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TO FIND A VEIN SPECIALIST NEAR YOU, VISIT VEINSonline.COM To make an appointment with Mr Braithwaite, Consultant Vascular Surgeon in Nottingham click here
What happens when I see Mr Braithwaite as an NHS or Private patient? You may have to wait for an appointment but when you see Mr Braithwaite, he will probably ask you questions about your veins and how they affect you. In addition he may ask about your past medical history and any medicines that you take regularly. Mr Braithwaite will then want to examine your legs so it is probably best to go to the appointment in loose clothing that can be easily removed . You will be asked to stand up so that Mr Braithwaite can see the arrangement of veins in your leg. He may ask you to lie on the examination couch so that he can examine the veins with an ultrasound machine. During this examination some special jelly will be put on your leg and a small pencil shaped Doppler probe will be used to listen to the blood flow in the veins. The purpose of the examination is to identify which veins in your legs are broken. Will I Have any other tests? Mr Braithwaite may arrange blood tests or ones to check your heart and lungs but these are rarely required. You may have to have a sophisticated vein scan called a Duplex scan if the pattern of your vein disease needs further assessment. What happens next? Mr Braithwaite will discuss with you the various options for treatment. It is possible that he will recommend that you do not need any treatment. He may suggest that you wear special stockings called compression hosiery. If so, he will give you a prescription. If you are an NHS patient, you will need to visit the appliance department to make an appointment to be fitted for the stockings. If you are eligible, you will have to pay a prescription charge for the stockings. If you are seen as a private patient, it may be possible to have the stockings delivered by post after Mr Braithwaite has measured your legs.
Mr Braithwaite may recommend an operation to treat your veins. There are several options. For most people the operation can be done as a daycase. You will need a general anaesthetic for this operation so Mr Braithwaite will have discussed this with you at the time of your appointment. Before the operation, Mr Braithwaite will discuss the operation again with you and then ask you to sign a consent form. He will then ask you to stand up so that he can mark where your veins are with a marker pen. This is so that they can be seen when you are lying down. Types of treatments that Mr Braithwaite might recommend: Short Saphenous ligation and strip
Will I need to have any stitches removed? The cuts will be sewn together with dissolving stitches and your leg will be bandaged up. If you have VNUS there may be no cuts at all. If you have a daycase operation, you can go home a few hours after the operation. Where will my operation be done as a daycase? If you are an NHS patient you will be sent an appointment by the City Hospital in Nottingham to attend a pre-assessment clinic. At this appointment you will meet a nurse from the department who will discuss what happens when you are admitted. About two weeks after the appointment, you will have your operation. Mr Braithwaite personally does 95% of the operations. Occasionally, one of the other specialist Vascular Surgeons will do your operation. Very occasionally, one of the registrars will do your operation. Mr Braithwaite will only ask a registrar to do your operation if he would be happy to have them do the operation on him. If you are a Private patient then your operation will be done at the Park Hospital or Nottingham Nuffield. Mr Braithwaite usually arranges any tests when he first discusses your operation. He will see you on the day of the operation when he will ask you to sign a consent form and will mark your legs. I am an NHS patient, how long will I wait? We do not want you to wait more than 6 months for your operation. If it cannot be done at the City Hospital or QMC within that time, you may be offered an operation at another hospital. IMPORTANT NOTE: If you do not have your operation at the City Hospital or QMC, the Government agency who pays for your operation may ask a surgeon you have not met to do your operation. In addition, the surgeon may not be an NHS consultant. You may therefore not have the operation that Mr Braithwaite had originally planned for you. If you are concerned about this, please ask the hospital that writes to you to explain who will do your operation. If you have any questions, do not hesitate to contact Mr Braithwaite. What happens if I need to stay overnight? Mr Braithwaite may ask you to stay in hospital overnight after your operation. This happens if you have complex veins, perhaps with an operation on both legs and if you have already had vein surgery in the past. If you cannot be looked after by a friend or family at home or if you are medically unsuitable for daycase surgery then you will need to stay overnight. If you are an NHS patient, Mr Braithwaite will arrange your admission to Queens Medical Centre. You will be seen in a pre-admissions clinic at the QMC about two weeks before your operation. At this appointment you will meet a nurse from the department who will discuss what happens when you are admitted. About two weeks after the appointment, you will have your operation. Mr Braithwaite personally does 95% of the operations. Occasionally, one of the other specialist Vascular Surgeons will do your operation. Very occasionally, one of the registrars will do your operation. Mr Braithwaite will only ask a registrar to do your operation if he would be happy to have them do the operation on him. If you are a Private patient then your operation will be done at the Park Hospital or Nottingham Nuffield. Mr Braithwaite usually arranges any tests when he first discusses your operation. He will see you on the day of the operation when he will ask you to sign a consent form and will mark your legs. What happens after the operation? After you wake up, you will notice your legs have been bandaged. The bandages are usually left on until the day after your operation. They are then removed by either a district nurse who comes to visit you at home if your operation was a daycase or by a ward nurse. You may have a shower or bath and new dressings may need to be put on the leg wounds. Afterwards, Mr Braithwaite advises that you wear a surgical support stocking for two weeks. Night and day for the first week and just during the day for the second. You can still bathe. Most people find that the stockings help with the discomfort in the legs after the operation. When can I get back to normal activities? This depends on you. 'If it hurts do not do it' is the best advice. You will have had an operation so Mr Braithwaite suggests you do not drive for 24 hours after your operation. Otherwise you can do anything you want. Your legs may ache for up to four weeks after the operation. Do I need to take time off work? This depends on your circumstances. It is probably best to book two weeks off work. Some people feel happy to work the day after the operation, others find it takes longer to get better. You are the best judge. People who are treated by VNUS can usually return to normal activities a day or two after the operation. What happens to my legs after the operation? You should be able to walk around normally after your operation. The blood in your legs will find a new way to flow through veins that are not diseased. Your thigh may feel stiff and sensitive. In addition you could get a large bruise in your thigh. This happens because of bleeding into the tissues after the operation has finished. The bleeding occurs because the long saphenous vein (A road) has been removed but there is still a space for the blood to leak into. This type of bruising is rare if you have VNUS. Within 6 weeks the bruising disappears but there are occasionally one or two hard lumps where the veins were. These lumps are old blood and they will soften and disappear. The lumpiness is the most common cause for concern after the operation. Do not worry, the lumps disappear with time. The thigh bruising does not normally happen if the VNUS or Venocuff techniques are used and appears to be less frequent with TRIVEX. Most people find that any discomfort goes by taking simple pain killers like paracetamol or ibuprofen. Will I see the Surgeon after the operation? Mr Braithwaite invites all of his patients for at least one follow up appointment. This is so that he or one of the nurse practitioners that work with him can check on the operation. This is the time to discuss how your operation has gone and to obtain your opinion on the results of surgery. Are there any side effects or complications with varicose vein surgery? Problems can occur after any operation but Mr Braithwaite takes great care to reduce the chance of any of them. In some people their can be side effects, most of which are temporary: Infection. Any cut can get infected. This happens in about 3 in every 100 operations, If you have an infection, the wound, usually the one in the groin, will become red and painful. If this happens, you should consult your GP. Bruising. Veins are filled with blood. When removed some blood leaks into the space where the veins have been removed, causing a haematoma. With time the haematoma disappears but your legs can turn some different colours in the meantime. Do not worry, your body will get rid of the bruise. Hard lumps where the veins were Occasionally one or two hard lumps remain where the veins were on the leg. These lumps are blood that has clotted under the skin. They are a bit like a blood blister. The lumps will not travel to any other part of the body and they will soften and disappear. The lumpiness is the most common cause for concern after the operation. Do not worry, the lumps disappear with time. Numbness Small nerves that allow you to feel you leg being touched can get damaged in the operation. This numbness can happen in about 1 in 10 operations but most people find it is not a problem. In time, the numbness goes as new nerves grow to replace the old ones. If you have a cut behind your knee, there is a small chance that a nerve called the sural nerve gets damaged. If this happens you will notice numbness on the little toe side of your foot. It is a strange feeling that gets better with time. Recurrence Varicose veins can be thought of like hair. They grow back. In some people veins come back or appear in new areas. If the long saphenous vein is removed, recurrence does not normally occur for over 5 years. If it is not removed, the veins can come back more quickly. For more information on recurrent varicose veins click here. Swollen ankles If your groin has been cut, the inflammation can reduce the flow of fluid called lymph through your lymphatics and glands. If this happens, your ankle or leg can become swollen if you stand for long periods. Swelling can also happen if you wear tight clothing on your legs. As the body heals, any swelling should disappear. Residual veins In some people (about 1 in 100 of Mr Braithwaite's patients), particularly those with multiple veins, one or two are left untreated. If these residual veins trouble you, then there are treatments that may help. Spider veins Some people develop tiny veins at the site of their avulsion scars. This does not happen to everyone and it is not known why spider veins appear. Tattooing Anything on the skin at the time of the operation can be pushed under the skin to cause a tattoo. Mr Braithwaite, normally does not cut the skin exactly where he marks someone's leg so he has not yet seen tattooing in anyone he has treated. Seroma If there has been some bleeding after the operation, a small blood clot under the skin called a haematoma can form. This usually goes away on its own. If the haematoma is over the shin bone, a lump may appear. The lump is often filled with clear fluid and is caused a seroma. If it occurs, it can be treated by taking the fluid away in the clinic using a small needle. Muscle or calf pain If one of the veins that has been removed continues to bleed after the operation, there can be bleeding into the muscle of the leg. This happens very rarely but if it does, it may be painful to walk. If the pain is in the calf it is best to check with your GP or specialist, to ensure that the pain is not from a Deep Vein Thrombosis. Skin staining In some people, the skin can still be dark in colour several months after surgery. Rarely it can be permanent. The staining occurs because some people's bodies do not remove all of the bruise that can happen after the operation. This leaves some of the colouring of blood (iron) under the skin. If this happens, the skin colour can change with exercise. There is little that can be done if this problem occurs but it is a rare complication. Most people (98%) are happy with the results of their varicose vein surgery. If you have any questions, write them on a piece of paper and bring them with you to your next meeting with Mr Braithwaite or your specialist. If you would like to see Mr Braithwaite as a Private Patient, please contact him at either the Park Hospital or Nottingham Nuffield.
TO FIND A VEIN SPECIALIST NEAR YOU, VISIT VEINSonline.COM
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