Microphlebectomy

If you are weak of stomach, you may not want to read this saga.  It will be ongoing – with new additions periodically.

On December 15th, I underwent a procedure called “Endovenous Laser Treatment with Microphlebectomy”.  What the HELL does that mean?  “Endovenous” = inside a vein; “micro-” =small; “phlebectomy” = removal of vein.

I have had a worsening varicose vein in my left leg for about 20 years.  I decided to see a vascular doctor about it recently.  I had it “treated” on Thursday.

Procedure – Thursday, December 15th, 2011

The day began at 5:30am (after giving my final exam in my night class the previous evening).  I had to shower  before the procedure because I would not get another shower until Friday evening.  I also had to apply Lidocaine cream to the entire area that was going to be worked on.  (I’ve had poor success with these lido-creams in the past and was not too confident for this time either!)  The lido-cream had to be Saran wrapped in place (no kidding!) and I got dressed.  A light breakfast, no coffee and WHEE off we went.

We arrived early.  The facility was not yet open.  I twitched.  At 8am we got registered and by 8:30 I was in my treatment room.  They gave me disposable shorts to wear, unwrapped my leg and washed down the entire area.  To my surprise, the lido-cream REALLY worked.  My left inner thigh and anterior/medial calf were completely numb!  It felt like they had been iced, but not cold, just that thick-numb-kinda-like-a-piece-of-meat feeling.  Once we had gone through all the releases and possible problems I was given a glass of water and Xanax (anti-anxiety medication) to relax.  The nurse suggested I take two, I opted for one – not really knowing what Xanax would do, and not really wanting to be totally out of it.

The doctor came in and traced out the veins on my skin with a Sharpie marker.  One of the nurses also came in with an iPod and asked what type of music I wanted to listen to during the procedure.  She offered elevator music, jazz, 80’s and all kinds of specific artists.  I told her that she could put on anything that did not distract the doctor from his primary focus – my leg.  She spun through the list for a bit, picked something and put the iPod in the docking station.

(HERE’S WHERE IT IS GOING TO START GETTING ICKY – YOU’VE BEEN WARNED)  The first part of the procedure was the endovenous treatment.  In my case, what this meant was that a fiber-optic with a laser was inserted into my Greater Saphenous vein starting just below my inner ankle bone (medial malleolus) and “gently” snaked up, inside the vein, to about the middle of my thigh.  (This reminded me a bit of the old RotoRooter commercials – but that may have had something to do with the Xanax.)  At about this time, I realized that the music that the nurse had picked was… JOURNEY.  LOL.  I hadn’t really noticed it (thank you Xanax) and when I did, I found that quite humorous.  With the laser in place, the fiber got slowly pulled back out with the laser firing every n-seconds to damage the inside (endothelium) of the vein.  This damage will cause clotting and, combined with compression, will collapse the vein.

WHEW it is nearly over, right?  Oh no, grasshopper – the best is yet to come!

The traces of the veins on my leg were to show the doctor the tortuous path of the vessel within the skin so that he could make small incisions near the vein, pull small sections of the vein out through the incision and cut it, and then make another incision about 1 or 2 inches away and PULL pieces of vein out of my skin.  Did it just get really warm in here?? That is the  microphlebectomy portion of the procedure.  There was lots more lidocaine injected into my skin around the areas of vein that were going to be “pulled”.  It was quite odd, come to think of it, because I was awake and talking with the doctor and could feel (and hear) pulling, puncturing, moving of my skin but could feel nothing.  The “meat-y” feeling of the skin was all I could feel.  It was attached to me, but not really part of me.  Only on one occasion was there a big, shooting pain – and that was when he touched a nerve that was running next to the vein.  BOY HOWDY was I awake then!  It felt like he was pulling miles of vein out of my leg, but after the procedure the nurse showed me the pieces (yes, I am that type) and it was less than 8 inches!  Finally after about 2 hours, we were done and the nurses washed me up, SteriStripped my “punctures” (no stitches), put gauze over EVERYTHING (a lot of extra lidocaine solution had been pumped in around my veins, and would be leaking out over the next few hours) and got me into my ever-so-lovely compression stocking (+30mmHg if you are interested).

The Xanax was fading, but still enough to make me a bit dizzy when I stood up to get dressed.  🙂  I was advised on my medications and sent off with Jack for a 20 minute walk.  All walking for the next two weeks is supposed to be slow and careful.  No cardio, nothing bordering on exercise, just enough to keep the blood flowing through the deep vein so as to  minimize the possibility of clotting in the deep vein.

After our walk, Jack took me to  my favorite comfort food place for lunch.  It is the ONLY place we ever go where I will order lasagna at a restaurant!  It is my absolute favorite and always makes me feel happy.  Full belly, drugs wearing off, a little walk and then NAP TIME.  The rest of Thursday was somewhat of a blur.  Walks around the block. Sitting with my leg elevated.  Napping.  The pain was not bad, more sore than pain.  The gauze under the compression stocking were NOT pretty, and I had a whole other day to live with that before I could take off the stocking, the gauze and have a shower!

Recouperation: Day 1

The cat did not sleep with me, which was probably better, and Jack stayed as far away as possible while still being in the same bed for fear of poking/kicking or otherwise inadvertently hurting me.  I still did not sleep very well, but also did not take the Vicodin that was sitting next to the bed.  My leg was sore and stiff when I got up, and I shuffled/hobbled/paced back and forth through the house for my prescribed 10 minutes as soon as I got up.  The cat followed me nervously and Jack watched and tried to stay out of the way.  A bruise had already started to bloom above the top of the compression stocking (it is a thigh-high).

Most of the day was spent grading final exams, answering e-mails and walking around the park near our house.  I think I did about 5 laps of the park throughout the day.  Each lap took me about 20 or 25 minutes.  I looked like a tired and broken old woman!  The twinges and pains from under the stocking were still not too bad.  My medication regime was Tylenol (pain relief) and Naproxen (NSAID; anti-inflammatory) and antibiotics.  The hardest thing was feeling tired after a short and SLOW walk around the park.  I *know* I’m healing and that there is a lot of energy expenditure at the cellular level, and it still seems ridiculous that I could be this tired.

We had a neighborhood “White Elephant” party in the evening, which was a push for my stamina the day after the surgery.  It was fun, but (in retrospect) too much too soon.  I stood a lot so by the time we got home I was very sore and swollen.  It was also time for my first shower since surgery.  I have to admit – it didn’t go so well.  🙁  The stocking was soiled with Sharpie marker, lido solution and blood.  I washed it for re-use (for the next two weeks!).  The gauze pads were dried onto my skin and the tape didn’t want to come off.  As I pulled off one gauze pad it took the underlying SteriStrip with it.  I bled.  The shower felt lovely and warm.  I had to gently soap the entire area to get off the dried blood and Sharpie marker.  It was very tender and sore.  I hate to admit it, but I cried like a little girl.  “What have I done?”  “I chose to do this!”  “I hurt.”  Jack wrapped me in a warm bathrobe and got me to lie down.  It felt nice to not be wearing the compression stocking at night.  I fell asleep very rapidly.