Confessions of a Varicose Vein Specialist – Happel Laser & Vein Centre

Confessions of a Varicose Vein Specialist – Happel Laser & Vein Centre

I Want to Make Varicose Vein Surgery in Pittsburgh Great Again

I would like to be brutally honest about the varicose vein specialty and being a varicose vein specialist.

The old adage that honesty is the best policy still prevails.

I would like to be insanely honest.

The purpose of this article is not to rant or vent.

I hope that you can learn more about the modern state of affairs in medicine and varicose vein treatments. This information will keep you out of trouble and benefit you.

This article is meant to help you to help yourself in choosing a varicose vein specialist.

I will begin and end this treatise on positive notes. Included will be the things that are wrong in the field of treating venous disease (the dirty little secrets that you need to know when seeking care for your varicose veins).

In the spirit of being totally honest, I‘d like to throw in a few pet peeves in this confession.

Reputation, Experience and Core Values.

Reputation and core values are everything in the treatment of venous disease. In the business world, the term for this is branding.

I’ve written articles in the past about the ethics of varicose vein centers.

We celebrated our two-year anniversary of Happel Laser and Vein Center accreditation. Our vein center was the fourth vein center in the United States to become vein center accredited.

Accreditation includes a comprehensive inspection. No other vein center in Pittsburgh has been able to achieve this.

No other vein center in Pittsburgh has been inspected.

They inspect hospitals, cars, restaurants don’t they? Do you really want to consider having a vein procedure done where no inspection has ever taken place?

My training in venous disease at the Mayo clinic was extensive and comprehensive. I trained under the world’s leading experts in venous disease including Dr. Peter Gloviczki.

My career after this training included the treatment of veins and arteries. I have treated venous disease exclusively for the past twenty years. I enjoy the confidence that comes from experience and training. Just as important is the knowledge from that experience of when not to do a varicose vein treatment.

Conservative care is sometimes the best depending on the circumstances. Knowing when the circumstances dictate conservative medical management versus a procedure comes from years of experience and that advanced training.

“Primum non nocere” is a Latin phrase that means “first, do no harm.” That is from the Hippocratic Oath that all physicians must recite upon completing medical school.

My Down and Dirty Complaints

Misconceptions – Many people are unrealistic about spider vein treatments. These treatments should only be considered by people with disposable income. If you are on a budget, have tuitions to pay, or credit card bills that you are paying off, you shouldn’t consider having spider veins treated. Perfection is not a realistic expectation. That is harder to expect when you are paying for cosmetic treatments out-of-pocket.

Magic – There is no magic laser. A laser is not going to shine on your legs and magically make your veins disappear. Some degree of discomfort is involved with any vein treatment. Pain perception varies widely from person to person.

Insurance – Insurance does not cover all vein treatments. To be brutally honest, it should not. I understand how much you pay for your insurance. If it’s cosmetic, your insurance company does not cover it. Just like a face-lift or a tummy tuck or breast augmentation. Please don’t ask me to try to bill for it anyway.

Insurance companies are disingenuous. They are financially driven. Health insurance companies determine medical necessity. Not the doctors. (Some of that may be a backlash against doctors recommending and performing unnecessary vein procedures). Nevertheless, varicose vein surgery insurance approvals are getting tougher.

Perfection – “I want flawless legs”.  It’s not going to happen. Realistically significant improvement – not perfection. Even people who come in with aching, heavy, tired and swollen legs, they tell me how good their legs look after their treatments. When I ask how they feel, they say that they feel good too.

Spider veins- Laser alone doesn’t work on spider veins – Take that to the bank. Injections or sclerotherapy is necessary to get to the root of the problem. Almost all vein centers that specialize in treating veins, recommend injections. Don’t waste money on laser alone for spider vein treatments.

Different treatments – My friend didn’t get the procedure that you’re recommending – not everyone gets the same  procedure or the same number of treatments. Venous disease varies widely from person to person. Some people have multiple roots to their venous disease. Some have their entire legs covered with enormous veins. Some people have only a few small bumpy veins.

Dishonest caregivers – There are dishonest vein doctors. They are not all located in south-central Florida where the biggest concentration of Medicare fraud exists in the country.

Dr. Happel stated,

“The worst Medicare and Medicaid fraud is rampant especially in the south-central Florida area. As reported in The Wall St. Journal, the largest ever health care fraud case was recently filed on behalf of the Justice Department. Conspirators and corrupt doctors have “ruthlessly and efficiently” lined their pockets with tens of millions of dollars according to Assistant Attorney General Leslie R. Caldwell. Medically unnecessary and harmful treatments have been perpetrated according to court papers. These types of fraud cases have billed Medicare alone more than ten billion dollars.”

The problem is that this isn’t only in Florida.

I see second opinions every week from suspicious people who believe that they received overly aggressive recommendations for their veins. For instance, the most common problem seen nationwide that I have witnessed is the recommendation for laser destruction of a normal saphenous vein or often multiple normal saphenous veins.

This is in our backyard.

Respect – Coming repeatedly late for appointments or not showing up at all after reserving an hour of time is a daily occurrence. Moreover, that occurs after we have already called to remind people of their appointments, as a courtesy.

Discontent in the Medical Field

Fifty million people in this country have varicose veins. One million people have venous ulcers.

Why are all the family doctors and emergency room doctors switching into vein care? To help this largely neglected group of people?

That would be so nice. But not really.

Look at the doctors in a vein franchise. A lot of them will have come from emergency room medicine, family practice, cardiology and radiology with no vein training before they went to a three-day course.

Doctors have become disenfranchised and burned out. There are high levels of depression, alcoholism and suicide. The apparent solution to the overworked and burned out doctor problem is to take longer with every patient, see less patients, make less money, and feel less legally liable, less stressed, and more fulfilled.

That’s not gonna happen.

So doctors switch into treating veins. The hours are easier, no weekends, no emergencies, no holidays.

That comes at a price to you if you assume that all doctors in all vein franchises are the same.

  1. Most vein doctors in Pittsburgh never trained in veins at all.
  2. They are learning on-the-job.
  3. You are the proverbial guinea pig.

You must take responsibility for your own vein health.

The truth is this. You must assume a role in seeking out the best varicose vein doctor even if it means driving for over a half hour.

Finally, my biggest pet peeves are health insurance companies, electronic medical records, and attorneys breathing down my neck second-guessing every decision that I make.


I don’t have the solution to the problems we all face in modern vein care.

But I do feel better now that I’ve confessed.

Let’s recap.

Here are five brutal truths that will help you if you have varicose veins.

Brutal truth # 1 – Realize that vein treatment is palliative in most cases.

That means if you live long enough, because of your genetics, you will make new veins. If they were treated inadequately because insurance companies won’t pay for what the doctor feels that you need, your varicose veins will come back sooner.

Brutal Truth #2 – Your health insurance company is not your friend. They limit care. Insurance companies (not doctors) determine medical necessity in order to save insurance companies more money.

Who’s to blame?

What came first – the chicken or the egg?

Brutal truth #3 – Doctors are flooding into the varicose vein field for a better life-style, which has resulted in an exponential increase in the number of varicose vein treatments.

This competition in an overcrowded field has had a negative impact.  This has resulted in many vein treatments that are unnecessary as well as unnecessary Doppler ultrasound testing.

Brutal truth # 4 – Surgery and medical procedures are big business. Doing vein procedures in a franchised chain is big business. Too many times in these circumstances, it’s unnecessary.

Brutal truth # 5 – People with spider veins are getting their saphenous veins burned and closed with laser and radio frequency ablations unnecessarily.

Since reimbursement is on a fee-for-service basis, this problem is not limited to the treatment of varicose veins. Unnecessary cardiac stents, leg artery and vein stents, and other procedures are rampant in other fields of medicine.

I do feel good after many long consultations when I tell people that they don’t need a procedure when it’s not indicated.

When I hear after a lengthy consultation, “Thanks for your time”, I know I did the right thing.

I have been practicing venous surgery and have been performing minimally invasive varicose vein treatments for over thirty years.

If you are looking for an honest opinion about your varicose vein problem, give us a call at 724-969-0600 or click here.

About The Author

Dr. John Happel

Dr. John Happel has been in practice as a surgeon since 1986 in the Pittsburgh region. He specializes in vascular surgery and has subspecialized in the treatment of varicose and spider veins since 1999. Dr. Happel is board certified in vascular surgery and recertified in vascular surgery in 2012. He was chosen in 1985 to fulfill the position for the vascular surgical fellowship at the world renowned Mayo Clinic.