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I’m Dr. Michael Bardwil, a vascular surgeon and owner of Texas Vein and Cosmetic Specialists: every day I treat patients with varicose veins in Houston, Texas. I want to ask, do you know what a vein mill is? If a puppy mill is defined as a “large-scale commercial dog breeding operation where profit is given priority over the well-being of the dogs” then a vein mill does the same thing but with people. People are herded in and out, and everybody gets a procedure, many get multiple procedures and profit is given priority over patient well-being. If you doubt this, look at the number of vein centers that have recently opened. Look at all the vein commercials on radio and TV.

How do you know that you are in a vein mill or the wrong office? Here are a few simple rules to follow:

Rule 1 – If you aren’t seeing a doctor then you are in a vein mill.

Rule 2 – If a non-physician performs the procedure to close your veins, then you are in a vein mill.

Rule 3 – If you think your vein problems involve one leg and you are told that both legs need to be treated, then you are in a vein mill.

Rule 4 – The more veins that you are told need to be closed, the more likely you are to be in a vein mill. On an average, patients who need a procedure, should need one or two veins closed. Three vein closures is suspicious is suspicious, four is more suspicious, more than four and you are undoubtedly in a vein mill.

Rule 5 – If you are there for a free consultation then you are likely in a vein mill. Remember, there is no such thing as a free lunch, and nothing is free.

Rule 6 – If you aren’t sure if you are ready to treat your veins, and you are being told that you really need to have your veins treated, then you are likely at a vein mill.

Rule 7 – If you ask a physician their primary specialty and they answer, “vein specialist”, then you are likely in a vein mill. Vein specialist is not a recognized specialty. A surgeon treating veins will answer surgeon. Specialists in fields lacking in credibility for treating veins won’t want to state their primary specialty.

Until 20 years ago the standard of care for treating varicose veins was a procedure performed in the operating room called a “vein stripping.” In 1999, the first of a new class of procedures was introduced, which allowed surgeons to treat varicose veins in the office rather than the operating room.

The good news was that treatment of varicose veins no longer required a hospitalization or a trip to the operating room and a general anesthetic. The new procedures were less invasive, and in properly selected patients, yield excellent results with high success and low complications rates.

The bad news was that while hospitals have committees to review physician’s credentials, based on their educational background and training, there are no such processes to protect patients from unqualified physicians performing procedures in their office.

Traditionally, varicose veins have been considered a surgical disease, performed by surgeons, because their training included treatment of varicose veins. This means that without restrictions on procedures performed in an office setting, any physician regardless of qualifications can perform procedures to perform varicose veins. This means that you have to do your research.

Two medical specialties that have exploited this loophole are radiologists and cardiologists. Radiologists are trained to read x-rays and to perform minimally invasive procedures, yet many have begun functioning autonomously opening vein centers., because there is nothing to stop them. Cardiologists claim to be are qualified to treat varicose veins, since they were trained to treat heart disease, even though the natural history and treatment of cardiac and venous disease have nothing in common.

Between a quarter and half of the new patents that we see each day have had previous vein procedures, up from 5-10% in 2003, and they are unhappy. Especially when non-surgeon specialists have treated them, and while the best vein doctors are surgeons, not all surgeons are good vein doctors. Unfortunately, once a procedure has been performed, it can’t be undone.

What should you do?

Consider a second opinion. There is nothing worse than knowing in your heart, that something wasn’t right and doing it anyway.

Patients choose to schedule a second opinion for a variety of reasons. Sometimes they weren’t comfortable with the recommended treatment or number of procedures recommended. Sometimes they were suspicious because they never saw a physician. Read the rules above and if any of those apply, you should strongly consider accepting this offer. To qualify, you will be required to bring your ultrasound report and treatment plan from the facility where you were evaluated. Dr. Bardwil is a board certified vascular surgeon with over 30 years of experience in treating veins and he will personally examine you, evaluate your records and treatment plan, then let you know if he concurs or recommends a different course of action. Then it’s up to you to decide, you are under no obligation for this professional opinion.

You have nothing to lose and may have more than you realize to gain.

Related post: Who should treat your varicose veins in Houston?

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Dr. Michael Bardwil
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