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Well, you've all been very good, you haven't asked a single question. I was expecting you
to put your hand up and interrupt but you're obviously ...
I've got a question.
You've got a question? After you've treated my thread veins, will
they come back?
Good question. A question I get asked a lot is "I had thread veins, if I have them treated,
what are the chances of them coming back?" Well, that's a very good question. If there's
an underlying problem with the veins, if there's reflux, then that should be treated first,
and often, after treating the reflux, the thread veins tend to get better of their own
accord, without any other additional treatment. However, if there's no reflux or if the reflux
has been treated and they don't get better, they will need injections by microsclerotherapy,
as I've mentioned.
Now, veins that have been treated are unlikely to come back but other veins nearby may cause
problems again so, unfortunately veins are made principally of collagen, and we know
that collagen changes with time. When we look in the mirror we see our skin changes with
time -- the skin I have now is not the same skin I had five years ago. The veins I have
now are not the veins I had five years ago, the collagen has changed and it has deteriorated.
So all vein problems, regrettably, get more common with time. As we get older more varicose
veins, more thread veins, not inevitably, but the risk. Now if you've had veins treated,
veins that are healthy now may become a problem in the future and they may require additional
treatment and this is a particular issue with thread veins.
You are quite right, if you treat thread veins now, it doesn't mean they've gone, you're
never going to have vein problems again. It's quite likely that you will need or desire
to have more thread vein injections as the years go by, and I usually say to people "have
your veins injected once a year or once every two years to keep them under control". The
analogy is, it's a little bit like weeding the garden -- you spend a whole weekend getting
the garden looking as good as you want it and you don't then say, well that's it, never
need to do anything in the garden again, because the weeds will regrow.
Another analogy which is sometimes helpful is it's a little bit like visiting the dentist.
You don't go to the dentist and have a lot of work done on your teeth and you say right,
that's it, never need to see the dentist again. Tooth decay continues, you need to keep your
tooth health, or your dental health, under review. So vein problems tend to recur and
tend to progress with time, so a lot of people now come after successful treatment, come
and see us once a year for a scan, for a check-up to allow us to identify vein problems at an
early stage. We can usually rectify with foam sclerotherapy before they become a major issue,
and this is certainly a trend that has been in continental Europe for many years - the
French do that regularly, you see your doctor, you see your dentist once a year, your doctor
once a year, and you see your phlebologist, who's a vein specialist, you see your phlebologist
once a year.
OK, thank you.
Thank you for that good question. Has anybody else got any questions, because you've been
very well-behaved, you haven't interrupted at all recently.
I've got a bit of a question, I don't know if I missed you saying it earlier, you were
saying about the complications of varicose veins and them being DVT, so does that mean
you have to have varicose vein problems before you get a DVT? No. That's a good question
-- does everyone who develops a DVT have varicose veins, or are there other causes? Well, it's
only a minority of people who have bad varicose veins who go on to get a deep vein thrombosis
and, equally, for the majority of people who have a deep vein thrombosis, there is nothing
wrong with their superficial veins. Varicose veins are a risk factor, they're not a very
strong risk factor, but they contribute.
In fact you may be surprised to know that the strongest risk factor for a deep vein
thrombosis is going into hospital - yes. So as soon as you go into hospital, that's a
time in your life when you are at greatest risk of developing a deep vein thrombosis,
for whatever reason you go in. Obviously not as a visitor, that would be silly, but if
you are a patient and you go into hospital, that's a time when you are at great risk of
a DVT. Why is that? Well, because you're sick for a start.
The second is you're going to be put in a bed and immobile and there's something wrong
with you, you may have heart disease, diabetes, infection, you may have had major surgery,
and the blood flow in your deep veins may not be good, particularly during a long operation
there may be very little flow in your deep veins. If you are immobile in bed, recovering
from trauma or recovering from major surgery you may not have very much flow in your deep
veins, and we also know that when you are ill your blood becomes more sticky, it becomes
more coagulable, more liable to clot, so being in hospital for any reason as a patient is
a time in your life when you are at great risk of a deep vein thrombosis.
In fact another horrifying statistic is that more people go into hospital and subsequently
die of a deep vein thrombosis, a clot in the leg which then moves and goes to the lungs,
more people die from that than MRSA or the killer bug Clostridium Difficile or breast
cancer or road traffic accidents all put together. So that is the main risk factor for DVT if
you want any worrying time, and that's why you see so many people wondering around hospital
with those white socks on, because now again NICE has said, a few years ago now, that everyone
going into hospital should have a DVT risk assessment and appropriate measures to minimise
that risk.
Varicose veins are not really a strong risk factor, but if you've got other problems going
on and you've got bad varicose veins, your risk is slightly increased, and we know that
if you have your varicose veins treated your risk goes back to what it would have been
had you not had vein problems. That's not a strong enough reason to have your veins
done because the additional risk is quite small, but it is a risk factor and there is
now good evidence. I'm a little concerned about superglue being
used in the veins during surgery. What happens when it gets in the body, does it coagulate
and get dispersed?
The superglue that is used is very quick-setting and it bonds permanently. This superglue,
as I say, has been in use in medicine for fifty years and it doesn't break up and turn
into anything nasty and it doesn't cause cancer, it doesn't appear to break up and move around
the body. The formulation that's been used for veins has been in development for over
five years, it's had extensive laboratory testing, it's had a lot of animal experiments,
so it's been put in the veins of animals and looked at, it's been looked at under the microscope,
you can take the veins out and you can look at them under the microscope at various times
after treatment and it appears that there are no safety concerns.
The company, Sapheon, is very meticulous about who does their superglue treatment. I had
to go to Hamburg in Germany for two days training before starting to use the VenaSeal system,
and then I had to sit an exam, and then I had to have my first case observed by a person
from the company to confirm that I was doing it properly. Only after those three safeguards
were we allowed to provide this treatment at our clinic and we have actually had Rod
Raabe, the inventor of the technique, come to our clinic to see us performing the treatment
and he did give us a rather ringing endorsement, didn't he Mrs English.
He did indeed, yes.
Yes. He said, and he's allowed me to quote him, is that he's been to all the clinics
that provide this treatment and we do the procedure as well as anywhere in the world,
so that's pretty good, and he's allowed me to quote that so I'm not saying anything that's
been made up.
So yes, you're right to be concerned, with any new treatment you need to be assured that
it's safe and that it's effective and one of the things that we're very pleased about
in our clinic is we are never the first. I would never want to be the first having any
treatment, and I wouldn't want any of my patients to be the first, so we don't do anything that's
experimental. We've never been the first to do VNUS Closure, never been the first to do
laser, never been the first to do ultrasound-guided foam sclerotherapy and we weren't the first
to do VenaSeal. We're usually among the earlier doctors, but we like to see the published
results first before we adopt anything. We look very carefully before we take anything
on. All the things we do are safe, that we would have done ourselves, that we're happy
to do for others. One of the tests I use is if I wouldn't do this procedure to a member
of my family, I wouldn't do it for a patient, and I think that's a good way of deciding
what's safe and what's good. .
I went to Lyon and I looked at steam and I thought I'm not convinced, I don't think I
would offer this to a member of my family in preference to another treatment, so that's
why we don't offer it yet. Evidence may come through, it's not there yet, evidence may
come forward that there are reasons to choose steam in certain situations, in which case
we'll reconsider it, we keep an open mind but we don't do anything that's experimental,
so I hope that answers your concerns about superglue and VenaSeal.
VenaSeal, is that preferable over the other treatments, why do you select that one? I
can see its benefits because you're just in and out of the Clinic quite quickly, is that
the main reason really? Yes. One of the questions I get asked quite
frequently is "why choose VenaSeal over some of the more established treatments like laser
and VNUS Closure?". It is relatively new, so although the results twelve months to twenty-four
months after treatment show that it's as good as endo-venous laser, it's not better in terms
of the risk of recurrence. However, there are some features that some people may prefer.
They might prefer the idea of not having local anaesthetic jabs, for example - some people
are very, very nervous about local anaesthetic jabs, very nervous, almost needle-phobic.
For them, having superglue would be an advantage, it's one local anaesthetic jab. There are
some people who think the idea of wearing a compression stocking, even for a week, is
dreadful, in which case VenaSeal gets over that problem.
Is it better? Well, it's more expensive - all new treatments tend to be more expensive.
The price may come down, there may be other formulations from different companies which
would put the price down. At the moment the main barrier to acceptance is the quite high
cost of VenaSeal in comparison with radio-frequency and laser. We don't have a lot of patients
who prefer it, but we've had probably up to twenty people now who've chosen VenaSeal for
those reasons mainly -- they want one local anaesthetic jab, they don't want to wear a
stocking, they want to drive themselves home straight away, and they want to have absolutely
no restrictions so they can get on a plane, they can drive, they can do whatever they
like with just one little Band Aid on their leg.
Is it better? Well, it's a value judgement really. It seems to be just as effective.
One of the ladies that we treated last year, she had four major veins in her legs which
were refluxing, so two in each leg, and in fact that was the person who Rod Raabe came
to observe us treating. Now she would have had to have had quite a lot of local anaesthetic
jabs. She had four local anaesthetic jabs and she walked out with four Band Aids on
her legs so she was delighted.
I think it's really a question of individual taste and discussing the pros and cons, discussing
the cost and seeing what works best for you but, as I say, everything that we do is effective
and we wouldn't offer you anything that wasn't very, very good.
Thank you.
You're welcome What's the cost if you've got one varicose
vein or if you've got lots of varicose veins? Yes. That's a very common question I get asked.
A lot of people ask me "the cost in your brochure is described as 'per leg' or 'per procedure'.
Does it matter if I've got lots of veins, one vein, five veins?". Well, one of the things
that we are concerned about, particularly for people who are paying for themselves,
is that we don't them to feel they're getting into something they can't afford, so we like
to keep things very transparent -- that is the price. If you've got a lot of veins on
your leg that need treatment, it's the same, we don't charge you per vein or per hour.
So you know before you commit yourself what the cost is going to be and we like to give
people a 'per leg' idea.
Some people require combination treatments, so some people require endo-venous laser treatment
and foam sclerotherapy and phlebectomy. We don't add all of those up, we just charge
the headline fee for the laser and we do the other treatments as part of that. So there's
no totting up, it's not like a bill at a restaurant where you have all the various items added
up. We tend to try and make it very transparent so people don't get any surprises. I wouldn't
want to start private treatment not knowing what the figure's going to be. Private treatment
can be very expensive, particularly if you go into a private hospital, and the charges
can add up very quickly. We try to take the risk of that away so if, for example, you
have a concern after your treatment you can speak to us, we don't start the meter running,
we'll give you advice over the phone. If you're concerned and you need to come and see someone,
have an additional scan, there's no charge for that. If, when you come back, we haven't
achieved those excellent results because there's still a lumpy vein present, and we think we
can improve that for you, we will treat you again at no extra charge. And if, in the unlikely
event that something is not right, we will see you and do our very best to put it right
for you at no extra charge. So we hope that everything's transparent.
Now for people who are insured, it is slightly different. The insurance companies like to
be billed for everything that we do and we bill for everything that we do. So we have
to have a system where, if you come and see us, we bill you. If you have a concern and
you need to see us and you have private health insurance, you need to tell your insurance
company and, when you come, we bill you because that's the way the private insurance companies
work. But for people who are paying out of their own pocket, we keep it as transparent
and as simple as possible because we don't want you to be surprised with unexpected bills.