We ask Mr. JK Wicks, one of Specialist Vein Health’s vascular surgeons to explain in his own words what the paradigm shift if varicose veins treatment means to patients.
There is a paradigm shift in vein treatment that has happened over the last decade. I’m not really a writer or a blogger but I feel this needs to be shouted from the rooftops.
Veins! “Veins are boring aren’t they? They’re just veins right? Don’t worry about them? They don’t cause you any bother do they? They are just cosmetic? The fix is worse than the problem isn’t it? You’re a veins surgeon Kes you think they should all be fixed.” That’s what I’ve heard many times from people including doctor friends and acquaintances. The last comment was the most recent one from a GP friend of mine said to me to insinuate that somehow doing veins is only performed so that Vein Surgeons can pay for the new bach or boat and that somehow veins are just cosmetic and never really cause serious problems.
Well let me tell you a story of a patient that I recently dealt with in my public practice. Let’s call him Mr SOS. His history is one of an athlete that in his teens and early twenties held Wellington records for both track and field. As he got older however, he became increasingly busy with his family and work. He was a landscaper and remained active but was overweight. About two years before he came to clinic, he noticed that his legs would swell by the end of the day and be painful. But what was more alarming was that he noticed the skin around his calves was discoloured with brownish pigment and quite thickened. He saw his GP but was reassured. “You probably have some veins but if they are not bothering you too much don’t worry. You don’t need to get anything done.” He carried on and didn’t worry. Things slowly got worse and then he got an infection after a minor trauma to his left leg. This settled with some antibiotics and he was told it’s probably just veins and the fix is worse than the problem. So he did, he carried on. Mr SOS is Samoan but born in Wellington married to a Pakeha. They have lovely family and they decided to go on family holiday to Samoa. While there he again had another infection which was poorly dealt with and when he returned to NZ he had to be admitted to hospital for cellulitis and had severe sepsis. He was in hospital for two weeks. He had a small area of breakdown of the skin around the inside of his left calf but this was small and the infection settled while in hospital. The physicians did not refer him to me at that time. He was told to follow-up with his GP. He did and he was again reassured. His skin had healed and he was back at work in his landscaping business. He waited another six months by which time he noticed his leg had become grossly swollen and the skin around his calf had broken down severely. The District Nurses were called in to help with dressings and it was the District Nurses that referred Mr SOS to my clinic on the insistence of his wife.
When I saw Mr SOS in my clinic he had a venous ulcer with a lymphangitic left leg with permanently damaged skin secondary to venous hypertension and lipodermatosclerosis. None of which is reversible with a vein procedure. I knew that I could get his ulcer healed and decrease recurrence by putting him immediately into compression bandaging and by treating his veins. Prior to this he had never been given compression stockings or been told that there was a vein procedure. This man is now 40 years old with a permanently disability. His left leg will never be normal again despite appropriate treatment. To cap this story off he had been paying for his private insurance for the last 20 years and had never used it for anything. If you find this story unbelievable well so do I but it’s a true story and one of many I see weekly.
The problem is that we have to stop saying veins are just cosmetic, its just veins don’t worry, they don’t cause bother, the fix is worse than the problem. Varicose veins or venous reflux can have significant and severe consequences. They aren’t just cosmetic really until they’ve formally been assessed. We as doctors cannot predict when and who will go down the severe route of venous hypertension, pigmentation and lipodermatosclerosis and venous ulcers. Newer endovenous treatments under local anaesthetic are uncomplicated minor procedures that can have huge benefits towards the prevention of ongoing reflux sequelae. These treatments are a world away from open varicose veins treatment that are complicated, require GA and immobilize patients for sometimes weeks.
My question to everyone as a Vascular Surgeon and yes as a veins expert is why would you not get assessed at very least? Why wait until you have an SOS. The problem will always get worse and the fix is not bad at all. This is a monumental paradigm shift.