When Cindy Asbjornsen was in her medical residency, she struggled with what discipline to focus on. She liked the hands-on nature of surgery, but not the life-or-death situations, and general practice wasn’t what she wanted to do. Surprisingly, she fell into the niche practice of phlebology – the practice of vein health. Asbjornsen never looked back.

Now, she is a nationally recognized vein specialist, one of five board-certified phlebologists in Maine and a Fellow in the American College of Phlebology, a distinction held by only 52 other doctors in the U.S.

Approximately half the U.S. population has venous disease, and it can affect men and women of all ages and activity levels. But the practice of phlebology is still in its infancy, and Asbjornsen is on the forefront of new medical techniques to fix damaged veins.

Asbjornsen also publishes Vein Health News, a national magazine aimed at helping educate primary care physicians about vein health. From her practice in South Portland, she treats patients suffering a wide range of vein disorders. Although she rarely deals with life-or-death maladies, Asbjornsen takes pride and satisfaction in helping patients take simple steps that can give them back their lives.

“Really, treating veins is all about quality of life,” Asbjornsen said.

Q: Can you explain a little about phlebology and how the practice of vein health has developed?

A: Phlebology has only really developed as a specialty in the last 20 years, but there have been huge strides in that time. It used to be that vein stripping – removing the vein from under the skin – was the only procedure available, and it’s a scary, invasive surgical procedure. That’s where a lot of people go when they think about vein health, but treatment options have grown a lot. Now, we can fix a lot of superficial vein diseases with procedures we can do right in the office, without having to go to the hospital.

Dr. Cindy Asbjornsen, right, performs a laser procedure on a patient at Vein Healthcare Center in South Portland in February. She is assisted by Sam Armfield, a registered vascular ultrasound technologist, center, and medical assistant Michaela Fortin, left. Staff photo by Shawn Patrick Ouellette

Q: What causes venous disease?

A: Healthy veins have valves that carry blood to the heart. When those valves are damaged, it can cause leaks that send the blood backwards into the legs. That deoxygenated blood can pool there, leading to heaviness and fatigue and causing varicose veins and other skin changes. Over time, the increased pressure can cause other valves to fail and blood will leak into soft tissue, leading to swelling, ulcers and other health problems.

Q: Vein problems have often been considered cosmetic, without real harmful health effects. Is that view still common?

A: For years, doctors told patients that spider veins were cosmetic, not a real health threat. Now, it is part of a continuum of severity. Vein disease can progress, going from spider veins up to lumpy, bumpy varicose veins, then to serious swelling, to skin changes consistent with an end-stage disease, and finally open venous ulcers. It isn’t a direct progression though. If you have spider veins you are at risk for ulcers, but it may not always lead to it.

Q: Who is at risk to develop venous disease?

A: There are three big risk factors – genetic predisposition, environment and hormones. People who work on their feet all day, like lobstermen, teachers, hairstylists and retail workers can develop vein problems because they don’t rest and elevate their legs when they should. Hormonal changes can be a risk, especially for women around puberty, at first trimester pregnancy and menopause. Older people are also at risk. Walking helps pump blood back to your heart, and as you get older you walk less.

Q: How can people prevent vein problems?

A: Regular exercise is important – try to walk at least 30 minutes a day. It doesn’t have to be all at once, little changes like parking a little farther away from the grocery store and walking over can make a big difference. When sitting down, try to elevate your legs to help send blood back to your heart. Compression socks and stockings get a really bad rap, but are really helpful. There are thousands of options, colors and styles now to choose from. I see patients all the time who do all the right things and still get vein problems, but the question is, could it have been worse if they didn’t try to prevent it?

Q: Are there any factors, like obesity, that make Mainers more or less at risk for vein disease?

A: I don’t know where Maine ranks, but I bet we have more vein disease because of our older population. Many problems may be going untreated because there are so few doctors in the state focused on vein health. The question of obesity is actually controversial. We’re not sure if obesity is a risk factor for vein disease, but morbid obesity can make it more difficult to identify vein problems because there is so much soft tissue.

Q: Some vein disorders can be life-threatening. Can you explain the risks and talk about how it can be treated?

A: Most common issues, like spider veins, occur in small veins close to the skin. But the deep vein system is also at risk, especially from blood clots called Deep Vein Thrombosis, or DVT. If it isn’t caught early, a blood clot can grow like a snowball and block the vein. Eventually, pressure will dislodge the clot and it will get sent to the heart, where it can be passed into arteries heading to the lungs or the brain. If it gets stuck in a cerebral artery, it can block off blood flow to the brain and cause an embolic stroke; if it gets stuck in the lungs, it becomes a pulmonary embolism, both of which can be fatal.

Q: Who is most at risk for serious deep vein problems and how can people prevent them?

A: People with prolonged immobility and blood-clotting issues, like cancer patients, are at risk, as are pregnant women, seniors and people with damage to their vein walls. Young, otherwise healthy people are a really scary group for us, because they are less likely to be concerned about pain that appears in their leg and might brush it off as a cramp or a minor injury. The only way to treat clots is if we catch it early with an ultrasound and then use blood-thinning drugs to treat it. If all of a sudden your calf swells up and you can’t explain it, you probably have a clot. It is not that easy to develop a clot, but people with those risk factors should pay attention, they are more common than people think. People have heard about DVT, they know it is scary, but they don’t know enough about preventing it. q