If you have questions about spider veins, varicose veins and how to treat them for healthy legs, make sure you’ve got the facts. In a recent interview, Jacksonville’s vein specialist, Dr. James St. George of the St. Johns Vein Center, gives answers to your questions.
Q: Why is treating varicose veins important to my health?
Dr. St. George: It’s not the varicose veins so much, that’s what you see. It’s what’s the varicose veins cause. For a lot of people it really affects their quality of life. They have a lot of cramping, swelling and pain in the legs. Their legs feel tired and heavy. They may have a lot of swelling. And for a lot of people this really affects their sleep and the quality of their day. Untreated over many years, and can lead to chronic changes in the skin and in some people even a breakdown of the skin and non healing wounds. It is something you should take care of both for the quality of your life and long term health.
Q: Are varicose veins mainly a cosmetic issue? 
Dr. St. George: Really you need to know what varicose veins are. Some people just have spider veins and their little itty bitty tiny varicose veins. And for those people it may be just cosmetic. But for some people, those veins may be a sign of something more problematic in the leg and they may have symptoms like pain, swelling and cramping in the leg and just an overall uncomfortable feeling in their leg and for those people they should have an ultrasound to exclude a medical cause of varicose veins.
Q: What causes varicose veins?
Dr. St. George: Well, it’s a lot of causes. It’s many things that add up over a period of years. For many people it is genetics- your mom had it, your grandpa had and so you have it. For about 80% of my patients it’s related to hormones, progesterone primarily. You have many, many years of your period, so your body has many years to respond to those hormones. And then pregnancy- when you get pregnant, the hormones get really high. Age- like everything as we get older, the veins weaken. And then people who have jobs that require them to stand all day like teachers, people in retail, hairdressers. All these things add up and over time, people develop these veins.
Q: How are varicose veins treated?
Dr. St. George: If you just have little cosmetic veins, then it’s a treatment that’s very simple. It’s called sclerotherapy which is a tiny injection into the vein that makes it disappear. If you have a medical reason or cause then it’s a little more involved. The problem there is that the larger veins in the leg are not working correctly and these veins have little valves in them. At the same time you want to close that vein and we use a procedure with heat to seal up the vein and close it so the vein can’t back up in it.
Q: What causes spider veins?
Dr. St. George: The veins have these little tiny valves in them and over time, the blood can back up in the veins and sit there. And over time, the veins dialate and you get these little, red, purple and blue veins that look like spider webs on your skin. If it’s just little areas on your skin that have these spider veins, you can treat them cosmetically.
Q: How are spider veins treated?
Dr. St. George: It’s really simple. These little dialated veins in your skin are not working correctly so we want to get rid of them with an injection called sclerotherapy. It’s a medication we inject with a very tiny, tiny needle. It’s a 30 gauge which is almost the smallest needle they make. We inject the medication into the vein, it damages the vein and it makes them scar down and close. Blood can’t back up into them. The blood gives the vein it’s color so you can’t see them anymore. So, cosmetically they’re gone.
Q: What causes blue veins?
Dr. St. George: Blue veins look like a road map under your skin and if you look very closely you’ll see that those veins lead to clumps of spider veins which are the feeders of those spider veins. What happens is those veins are not efficiently taking blood out of the leg so the blood backs up in your vein and over time and they dialate and you see those blue veins under the skin. The blue, purple veins look like spider veins and the blood inside gives them the color.
Q: How are blue veins treated?
Dr. St. George: Sclerotherapy, just like spider veins. So, it’s an injection of a medication specifically designed to make the vein scar down and close. When the vein scars down, the blood can’t back up into it anymore. It’s the blood that gives it the blue appearance under the skin. And on the little tiny veins like spider veins, it makes them disappear as well.
Q: What causes veins to appear in my pelvic area?
Dr. St. George: Usually you’ll see that after having one or multiple pregnancies. So, the same causes that lead to varicose veins in your legs- genetics, hormones and other factors can cause varicose veins around the uterus or the ovaries which you may then see as varicose veins in the groin area or pelvic area. And again, this is after many pregnancies. But, they can be treated very simply just like we treat varicose veins in the legs.
Q: Does living in a warm climate impact vein health?
Dr. St. George: It can. Mostly because of the warmth. The veins will dialate in response to warmth. So, if it’s hot out your veins get bigger. So, if you have a predisposed problem to varicose veins like blue veins, they will get larger. You may notice them more in the warmth and there are other times in your life you may notice them more. In women, their veins will be more prominent just before or during their periods. They may also be more prominent after exercise.
Q: Does sclerotherapy treatment hurt?
Dr. St. George: The needle we use to inject these veins is one of the tiniest. It’s a 30 gauge needle. When you inject veins with this tiny little needle, I’ve heard it described as “tweezing an eyebrow.” So, that first tweeze isn’t so bad, but after a whole bunch of tweezes it’s annoying, but I wouldn’t call it painful.
Q: Why do I need compression hose?
Dr. St. George: Well, when you treat veins, we’re trying to close the veins that are abnormal. So, in the case of spider veins, we’re trying to make them scar down and disappear. If it’s a medical problem and larger veins, we’re also trying to make them scar down and disappear with a different technique. Either way, as part of that treatment, you want to keep those veins compressed to assist with those veins scarring down, closing and disappearing.
Q: What cosmetic treatments are offered at SJVC?
Dr. St. George: Many women come to us for their spider veins. They would like to be able to wear shorts again or go to the beach in a bathing suit or wear skirts, so we use sclerotherapy for those spider veins. As part of a full service, we also offer BOTOX injections and Juvederm filler injections for the treatment of lines and wrinkles and a full line of dermatologic products including Obagi and Topix.
