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Varicose and Spider Vein Therapy
Kenneth Zahl, MD 23 North Fifth St. Stroudsburg PA 18360 Phone: 570-213-0292 Fax: 973-989-2645		INDICATIONS It is estimated that up to 70% of adult women ( and a small percentage of men) will be afflicted with enlarged "dilated" leg veins at some time in their lives! Both large varicose veins and smaller "spider" veins can cause leg aching, fatigue, throbbing, itching, cramps (even night cramps!), restless legs and burning. Most importantly, these veins can be eliminated non-surgically, safely, and with injections or laser therapy. TECHNIQUES With modern refinements in available solutions and techniques, sclerotherapy is a safe and very effective treatment for the full range of dilated veins. Advances in laser technology make this a powerful additional tool for very fine spider veins. CAUSES Both spider veins and larger varicose veins are caused by abnormally high pressure within the affected vein. In most cases the cause of this high pressure is hereditary. Larger varicose veins have abnormal valves that fail to keep blood flowing toward the heart. Blood flowing downward instead of upward in the legs causes the vein walls to stretch out until the vein bulges from the skin surface. Smaller dilated veins, including spider veins, are usually caused by a combination of a hereditary tendency and hormonal effects such as those during puberty or pregnancy. TREATMENT OPTIONS Sclerotherapy, uses the body's natural healing abilities to close off abnormal veins. After being injected with a liquid that irritates and slightly damages the lining of the vein, the body responds by filling the vein with scar tissue. Once flow is eliminated, the vein disintegrates. In my office the solution used for treatment is sodium tetradecyl sulfate (Sotradecol). This solution has been FDA approved since 1946 and has a long record of safety and effectiveness. I prefer this solution to hypertonic saline which is not FDA approved for this purpose. It is also more painful and problematic if it goes out of the vein. It has been shown that a dilute (0.175%) solution of Sotradecol is effective and safe. A course of treatment can include from one to five treatment visits at bi-weekly to monthly intervals. An extremely fine needle is used so that there is almost no pain or discomfort or bruising. RECOVERY Unlike surgery, there are no stitches or scars, only some bruising and come minimal discomfort (usually handled by Tylenol or acetamenophen). I have patients walk right out of the office and advise them to use elastic bandages for two to four days. INSURANCE QUESTIONS Will insurance pay for sclerotherapy treatment? Most insurance companies do not pay for sclerotherapy treatment (or any other treatment) if it is performed for cosmetic reasons. Some insurance companies do pay benefits if there is pain or discomfort which impedes activity. Each insurance carrier is different, and it is recommended that individuals check with their own agents to determine if there is coverage. The following is a list of different types of insurance plans that might help you in determining your benefits: Fee-For-Service: This kind of health plan is best suited for people who want a lot of options and are willing to pay for it. In other words, it allows you to select any physician or hospital your heart desires. The other good thing about it is that it allows you to self-refer. However, there is still no guarantee that they will consider the vein injections medically necessary. PPO (Preferred Provider Organization): If you use the doctors and hospitals on your list you'll greatly reduce deductible and copayment costs and there won't be as much claims paperwork. However, you may also select your own physician and self-refer (at higher cost). Currently, Dr. Zahl, is not a member of any PPO. EPO (Exclusive Provider Organization): Similar to a PPO except that the coverage for non-listed physicians and services may be less, and there are more rigorous utilization review requirements. HMO (Health Maintenance Organization): Your selection of doctors and hospitals is strictly limited to those on the HMO list. You also have to choose a primary care physician with whom you have to consult for all referrals regarding specialized care or hospitalization, including a referral for vein treatment. If you receive treatment without authorization from a non-HMO physician you will not be covered. Currently, Dr. Zahl is not a member of any HMO other than GHI, NY Life and PHPNJ. POS (Point of Service): This is a combination platter of HMO, and Fee-For-Service. If your insurance card has POS it allows you to go out of the HMO network and chose your own doctor. Usually there is a deductible and percentage co-pay. Medicare: Medicare rules change almost daily, but currently Medicare covers treatment considered medically necessary if referred from the primary physician. Cosmetic vein treatment can be obtained, but no Medicare form will be filed, and the patient will be responsible for payment of bills. Medicare HMO: Available to Medicare-eligible individuals, this plan puts you in an HMO(see above) in return for lower rates. You have restrictions that are the same as in any HMO. Medicare Supplement or Medigap: This policy is added on to regular Medicare coverage to cover cost not covered by Medicare. Restrictions would depend on which plan you choose. How Do You Decide If This Treatment is Right for You? I feel strongly that an educated and informed patient achieves the most satisfactory outcome. A thorough understanding of your problem is critical in getting the best results. Before any treatment is recommended or any estimate of cost is made, I ask you to visit for an initial evaluation. At that time you will receive educational material, have a full history taken and undergo a complete examination of your veins. Some patients should have a doppler or duplex ultrasound evaluation of the circulation in your deep and superficial veins. After this examination has been completed, we will be able to give you a complete understanding of the nature of your vein problem and the options for treatment. MY BACKGROUND For my complete Curriculum Vitae see the Home page or ask for it in the office. As an anesthesiologist and pain specialist accurate injections are a must. I have experience with fine needles, and of course avoiding pain during injections. I have watched many varicose vein surgeries and perform many vein injections. I have had formal training in the field as well. Of course, there is a logical overlap between pain treatment, my anesthesia background and pain practice.

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Varicose and Spider Vein Therapy