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Patient Information for Radiofrequency Ablation

Patient Info

If you are on blood thinning medication (i.e. Plavix, Coumadin, Eliquis, Xarelto, and Aspirin) please notify us (the risk is increased bruising). If pain medication is needed before the procedure, please take Ibuprofen or Tylenol.

If you are particularly anxious about medical procedures, a mild sedative (Valium) might be prescribed prior to the procedure. This will help relieve any anxiety about the procedure. If the medicine is taken, you will be required to have a driver bring you to the procedure and take you home.

Eat a nutritious breakfast/lunch prior to the procedure. Maintain adequate hydration prior to appointment.

Shower before your visit. You will be able to shower the morning following your procedure. Prior to the shower, remove the overlying gauze and you may shower and begin a daily application of lotion to your leg(s).

Please avoid scraping/removing any scabs or shaving at the laser entry site(s).

Wear loose fitting, comfortable clothing. When you arrive home, we ask that you complete three separate 20 minutes walks during the day of the procedure and 1-2 walks a day for the following week. It is normal to notice a small amount of fluid drainage on the gauze following the procedure (in the initial 24 hours). Your leg may also feel “tight” and some bruising and discomfort is expected for 7-14 days afterwards.

Please bring your compression stockings to the office. We will only require you to wear stockings on the leg we treat. You will be asked to wear the compression stocking overnight, and then during the day for 3 days following the procedure.

You may return to work the same day. Some patients (in more intense occupations) find it helpful to take a day or two off of work. Please limit exercise to walking for 3 days following the laser. Running, weightlifting, and other high impact activities may be resumed at that time.

Please avoid flying for 1 day and long car trips (>2-3 hours) immediately following the procedure.

Please refrain from hot tubs/swimming for 3 days following the procedure.

Please have Motrin/Advil (ibuprofen 200mg-take three tablets every (6) hours with food) OR Aleve (naproxen 225mg -take two tablets every 12 hours with food) available at home. You will be encouraged to use ONE of these medications on a daily basis for 1 to 2 weeks. Please let Dr. Buckner or his team know if you are already taking a prescription anti-inflammatory like Celebrex or Mobic. Although unusual (<2% of patients), you may require an additional narcotic medication.

You will be scheduled for an appointment approximately 1 week after the procedure. A follow-up ultrasound will be performed at that time. Additional procedural appointments will also be scheduled as indicated with your individualized treatment plan.

Please do not hesitate to call the practice at 240-913-5900 for any questions not addressed on this form

Pre-Procedure Instructions for Radiofrequency Ablations

Getting back to normal is easy when you follow these procedure prep instructions for your laser or radiofrequency treatment.

  1. Drink plenty of water.
  2. Bring your compression stockings with you the day of our procedure.
  3. Wear loose, comfortable clothing, such as long pants, shorts, or a skirt.
  4. Undergarments may get stained, as the doctor preps the entire leg including the groin area.
  5. Bring a referral to your first procedure if required by your insurance. If you have any questions concerning this, please call us. (Each patient’s treatment plan and insurance plan is different. An additional referral may be needed.)

Jobs which require a high degree of physical activity may require additional time off work.

Post-Procedure Care for Radiofrequency ablations

Although the healing time for laser and radiofrequency treatments is minimal, we do advise following several steps after your procedure to ensure there are no complications with your recovery.

  • Avoid prolonged sitting or standing. Walking is encouraged.
  • Refrain from strenuous activities and heavy lifting for the first week.
  • Compression stockings will help with the closure procedure. The more you wear them, the better you'll feel. However, wearing them for 3 days after the procedure is mandatory. (You may take them off at night.)
  • A follow-up Duplex ultrasound will be scheduled 3-7 days after your procedure.
  • If you plan on sitting for more than 3 hours, try to get up and move around every hour after your procedure.
  • You may shower, but no tub baths, swimming, or hot tubs for 3 days. Apply a quality skin lotion to your legs daily after showering.
  • In rare occasions, bleeding through the bandages may occur. Lie down, elevate your leg, and apply direct pressure until the bleeding has stopped. If the bleeding persists, please call Dr. Buckner at the office.
  • It's normal to experience some tenderness and possibly some bruising along the areas where local anesthesia was administered.

Things to Expect During your Recovery

Treatment Day & Up to Two Weeks Post-Procedure

  • You may notice bruising and some aching along the treatment pathway. You may also note some aching or pulling in the groin or on the leg below the treatment zone. The above symptoms may first be noted several weeks after the treatment.
  • You may notice some clear or pinkish fluid that emerges from the anesthetic sites for the first day or two following treatment. This is normal and will resolve by 48 hours from treatment.
  • You may notice a dime size or quarter size drop of blood below the clear bandage. If the bandage separates from the skin, you may remove it; elevate the leg, hold direct pressure for two minutes, then place a standard band-aid over the site.
  • For treatment of veins along the inner calf you may notice some numb areas along the treatment path or below a few days after the treatment. This is caused by inflammation in the region. The numbness usually resolves in 4-6 weeks and may be accompanied by a “pins and needles” sensation.

Please call us for – swelling of the leg, fever, difficulty walking, any significant drainage other than what is described above, or for any question, at any time.

  • You may resume normal activities immediately, but you might experience discomfort and bruising along the course of the treated vein. The bruising may be extensive in the thigh, but typically resolves in 1-2 weeks. If you need to take something for pain relief, we recommend starting with 600mg of Ibuprofen every 6 hours (taken with food). If you're unable to take non-steroidal anti-inflammatory drugs due to an allergy or other medical condition, it's acceptable to take Tylenol instead: up to 500mg every 12 hours. If the pain you're experiencing seems severe (i.e. you can't sleep or walk) and it's not alleviated with the aforementioned medications, please call our office or answering service for further assistance. Ibuprofen and Tylenol work well together and can be taken at the same time.
  • We recommend waiting 2-3 days before resuming a routine exercise such as running, weightlifting, or cycling, for example. We also recommend that you abstain from lifting anything over 20lbs for 24 hours. Until then, a modified workout is recommended: walking is encouraged, treadmill use is fine, but no running or vigorous activity, and no weight bearing exercises specific to the legs and/or arms, as those will exert extra force onto the lower extremities. Because the vein is in the healing process, any additional force may cause the treated vein to reopen.
  • Our procedures are performed in a sterile environment in an effort to reduce the risk of infection. The risk of developing an infection as a result of these procedures is extremely low, however, to further reduce the risk, we ask that you abstain from soaking in pools, hot tubs, or bathtubs for 7-10 days after the procedure. Showering is fine, but we ask that you wait 24 hours after your procedure before you remove the ace wrap that we apply.
  • A sensation of tightness or pulling along the length of the treated vein is normal and to be expected. Prior to treatment, the veins are very flexible. However, once treated, the vein contracts and becomes scar tissue–typically perceived as a cord-like sensation. This can develop 1-4 weeks after treatment and resolves over time.
  • Areas of inflammation can be common after treatment. Typically, these areas are red, swollen, tender, and have a sensation of warmth. As the treated vein closes, it can cause an inflammatory reaction. This can occur within 1 week after laser or radiofrequency ablation treatment, or 3-6 weeks after foam sclerotherapy treatments.
  • Feeling hardened, tender knots in the areas of treatment is also a normal part of the healing process. We typically refer to this as “trapped blood”, and it occurs when blood is trapped within the treated vein and starts to clot. These aren't usually dangerous to your health, however, they can be tender and warm to the touch. To relieve discomfort and promote the healing process, we recommend applying a warm, moist compress a few times a day, along with gentle massage. This will help assist in the natural reabsorption of these areas. Without intervention this will still occur, but these recommendations will expedite the process. Dependent upon degree of discomfort, there's also the possibility of having a thrombectomy performed to produce immediate relief. This would require local anesthesia of the area and a stab puncture in the skin to express and squeeze out the trapped blood. If you notice warmth or redness in the leg that's associated with severe pain, fever, or increased swelling in one leg that's new, please reach out to us.
  • Skin discoloration can occur when the treated vein lies close to the surface of the skin. Once treated, the byproducts of the blood are absorbed by the overlying skin and they possess a staining component. Throughout the healing process this will lighten, though it can take several months depending on the size of the vein.
  • Some veins require multiple treatments to completely disappear. We'll reevaluate these veins at the one month follow-up to determine whether or not more treatments are warranted. Sometimes, insurance companies will pay for sclerotherapy after an ablation in order to treat remaining surface veins, but if this isn't an option, Dr Buckner will discuss other treatment options with you.
  • Some patients may experience a decrease and/or a loss of sensation localized to the treatment area, especially along the shin bone and/or ankle region. This is due to nerve irritation and will resolve gradually throughout the healing process.

Medications

  • If needed for discomfort, we recommend over the counter Motrin per label instruction. If Motrin is inadequate then you may use Tylenol. If you take pain medication for other conditions you may use this medication instead of the above, unless specifically instructed by Dr. Buckner.
  • Unless specifically instructed by Dr. Buckner, you may resume your prescription medications as usual. You may use baby aspirin as part of your normal regimen. If you must take anti-inflammatory medication, for arthritis, for example, then please do not increase from your regular dosage. If you suffer from migraines, you may use whatever you normally do should you have a migraine headache.

Diet and Activity

  • You may resume normal diet following the procedure. You may drink alcohol in moderation following the procedure.
  • You may shower the morning following the procedure, but do not submerge (bath or swimming) the legs for five days following treatment.
  • We encourage light aerobic activity immediately following the procedure. Examples include walking on a level surface, elliptical machine at low resistance and low incline, recumbent bicycle, regular biking on a level, paved surface, no hills or straining, and swimming is permitted five days following the procedure. Dancing is permitted, but no jumping or impact.
  • Avoid intense core exercise (sit ups, crunches, squats, pilates, yoga) for the first week following the treatment.
  • If you must sit (i.e., computer work) or stand continuously (i.e., grocery sales associate) for more than 90 minutes we advise a 5-10 minute break to walk and/or elevate the legs.
  • You may engage in intimate activity but avoid pressure on the inner thighs. - Unrestricted activity may resume after 2 weeks.
  • For any other specific questions about activity restrictions, please ask Dr. Buckner.

Travel

  • You may travel by car after the procedure. If you will be seated for more than 90 minutes, we ask that you take a break and walk for 5-10 minutes.
  • We advise no air travel for at least five days following the procedure. You must have a follow up ultrasound scan prior to air travel; this is done within 7-10 days after treatment per our protocol. If you are a pilot, please discuss this with Dr. Buckner.

Compression Stockings

  • We advise the use of medical grade graduated venous compression stockings after all vein procedures. We have these available for purchase if you do not have a fresh pair. For treatment of the Greater Saphenous Vein (in the thigh) we advise full length pantyhose, 20-30 mmHg rated compression. For treatment of calf veins, you may use thigh high stockings. Calf high stockings are not recommended.
  • We instruct you to wear the stockings 24 hours and overnight following the procedure. You may remove the stockings for showering. We advise daytime use for 3 days after the 48-hour period; however, Dr. Buckner may have an individualized recommendation based upon your case.
  • If you feel numbness in the foot or toes, or pain in the calf or foot with use of the stockings, please discontinue use (remove the stockings) and notify Dr. Buckner.
  • We can provide you gloves to assist with donning. See your patient information package from your consult for more information and tips.

1 Month Post-Procedure

  • Healing is still occurring, therefore continued improvement in your symptoms will take place. It's likely that some swelling may be visible but should diminish more within the next 3-6 months.
  • Some patients continue to feel a “tight” sensation in the treated vein, which is still normal at this point in the healing process, though it should start to gradually resolve.
  • Residual knots/trapped blood areas are possible, but you may notice the tenderness you initially felt in the area is starting to decrease. This is normal and continuing with warm compresses and gentle massages with a quality skin lotion is recommended, as previously indicated.
  • Around this point in time, you may be scheduled to come in for your one month post-procedure follow-up scan. New findings may be revealed on the ultrasound study, as this is the chronic nature of venous insufficiency. Whether or not further treatments are needed will be determined based on each patient’s individual symptoms and ultrasound study findings. All of this will be discussed with you in a consultation after your scan.

6 Months Post-Procedure

  • Most people find any residual symptoms from the procedures, such as numbness, discoloration, and hardened areas, will have resolved, or been significantly reduced, at this point in the healing process.
  • If you notice these symptoms are worsening in any way, or if new symptoms appear, such as aching pain, swelling, heaviness, or fatigue, we recommend you make a follow-up appointment, as this could indicate underlying venous disease that may need to be treated.

Beyond 6 Months Post-Procedure

Venous insufficiency is considered a chronic and progressive disease process, therefore we eliminate those veins that are initially seen to be refluxing–in other words, not moving the blood properly. In time, however, other veins may become dysfunctional, which is why we provide a surveillance and monitoring service to our patients. We recommend reevaluation at the one month, six month, and one year points post-procedure. After the first year is complete, you'll need annual follow-up appointments. If at any time throughout the process you develop new or worsening symptoms, you should contact our office to make an appointment for evaluation.

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