Deep Vein Thrombosis (also known as DVT) occurs when a blood clot is formed in a vein deep inside the body.  It is a common medical condition that is under-diagnosed.

According to a research done by the American Public Health Association (APHA) in 2003, almost three-quarter (74 percent) of American adults have little or no awareness of DVT; among those who are aware of such condition, more than half (57 percent) were unable to identify any common risk factors or pre-existing conditions that could lead to the development of DVT. In general, 95 percent of the respondents expressed that their doctors never discussed about this medical condition with them.

DVT, if left unnoticed and untreated, can be fatal. The blood clot can break off in the travel in the bloodstream to the arteries in the lungs and block off blood circulation, causing damage to the lungs and other organs.

WHO IS AT RISK?

The risk of getting DVT is subjected to three main factors:

1. Inactivity/Prolonged Immobility – People who are undergoing operations, long recovery time after operations or from fractures, long haul flights or having lifestyles that do not have much leg activity. Stagnant blood in the veins will tend to form clots.
2. Clotting factor disorder – People who are born with thicker blood (which tends to clot easily) or people who are under medications such as contraceptive.
3. Damaged veins

Anyone who falls under any of these three categories could be at risk of DVT.

SYMPTOMS OF DVT

If your leg suddenly becomes swollen or experience pain in your calves, please consult your doctor immediately.

DVT PREVENTION AND TREATMENT

There are several ways to prevent DVT:

1. Wear compression stockings whenever you are undergoing long hours of inactivity or taking a flight that is more than 3 hours.
2. If you have suffered from DVT before, do consult your doctor and get yourself an anticoagulant medication before you embark on your flight.

If you suspect that you are in risk of DVT, you can always come to The Vein Clinic and arrange for a DVT scan with Dr. John Tan. The 15-30mins scan is all it takes to find out if you are at risk.

Also, if you tend to travel a lot, investing in a good pair of compression stockings can play a big part in DVT prevention. Compression stockings and anticoagulant medications can be purchased from The Vein Clinic upon your consultation with Dr. John Tan.

by Lorinda
Staff of THE VEIN CLINIC & SURGERY

References:

American Public Health Association (2003) “DEEP-VEIN THROMBOSIS: ADVANCING AWARENESS TO PROTECT PATIENT LIVES” Published in 26 February 2003
Retrieved from http://www.apha.org/NR/rdonlyres/A209F84A-7C0E-4761-9ECF-61D22E1E11F7/0/DVT_White_Paper.pdf on 5 April 2012

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All you need to know about Sclerotherapy! Final Instalment!

Q: If my compression stockings get stained by blood, what should I do?

If your compression stocking gets stained, you can simply soak them in water or detergent then hand-wash and air dry them. Please do not place them into the washing machine and put them under direct sunlight.

Q: Is there anything that I need to pay attention to, when wearing the compression stockings?

Firstly, the compression stockings are of a different type and class from the usual ones, hence it may be difficult to apply for someone who’s wearing them the first time. As you are applying the compression stockings, do make sure that you are not pulling them by your nails because they can tear/run. Pull up the stocking bit by bit and do not let multiple layers rest on one part of the leg, because it will be harder to pull them up. Also, the compression will be concentrated on that certain portion of the leg, which can sometimes make you feel uncomfortable.

When applying the compression stockings, look out for heel portion of the stockings (They look exactly like socks.), and make sure that you secure the heel portion to your heel first before pulling the rest of the stockings up your leg.

Some patients are allergic to the silicon pieces at the top of the compression stockings. Those silicon pieces are there to ensure that the compression stockings don’t slip down when you’re walking or going on your daily activities. However, if you find rashes, swelling and redness at around that area, you are probably allergic to the silicon material. To ease the allergic reaction you could choose to fold down the top area of the compression stockings or try wearing the compression stockings inside out.

Q: I see this little bump a few days after the sclerotherapy injection session. It feels a little hard and uncomfortable. What’s going on?

This bump is probably a result of blood-trapping in the treated veins. For some reason the compression stockings didn’t manage to compress the treated vein well enough that blood managed to go into these dead veins and they become trapped inside because the vein is no longer functioning. Do not be alarmed, your body will eventually absorb the blood back into the body.

Alternatively, you can speed up this recovery process. You can come back to the Vein Clinic and let Dr. John Tan do a DRAINAGE session for you after 1 month. He will use a slightly bigger needle to draw out the trapped blood within your dead veins.

by Lorinda
Staff of THE VEIN CLINIC & SURGERY

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• Do you have big, bulgy and ugly veins on your legs?
• Are the spider veins on your legs causing you distress?
• Do you often experience aches, tiredness and cramps on your legs?

√ No Surgery          √ No Hospitalisation

√ No Scars             √No General Anaesthesia

We have Good News for you

We are now able to remove varicose veins without any open surgery through the use of Endovenous Laser Treatment.

This method involves inserting a fine wire into the varicose veins and sealing them with laser pulses without any cuts. The 20-30 minutes procedure can be done under local anaesthesia without the need for hospitalization. Once the wound heals, there will be no visible scars.

Join us at this talk and find out how you can get your varicose veins treated without surgery and how you can get rid of your spider veins through micro-sclerotherapy!

Speaker: Dr. John Tan
Forum Date: 24th March 2012
Time: 2pm (Registration and Attendance starts at 1:30pm)
Venue: The Vein Clinic (290 Orchard Road, #11-08 Paragon- Please take the lift at TOWER LIFT LOBBY 2)
Registration Fee: $10/person (Payment to be made on the day of event, refreshments are included.)

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All you need to know about Sclerotherapy! Part III!

Q: When can I take a bath?
You can take a shower after the sclerotherapy procedure, but do remember to put the compression stockings back on immediately after that. If you experience difficulty wearing the compression stockings, you may choose to take a bath before coming for the procedure, or you can wait till 48 hours later to take them off and shower.

Q: Can I go overseas after the sclerotherapy treatment?

Usually, Dr John Tan would advise patients to refrain from travelling in long haul flights for 1 week after the injection, because of the risk of Deep Vein Thrombosis (DVT).In any case in which you really need to travel long distance, Dr. John Tan could prescribe you an anti-coagulant medicine/ injection to reduce your chances of getting a DVT.However, if your treated veins are all fairly small, you could choose to wear the compression stockings when you are on the plane. If your flight is around 1-2 hours, then there’s no need to be concerned because the DVT risk is so small. If you are still unsure, you can discuss this further with Dr. John Tan.

Q: Can I go Sun tanning or massaging after the sclerotherapy treatment?

Refrain from going under sun to tan or massaging the treated areas for 1 week. After 1 week, you can resume your massaging/ sun tanning activities.

Q: Will the veins come back?

For the veins that Dr. John Tan has treated with injection sclerotherapy, they will not recur. However, new spider veins may be visible if you continue living a lifestyle that stresses your veins (e.g. standing or sitting for long time/ holding a profession that requires you to do so, taking long haul flights regularly or pregnancy.)

Q: Can I drink alcohol after the injection sclerotherapy?

Dr. John Tan would discourage alcohol consumption as a precautionary measure, though alcohol does not have direct effect to the sclerotherapy treatment. Dr. Tan would advise patients best to stay off alcohol on the procedure day.

To be Continued…

by Lorinda
Staff of THE VEIN CLINIC & SURGERY

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All you need to know about Sclerotherapy! Part II

Q: Is there anything that I need to prepare for the procedure, like fasting and all?
The sclerotherapy procedure does not require any prior preparation. However, if you have a pair of compression stockings at home or you have previously gone through similarly procedures in the vein clinic, you are required to bring the compression stockings along. You may also want to consider bringing a pair of comfortable shorts to change; the Vein Clinic will provide patient gowns and skirts if you don’t have any.

Q: What happens during the injection?
Before you start on the sclerotherapy process, Dr. John Tan will go through the sclerotherapy consent form with you, so that you will know what to expect out of the sclerotherapy procedure as well as after the injections.

After giving your consent, Dr. John will then prepare the medicine for injection. The injection process is as follow:

1. Dr. John Tan will use a special device called the “Veinlite” to locate the ugly bluish-green veins and inject them first. Those veins are normally the “feeder” veins for the smaller and more prominent spider veins, which are purple and red in colour. Killing off the feeder vein will ensure that the veins that the smaller veins will not recur after they are injected.
2. Then Dr. John Tan will then go on to inject the red and purple spider veins. This process will repeat about 4 times for each side of the leg.
3. After the injections, you will start wearing the compression stockings.

Q: How long do I have to wear the stockings?
After the sclerotherapy procedure, you are required to wear your compression stockings for 5 days – on the day you finished the sclerotherapy procedure, you are required to keep the stockings on for 24 hours. The second day onwards, you can take the compression stockings off at night when you sleep, and only put them on during the day.

To be Continued…

by Lorinda
Staff of THE VEIN CLINIC & SURGERY

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All you need to know about Sclerotherapy!

Sclerotherapy is a treatment used widely by vascular surgeons/consultants as well as vein clinics. A sclerosing solution (a type of medicine that will irritate the walls of the veins) will be injected into unsightly spider and reticular veins, causing them dissolve/die off as the body slowly absorbs them back. Don’t be alarmed, all you’ll see on the surface is just slight redness and swelling like mild mosquito bites, maybe a little stingy and itchy feeling after the procedure; but they will go away within several weeks.

Before you decide that this is THE treatment for your veins, make sure you have arranged for an ultrasound assessment with Dr. John Tan to see that there is no deeper vein problem involved. Treating the spider veins alone will not be effective if you have an internal vein problem. Hence it’s best to do a thorough check before making the decision for your treatment options.

Q: Injections?! Are they going to be painful?

The injection needles are extremely small, so they shouldn’t be more painful than a small ant bite. However, on areas which are more sensitive, e.g. the ankle area, knee area or the area at the back of the leg, the injection pain may be more significant. If you have a low threshold for pain, you are advised to take some painkillers an hour before the procedure. It is also important that your body remains still during the procedure as any movement from your body can cause the injection needle to miss injecting into the right veins.

Q: What happens to those ugly spider veins?
The sclerosing solution that was injected into the thread-like veins will irritate them, causing inflammation. The effect of the sclerosing solution will also cause the walls of the ugly spider veins to breakdown and dissolve; those veins will die off and thereafter be absorbed back into the body.

Q: Is killing off the ugly veins unhealthy for the body?
Nope! As much as your veins might not be as bad as those bulging ones, some of them can be appear to be quite ugly and painful. Those veins are reticular veins (which appear to be blue and greenish in colour) and spider veins (which are usually reddish and purplish in colour) and they do cause aching, cramps, tired legs and other symptoms for some patients. These unhealthy veins are no longer useful for the body because their dysfunctional valves limit blood circulation. It is indeed an irony that though you might have one vein (or a few veins) lesser, your blood circulation is actually better because the blood in your body will go to other functional veins and serve their purpose.

To be Continued…

by Lorinda
Staff of THE VEIN CLINIC & SURGERY

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Your complete guide to post- EVLT/ EndoVenous Laser Treatment Care! Part III

Cleaning of wounds

• AFTER 48 HOURS, when your dressings are removed, you may shower/bathe.
• DO wash your wounds with warm soapy water once a day and gently pat dry. You can leave them open to air.
• DO NOT apply any lotions, ointments or creams to your needle wounds unless otherwise advised by Dr. John Tan.

Driving

• DO NOT drive within the first 24 hours after your EVLT/ Endovenous laser treatment as the administered medications before the surgery may cause drowsiness and impair reflexes. Avoid driving if you are required to take the prescribed narcotic pain medication at home.

Work

• You may return to work as soon as 1-3 days after your EVLT/ Endovenous laser treatment procedure, depending on how you feel. Usually, most patients only require a day off from work, however, you can request for up to 3 weeks of medical leave if you desire.

Positioning

• You can lay flat/ on your stomach/ on your side, just make sure that your legs are straightened out and elevated whenever possible.

Medications

• DO resume your usual medications immediately
• DO take an anti-inflammatory medicine if you feel significant pain
• DO NOT use a heating pad, an electric blanket on high power, or soak in a hot tub or steaming hot bath for 2 WEEKS unless otherwise advised, as the heat from these products or activities can dilate the vein and re-open it.
• You may apply ice pack to your groin and inner thigh area or calf area on top of your stockings/bandage for the first 24 hours (15 – 20 minutes on: 2 hours off)

Others

• If you notice some bleeding from your incision, do not be alarmed as bleeding is likely to occur on the day of your procedure, especially after you have done your walking.

by Lorinda
Staff of THE VEIN CLINIC & SURGERY

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Your complete guide to post- EVLT/ EndoVenous Laser Treatment Care! Part II

Now, for the Do’s and Don’ts for your daily activities and the removal of dressings:

Daily Activities

• DO walk as much as possible right after the procedure. You are advised to walk a minimum of THREE times a day for at least TWENTY minutes over the first THREE days. From day four through seven, you are advised to increase the frequency of your daily walk from THREE times to FOUR times.
• DO NOT attempt vigorous exercise such as running, jumping, high impact aerobics or lifting of weight greater than 30 pounds for TEN to SIXTEEN days. You may use a treadmill, stair climber or a stationary bike; however, avoid putting any resistance on the equipment.
• DO NOT SIT or STAND for too long without wearing your compression stockings. If you are taking long haul flights, wear your compression stockings and DO ankle flexes to work on the calf muscles and assist in blood return (venous circulation) in your legs.

Removal of Bandages and Stockings

• DO WEAR THE STOCKINGS AND BANDAGES CONTINUOUSLY FOR 24 HOURS AFTER EVLT/ ENDOVENOUS LASER TREATMENT
  • You can remove your outer bandage AFTER 24 HOURS. Keep your compression stockings on.
  • You can pull down your compressions stockings and remove the dressing/s AFTER 48 HOURS. Thereafter you may remove your compression stockings to shower and sleep each night, however, the stockings must be worn back immediately for the rest of the day. You may opt to leave your compression stockings on while showering or sleeping if you experience difficulty re-applying them.
  • DO WEAR YOUR STOCKINGS FOR A TOTAL OF 7 DAYS (From the day of surgery)
    • If you choose to remove your compression stockings during shower or sleep, you can get another person to help you.
    • If you choose to shower with your compression stockings on, you can use a trash bag and secure it with tapes. In the event when your stockings get wet, you may use a hairdryer to dry them.
    • You can consider wearing a pair of rubber gloves while applying your stockings. Rubber gloves help provide a better grip and prevent “runs” and tears on your compression stockings.
    • You can continue wearing your compression stockings after 7 days. You are encouraged to wear the compression stockings regularly if you are in a profession that requires you to stand or sit for long periods of time. Compression stockings will be able to provide support for your leg and help reduce discomfort.  

To be Continued…

by Lorinda
Staff of THE VEIN CLINIC & SURGERY

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Your complete guide to post- EVLT/ EndoVenous Laser Treatment Care! Part I

You have now completed the Endovenous Laser treatment surgery; there are some things that you need to expect during the course of recovery, as well as the Do’s and Don’ts. Don’t worry; we’ll go through one by one.

Firstly, what should you expect after your EVLT surgery? Some of these have been explained to you via the consent and marking session with Dr. John Tan, so you’ll find them familiar:

1)     You may experience certain pain such as aching & burning pain, along with some tightness around the treated areas after the local anaesthesia wears off.

2)    You may experience considerable amount of bruising around the groin medial thigh and upper calf area. The bruising is only temporary and will be expected to clear in 7-14 days’ time.

3)    You may experience swelling in some of the treated areas. Swelling usually occurs immediately after the surgery and may last from several days to several weeks. Taking anti-inflammatory medicine such as Daflon will help to ease the swelling and lowers the risk of developing Phlebitis (inflammation of the vein).

4)    If you may feel a hard cord extending in the following areas:

1. Your groin area if you had an EVLT/ Endovenous Laser treatment of your Great Saphenous Vein (GSV)
2. Your posterior calf if you had an EVLT/ Endovenous Laser treatment of your Small Saphenous Vein (SSV)

These areas may be tender to touch and you may feel a tight or pulling sensation when you wake up in the morning or during periods of inactivity throughout the day. This is temporary as the discomforts will resolved over the next several weeks to months. Walking is encouraged as it can help decrease these discomforts.

5)    You may still see some varicose veins after the EVLT/ Endovenous Laser treatment procedure. This is normal as they will take some time to fade.

To be Continued…

by Lorinda
Staff of THE VEIN CLINIC & SURGERY

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Your complete guide to EVLT/ EndoVenous Laser Treatment procedures! Part II

Part 2 starts on the day of surgery, if you have missed out on part one of the guide, click here: How to prepare for Endovenous Laser Treatment

Day of Procedure

You are required to be at The Vein Clinic an hour before your scheduled EndoVenous Laser Treatment so that Dr John Tan can do some marking on your legs to locate the varicose veins as well as to go through the treatment consents with you.

Marking of Veins

• You will first be directed to the ultrasound room where you will be seated on the treatment couch with your legs rested on the footstool. (In the exact same fashion you did for the ultrasound scan) Dr John Tan will use a device called the “Veinlite” to locate your bulging varicose veins, in which he will be treating with Needle Avulsion (also known as Needle Phlebectomy). Your veins will become more prominent when you are standing or sitting and less visible when you’re lying down because of the effect of gravity, hence it is important to mark out the varicose veins before surgery so that Dr John Tan can locate them and effectively administer the treatment during surgery.
• After marking your bulging varicose veins, Dr John Tan will move on to mark the deeper varicose vein/s that are to be treated with Endovenous Laser. Dr John Tan will use the ultrasound machine to locate the “leaking veins” and in the same fashion, mark the varicose vein/s that he will be treating.

Consent

• As part of the consent, Dr John Tan will be going through the treatment options as well as their pros and cons with you:
  • Local Anaesthetic: By injecting an anaesthetic agent into the skin layer of the leg, patients will be able to go through the surgery in a conscious state. Patients will only have to endure the initial needle pain for the anaesthetic, after the numbness takes over, they will not feel any more pain. Depending on how extensive the treatment will be, multiple injections might be needed.
  • Sedation: Patients who are afraid of needle pains can choose this option; they can sleep through the procedure instead. However, as safe as sedation can be, it adds risks to the procedure. Such risks include allergic reactions to the sedative medication and in very rare cases, respiratory depression – which is more common with patients who are more advanced in age. To prevent the occurrence of respiratory depression, your blood pressure, heart rate and breathing will be constantly monitored throughout the surgery.

Dr John Tan will be going through the Endovenous Laser Treatment and sedation consent in further detail with you.

After you have given your consent, your blood pressure and pulse rate will be taken. If you do not have a pair of compression stockings, the vein clinic will be measuring a pair for you. You will be briefed about post-treatment care and undergo financial counselling and billing before the procedure begins.

To be continued…

by Lorinda
Staff of THE VEIN CLINIC & SURGERY

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