Boston Marathon Winner Finishes in Compression Socks

The first American man to win the Boston Marathon since 1983 crossed the finish line last week.  Meb Keflezighi, 38 , won the men’s division while wearing CEP compression, a line of Mediven medical compression stockings. Meb has been publicly wearing CEP compression socks for years, including as the US Olympic marathon runner.


CEP Compression

Due to the health benefits that come from compression socks, other athletes are also using compression socks to decrease muscle fatigue and improve performance and recovery. It seems as though every runner is wearing compression socks these days.  Compression is not just for athletes. Compression has been used for decades as the treatment for vein disorders. In the field of venous disease, they are the gold standard in conservative management for vein conditions such as varicose veins and venous insufficiency. For those who have jobs that require prolonged periods of standing or sitting, compression can help with occupational leg swelling and fatigue. They are also recommended during air travel to reduce the risk of deep venous thrombosis (DVT).

CEP Compression socks, like those worn by Meb Keflezighi in the Boston Marathon can be found at

How To Reduce Your Risk of DVT During Air Travel

A deep vein thrombosis (DVT) is a blood clot that develops in the deep veins of the legs. If it travels to the heart and lungs (pulmonary embolism), it can be fatal.  Blood clots, (DVTs) are a serious condition and occur in 1% of airline passengers in long haul flights greater than 8 hours.  On last night’s episode of Bravo’s TV Series, The Atlanta Housewives, actress, housewife and Dancing with the Star’s, Nene Leakes described her recent DVT and pulmonary embolism from a plane flight. She now ‘wears compression socks’ which is an important component to reduce complications of vein conditions.

The key to preventing blood clots in the veins (DVT) is knowing the risks and taking steps to minimize the danger. Here are a few important practices you can follow to help prevent a potentially dangerous blood clot and increase your comfort.

#1) Bend Your Feet While Seated


Compression stockings should be worn during travel to reduce the risk of blood clots. Blood clots in the leg veins occur in 1% of airline passengers on flights longer than 8 hours.

Increase blood flow through your legs by bending your feet up and down when you’re seated, or by getting up and moving around every hour or so.

#2) Avoid dehydration

Avoid excessive alcohol and caffeine during airline flights and drink plenty of water.  Choose water over caffeinated or alcoholic beverages

#3) Avoid crossing your legs

#4) During the flight, walk around the cabin whenever you can

#5) Consult your doctor before flying if you are pregnant or have recently given birth; use birth control or other hormone therapies; or have had a stroke or recent surgery

#6) Wear graduated compression stockings

Wear graduated compression stockings when you travel. Medical grade compression stockings can help prevent veins from stretching when your legs are bent for long periods of time and prevent pooling of blood within the veins.  Compression stockings should be worn during long periods of travel by airplane or by car or train.  Medical compression stockings for travel can be found at:


What is the Relationship Between Leg Cramps and Venous Disease?

Leg cramps occurring at night (nocturnal leg cramps) are a common symptom of venous disease. In fact, in the San Diego Population Study, leg cramps were the second most common symptom in people with venous disease with a prevalence of 14.3%. Leg aching (17.7%) was the most common complaint and tired and swollen legs were also predominant symptoms.

Healthy veins collect the de-oxygenated blood from the tissues. The venous blood, which is low in oxygen and high in waste products is returned to the heart and lungs where it is replenished with oxygen and nutrients.  In diseased veins, the blood circulates poorly, allowing blood to pool and become stagnant. The exact mechanism that causes cramping in the legs is uncertain.  But, when the cramping is  caused by the poorly functioning veins, the symptoms are often alleviated by correcting the underlying problem.  Conservative measures, such as elevating the legs, walking regularly, and wearing compression therapy may reduce the frequency of night cramps. Treating the underlying venous insufficiency may be curative.

Leg Cramps and Varicose Veins

Varicose Veins and underlying venous insufficiency are a common cause of night cramps, or leg cramps occurring at night. They most frequently affect the upper legs, causing cramping in the thigh but may cause calf cramping.

There are many causes for leg cramps and if you suffer from night cramps it is important to be properly evaluated to determine the cause.  Cramps that occur with exercise are more likely to be associated with a more serious condition. If your muscles cramp with walking for a short time and recover with rest this may indicate arterial disease.  Other causes for leg cramps include muscle injury, thyroid conditions, pregnancy, electrolyte imbalance, dehydration or other causes.

To help identify the cause, it may be helpful to keep a log of daily activities, or change in activities; for example, heavy exertion may indicate a muscular cause or long periods of standing or sitting may favor venous disease.  A recent study showed that prolonged standing at work may be an important risk factor for varicose veins and nocturnal leg cramps.

Check with your primary care physician to rule out other causes for leg cramps. Blood tests can check for thyroid, kidney and electrolyte conditions.  You may also have undiagnosed venous reflux.


At La Jolla Vein Care, our vascular imaging scanners help us detect  vascular causes of leg pain. For example, we can utilize one of our three duplex ultrasound imaging systems to scan for blood clots in the leg veins (deep venous thrombosis), venous insufficiency and identify significant problems in the arterial circulation.


Call us for more information about our vascular imaging services 858-550-0330.

Before and After Photos: Spider Vein Treatment

This patient recently asked us to post his ‘before and after’ photos of his spider veins on the inner ankle (medial malleolus) following treatment here at La Jolla Vein Care.  He is a 62 year-old gentleman whose wife found the appearance of these unsightly veins a nuisance and they also caused itching. As a result, he wanted them to ‘disappear’ before summer. Four weeks after his second treatment session,  (8 weeks total) most of these diseased blue and red dilated vessels had disappeared.  He was treated with two sessions of liquid sclerotherapy using Asclera pharmaceutical grade solution. He wore his compression stockings the entire 8 weeks.

vein pictures

Before and after spider vein photos at la jolla vein care.

Sclerotherapy is used to treat the small spider veins on the legs. Only a trained physician or RN/PA should administer sclerotherapy injections. Sclerotherapy usually requires more than one treatment session for best results and may take several weeks to see optimal results. The national average is 3-5 treatment sessions. A different type of sclerotherapy, called foam sclerotherapy is used to treat larger blue, reticular veins and varicose veins. This should be done under ultrasound guidance and is performed by a Medical Doctor. Read more about sclerotherapy and ultrasound-guided foam sclerotherapy at La Jolla Vein  or click here to see more La Jolla Vein Care’s before and after photos.

Does Insurance Cover Varicose Vein Removal?

Vein procedures are generally a covered benefit by most insurance types (including Medicare) if they are considered medically necessary. Medical necessity requirements varies by the individual policy, but in general the varicose veins must cause symptoms such as leg pain, heaviness, fatigue, aching, restless legs, swelling or skin changes such as darkening of the skin around the ankles. Sometimes varicose veins can cause  complications such as phlebitis, bleeding, ulceration or skin changes; these are considered medical conditions. If varicose veins do not cause symptoms, they are considered to be a cosmetic issue in the eyes of insurance.

An ultrasound examination is necessary to provide an overall assessment of the severity of the vein condition. This is a diagnostic study and usually covered by insurance.

In most cases, insurance companies require that conservative measures have been tried for several weeks. Conservative measures include compression stockings, leg elevation, exercise, weight loss or maintaining a healthy weight, NSAIDS or other medication and hot/cold packs.  Many insurance types REQUIRE 6 to 12 weeks of wearing medical grade compression stockings prior to being approved for treatment.

Sometimes, flexible spending accounts can be used to pay for or may reimburse for compression stockings, varicose veins and spider vein treatments.

For more insurance information and questions, email

La Jolla Vein Care Chosen To Participate in Compression Trial

La Jolla Vein Care Participates in ACTitouch Adaptive Compression Therapy Trial
compression pump

La Jolla Vein Care participates in compression therapy trial

Selected patients at La Jolla Vein Care will be offered to participate in the ACTitouch compression trial.  Compression therapy is used for the treatment and prevention of vein disorders in the form of compression garments like compression socks and stockings, multi-layer wrappings, gel paste boots or devices such lymphatic pumps. The ACTitouch is a new compression device designed for ease of use and comfort.  The ACTitouch Adaptive Compression Therapy system combines two proven therapies—intermittent pneumatic compression and sustained gradient compression—in one easy-to-wear device. It is designed to mimic the action of the calf muscle pump through application of optimal gradient pressures.  It is lightweight and compact, so it may give you the freedom to stay active while helping you reduce edema and heal venous leg ulcers. Because it is easy to use, the ACTitouch system may help promote greater patient compliance.  The study will assess whether or not patients who are unable to wear compression garments are more compliant with using the ACTitouch system because it is easier to use.   This device may offer effective daily at-home treatment of venous insufficiency for those who cannot use other types of compression.




Non-surgical Varicose Vein Removal

Fortunately, Vein stripping surgery is a thing of the past. Modern varicose vein treatments are minimally-invasive with little pain or down-time.  There are different non-surgical treatment options offered at La Jolla Vein Care. The advantages of the modern non-surgical treatments are that return to normal activities is almost immediate, there is little pain or bruising and there are no scars! The different non-surgical treatments that are used to eliminate varicose veins at La Jolla Vein Care include:

Before and After Varicose Vein Treatment

This young La Jolla Vein Care patient’s varicose veins were a result of an incompetent great saphenous vein. As a result, her treatment included radiofrequency closure of the great saphenous vein with foam sclerotherapy used to treat the surface bulging varicose veins.

Before and After Varicose Vein Treatment

This is another before and after picture of the same patient whose bulging varicose veins were removed without surgery at La Jolla Vein Care, utilizing radiofrequency and foam sclerotherapy treatments.

1) foam sclerotherapy, which uses an injection of a solution to collapse the vein, 2) radiofrequency ablation, which uses radiofrequency energy to heat and collapse the vein, 3) clarivein or mecahnochemical ablation which utilizes a small wire that spins while delivering a liquid solution to the vein and 4) microphlebectomy, which uses tiny incisions to remove the veins. More information can be found about each treatment type on our website.  The best treatment type depends on the size and locations of the veins affected and the patient preference.   Many times, a combination of treatments will be recommended.


LJVC Welcomes Hilary Black, RN


Hilary is a Registered Nurse who treats cosmetic spider vein conditions at La Jolla Vein Care’s Cosmetic Sclerotherapy Clinic.

LJVC welcomes Hilary Black, RN! Hilary has worked with LJVC for a few months now in our cosmetic spider vein clinic, helping patients get rid of unsightly spider veins on the legs.  Hilary also continues to work with Dr. Sadrian, plastic surgeon.  She  received her Bachelor of Science in Business from U.S.C. in Los Angeles prior to graduating from Maric College of Nursing in San Diego.  Hilary worked on the cardiac care (telemetry) unit immediately after graduating from nursing school before she joined the aesthetic world. Since then she has worked for over 12 years in the aesthetic arena.   Her experience includes the use of many state of the art lasers and injectibles, including those for vein treatment.   She has worked with and continues to work beside surgeons to provide specialized aesthetic treatment plans for her patients.  She has performed thousands of procedures and strives to provide a beautiful and lasting result for each patient.Hilary lives in Carmel Valley and enjoys spending time with her niece and nephews, shopping, reading, traveling and going out with friends.

To schedule an appointment with Hilary in our cosmetic spider vein clinic, please call 858-550-0330. Summer’s around the corner, and leg vein conditions  may take more than one treatment and several weeks-months for best results.

Meet La Jolla Vein Care’s Dr. Fronek, Vein Specialist

Helane Fronek MD, FACP, FACPh is one of La Jolla Vein Care’s esteemed board certified vein specialist.  Dr. Fronek _NOR1964entered the field of phlebology in 1985 and has been an integral part of the development of this new medical specialty. As the Director of the Varicose Vein Clinic at Scripps Clinic, she provided cutting edge treatment for the entire spectrum of superficial venous disorders and conducted research on venous leg ulceration, compression therapy, and emerging therapies for varicose veins. Dr. Fronek is a past president of the American College of Phlebology, the largest medical organization devoted to vein care. She is a respected speaker and educator in all aspects of diagnosis and treatment for venous disease and communication in the medical arena.

Dr. Fronek was the first recipient of the American College of Phlebology’s prestigious Leadership Award. In 2011, Dr. Fronek was honored for her contribution to the field of phlebology and named an honorary member of the ACP. This award is given to one leader in the field, amongst national and international members.

Board-certified in both Internal Medicine and Phlebology, she is also Assistant Clinical Professor of Medicine at UC-San Diego School of Medicine, where she teaches medical students the practice of physical examination and the art of medicine. Dr. Fronek has dedicated her career to providing technically excellent and compassionate care to her patients and to inspiring and teaching the next generation of phlebologists. Dr. Fronek is well known for authoring, ‘The Fundamentals of Phlebology’ which is a medical textbook used by most Phlebologists entering the field.

Dr. Fronek is accepting new patients. To make an appointment with Dr. Fronek, call 858-550-0330.


Dr. Nisha Bunke

Meet Dr.Bunke, La Jolla Vein Care Specialist

Dr. Nisha Bunke

Dr. Nisha Bunke Paquette, MD, FACPh is one of La Jolla Vein Care’s highly trained board-certified venous disease specialist.  Dr. Bunke specializes in highly advanced and minimally invasive outpatient procedures for treating a wide spectrum of venous conditions. Dr. Bunke  is one of a few southern California physicians board-certified and fellowship trained in Venous and Lymphatic Medicine. She was the first physician in the United States to complete fellowship training supported by the American College of Phebology and was mentored by world renowned vascular surgeon, Dr. John Bergan. Presently, she sees patients at La Jolla Vein Care, San Diego County’s largest dedicated vein center.  She is also a Volunteer Clinical Instructor of Surgery at the University of California San Diego (UCSD) School of Medicine, member of the Scripps Ximed Medical Group and Veteran’s (VA) Medical Center. For five years, Dr. Bunke  has run the vein clinics at the VA Medical Center, providing vein care for our veterans. From 2010 until 2012, she also directed UCSD’s Vein Clinic.

Dr. Bunke is a physician and scientist, actively leading clinical research studies. In 2009, Dr. Bunke  was awarded the Internationale Union of Phlebologie Research Fellowship and the Best Young Presenter Award in Monaco. Collectively, Dr. Bunke  and Dr. Bergan were awarded the 2008 JOBST Research Award for the Advancement of Phlebology for their research on Inflammatory Bio-Markers of Venous Insufficiency. Moreover, Dr. Bunke-Paquette is a member of The Clinical and Translational Research Institute (CTRI) of the University of California San Diego (UCSD), the American Medical Association (AMA), San Diego County Medical Society, Society for Vascular Medicine, American College of Phlebology (ACP), American Venous Forum (AVF) and the Society for Vascular Ultrasound (SVU).  She has published chapters in several medical textbooks, academic journals and most recently co-edited the second edition of the Vein Book, along with John Bergan.

To make an appointment to see Dr. Bunke, call 858-550-0330. 065_NOR2320