Went for the third of the four surgeries for varicose veins in my legs. Tweeted the whole procedure again (see below). And since this procedure was soooo much more graphic, I got the pix and video to go with it. To bring everyone up to speed, the first two surgeries were laser ablation from the front and back of the legs. That sealed off the problem veins. The last two are the actual removal of visible veins which have proven to be painful. The pain was the result of phlebitis. As Dr. Bonau removed the veins, he asked if I had ever had phlebitis. The veins showed signs of it and the pain that I have had would be consistent with that diagnosis.

Fair warning: the pix and vids are pretty graphic. Not for the squeamish. All pix and vids were shot by me personally while they did the work on my legs. The areas were deadened so I felt nothing, but it was still a bit unnerving to watch the doc tugging on my body like he was.

Thanks agin to all of you following along and thanks for the supportive messages before, during and after surgery. A special shout out to @MindofAndre twitter and blogger trailblazer.

The tweets (messages on twitter) was so popular last time, I did it again for the follow up laser ablation surgery done on the back of my legs for varicose veins. You can catch the first installment here if you missed it.  And once again, I went through the trouble of reverse flowing the tweets so they go in order as you read down. For the record, I saw Dr. Roger Bonau at The Surgical Clinic in Nashville.

The discomfort this time may be a little bit more apparent from the posts. But the post op has been better. Luck of the draw, I guess.

The award for best tweet to me during the surgery comes from good friend and health care law blogger, Bob Coffield (catch his tweets @bobcoffield on twitter):

@robert_hendrick another twitter use. Monitor real time malpractice. Going to start including tweet requests in discovery

@bobcoffield doc found no humor in tweets in discovery. I did though.

@Robert_Hendrick did you tell him that I am on the defense side?

Enjoy!

Live from surgery part 2. Tweeting my surgery starting around 9am

Sooo. Valium $2.63 last time. $2.29 this time at same kroger. Must be on sale. Purely for research. Going drug free.

Uh oh. The staff at the doc’s office is following me on twitter now.

Getting quick ultrasound on previous surgery spot. Healing nicely.

Smearing betadine on my legs now. COLD.

Waiting for the rock star doc to show for surg. Country music playing in operating room. I love Nashville.

Doc walked in “what the hell are we listening to?”

First stick. No big deal. Still feel the flush and warmth in my body. Nerves.

Man I’m sweating. Stress of recent days ha heightened my apprehension over this. Doc in canulating (trying to get needle in vein)

Dr. Bonau says of the canulating “This is a bit tortuous.” Mmmmhmmmm.

Doc jinxed us when he said “this will be easier than first one.” Getting more lydocaine right now.

Wondering where the health content 08 tweets are. Not seeing any.

@dian_luffman the adrenaline rush has abated. Still on leg #1. Searching…searching…searching

Left leg canulated. FINALLY! Going for other leg and planning to laser both at one time.

@bobcoffield thanks for the distraction.

Doc is giving me his entire educational background. Been at tulane, NY, sloan kettering, st thomas, vandy…

No more pain than the first time. Far more tedious. “Worst is over.”

Firing up the laser…

Lydocaine going in around laser site. Flattens the vein a bit by putting pressure protectsthe vein from the heat.

Ooooooooow. Bad stick. Bad bad stick. Ow ow ow ow ow

Taste of burnt blood in the back of my throat from laser

Right leg hurt like shit up in the hammy. Left leg done and no pain at all.

Oh so glad to be done. Cleanup to ensue. More COLD stuff on my legs to clean.

So doc goes in at calf. Runs catheter up leg about 12″ and then lasers 12″ of vein shut.

Only getting compression wrap on calves. w00t! No behind the knee wrap.

@bobcoffield doc found no humor in tweets in discovery. I did though.

And done. Thanks to everyone!

8 hours after the surgery, the lydocaine has worn off.

Ah. Now I’m getting the feeling of little bee stings up the back of my left leg. This is fun (sarcasm noted).

First off, thanks for all of the concern and support from so many people over the past few days WRT my surgery. It seems I’m telling people things and repeating myself and I hate to bore anyone, so I’m putting this together to give folks the details and use my own experience as a personal example of why change:healthcare does what it does.

Why change:healthcare Does What It Does:

The business end of things…My doc will bill my insurer somewhere around $6,124. However, the allowed amount with my insurer is $2,904. Per the FANTASTIC staff at Dr. Bonau’s office, “double check with [insurer] to be sure and I don’t even know if they will tell you an exact number but you can try… The procedure codes are 36478/36479″

They also pointed me to the insurer’s financial counselor complete with the phone number.

Had I been uninsured, the amount would have been $6,124. On a different insurance, the cost would most assuredly been something OTHER THAN $2,904. And had my surgery not been Medically Necessary, and I had simply done self-pay without submitting a claim, I may have been expected to pay $6,124. Keep your eye on the peanut, now which shell is it under?

change:healthcare helps people sort through all of that.

My Status:

I’m doing well. 48 hours out of surgery the wrap is off, I have to wear a support sleeve on the leg, but I got on my bicycle on the stand in my home office. Rode for an hour at a moderate pace on an easy gear. Felt great to move again. Doing well.

So well in fact that I failed to take the prescribed ibuprofen today (day 2 post surgery). Should have taken some on waking up at 6 AM. After lunch, I started to feel it a bit, and finally got the anti-inflammatory into my system at around 2PM (Kids, do NOT try this at home).

The Procedure:

The procedure I had is called laser ablation or a phlebectomy. It beats the living crap out of the other option which is the traditional vein stripping I had done 25 years ago (I describe the traditional method below).

With laser ablation, they do a local anesthesia and then they insert a catheter into the leg near the vein. they run a fiber optic cable into the vein and use a laser to cauterize the vein closed. I literally stood up from the procedure and walked out the door. The other method would have left me bed ridden for several days and as much as 6 weeks from any significant physical activity (Boooooooooo).

The degree of discomfort during the procedure was less than that of getting some ink. Post-op, the discomfort is minimal and far less than the discomfort that I used to live with on a day to day basis. I did not realize how much pain I was living with day in and day out.

History:

I have a long-running history of varicose veins. My first surgery was at age 16 on both legs. Had a second surgery at 18 on the right leg. That would have been 1983-85 time frame. There was no ultrasound in those days to see what was going on inside, so they did what they thought was best, but in fact it turned out to create future problems. So here I am today some 25 years later dealing with it again.

I went to Doctor N., Head of Vascular Surgery at a large academic hospital which shall remain nameless. I told him the procedure I wanted - laser ablation. He told me the veins were not big enough and that the method would be the traditional vein stripping.

In vein stripping, they put you under general anesthesia and make numerous small (1-2 inch) incisions all down your legs, tie off the veins at those spots, cut them and pull them out. Bad news. Long recovery times (6 weeks) and severe bruising of the legs all along the path of the veins. That’s what Doc N. wanted to do to me. I declined.

A good friend of mine I ride bikes with had the same condition and recommended Dr. Bonau instead. My buddy told me that he did not realize how much pain he was living with until after surgery. Pre and post, the relief is hard to believe. I am ever so grateful to my fellow cyclist.

Had a bit of outpatient surgery done on my legs today. Laser ablation on my legs to eliminate varicose veins. Basically they numb the site, locate the vein using ultrasound, insert a fiber optic cable and cauterize the veins closed at the faulty junction. I was awake and on no drugs for the whole procedure. Opted out of the Valium to calm my nerves. And I “tweeted” (used twitter) the entire experience in real-time. Some of those who follow me suggested I post the tweets. So here they are. For the twitter-savvy, the order is in chron order - went thru the trouble so it would read from top to bottom.

Alrighty now. Get ready for live tweets from surgery. Getting laser ablation on my legs this am.

Got some great paper shorts. Then they french cut them up the side. Gr8!

Pre-op ultrasound.

I’ve got 10mg valium just in case I get nervous. So far no drugs.

Betadine on the legs. Damn this room is cold.

Ah, the joys of medicine. All dignity is sacrificed

Enter the rockstar…erm…doc

Oh crap. The ultrasound is running thru a laptop running windows platform.

To clarify. Having laser ablation to remove varicose veins.

First stick. Little bit o lidocaine. No biggee. Laser in.

2 lasers in top part of left leg. Little bit of sting not bad. Getting a tattoo is worse.

Doc explaining procedure and pointing out what’s going on on the screen.

Looking at ultrasound, doc says,”That’s the sheath and this is the laser” blown up to several times actual size this looks painful. But its not.

Lydocain and sodium bi-carb going in around site for laser. Provides better contact and numbs. Extreme laser heat next.

Head down to make vein smaller. First shot of laser stings a bit. Getting more numbing med.

Getting a bit of a burning taste in the back of my throat. Normal perdoc. No pain now from laser.

2 veins down. 2 to go. 1 lower left leg. 1 lower right leg. Top left leg done.

FYI there will not be pix of this one. Will bring cam next time. Back of the legs in a couple of weeks.

“Lower leg harder to anethesize” yeah thanks doc. Noticing that.

And lasering the lower left. Much quicker set up.

Dr. Bonau rocks! Gr8 sense of humor about all of this. He’s not sure what twitter is but he’s indulging me.

Feels like a bad windows program – searching…searching…searching. Looking for something on left leg. Left is all in back so will get it in 2 weeks. Done.

Now its time for cleanup. Wiping down the betadine from my freshly shaved legs. Maybe I’ll b faster on the bike now.

@bobcoffield @matt_mueller @georgesibble and others. Thanks for all of the support. @caparks. Thanks for the ride.

Leg wrapped tight. Stays bandaged for 48 hrs. No bath. Hmmmm.

Kroger pharmacy - healthcare consumer shout of the day! They have $4 generics but 3x 10mg valium generic only $2.63.

@jenmccabegorman I’m sure its even cheaper in the netherlands.

@bobcoffield had this done at ages 16 and 18. Now at 41. Have watched options evolve. Laser ablation is best imho.

@georgesibble Yep. Normal routine. Movement is good for circulation in lower leg. No heavy lifting. Ibuprofen o’ plenty.

Transparency: Dr. Bonau has performed this surgery 2500 times. 2 cases w complications. Both successfully resolved.