Your first visit, mapped to your vessels.

How to prepare

• Wear or bring loose shorts and socksYour legs are prepped from hip to ankle. Wear something you don't mind getting ultrasound gel or antiseptic on.
• Skip the lotionLotion repels ultrasound gel and blurs the images your technologist needs.
• Drink water beforehandWell-hydrated veins are easier to see, which makes the scan faster and more accurate.
• Bring a full medication listInclude supplements, hormones and any blood thinner, with the dose.
• Know your family historyGenetics is the single biggest risk factor for varicose veins. Ask your parents and siblings before you come.
• Note what you've already triedHow long you've worn compression, what strength, and whether it helped. Insurers ask, and so will we.
• Write your questions downBring the list. We'd rather answer everything now than have you leave wondering.

What happens during the visit

1. Health historyWe go through your symptoms, your day-to-day activity, previous clots or leg injuries, pregnancies, and what's changed recently.
2. Leg examStanding and lying down, because veins look different under gravity.
3. Duplex ultrasoundA registered vascular technologist maps blood flow in both legs and finds the valves that are leaking backward. It's painless and takes the bulk of the appointment.
4. Your plan, the same dayYour physician reads the scan with you, points to the veins causing your symptoms, and walks through the treatment options that fit them.

Vein disease is not cosmetic. Venous insufficiency is a circulation problem, and most treatments are covered by insurance once symptoms and ultrasound findings are documented.

What happens after

Most plans start with a documented trial of compression therapy - that's both good medicine and what nearly every insurer requires before approving a procedure. From there, treatment is matched to the vein: radiofrequency or laser ablation and medical adhesive closure for the large refluxing veins, foam sclerotherapy for branches, phlebectomy for bulging surface veins, and visual sclerotherapy for spider veins.

Our patient care team handles the insurance side - verification, prior authorization, and a written cost estimate before you commit to anything.

How to prepare

• Don't fast - eat and drink normallyThis is a testing and talking visit, not a procedure. Take your regular medications on schedule.
• Bring walking shoesIf your leg pain only shows up when you walk, we may repeat the ankle pressures after a short treadmill test.
• Bring your recent labsA1c, kidney function, cholesterol. If you don't have them, bring your primary care or cardiology office name so we can request them.
• List every blood thinner and heart medicationAspirin, clopidogrel, apixaban, warfarin, statins, insulin - dose and how long you've taken it.
• Map your walking distanceHow far can you go before the pain starts, and how long until it stops after you rest? Pace it out at home; it's the most useful number you can bring.
• Document prior workAny stent, angioplasty, bypass or amputation - approximate dates, hospital, and surgeon if you remember.
• Bring wound photosIf you have an open sore, photograph it before dressing changes. Bring the dressing supplies you're currently using.

What happens during the visit

1. Health history and risk reviewSmoking, diabetes, kidney disease, cholesterol, blood pressure, and any heart or stroke history. PAD rarely travels alone.
2. Pulse and skin examWe check pulses at the groin, knee, ankle and foot, and look closely at skin, nails and any wounds.
3. Ankle-brachial indexBlood pressure cuffs at both arms and both ankles. Comparing the numbers tells us how much flow is reaching your feet.
4. Arterial ultrasoundA duplex scan locates the narrowed or blocked segments and shows how severe each one is.
5. Your plan, the same dayWe show you where the blockages are and what each option would and wouldn't fix.

If you have wounds, rest pain, or discoloration in the toes, tell the scheduler when you book. That's limb-threatening ischemia and it gets an expedited appointment.

What happens after

Not every blockage needs a procedure. For most people with claudication, the plan starts with structured walking exercise, smoking cessation support, and medications that protect the artery - that combination outperforms stenting for walking distance in most studies. If your disease is severe, if you have a wound, or if your symptoms don't improve, we'll discuss angiography with angioplasty, atherectomy or stenting.

Before any procedure using contrast dye we check kidney function, and we'll tell you exactly which blood thinners to hold and for how long.

How to prepare

• Bring your knee imagingX-rays from the last year and any MRI. A disc, a portal login or the imaging center's name all work - the report alone isn't enough, we need the images.
• List your injections with datesCortisone, gel or hyaluronic acid, PRP. What you got, when, and how many weeks of relief each one gave you.
• Bring your orthopedic notesIf a surgeon has already given you an opinion on replacement, we want to read it. GAE works alongside orthopedic care, not against it.
• Point to the painInside of the knee, outside, front, behind? GAE targets specific arteries, so where it hurts changes which ones we treat.
• Score your worst weekRate your pain 0 to 10 on a bad day and a good day, and note what you've stopped doing because of it. This is the baseline we measure against.
• Flag blood thinners and kidney problemsBoth are manageable, but they change the pre-procedure plan. Tell us at the consultation, not the week of.

What happens during the visit

1. Pain history and examWe examine the knee, check range of motion, and find the tender areas that correspond to the genicular arteries.
2. Imaging review, togetherYour physician pulls up your X-ray or MRI and shows you what the joint actually looks like and how it lines up with where you hurt.
3. An honest candidacy answerGAE works best for mild to moderate arthritis with inflammation and persistent pain. If your joint is bone-on-bone and a replacement would serve you better, we'll say so.
4. How the procedure worksThrough a pinhole in the wrist or groin, tiny particles reduce the abnormal blood vessels feeding inflammation in the knee lining. No incision, no implant, no general anesthesia.

GAE doesn't repair cartilage or reverse arthritis. It targets the inflammation driving the pain. Most people who respond notice change over several weeks, not overnight.

What happens after

If you're a candidate, we order pre-procedure bloodwork - kidney function and clotting - and give you written instructions on which medications to hold. The procedure itself is outpatient under light sedation and usually takes one to two hours. You go home the same day, walk out on your own, and most people are back to normal activity within a few days.

We'll see you back to re-score your pain and confirm the knee is responding. Physical therapy often works better afterward, once pain is no longer limiting what you can do.

How to prepare

• Bring the imaging, not just the reportMRI or diagnostic ultrasound of the painful area. Discs, portal access or the imaging center's contact details.
• Dress for access to the jointWe need to move and examine the shoulder, elbow, hip or foot without you changing into a gown.
• Bring your therapy recordHow many weeks of physical therapy, what exercises, and whether anything helped even temporarily.
• List injections and datesSteroid, PRP, dry needling, shockwave. TAME is for people these haven't fixed, so this history matters.
• Keep a week-long pain diaryWorst pain, best pain, what triggers it, whether it wakes you at night. Bring it on paper or on your phone.
• Note what you can't do anymoreLift a jacket overhead, grip a coffee cup, take the first steps out of bed. Function is how we'll measure whether this worked.

What happens during the visit

1. Pain and function historyHow long, how it started, what's failed, and what you need to get back to doing.
2. Focused examWe reproduce the pain with specific movements and pressure, which localizes the tissue that's inflamed.
3. Imaging reviewWe look for tendon changes and, on ultrasound, the abnormal vessels that grow into chronically inflamed tissue.
4. What TAME doesThrough a pinhole in the wrist or groin, temporary microparticles shut down those abnormal vessels and the nerve fibers that grow with them. The tendon keeps its normal blood supply.

TAME is newer than the other procedures on this page and isn't right for every diagnosis. If your imaging points to a full tendon tear or a mechanical problem, surgery may be the better answer, and we'll refer you.

What happens after

If TAME fits, we arrange pre-procedure labs and medication instructions. The procedure is outpatient, takes about an hour under light sedation, and you leave with a bandage rather than stitches. Most people return to desk work the next day.

Relief is gradual - typically over four to twelve weeks as the inflammation settles. We follow up to re-measure your pain and function, and we'll coordinate with your therapist or orthopedist throughout. Because coverage for TAME varies by insurer and diagnosis, our team will confirm your benefits in writing before scheduling.

How to prepare

For both: bring a full medication list including blood thinners, don't fast, and expect questions about kidney function since the procedure uses contrast dye.

What happens during the visit

1. Symptom history and scoringWe use a standardized score so improvement can be measured objectively rather than by memory.
2. Imaging review, togetherYour physician shows you the size and position of the prostate or fibroids and explains how the arteries supply them.
3. Candidacy, honestlyEmbolization suits many people but not all. Very large or oddly positioned fibroids, or a prostate with certain anatomy, may respond better to another approach - and we'll tell you if so.
4. How the procedure worksThrough a pinhole in the wrist or groin, microscopic beads reduce blood flow to the prostate or fibroids. The tissue shrinks over the following months. Nothing is removed and the organ stays in place.

What happens after

If you're a candidate, we order pre-procedure labs and, when needed, additional imaging to map your arteries. You'll get written medication instructions and a clear picture of recovery.

Both procedures are outpatient with light sedation. Prostate patients typically notice improved flow over four to twelve weeks. Fibroid patients often see bleeding improve with the very next cycle, with pressure and bulk symptoms easing over three to six months. Cramping in the first few days is normal and expected - you'll go home with a plan for managing it, and a direct number to call.

How to prepare

• Bring your colonoscopy reportThis is the one thing we can't proceed without. Rectal bleeding has other causes, and they have to be ruled out before we treat hemorrhoids.
• Bring recent blood countsHemoglobin, iron and ferritin. Chronic hemorrhoid bleeding is a common and often missed cause of anemia.
• Describe the bleeding plainlyHow often, how much, whether it drips or streaks, and whether it's changed. Clinical detail helps more than delicacy here.
• List what you've already triedRubber band ligation, sclerotherapy, infrared coagulation, hemorrhoidectomy, and how each went.
• List all blood thinnersIncluding aspirin and fish oil. Many hemorrhoid patients are on anticoagulation, which is exactly why they bleed - and why HAE is often a good fit.
• Expect a brief examAn anorectal exam is part of the consultation. It's quick, done privately with a chaperone available, and you can ask us to stop at any point.

What happens during the visit

1. History and gradingWe establish how long you've been bleeding, whether tissue prolapses, and how much this is affecting daily life.
2. Records reviewWe confirm the source with your colonoscopy findings and check whether the bleeding has cost you blood counts.
3. ExamA short anorectal exam to grade the hemorrhoids and check for fissures, tags or other findings.
4. How the procedure worksThrough a pinhole in the wrist or groin, small coils and particles reduce the arterial flow feeding the hemorrhoids. Nothing is cut, nothing is removed, and the sphincter is never touched - which is why there's no wound to heal and no risk to continence.

HAE is most effective for bleeding. If your main problem is large prolapsing tissue, itching or a thrombosed external hemorrhoid, a colorectal surgeon may serve you better, and we work closely with several.

What happens after

If HAE is right for you, we arrange pre-procedure labs and medication instructions. In many cases blood thinners can be continued, which is a significant advantage over surgery.

The procedure is outpatient under light sedation, takes about an hour, and you go home the same day. There's no wound, no packing and no sitz baths - most people return to work within a day or two. Bleeding usually improves within the first few weeks. We'll follow up to recheck your symptoms and, if you were anemic, your blood counts.