“Additional therapies that can be offered. The starting point for these patients is compression stockings, again, for two reasons. The first one is because some people can get relief in their complaints, meaning the pain, swelling, discomfort, just with compression stockings. That is the main reason. The second reason, sadly, almost as important as a clinical reason is because insurances will not cover surgical therapy with these patients unless they have tried three months or more of compression stockings before. So it doesn’t matter if the patient is miserable with pain and swelling. If they have not tried compression stockings, and you feel that a patient is a surgical therapy, they ask the patients to pay out of pocket. So usually you have to go through the emotions of meeting somebody and say, here are the prescription for the stockings. You gotta go and come back in three months and see me. Now, several things can happen. One of them is patients patiently wait for three months and come back to their appointment to tell you that, yeah, this is fantastic.
You cure me. I have no problems. I don’t want anything else. Unfortunately, that’s rare, more often than not. Patients will come after three months and say, my symptoms are the same. I haven’t changed a single bit, or the stockings are really difficult to put in enough because they have a great pressure and that pressure can be defined by the physician depending of your patient once again. Imagine a patient who’s 65 and who has severe arthritis of the hands who lives by herself. That patient has to put the stockings on enough with severe arthritic pain. So it’s really unrealistic for that patient to be expected, to use these stockings and tell me the effect. Cause they cannot even put it on and off. So, and like that, sometimes these stockings will make the condition worse. They say that the pain and discomfort is much bigger when they have it on so they decide to remove it.
And so sometimes they’ll even wait for three months, they come two or three weeks after to say, this is impossible. This is like a jumble of torture they are prescribing me. And so I want to have something done at that point. You have to justify to the insurance company, whether they actually use them for three months, it didn’t work. They use them for three months and the symptoms are worse or they couldn’t even pass two weeks because it was impossible. And therefore we’re requesting surgical intervention. So at that point then is when surgeons come into play.”