2013-05-25T10:41:46-04:00 Eddie Chaloner http://www.huffingtonpost.co.uk/author/index.php?author=eddie-chaloner Copyright 2008, HuffingtonPost.com, Inc. HuffingtonPost Blogger Feed for Eddie Chaloner Good old fashioned elbow grease. tag:www.huffingtonpost.com,2013:/theblog//3.2866342 2013-03-13T07:57:36-04:00 2013-05-13T05:12:01-04:00

Eddie Chaloner http://www.huffingtonpost.com/eddie-chaloner/
I recently wrote on popular questions about vein treatment, but am painfully aware that often the people seeking out healthcare answers are women. 40 per cent of all women will experience varicose veins at some point in their lives, but so will 25 per cent of men. And they aren't requesting medical advice soon enough.

I run a scheme that focuses on busting the myths around varicose veins by offering a free assessment for people worried about their vascular health. I'd urge wives, sisters, girlfriends, mothers and daughters to encourage the men in their lives to seek out a surgeon who can do something similar, in confidence and without stigma. It's important to seek medical attention before the condition gets to an advanced stage- but historically the men I see wait far too long before admitting their varicose veins are a problem, and this is worrying.

Veins exist as passageways to carry oxygenated blood around our bodies. Blood is pumped through veins by a combination of muscle contraction and valves. If these valves fail, though, there are problems. If valves fail to propel blood around the legs in particular, it pools in the calf area. This is what causes clustered and blue veins.

Varicose veins can be largely only cosmetic. Possibly, that is why male patients are reluctant to seek out treatment. However symptoms such as chronic aching and itching can cause great discomfort, and in some severe cases can rupture and cause ulcers in the legs.

The only treatment for varicose veins is surgery. Fortunately, this is now non-invasive and done on an out-patient basis. Vein surgery has evolved to use mostly lasers or radiofrequency to close the leaky vein by burning it. Sclerotherapy uses foam sclerosant to seal veins by burning the inside of them. 85% of vein patients are eligible for laser or radiofrequency treatment.

Men with varicose veins tend to visit their GP or a specialist at a later stage of the condition than their female counterparts- usually when the veins are very painful or when they are starting to cause skin damage. By waiting until this advanced stage, men are at a higher risk of developing the worst vein problems, including venous ulcers, and it makes treatment much more complicated.

There are many things we can do to help our vascular health, from regular exercise to healthy diet, but it's important that we treat prevention and cure with the same seriousness. Both sexes must recognize the severity of varicose veins, and men especially must be bolder in consulting a professional about what could, potentially, become a much bigger problem.]]> tag:www.huffingtonpost.com,2013:/theblog//3.2757730 2013-02-25T06:18:46-05:00 2013-04-27T05:12:01-04:00

Eddie Chaloner http://www.huffingtonpost.com/eddie-chaloner/
I see and treat hundreds of patients every year with vein disorders. Varicose veins cause a wide spectrum of problems, from the purely cosmetic dissatisfaction and embarrassment, to painful aching and 'heavy legs' and ultimately severe skin damage and ulceration. There is often some confusion about the solutions available.

Until the turn of the century, the only surgical option was the high tie and strip operation, with prolonged post operative recovery times and quite high recurrence rates. The exciting news, though, is that we've come a long way from only a single choice in resolving the varicose veins problem.

The treatment methods developed over the last decade are minimally-invasive and can be performed largely under local anaesthetic with no scars and rapid recovery from treatment. Look out for Endovenous Laser Treatment, radiofrequency ablation and foam sclerotherapy as examples of innovative procedures with good long-term results in experienced hands. Patients considering treatment for varicose veins should seek a consultant who has experience in most or all of these options. Surgeons who can only provide open surgery (the high tie and strip) are out of date and well behind the times.

Veins are blood pipes that allow blood to flow back from the legs to the body. Patients often ask whether treating faulty varicose veins will cause a problem with the blood flow from the leg. This is absolutely not the case- we have enough veins in our legs to make a pair of fishnet stockings- we just can't see them all on the skin surface. The vast majority of the blood flow back to the body goes back in the deep leg veins which are not affected by varicose veins surgery, and the blood from the legs is 're-routed' into the deep veins after surgery.

Deep vein thrombosis, or DVT, is a common worry, too. A DVT is a serious matter, and is a possibility after any kind of surgery. After vein surgery though, the risk is very low when compared to other types of surgery, such as knee replacement or abdominal operations.

As a rough guide, the risk of DVT after vein surgery is about one in 1,000 cases and every possible precaution should be taken to prevent this serious complication. Using anticoagulant "blood thinning" drugs before treatment and preferring local rather than general anesthesia to reduce immobility time after surgery, are both common practices which reduce the risk to an absolute minimum. Sadly there is no way of eliminating the risk entirely.

For patients who consider themselves to be at a particularly high risk of DVT- for example, those who have had a previous DVT, or have known risk factors for DVT- it's sensible to request prolonged anticoagulant injections for 3 to 5 days after vein surgery.

Probably the most voiced varicose veins treatment question I get is about flying, particularly after surgery and the risk of DVT. We do know that there is an association between flying and the risk of DVT, but again the risk is quite low and largely confined to long haul flight. For this reason, it is sensible for patients to avoid long-haul flights for about a month after treatment. For patients who absolutely have to fly, again anticoagulant injections close to the time of the flights reduce risk as much as possible.

In short, varicose veins treatment in the 21st century is simple, effective, and though not without a small element of risk, pretty much as safe as surgery can ever be.

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Eddie Chaloner http://www.huffingtonpost.com/eddie-chaloner/
Medical interventions, such as types of cosmetic surgery, are often a lifestyle choice rather than medical requirement- a state-funded system does not exist to provide these kinds of treatments.

The more serious the condition, the more urgent is the need for treatment. That sentiment is straight-forward and underpins the relatively new NHS concept of procedures of limited clinical value (PLCV).

PLCV is officially described as a quantitative way to establish the ranking importance of clinical needs. In reality, though, procedures of limited clinical value is a term used to justify removing funding for an increasingly lengthy list of treatments in order to reduce health service expenditure.

What concerns me is the widening definition of PCLV to include proven operations known to enhance health and improve quality of life. Many of the procedures now deemed 'low value' are actually those which prevent complications and more serious conditions developing later in life.

My own specialty is varicose vein treatment. The NHS has always declined to treat patients for whom the condition is purely cosmetic- those patients have, quite reasonably, always had to seek treatment in the private sector. However there is now a substantial increase in the number of uninsured patients referred to me privately by NHS GP's- patients who, in my opinion, are medically deserving of subsidised treatment.

Current policy is very strict. Most NHS Primary Care Trusts only permit vein surgery to be carried out in cases where varicose veins are so severe that the patient has skin damage or an established ulcerated area on the lower leg. Patients have to suffer through the pain and discomfort caused by varicose veins, only awarded treatment when the condition has worsened. The alternative is to self-fund within the expensive private sector.

This option is being faced by more and more people. In 2003-2004 the NHS carried out over 46,000 varicose vein operations, but by last year this figure had fallen by almost half.

The most affected patients are those who can't afford the high cost of private healthcare. A painful condition that can be cured almost completely with a proven and successful 30-minute local anaesthetic procedure has been placed far out of reach for thousands of people.

Viable alternatives to our current 'all or nothing' state healthcare system are common in other countries, where co-payment schemes for drugs and treatments that fall outside of the state's remit work well. Patients can access low-cost subsidised treatment for services that the state cannot afford to fully fund.

France, Germany, Australia and Ireland already operate funding systems where the Government covers a percentage of healthcare cost. Patients are covered by low cost, state-subsidised insurance plans, self-funding the excess. Low-income or unemployed patients are fully funded. Variations of schemes like this are found in almost all developed countries outside of America. Except, of course, in the U.K.

The refusal of the NHS to hold a dialogue about similar co-funding arrangements means that patients are suffering in order to preserve the ideological purity of state medicine that is 'free at the point of use.' I don't think that is reasonable.

The problem is largely political rather than clinical or administrative- the electorate are fearful of any change to the NHS, which is often perceived as a cornerstone of British society. But in a week where the NHS has been expanding plans to commercialise its brand and franchise abroad, it's ironic that our domestic funding options are embarrassingly inflexible compared to the rest of the developed world.

As the budgetary squeeze tightens and the list of procedures defined as being of 'limited clinical value' expands, the need for radical change to the NHS funding model is becoming increasingly apparent. Continuing a dogmatic adherence to current legislation restricts access to treatment, limits patient choice, and stifles competition- and that puts our healthcare a long way behind the rest of the developed world.]]>