La Jolla Vein Care

10, 3, 2022

Understanding Venous Insufficiency

2022-03-17T10:18:32-07:00

When you become a patient with La Jolla Vein Care, you will go through a screening process, and a vascular evaluation using ultrasound technology to diagnose your venous reflux disease. Chronic venous insufficiency is a disease affecting at least 50 million Americans. It is very common, but unfortunately undiagnosed. Through our venous insufficiency Duplex Ultrasound test, our vein specialists can determine exactly what is going on in the patient’s veins. 

 

The anatomy and process of venous insufficiency or venous reflux disease: 

One of the major veins that takes the blood to the heart is deep inside the muscles of the thigh and calf called the deep veins. Parallel to this lies the superficial veins inside the legs. Superficial veins dump the blood into the deep vein in the groin area and collectively they take the blood back to the heart. 

The direction of the blood flow begins from the ground up towards the heart. Both deep and superficial have a structure system known as the valves. They function as a safety unit directional valve system. Where the blood can flow upward and not downward and be open or closed off. Similarly the same type of structure is found in your heart with heart valves. 

Over the course of the years, depending on your occupation, family history, pregnancy, surgeries, any trauma or injury to your legs, and any kind of underlying muscular or skeletal problem will contribute to problems with the valves in your legs. The valves, over the course of the years may get farther apart from one another. They will still be able to open and close, but the main problem will be the blood flow will not be able to go in one direction. This causes the veins to become enlarged. As a result,  the valves remain open and the blood to flow upward and also downward. This is known as venous reflux disease or venous insufficiency. 

venous reflux disease

 

A consultation with one of our vein specialists for chronic venous insufficiency involves taking a detailed history and physical examination in combination with a venous reflux ultrasound study.  Based on your personal findings, a customized treatment plan will be discussed which may include doing nothing, conservative management, or various treatment options based on your individual needs. 

For any more questions about venous disease and the process of diagnosis and treatment, please call us at (858)-434-5998.

 

Understanding Venous Insufficiency2022-03-17T10:18:32-07:00

28, 4, 2021

Vein Care’s Dr. Foghi Interviewed in San Diego Voyager

2021-04-28T00:28:48-07:00

We would like to share with you our very own Dr. Armin Foghi’s interview in San Diego Voyager Magazine. Dr. Foghi discusses his career path, obstacles and what makes him happy. This read gives you a personal take on one of San Diego’s best vein specialists- dedicated to the diagnosis and treatment of vein disorders.
You can find the link to the interview here

Vein Care’s Dr. Foghi Interviewed in San Diego Voyager2021-04-28T00:28:48-07:00

22, 6, 2020

Understanding Insurance Coverage for Varicose Veins

2021-11-13T14:15:50-08:00

Does Insurance Pay for Varicose Vein Treatment? Here are the criteria that determine if insurance pays for varicose vein treatment

Most insurance types (including Medicare and Molina) will cover varicose vein treatments that are considered “medically necessary care” but not for “cosmetic care”.  Varicose veins (bulging leg veins) have to cause symptoms such as leg pain to be covered by insurance. Spider veins (tiny clusters of blood vessels at the skins surface) are considered a cosmetic treatment and are not covered by any type of insurance.

4 Main Criteria for medically necessary vein treatment

  1. Varicose veins must cause leg pain or other symptoms.

Medically necessary vein treatment means that the varicose veins must cause symptoms such as leg pain,  heaviness, persistent swelling, night-time cramping, or burning. Complications of varicose veins that may indicate treatment include leg ulcer (open wound) from the vein problem, recurrent blood clots or phlebitis, ruptured bleeding vein, or skin discoloration around the ankle.

  1. Symptoms affect daily life.

The symptoms must be severe enough to affect a person’s ability to do their daily routines or work. For example, a teacher may have varicose veins that prevent them from standing and doing their job, because they have to take frequent breaks to elevate their legs. A server at a restaurant may no longer be able to work long shifts, due to leg pain after a few hours. Symptoms can interfere with lifestyle by limiting the amount of exercise one hopes to achieve, or the inability to cook or do house chores due to leg pain.

  1. Conservative treatment must be tried for 6-12 weeks.

In most cases, insurance requires that conservative measures have been tried for several weeks. Conservative measures include compression stockings, leg elevation, exercise, weight loss, anti-inflammatory medication such as ibuprofen or vasoactive agents such as horse chestnut or Vascular, and hot/cold packs.  Many insurance types REQUIRE 6 to 12 weeks of wearing medical-grade compression stockings prior to being approved for treatment.  You should have your consultation as soon as possible and begin implementing conservative management into your lifestyle. You should begin keeping a daily log documenting that you are using conservative treatments. If your primary care physician has already prescribed compression stockings, it is helpful if you have a note, you’re your doctor or the prescription, as this counts toward your conservative management time period.

  1. Venous reflux must be demonstrated on ultrasound.

Underlying venous insufficiency must be documented by ultrasound examination. The ultrasound study to determine the treatment and the physician visits are covered benefits with most insurance types.

Treatments that are not covered by insurance because they are considered to be ‘cosmetic services’ include:

  • Varicose veins that do not cause any symptoms
  • Spider veins

Does Your Vein Condition Qualify for Medical Necessity?

If you have answered ‘yes’ to each of the 4 categories, then you are likely to meet medical necessity criteria for vein treatment. Disclaimer: this is a simplified questionnaire for patient convenience and understanding.

  1. Do your varicose veins cause at least one of the following symptoms?
  • Leg pain
  • Heaviness
  • Persistent swelling
  • Aching, heaviness, or throbbing

And/ Or have you suffered from one of the following complications of varicose veins?

  • Leg ulceration
  • Ruptured bleeding vein
  • recurrent blood clots or phlebitis
  1. Do your symptoms (leg pain, etc.) affect your daily life?

Do Varicose Veins symptoms (leg pain, etc.) affect your daily life

  • Yes, it affects my job
  • Yes, it affects my home
  • Yes, it affects my daily routine or leisure
  1. Have you already tried conservative management and the conservative management has not completely resolved your vein condition?
  • Yes, I have tried compression socks/stockings/ AND two or more of the following:
  • Leg elevation
  • Exercise
  • Weight loss
  • Ibuprofen or other NSAID
  • Ice or heat packs
  • Venoactive medication such as Vascular or OTC supplements like horse chestnut or grapeseed extract
  1. Did you have an ultrasound examination that demonstrated underlying venous reflux disease?
  • Yes, my ultrasound demonstrated and documented backward flow in my veins (venous reflux)
  • No, the ultrasound examination concluded my veins have normal function.

However, some individual insurance policies exclude varicose vein treatment- this is usually a result of employer exclusion. Sometimes in this case, one may ask the employer to include varicose vein treatments on the policy. You may call the number on the back of your insurance card to ask specifically if they cover vein treatments. When you start a vein treatment process with us, we will help you to understand what your insurance will cover. Our prior authorization specialist will obtain preauthorization (approval) for your treatment and can answer questions.

For a list of insurance types we accept at La Jolla Vein Care, click here.

Understanding Insurance Coverage for Varicose Veins2021-11-13T14:15:50-08:00

Escleroterapia con Espuma por Venas Varicosas

2020-09-17T21:31:06-07:00

Escleroterapia con Espuma Guiada por Ecografía

La escleroterapia con espuma guiada por ecografía funciona bien para tratar las venas varicosas superficiales y las venas que no son visibles a simple vista. La espuma medicada puede observarse en la ecografía, lo que nos permite administrarlo con precisión y dirigirlo hacia las venas varicosas más cercanas. La escleroterapia con espuma puede ser utilizada de manera segura para las venas que recorren cerca de la piel o los nervios. También se desplaza fácilmente a través de las venas con muchos giros y vueltas.

¿Qué es polidocanol (Asclera®)?
Se puede utilizar una variedad de medicamentos esclerosantes
para las venas, pero preferimos el polidocanol (marca Asclera®)
porque es el más cómodo para el paciente y tiene el menor riesgo
de efectos secundarios. Es un medicamento de tipo detergente que
afecta el revestimiento interno de las venas. Esto hace que la vena
deje de fluir y que posteriormente se cierre por completo. El
polidocanol ha sido bien estudiado y aprobado por la FDA desde
2010 para el tratamiento de las venas varicosas, y ha sido utilizado
en Europa durante décadas. El polidocanol se convierte en una “espuma jabonosa” para tratar venas más grandes. Este es un uso fuera de indicación del esclerosante, pero es muy efectivo y bien tolerado. Los proveedores de La Jolla Vein Care tienen una amplia experiencia con la escleroterapia con espuma.

Escleroterapia con Espuma por Venas Varicosas2020-09-17T21:31:06-07:00

LA JOLLA VEIN CARE EMBRACES TELEMEDICINE AND INTRODUCES REVOLUTIONARY MOBILE ULTRASOUND SERVICES AMID COVID-19 CRISIS

2020-09-18T01:57:11-07:00

Telemedicine and Mobile Ultrasound Services Made Available throughout Southern California in an Aim to Ensure Important Health Concerns Don’t Go Untreated While Many Continue to Shelter in Place

 LA JOLLA, CALIF. (June 9, 2020) – La Jolla Vein Care (LJVC), a leader in vein treatment serving the Southern California community for more than a decade, is actively working to enhance its traditional service offerings to assist new and existing clients amid the unprecedented times brought forth by COVID-19. In a world of social distancing and self-quarantine, many individuals are postponing medical care in a bid to reduce virus exposure levels – a move many healthcare experts anticipate may lead to worsening symptoms and potentially dangerous complications down the line. To offset the concern that underlying vein diseases will go unchecked to the detriment of patient well-being while also addressing the public desire to avoid unnecessary outings; La Jolla Vein Care has deepened its commitment to best-in-class telemedicine offerings and has recently launched a new mobile ultrasound service.

“House calls are something many people see as a thing of the past, but with the inactivity of self-quarantine potentially exacerbating underlying vein diseases combined with an overall reluctance to venture out to visit a doctor, we knew something needed to be done,” said Dr. Nisha Bunke, MD, FACPh, RPhS, venous disease specialist and vein clinic medical director at La Jolla Vein Care. “We’re proud to roll out these new service offerings to meet patient needs and adapt to changing preferences during this difficult time.”

While varicose veins may be unsightly, they are not simply surface-level ailments and an ultrasound exam is required to diagnose the underlying venous diseases that cause these issues.

When left unchecked, the conditions can lead to chronic ailments like venous ulcers, but many people suffer from acute complications such as thrombophlebitis (blood clots within the veins), spontaneous vein hemorrhage, and disabling leg pain– so appropriate treatment should not be delayed, if at all avoidable.

As the first company of its kind to offer direct care to patients in their homes, La Jolla Vein Care has adopted the use of both telemedicine and state-of-the-art mobile ultrasound services via Terason uSmart 3300 NextGen technology. While telemedicine was quickly made available for consultations, pre-procedure assessments and post-procedure follow up appointments, the treatment center is advancing its accessibility initiative through new in-home mobile ultrasound diagnostics conducted by certified technicians – ushering in a new era of vein care.

Patient safety is at the forefront of LJVC’s new mobile service offerings – from the utilization of hospital-grade cloud storage systems, to cutting-edge technology that allows doctors to view results safely from a distance and adherence to all CDC guidelines including temperature checks and personal protective equipment (PPE).

Most assessments will begin with a telemedicine “visit,” followed by a mobile ultrasound screening in the patient’s home, spanning a wide radius of service area ranging from Chula Vista to San Juan Capistrano. If an in-office procedure is deemed necessary, temperature checks, ample PPE, and multiple hand-washing and sanitizing stations are available before coming into the building—and even then, only one patient will be allowed in the office at a time. Patients can conveniently wait in their cars until they are notified by text that their examination room is available.

Telemedicine and tele-radiology services are currently available to patients without additional convenience fees. LJVC accepts most PPO insurance types and considers itself now ready for the new normal of non-emergency medicine.

To book a telemedicine consultation with La Jolla Vein Care, visit https://ljvc.wpengine.com/or call (858) 550-0330.

 

LA JOLLA VEIN CARE EMBRACES TELEMEDICINE AND INTRODUCES REVOLUTIONARY MOBILE ULTRASOUND SERVICES AMID COVID-19 CRISIS2020-09-18T01:57:11-07:00

COVID Precautions at La Jolla Vein Care

2020-09-18T02:11:40-07:00

While we offer telemedicine visits and in-home ultrasound diagnostics, if you prefer or need to come to our office, we want you to know about the extensive COVID precautions we have taken to ensure our office is one of the safest places you can be.

We want you to know that our first concern has always been the safety and care of our patients and our team. Although the coronavirus pandemic is new to many of us, infection control is not new to healthcare. For decades, OSHA has mandated that medical practices follow the strictest guidelines in infection control.  In order to put your mind at ease we at La Jolla Vein Care want to share with you some of the practices we employ to ensure our patients that our office is one of the safest places you can be.

 

La Jolla Vein Care Staff wearing masks

La Jolla Vein Care Staff wearing masks during procedures

 

  • Less appointments will be scheduled throughout the day so that there will be minimal people in the lobby, with little or no wait time.
  •  We’re extending our hours and offering after-hours appointments to minimize the number of patients in office at a given time.
  •  Park and Wait check in. If you prefer, you can wait in your car and we will text you when we are ready to room you. We recommend this for patients checking in prior to procedures.
  • Prior to every visit, we will ask you screening questions, to ensure symptomatic or at-risk patients reschedule their appointments to avoid community spread.
  •  You must wear a mask or cloth facial covering to be permitted into the building. You will be provided with a mask and asked to wear it while in our office. You also will be asked to disinfect your hands with hand sanitizer. Please note only the front entrance is open at the Scripps XiMED building. There is currently no third-floor access via the parking structure.
  • Our staff are required to wear masks for your protection.
  • We are seeing all patients in suite 530.  When you enter our waiting room you will notice that some chairs have been removed in accordance with national social-distancing recommendations.
  • We are eliminating coffee service, snacks and water coolersfrom our waiting area to reduce chance of community transmission.
  • Daily, we are screening our staff and following CDC guidelines regarding staff members who are ill or may have been potentially exposed to COVID-19
  • As a medical facility, we have always had a policy of sanitizing any surface after each patient encounter – but we are increasing our vigilance and frequency of disinfecting during this time.
  • Please fill out any forms electronically if able and return them prior to your appointment.
  • If you need to fill out any forms or sign consents, we have single use pens.
  • We encourage Virtual options and mobile ultrasound at-home visits when possible.

 

COVID Precautions at La Jolla Vein Care2020-09-18T02:11:40-07:00

25, 5, 2020

Memorial Day Observation

2020-09-18T18:59:22-07:00

In observance of Memorial Day, our office is closed. We would like to honor the men and women who have sacrificed their lives while serving in the military. Most of us at La Jolla Vein Care have a direct military connection, and we continue to honor veterans and current military. We have chosen to be a vein care provider for veterans, military retirees, and active military and their spouses with VA CHAMPS, and Tricare.

Both Dr. Bunke and Dr. Lucas have cared for veterans at the VA HealthCare San Diego and VA Memphis correspondingly.

Memorial Day Observation2020-09-18T18:59:22-07:00

Leaky Vein Valve Disease and Varicose Veins

2021-11-05T10:56:55-07:00

Venous reflux disease refers to ‘leaky valves in the veins of the legs. Reflux may occur in the deep and/or superficial leg veins. The deep veins are those within the muscle; they bring at least 80-90% of the blood from the legs back to the heart. The superficial veins are outside of the muscle and under the skin. The main superficial veins are the Great Saphenous Vein that courses up the middle of the thigh and calf and the small saphenous vein, which courses up the back of the calf. Normally, there are one-way valves within the leg veins, which help blood flow in one direction: toward the heart. This means blood is traveling against gravity. The calf muscle also helps move blood toward the heart. When vein valves are leaky, blood flows backward (reflux) towards the feet. Blood pools in the lower legs, causing bulging veins at the surface. Symptoms include leg heaviness, leg fatigue, leg pain, ankle swelling, phlebitis (inflamed and painful veins) restless legs at night, and night cramps. Venous reflux disease is progressive and worsens over time. Skin changes may also develop, including darkening of the skin around the ankles. The darkening of the skin is sometimes referred to as venous stasis skin changes. The skin can become dry and itchy (venous eczema). Eventually, the skin can break down causing a wound, called a venous leg ulcer.

Leaky Vein Valve Disease and Varicose Veins

Leaky Vein Valve Disease and Varicose Veins2021-11-05T10:56:55-07:00

We’re Open: Extended hours, Curb-side check-in, & Virtual Visits

2020-09-18T19:08:55-07:00

We’re Open

Resuming In-office Services

La Jolla Vein Care has been actively monitoring the COVID-19 pandemic and its impact on our patient care and office protocols.  Our highest priority is to continue providing the highest standard in vein care in a safe environment for our patients and staff.  We have created and implemented a strategic plan using best available practices to minimize the risk of person-to-person COVID-19 exposure in our practice.  These guidelines are in compliance with all State, Local, and CDC guidelines and guidance of the CMA, California Department of Public Health, Center for Disease Control.

While we continue to encourage virtual visits and at-home mobile ultrasound diagnostics, our office has re-opened for medical necessity treatments and for those who require in-office visits. Medical necessity conditions include complications from venous reflux disease and varicose veins such as thrombophlebitis (blood clots), vein hemorrhages, venous leg ulcerations (open leg wounds), and symptoms that interfere with one’s ability to work or maintain daily activities such as leg pain, heaviness, throbbing, swelling and night symptoms that interfere with rest such as restlessness and night cramps.

Cosmetic spider vein treatments are postponed until a future date.

 

SAFETY

We want you to know that our first concern has always been the safety and care of our patients and our team. Although the coronavirus pandemic is new to many of us, infection control is not new to healthcare. For decades, OSHA has mandated that medical practices follow the strictest guidelines in infection control.  In order to put your mind at ease we at La Jolla Vein Care want to share with you some of the practices we employ to ensure our patients that our office is one of the safest places you can be.

  • Less appointments will be scheduled throughout the day so that there will be minimal people in the lobby, with little or no wait time.
  • We’re extending our hours and offering after-hours appointments to minimize the number of patients in office at a given time.
  • Curb-side check in. If you prefer, you can wait in your car and we will text you when we are ready to room you. We recommend this for patients checking in prior to procedures.
  • Prior to every visit, we will ask you screening questions, to ensure symptomatic or at-risk patients reschedule their appointments to avoid community spread.
  • You must wear a mask or cloth facial covering to be permitted into the building. You will be provided with a mask and asked to wear it while in our office. You also will beasked to disinfect your hands with hand sanitizer. Please note only the front entrance is open at the Scripps XiMED building. There is currently no third-floor access via the parking structure.
  • Our staff are required to wear masks for your protection.
  • When you enter our waiting room you will notice that some chairs have been removed in accordance with national social-distancing recommendations.
  • We are eliminating coffee service, snacks and water coolersfrom our waiting area to reduce chance of community transmission.
  • Daily, we are screening our staff and following CDC guidelinesregarding staff members who are ill or may have been potentially exposed to COVID-19
  • As a medical facility, we have always had a policy of sanitizing any surface after each patient encounter – but we are increasing our vigilance and frequency of disinfecting during this time.
  • Please fill out any forms electronically if able and return them prior to your appointment.
  • If you need to fill out any forms or sign consents, we have single use pens.
  • We encourage Virtual optionsand mobile ultrasound at-home visits when possible.

 

We want to assure you that we are taking every precaution to make La Jolla Vein Care a place where you can feel safe and comfortable receiving the best possible care. If you have any specific questions, please call us. We look forward to seeing you at your next visit. We hope at this time that you and your loved ones are healthy and safe.

 

Stay connected to learn more about some exciting changes and how we are redefining vein care in 2020, Vein Care ReimaginedTM

 

We’re Open: Extended hours, Curb-side check-in, & Virtual Visits2020-09-18T19:08:55-07:00

Potential Link Between Blood Clots and Coronavirus 

2020-08-19T01:19:16-07:00

Blood Clots in Patients with SARS-CoV-2

Many physicians treating patients with SARS-CoV-2 have noticed an increased incidence of blood clots, including deep venous thrombosis (DVT) and pulmonary embolism.  Studies at this point are lacking but there is a hypothesis that this infection affects coagulation. For this reason, the International Society on Thrombosis and Haemostasis has recommended that all patients with SARS-CoV-2 infection, including those that are not critically ill, should receive prophylactic dose low molecular weight heparin unless contraindicated.

Deep venous thrombosis (DVT)  can pose an additional very serious complication to these patients because blood clots in the veins can break loose and travel to the heart and lungs, blocking blood flow (pulmonary embolism). Deep vein thrombosis signs and symptoms can include: Swelling, leg pain (often cramping or sudden difficulty walking), red discoloration of the skin and a feeling of warmth in the affected leg.

Potential Link Between Blood Clots and Coronavirus 2020-08-19T01:19:16-07:00
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