The specific problem with teaching
Plenty of jobs involve standing. Teaching involves standing on somebody else’s schedule, which is the part that matters for legs.
Blood gets back up the leg because the calf muscles squeeze the deep veins with every step, and one-way valves stop it falling back between steps. That pump needs walking to work. Standing in one place switches it off while gravity keeps loading the column of blood in the leg — and unlike almost any other setting, you cannot decide to walk it off, sit down for ten minutes, or get your feet up. The bell decides.
Do that for six hours a day across a career and valves that were fine at twenty-five are frequently not fine at forty-five. Add pregnancy, which raises venous pressure sharply and is among the strongest risk factors there is, and the picture that turns up in this office is extremely common.
What it looks like
It starts as fatigue rather than pain: legs that are heavy by the last period, ankles that have sock marks by the afternoon and are normal again by morning, cramps that wake you.
Later it stops settling overnight. Veins become visible. The skin around the ankle can itch, thicken or stain brown — which is what sustained pressure does to tissue over years, and which sits on the path toward a venous ulcer.
The evening-worse, morning-better pattern is the single most useful thing you can tell us, so say it.
And the back
Standing all day, bending to desks, carrying materials. Lower back pain is close to universal in this group and is generally muscular or facet-joint pain rather than anything alarming — but it is examined rather than assumed, because pain that travels down the leg could be the spine or could be the veins, and those are treated in opposite directions.
That is the advantage of a practice that does both. Dr. D’Alessio is board-certified in Physical Medicine & Rehabilitation — the specialty built around restoring function without operating — and both examinations happen in one appointment.
What happens
A standing duplex ultrasound where the history warrants it: painless, about half an hour, performed upright because gravity is the load being tested. It shows which veins are refluxing and how far, and it is what most insurers require before approving treatment.
Then a conversation about what was found — including, where it applies, that your veins are fine and the problem is somewhere else.
Treatment
Vein treatment is office-based and under local anaesthetic: radiofrequency ablation, Varithena® microfoam, or sclerotherapy for surface vessels. You walk out and drive home. Back pain is treated without surgery.
Compression, worn during the school day, is the practical measure that changes how the afternoon feels while everything else is arranged — and it needs to be at a real pressure, properly fitted, which most over-the-counter pairs are not.
On benefits
NJEA, district and municipal plans frequently include out-of-network benefits. Whether yours does, what it covers and what you would be responsible for are verified and explained before anything is scheduled.