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Tuesday 29 May 2012

Vulval Varicose Veins on Embarrassing Bodies tonight

Mark Whiteley of The Whiteley Clinic has been asked to supply photos and facts about varicose veins of the Vulva for the TV Program "Embarrassing Bodies" to be screened tonight.

This very common, but much under recognised, problem has been treated successfully by The Whiteley Clinic since 2000. We have treated more patients with this condition than any other clinic in the world, and the veins are classified by The Whiteley Clinic Vulval Varicose Vein grading system:


Description
Frequency seen at present
Grade 0
Normal – no varicosities nor venous reflux in vulva
Usual
Grade 1
No visible varicosities in vulva, but ultrasound proven reflux in vulval veins usually with para-vulval varicose veins seen on inner thigh
Common – 1 in 7 females presenting with leg varicose veins (1 in 5 of those post vaginal delivery)
Grade 2
Visible varicosities seen through mucosa of inner labia and lower vagina and ultrasound proven reflux in vulval veins.
Uncommon
Grade 3
Isolated varicosities seen on standing through skin of outer labia majora without a distortion of the general anatomy of the area
Very uncommon
Grade 4
Extensive varicosities of the labia, distorting skin and distorting the gross anatomy of the area on standing
Rare

see:

www.vulval-varicose-veins.co.uk

Sunday 27 May 2012

Mark Whiteley in the Telegraph.co.uk

Today (Sunday 27th May, 2012) the lovely Kate Shapland mentioned Mark Whiteley in her blog on The Telegraph.co.uk under the title:

"WHERE TO GO FOR VEIN REMOVAL"

Kate is specialist journalist who runs a blog called "The Leg Room"

http://fashion.telegraph.co.uk/beauty/news-features/TMG9290946/Beauty-Notebook-Super-skin.html

Saturday 26 May 2012

"Pioneering research means Whiteley is still leading the way"

For full article, see Surrey Advertiser 25th May 2012
Business News Extra - page 4
This week, Mark Whiteley and his research fellows at The Whiteley Clinic were featured in The Surrey Advertiser.

The article outlined the research and development that The Whiteley Clinic has supported over the last 10 years, in the areas of Varicose Veins treatments, Leg Ulcer Treatments and the development of Laser Sweat Ablation.

Students (ether students wanting a career in medicine or medical students who want to progress their careers) who would like to get involved in the research, are invited to contact The Whiteley Clinic on info@thewhiteleyclinic.co.uk.

Friday 18 May 2012

Why is anyone still having vein stripping?

A 40 year old lady came to The Whiteley Clinic this week with recurrent varicose veins. She had been to a "vein expert" elsewhere, who had recommended vein stripping under a General Anaesthetic in 2003.
Patient had stripping of right Great Saphenous Vein 3 times
since 2003 by a "vein expert" in London
She had her vein stripped in 2003. Not surprisingly this vein came back again as they usually do after vein stripping.

Unfortunately she has gone back to the same "vein expert" twice since - and had further vein stripping under general anaesthetic twice since!!!

When examined at The Whiteley Clinic, she was found to had strip tract re-vascularisation - re-growth of the vein due to the stripping process.

Duplex ultrasound report showing that Great Saphenous Veins
has grown back - Strip Tract Revascularisation 

This sort of problem is found regularly after vein stripping procedures.

Since we brought endovenous surgery into the UK in 1999, we have not seen a single case of revascularisation in any of our patients following endovenous techniques.

This patient will be treated by 2 sessions of endovenous surgery to her leg, both under local anaesthetic. She will be able to walk home afterwards - true walk-in walk-out surgery.

If she had had this in the first place, it is unlikely she would have need the subsequent 2 operations that she had, nor what we need to do now.

For more information, see http://www.veinstripping.co.uk/

Monday 14 May 2012

"Superglue" to treat Varicose Veins?

A "superglue" to stick varicose veins together needing virtually no anaesthetic at all, has been developed by Sapheon, a company in the United States.

The product, called "venaseal", is based upon a product that is already used successfully to close other blood vessels elsewhere in the body, such as arteries in the brain.

Only tiny amounts of the "venaseal" who are needed to treat the great saphenous vein, the commonest cause of varicose veins. The great saphenous vein runs between groin and ankle. To successfully treat varicose veins, surgeons usually need to treat the section of this vein that runs between groin and the knee.

Traditionally, this sort of surgery has been done under general anaesthetic using a "stripping" technique (www.veinstripping.co.uk). However over the last 10 years or so, general anaesthetic and stripping has been completely replaced by local anaesthetic endovenous laser ablation (EVLA) or radiofrequency ablation (RFA) in good vein practices.

However these ablation techniques use heat to destroy the vein and so require a lot of local anaesthetic to be injected through the skin and around the vein - a process called tumescence. Unfortunately the injection of tumescence can be very uncomfortable and even painful in some people.

Therefore over the last few years there has been a search for a way to close veins without using heat and thus not needing tumescent anaesthesia to be injected.

Several techniques have been suggested, some of which have been featured before in this blog or on The Whiteley Clinic websites, along with reasons why we do not support them.

Many doctors have started using ultrasound guided foam sclerotherapy which, although very useful in the small veins, has a very poor success rate in the larger veins such as the great saphenous vein. Therefore foam sclerotherapy is a great adjunct to treatments of the great saphenous vein, but it is not a good treatment by itself.

In contrast to this, "venaseal" is looking very promising. The glue is injected under ultrasound control through a single needle access point - the only area that needs any local anaesthetic for the procedure. The early data seems to suggest that the glue sticks the vein together and causes such an intense reaction, the vein appears to be completely destroyed.

If this proves to be the case, it could well be an improvment on endovenous laser ablation (EVLA) and radiofrequency ablation (RFA) which both produce excellent results when used by experts in the correct manner.

In view of this exciting development, The Whiteley Clinic has decided to join the multicentre international trial of "venaseal".

Any patients who are interested in either having "venaseal" treatment at The Whiteley Clinic or being included in the study, are invited to contact us on info@thewhiteleyclinic.co.uk.

Ask an Expert on The College of Phlebology

Since the launch of The College of Phlebology (www.CollegeofPhlebology.com) last month, the "Ask and Expert" section has yielded some of the most useful tips for those people treating veins:

Examples of recently asked and answered questions by Members are:

Q - How far down the calf are you comfortable using laser for gsv or ssv, with regard to nerve damage risk?

Q - Is there any rationale for superiority of applying tumescent from proximal to distal rather than starting at the level of the sheath?

Q - I take it that you still aim for LEED of 60-90 j/cm even with 1470nm laser + radial fiber, and 10W, rather than 5-6W and 30-50 j/cm?

Q - for superficial truncal veins and accessory truncal veins, what depth from skin is your cutoff for avoiding laser for fear of producing a hard pigmented cord?

These questions and more are answered - and any member can pose any questions on vein treatments to the experts on the Advisory Board.

Saturday 12 May 2012

Curing leg ulcers

 First - an e-mail that arrived today:

"Hey Mark,
I saw one of your patients daughter in clinic yesterday .... I referred her to you she had terrible trouble with her leg ulcers, her daughter was so happy and singing your praises and mine for referring, she is off the morphine and walking around, her district nurses cant believe it, just thought I would let you know."


Leg ulcers are a horrible - you might not want to look at these pictures. However, in the UK about 500,000 people and in the USA some 2.5 million people regularly get these. They are often painful and always ruin peoples lives.


Day 1 - Patient has been told by a teaching hospital she will take 2 years to heal!!!
She is on morphine, dressings and compression bandaging. She underwent The Whiteley Protocol
having a scan to show the venous reflux and local anaesthetic endovenous surgery 
Leg ulcers are usually venous leg ulcers (cause by venous reflux) and they are almost always treated by nurses using dressings and compression bandages. 

Day 4 - 4 days after Whiteley Protocol treatment - ulcer left open to the air.
Nurses not allowed ot put dressings on ulcer 
Over the last few years, The Whiteley Clinic has been one of the new wave of vein clinics around the world that have introduced local anaesthetic endovenous surgery. We have spent years researching and understanding venous reflux and venous disease (see the book - "Understanding Venous Reflux - The cause of varicose veins and venous leg ulcers).

Day 8 - Scabs are allowed to form as they are nature's dressing - and allow health skin to form underneath.
We have developed The Whiteley Protocol - a system where we can assess all venous reflux (from Thread veins, through varicose veins, the venous eczema and leg ulcers).

Day 14 - Scabs about to fall off and no pain killers needed now.
Patient is up and walkiong about, pain free for the first time in months

By understanding the underlying problem with the venous reflux, we find that we are able to cure over 60% of people with leg ulcers. We cure them by fixing the reflux using our local anaesthetic endovenous methods and then allowing the ulcer to heal by exposure to the air (and NOT allowing dressings and bandages which now are not needed). 

Day 19 - Paitient well on way to healing, walking without aid and on no pain-killers
No comperession bandaging nor dressings have been used since.
Unfortunately, most people with leg ulcers never get a chance to be investigated and cured - and most doctors and nurses never tell their patients that local anaesthetic surgery might be able to cure their leg ulcers and stop them needing dressings and bandaging.

Look out for the Whiteley Clinic research into leg ulcers that is shortly to be published.

For more information see www.legulcers.co.uk
 

Wednesday 9 May 2012

Pelvic cause of varicose veins - a problem often missed


Para-vulval veins - a sign of pelvic venous reflux. All of this lady's varicose veins came form her pelvis.
Traditional varicose veins surgery of the leg veins would not cure her.
This 38 year old lady, who has had 2 children, found her varicose veins on both side were getting worse.

A previous treatment of foam sclerotherapy to leg veins had not improved them - and in fact they had continued to deteriorate.

On examination, she had these large varicose veins at the top to the leg, on the inside of the thigh.

These veins are called para-vulval veins, as they emerge onto the leg next to the vulva. There is also a varicose vein coming onto the leg from the anal area.

This is a classic presentation of Pelvic Vein Reflux - www.vulval-varicose-veins.co.uk.

When this lady had her duplex ultrasound scan by the specialist vascular technologists at The Whiteley Clinic, it was found that her Great Saphenous Veins and Small Saphenous Veins on each side were perfectly normal.

If this patient had gone to a normal "vein specialist" it is likely she would have been offered stripping, endovenous laser or radiofrequency ablation - all of which would fail in her case.

What she needs is pelvic veins embolisation and then the legs can be treated successfully after the pelvic problem has been fixed.

www.vulval-varicose-veins.co.uk

For professionals, this and other complex problems will be discussed with members on www.collegeofphlebology.com

College of Phlebology - CollegeofPhlebology.com


The College of Phlebology - The Internet resource for excellence in Veins
The Whiteley Clinic is proud to be Gold Members of The College of Phlebology.

The College of Phlebology is an internet based college, that has something for everyone.

For patients / the public, the College of Phlebology website provides:
  • information about veins and vein conditions
  • the latest vein treatments
  • a search facility to find your local vein expert
For doctors and nurses who treat veins - from thread veins, to varicose veins and leg ulcers:
  • training videos
  • news items about vein treatments
  • forums to "ask an expert"
  • use of MCPhleb if you treat thread veins
  • use of FCPhleb if you operate on varicose veins and leg ulcers
Launched only a month ago, The College of Phlebology is rapidly growing as a resource for information and education for those interested in veins and vein conditions.

www.CollegeofPhlebology.com

Saturday 5 May 2012

Book ranked 3rd in class on Amazon

Understanding venous reflux - proving popular with varicose veins and ulcer patients
On today's rankings, "Understanding Venous Reflux - the cause of varicose veins and venous leg ulcers" was ranked 3rd best selling book on Amazon.co.uk in the class: "surgery > vascular".

It was also ranked 23rd under "medical research".

The book was written as a simple explanation as to how varicose veins and leg ulcers develop from the failure of the valves n the legs - by taking the reader through a step by step account of how the circulation works.

Research from the publishing company has shown that over 75% of the books have been bought by people who have varicose veins or leg ulcers - or friends or relatives of someone who has - and only 25% by healthcare professionals.

The aim of the book is to help anyone to understand how leg veins work - and what goes wrong with them.

The next book in the series - due out this summer - then outlines how these problems are best treated, and explains why some of the older techniques (and a few of the new ones) don't work effectively.

Friday 4 May 2012

Why Thread Veins need Duplex before Treatment

This lady in her 50s, came to have her thread veins treated at The Whiteley Clinic this week.

Apparently "simple" Thread Veins of the Leg 
She had been to one General Practitioner who had told her that they were cosmetic veins only and did not need treatment. This general practitioner had then given her "cream" telling her the veins with disappear.

Of course they did not, has thread veins of the legs cannot be treated successfully with cream of any sort.

More importantly, no doctor can ever pass judgement on veins without a duplex ultrasound scan showing exactly what is going on in the veins, deeper in the leg.

Apparently "simple" thread veins of the leg on standing
Fortunately, she saw a second general practitioner who is aware that almost 90% of people with "simple" thread veins have underlying venous reflux - or "hidden varicose veins".

Therefore she was referred for a full assessment to The Whiteley Clinic.

Although no varicose veins are visible on standing, a full venous duplex ultrasound scan was performed which is shown below.

Duplex ultrasound scan - X shows venous reflux 

The venous duplex ultrasound scan shows that the great saphenous vein (GSV) has venous reflux from the upper thigh all the way to the ankle. The patch of thread veins is coming straight off one of the branches (or tributaries) from this.

Therefore blood refluxing or "falling" down the great saphenous vein (GSV) is impacting directly onto the thread veins.

If this patient had gone to a cosmetic practice or beauty clinic which did not have a minimum of hand held Doppler but preferably colour flow duplex ultrasound, it is likely that she would have been offered treatment for the thread veins.

Treating these thread veins without treating the underlying cause first is highly likely to cause a disaster, with the patch of thread veins becoming either larger and more difficult to treat (telangetic matting) or brown staining with a progression to more thread veins in the future.
The thread vein course run by The Whiteley Clinic at The Clinical Exchange teaches all delegates why it is essential to perform Doppler examination as a minimum, and how to perform it correctly.
For anyone who has read "Understanding Venous Reflux - the cause of varicose veins and venous leg ulcers" you will be able to see that this patient has phase 1 passive reflux. As such a hand held Doppler at the groin alone would not have been enough to diagnose her.
This patient needs endovenous laser ablation or radiofrequency ablation of her great saphenous vein before her thread veins can be successfully treated.
For more discussion about this and similar cases, please see www.collegeofphlebology.com.
For information about thread vein courses please see www.theclinicalexchange.com



Varicose veins of abdomen and leg ulcer

This patient presented to The Whiteley Clinic this week. He is in his 60s and has a leg ulcer of the right ankle.
Leg ulcer of right leg (covered by clear dressing)
As a child, he had been given injections penicillin into his thighs at age 3 weeks. As he grew up, his legs swelled regularly and he had "fragile veins".

Examining his abdomen when standing, he showed varicose veins of his right lower abdomen running from groin to flank.

Varicose veins of patients left lower abdomen groin up to the flank
This is a rare pattern of varicose veins seen when the veins deep in the pelvis have been blocked for a very long time.

For more pictures and discussion about this case, see: www.CollegeofPhlebology.com

Thursday 3 May 2012

Whiteley Clinic - 9th Fastest Growing UK Health Company

The Whiteley Clinic - 9th Fastest Growing UK Health Company
This month, the Plimsoll "UK Private Hospitals and Clinics Industry - Individual Company Analysis" was published.
The Plimsoll analysis compared the 261 UK Private Hospitals, Clinics and Health Companies.
We are delighted that The Whiteley Clinic came out as 9th fastest growing of these UK companies - and was listed as 22nd best trading partner.