: 
Awareness of venous reflux disease is the most important thing when discussing proper identification and treatment. Early signs of aching and heaviness that are often dismissed as being caused by other things should be investigated with an ultrasound. Unfortunately, when people don't have obvious varicose veins, primary care doctors and patients don't think about venous reflux being the potential problem.
Wednesday September 14, 2011 12:28 Dr. Hancock
12:29
Prue: 
And how would it be treated in the early stages - before veins are visible?
Wednesday September 14, 2011 12:29 Prue
12:30
Dr. Hancock: 
When I see patients in the office with suspected venous disease, we start with compression stockings to determine if they get relief. An ultrasound is performed to assess for the presence of reflux. After a trial of compression therapy, they generally proceed to definitive treatment which means "closing' the underlying refluxing vein.
Wednesday September 14, 2011 12:30 Dr. Hancock
12:30
Prue: 
Thank you. I'll be closing the chat in just a couple of minutes. I want to thank Dr. Hancock so much for answering readers' questions and shedding light on the issue of spider veins and varicose veins.
Dr. Hancock -- if you have anything else you'd like readers to know, please pass along the information now. Thanks again for your expertise and participation.
Wednesday September 14, 2011 12:30 Prue
12:31
Dr. Hancock: 
Venous reflux disease is more common than heart disease and other circulation disorders. If you believe you may have symptoms we have talked about, you should have your legs checked early.
Wednesday September 14, 2011 12:31 Dr. Hancock
12:32
[Comment From JamesJames: ] 
Is a prescription needed for compression stockings?
Wednesday September 14, 2011 12:32 James
12:33
Prue: 
Readers: Join us every Wednesday at noon for our weekly chats on health-related topics.
Dr. Hancock - thanks so much. Please let readers know how they can reach you.
Wednesday September 14, 2011 12:33 Prue
12:33
Dr. Hancock: 
Yes for local places. Some local distributors will file with insurance though insurance most often does not pay. Lots of online sources are available and prescription is not required.
Wednesday September 14, 2011 12:33 Dr. Hancock
12:33
Dr. Hancock: 
You can find us on www.hancockvein.com or call the office at 873-0138.
Thanks.
Wednesday September 14, 2011 12:33 Dr. Hancock
12:34
Prue: 
Thanks very much. I'm closing the chat now.
Wednesday September 14, 2011 12:34 Prue
12:34