The VeinCare Centre clinic brochure August 2014

www.theveincarecentre.co.uk 0800 698 3467

A Clinic dedicated to the Care of all Vein Conditions Using the Latest Diagnostic & Treatment Methods

Vein conditions are common and distressing with approximately 40% of adults currently troubled by vari-cose veins and thread veins. Not only do they cause significant dis-comfort and embarrassment, vari-cose veins can be complicated by varicose eczema, bleeding, leg ul-ceration and phlebitis. Unfortunately such vein conditions are not a priority in the NHS. You can now have access to high quality advice and treatment in one clinic. The VeinCare Centre specialises in the treatment of varicose veins and thread veins at clinics across south-west England. All of our vein treat-ments are performed by our experi-enced consultant vascular surgeons under local anaesthetic as a walk in, walk out procedure.

Dr Haroun Gajraj, FRCS Consultant Vascular Specialist

The VeinCare Centre The Melbury Clinic Higher Barn, Holt Mill Dorset DT2 0XL

Innovation in Vein Care

Laser Treatment EVL

VNUS ClosureFAST

Foam Sclerotherapy

Venaseal™ (Superglue)

Treatments carried out under ultrasound

guidance

One stop consultation and duplex scan

Microsclerotherapy for thread veins

Advice on DVT prevention

Medical Compression hosiery

All Assessments based on comprehensive

venous duplex ultrasound scan

A Completely New Approach to the Treatment of Vein Conditions


Dr Haroun Gajraj FRCS

Founder of The VeinCare Centre

“I have over 25 years’ experience treating people with varicose veins, thread veins and other vein complications such as phlebi-tis, varicose eczema and varicose ulcers. After 13 years as a con-sultant in the NHS, I now special-ise exclusively in providing the latest treatments for these very common problems privately.

Training and Experience Medical Graduate of Kings College Hospital, University of London Specialist Vascular Surgery training at St Thomas’s hospital and

St George’s hospital in London Fellow of the Royal College of Surgeons of England Member of the Vascular Society of Great Britain and Ireland Member of the Royal Society of Medicine and Venous Forum Member of the American College of Phlebology Founding member of the British Association of Sclerotherapists Director of VeinCare Training Director of The Melbury Clinic Previously Consultant Vascular Surgeon in the NHS for 13 years Previously Clinical Director of Surgery at Yeovil District Hospital

and Surgical Tutor Royal College of Surgeons of England

I founded The VeinCare Centre to provide the latest treatment options and the highest standard of care”.


Jane Gajraj

Jane is Co-Director of the Clinic

Additionally, she works as a Counsellor. She graduated from BCPC with a Diploma in Humanistic and Integrative Counselling in 2009, and became BACP Accredited in Janu-ary 2012. She now works in private practice from her home in Sherborne and also works as a Trustee and volunteer counsellor for Dorset Action on Abuse. In her spare time, she enjoys walking, going to the gym, travel and African drumming.

Ros English

Ros is the Clinic Manager

Originally trained as a nurse, I have worked in private healthcare management for more than 20 years, from the opening of the private ward at Yeovil District Hospital which I ran for 10 years before moving to the private ward at Musgrove Park Hospital in Taunton. Helping to establish and develop The Melbury Clinic & VeinCare Centre has been an enormous pleasure and learning experience. We have always aimed to offer all -round high quality treatment and service to our patients, and I am proud that the clinic has progressed to be the centre of excellence for varicose vein treatments that it is today.

Tina McLean

Tina is the Office Secretary and Administrator

After completing a bi-lingual secretarial course at SCAT in Taunton, Tina worked prin-cipally in the customer-focused hospitality industry, mainly in London but also spend-ing some time in Germany and Australia. She returned to the West Country in 2010 and has been employed as Secretary/Administrator at the Clinic since August 2011.

Gaynor Hughes

Gaynor is a Clinic Nurse

I have been working at the Melbury Clinic since 2011. I am an experienced Registered General Nurse (RGN) & Aesthetic Nurse and my background also includes orthopaedics, ITU, pain management and oncology. As well as working as an aesthetic nurse here at the Melbury Clinic, I am part of the team who specialise in varicose veins. I aim to provide high standard of nursing care to clients having varicose vein treatments, from the first initial appointment, assisting with the procedures and through to after care. Making sure that the pathway the clients undertake throughout their treatment goes smoothly and offer advice for any queries that arise. If its information on the medical hosiery you want, I’d be happy to help by giving some expert advice about the hosiery whether you require treatment or not. As part of the service, I can offer a nurse con-sultation for those who would like further information about varicose veins which has been found useful prior to making an appointment with the vascular surgeon.

The VeinCare Centre Team


Pam North Pam is a Clinic Nurse

I am a Registered Nurse and have worked at The Melbury Clinic & VeinCare Centre since 2006. During that time I have witnessed the clinic’s transition into the specialist centre for vein treatments that it is today. I enjoy working in a small harmonious team which offers high quality care tailored to each patient’s requirements, and in a re-laxed friendly atmosphere.

Jane Pearse

Jane is the Clinic Nurse-Assistant I have worked at The Melbury Clinic as a nurse assistant since it opened 10 years ago, and I have seen it grow into a very well-established vein care centre. Our clients trav-el from far and wide. They are always very complimentary about the clinic and the services it offers, and they are delighted with the fantastic results that are achieved.

Wendy Parsons Wendy is the Clinic Vascular Technologist

I qualified as a Radiographer in 1979, then went on to specialise in Ultrasound gaining my Ultrasound qualification in 1987. Since then I have worked in the NHS performing a wide range of ultrasound examinations. I have worked with Haroun since 2001 helping him develop the vein treatments he now provides here at the Melbury clinic. I now run diagnostic clinics for him in Poole and Bristol as well as at the Melbury, whilst continu-ing my NHS practise covering the ultrasound service in several hospitals in the area.

Amanda Evans Amanda is the Clinic Payroll Officer and Bookkeeper

I am an AAT qualified accountant who has been in this profession for 24 years, eleven of them in self-employment. I have enjoyed 10 of those years working alongside The Melbury Clinic, watching it grow from the very beginning, blossoming into the highly successful and reputable business we know now, and I enjoy working with the clinic staff very much As well as running my business, my personal interests include travel-ling, snow boarding and concerts.

Sonia Wilson Sonia is the Clinic Cleaner

Domestic Goddess – for many years I was a receptionist in a local business until I took retirement, only to be tempted back to work by The Melbury Clinic! I enjoy chatting to patients and working in this friendly atmosphere and lovely surroundings. My hob-bies include dancing and walking my springer spaniel dog.

The VeinCare Centre Team


Women tend to seek advice for their varicose veins more than men for many reasons: They are more concerned about the cosmetic

appearance Women tend to access health advice more than

men for a whole range of health issues Women tend to visit their GP more often for

other reasons such as family planning and to accompany children

This has led some to believe incorrectly that vari-cose veins are more common in women than men. In fact some studies have suggested the opposite -that varicose veins may actually be more common in men than women

What causes varicose Veins? No-one knows for sure, but varicose veins are probably due to a failure of the valves that pre-vent the down flow of blood in the wrong direc-tion. Normally, the flow of blood in the veins is towards the heart and in the legs the flow is from the feet upwards. Abnormal down flow is called reflux and this leads to varicose veins. Im-portant factors are:

Heredity

Pregnancy

Overweight

Lack of exercise

Smoking

Unhealthy lifestyle

Standing for long periods

Varicose Veins


What do veins do? There are two sets of veins in the leg. A deep set within the muscles and a su-perficial set just underneath the skin. Veins carry blood back from the leg to-wards the heart and most of the blood (more than 95%) is carried back in the deep system. Very little blood is actual-ly carried back in the superficial veins. The small amount of blood that is car-ried up by these veins finally enters the deep system at certain points called perforators. The most important drain-age points are in the groin and behind the knee. As the muscles of the legs contract, the deep veins are squeezed and blood is pushed up against gravity towards the heart. When the muscles relax, the blood is prevented from coming back down the leg towards the feet by the closure of valves, which are delicate folds of the lining of the veins. The combined action of the muscles con-tracting and the valve shutting keeps blood moving in the correct direction. If the valves are not working properly, blood may spill down in the wrong di-rection (called reflux), filling the super-ficial veins and causing varicose veins. An ultrasound scan is very important in identifying the exact position of the faulty valves.

We believe that all vein assessments and treatments should be based on duplex ultrasound.


Are Varicose Veins Simply Cosmetic? The majority of people with varicose veins come to no harm at all. Even those people who have ache, discomfort and swelling are un-likely to develop serious complications. For this reason, many doc-tors believe that varicose veins are not important. Indeed, the treatment of varicose veins is not a priority in the NHS and some people are denied NHS referral and treatment. To some extent this is understandable as the NHS has many pressures requiring its valu-able resources such as the treatment of cancer, heart disease, dia-betes and care of the elderly - to name just a few. Even if your varicose veins are severe, your GP may not be able to help and may not be able to refer you for treatment. Nevertheless, varicose veins cause severe embarrassment for many, who are unable to wear shorts, go swimming or enjoy holidays on the beach. What complications can arise? Varicose veins are associated with abnormal down flow of the blood, called reflux. When this is present for a long time, the skin may be damaged and a condition called varicose eczema develops. This is a warning sign that the skin is unhealthy and vulnerable. A trivial injury can cause a leg ulcer, such as a knock from a shop-ping trolley. Although many people with varicose veins are concerned about a leg ulcer, in fact the majority will not develop this condition. If however the skin around the ankle develops any eczema-like changes, advice should be urgently sought.

DVT is a feared complication of varicose veins and although it is a risk factor, for-tunately DVT is very rare. More significant factors are admission to hospital, major surgery, previous history of DVT, family history of blood clots, long-haul flights and journeys, pregnancy and inherited blood-clotting disorders. Diagnosis can be very difficult, but swelling of one calf is suggestive. We believe that early treatment improves results In some cases, NHS treatment for varicose veins will only be available after complications have arisen. Many vein specialists believe that treatment at an earlier stage improves the cosmetic results and prevents these complications.


The four main treatment options are: VNUS Closure Fast and Endo-venous laser (EVL)- these in-

volve the use of fine catheters placed inside the vein to heat it and seal the varicose veins

Injections of solutions called sclerosants into the vein which start a healing process in which the vein shrinks and disappears

A non-thermal medical adhesive called Sapheon Venaseal™. A fine catheter is inserted into the refluxing vein and a medical "superglue" is administered inside the vein causing it to permanently close

Microsurgical removal of veins called Microphlebectomy

Few clinics are able to offer all four treatment options. At The VeinCare Centre, your needs are assessed and a tailored treatment plan is formulated for you. This may consist of more than one option to get the best result. For example a combi-nation of VNUS ClosureFast followed by injections may be appropriate for you. In such cases, the pros and cons will be discussed in detail and you will have access to all the latest treatments. At each stage you will receive written information about the recommendations including the costs and you will be given time to make your decision based upon this information.

What treatments are available for varicose veins? There isn’t yet a perfect treatment for varicose veins. A perfect treatment would remove all the varicose veins completely to give you the blemish-free legs you had when you were younger, the varicose vein would never return and there would be no side effects or complications from treatment. If the assessment is based on a comprehensive ultrasound scan and the treatment is performed under ultrasound guidance, the majority of people get an excellent result and are very pleased.


VNUS ClosureFast VNUS ClosureFast is the latest “state of the art” treatment for varicose veins. It produces rapid results and an excellent cosmetic outcome. The treatment is usually carried out un-der local anaesthetic as a day case or “walk in, walk out” procedure. This means that charges are reduced, time off work is minimal and therefore the treatment is highly cost effective. Your suitability for VNUS ClosureFast is assessed by a comprehensive ultrasound scan. After numbing the skin with local anaesthetic (similar to a dentist’s injection) and clean-ing the skin with antiseptic, a fine needle is inserted into the refluxing veins under ultra-sound guidance and then a fine catheter is passed up the vein. At all times, the exact po-sition of the catheter is monitored by ultrasound. The precision radio frequency energy (a little like microwaves) seals the vein instantly and the catheter is gently withdrawn along the length of the unhealthy vein. The whole process is checked at every stage by ultra-sound to ensure excellent results. After the procedure, a high quality medical graduated stocking is worn for 7 days contin-uously and thereafter during the day for two more weeks. Walking and normal activities are encouraged. Most people can get back to normal activities such as work and driving in a day or two. Simple painkillers such as paracetamol and ibuprofen are only rarely re-quired. With VNUS ClosureFast treatment, the veins with faulty valves are sealed under local an-aesthetic without surgery. The highly-targeted energy gets your leg looking and feeling better fast. Treatment in less than 2 hours Local anaesthetic, day case or “walk in walk out” treatment Little or no time of work No painful cuts or scars in the groin No painful stripping Rapid return to normal activities including

driving Excellent cosmetic results with no ugly scars Low risk of recurrence May be more suitable than laser in certain circumstances The treatment is carried out under the “watchful eye” of the ultrasound equipment to ensure successful closure of the faulty veins. As there are no surgical cuts, there is virtu-ally no risk of infection, which can occur occasionally after traditional operations.


Endo-Venous Laser (EVL) This procedure uses the precision of laser energy and is performed under local anaesthesic. A fine catheter is inserted into the affected veins under ultrasound guidance using a small nee-dle. The laser fibre is positioned in the groin at the root of the reflux. The position of the laser fibre is checked using ultrasound. Using laser energy the vein is heated and sealed. Surgical cuts in the groin are avoided and there is virtually no risk of infection or wound healing problems. There is no stripping out of the vein and so bruising and pain is mini-mal. Minimally invasive non-surgical treatment No painful cuts or scars in the groin No painful stripping Rapid return to normal activities including driving Excellent cosmetic results Relief of symptom Low recurrence of vein problems May be more suitable than VNUS Closure in certain circumstances

The specialists at The VeinCare Centre are able to advise you about your suitability for VNUS ClosureFast and Endo-Venous laser following your ultrasound scan. Not all clinics are able to offer both treatment options.

Sapheon Venaseal™ "Superglue" For Varicose Veins The VeinCare Centre was among the very first clinics in the UK to treat veins with a revolu-tionary non-thermal method (no heat energy). Since September 2012, The VeinCare Centre has been able to offer the new Venaseal™ or "superglue" treatment by Sapheon to private patients.

Venaseal™ or "superglue" treatment by Sapheon is a unique non-surgical treatment that uses a medical adhesive to safely and effectively treat varicose veins. Unlike other treatments, VenaSeal™ does not require tumescent local anaesthetic around the vein, so there are far fewer injections. The VenaSeal™ procedure also eliminates the use of heat (or thermal energy) so there is virtually no risk of nerve or skin injury. As the medical "superglue" sets within a few minutes, there is not the prolonged healing process associated with ultrasound-guided foam sclerotherapy and medical stockings are not required afterwards.

How does the VenaSeal™ system work? A tiny catheter is positioned inside the unhealthy vein using ultrasound through a small punc-ture in the skin. Next, a small amount of adhesive is delivered inside the vein using a special dispenser to seal the vein which has been identified as being unhealthy and which is causing the varicose veins. After the treatment, blood then travels back to the heart in nearby healthy veins. The glued vein is then absorbed by the body's natural healing processes.


Is the VenaSeal™ adhesive used during the procedure safe?

The VenaSeal™ adhesive that is used during the procedure is made with a medically approved type of Cyanoacrylate, which has a proven track record of over 50 years of use in the field of medicine. The VenaSeal™ system uses a unique formulation of the compound and it is specifi-cally designed for the treatment of varicose veins. Being such a new procedure, the Venaseal™ or "superglue" treatment by Sapheon does not have a procedure code and it is therefore not covered by private medical insurance such as BUPA, WPA, AVIVA or Simply Health. It can only be offered to those patients who are paying for themselves. Patient suitability for the Venaseal™ or "superglue" treatment will be determined after a full consultation and duplex ul-trasound scan. After your assessment, the Venaseal™ or "superglue" treatment will be discussed as well as more established alternatives such as VNUS Closure, Endovenous Laser (EVL) and Ul-trasound Guided Foam Sclerotherapy. The early results of international research do look very promising. However, because the Venaseal™ or "superglue" treatment for varicose veins is so new, there isn't sufficiently long clinical follow up to confirm that it keeps the vein closed in the medium to long term in every case. The Venaseal™ or "superglue" treatment for varicose veins reduces the number of local anaesthetic injections significantly, but if additional proce-dures are needed such as phlebectomies, then additional injections may be needed. Finally, as the Venaseal™ or "superglue" treatment for varicose veins is so new, the cost is higher than that of Endovenous Laser or VNUS Closure The VeinCare Centre is very happy to offer the Sapheon Venaseal™ or "superglue" treat-ment to patients on the understanding that:

It is not a completely injection-free procedure

The results of long term follow up are not available as it is so new

Private health insurance companies do not pay for this procedure

Foam Sclerotherapy Ultrasound-guided Foam Sclerotherapy Injection treatments have been used for many years to treat varicose veins. Two recent deve-lopments now allow us to use an injection technique to treat varicose veins that was previously only treatable by surgery. These are the use of ultrasound to guide the injection and the prepa-ration of the chemical as foam. Over the last 10 years or so, the use of foam injection was widespread in France, Spain and Italy and more recently the technique is being used in the USA. The treatment can be performed as a “walk in, walk out” or “lunch hour procedure”. What is Foam Sclerotherapy? The solutions that are injected are exactly the same as those which are already used to treat varicose veins. These are mixed with air to create foam, which looks a little like hair mousse, or shaving foam. Many medical and scientific studies have confirmed that Foam Sclerotherapy has an excellent safety record and that it produces excellent results in the treatment of vein reflux and varicose veins.


How does the foam work? After injection, the foam pushes the blood out of the way and completely fills the vein. The lin-ing of the vein is instantly removed by the foam (this doesn’t hurt) and the vein responds by shrinking and the vein walls stick together. The channel through the vein is sealed and over the course of a few months the vein is completely absorbed by the body’s healing processes.

The treatment Treatment is performed in a treatment room and not an operating theatre. The patient rests comfortably on an examination couch. A small amount of local anaesthetic is used to numb the skin of the leg and a small needle is inserted into the refluxing vein that is feeding the varicose veins. The position of the needle is carefully monitored using ultrasound so that feeder veins are closed. Foam is then injected and its progress into the feeder veins and varicose veins is careful-ly monitored with ultrasound. The whole treatment usually takes no more than 45 minutes. Fi-nally a firm bandage is applied to the leg. The aim of this is to keep the veins compressed so that they do not fill with blood when the patient stands up. The bandage is usually worn for a week followed by an elastic compression stocking for a further week. When the bandages are removed at the follow-up appointment it is usual to find that all the varicose veins have been sealed. The leg may be a little bruised at this stage, although this is usually fairly minor. If any varicose veins have not been completely treated in the first session, they are injected and band-aged to complete removal of all veins. If varicose veins are present in both legs, the treatment is given to one leg at a time with an interval of one to two weeks.

Who is suitable for Foam Sclerotherapy? Most people with small or moderate sized varicose veins can be treated in this way. People with severe vein reflux are usually best treated by Laser or VNUS Closure FAST to obtain a more rapid improvement. People with large varicose veins lying close to the skin are also better treated by Microphlebectomy to avoid the brown discolouration of the skin which may occur after Foam Sclerotherapy.

Key features Ultrasound-guided Foam Sclerotherapy is a new method of treating varicose veins There is no need for an operation under general anaesthetic The treatment involves injections under local anaesthetic A treatment session is complete in about 45 minutes The treatment is carefully monitored using ultrasound A firm compression bandage must be worn for a week afterwards The cost of treatment are much lower than for surgical methods Minimal or no time off work The VeinCare Centre has been at the forefront of the introduction of Ultrasound Guided Foam Sclerotherapy into the UK and its specialists have many years experience of its use in a wide variety of vein conditions.


The techniques used by The VeinCare Centre are associated with high patient satisfaction rates. Each procedure is tailored to the precise pattern of reflux identified by the ultrasound scan. Early diagnosis and treatment ensure that the condition is not allowed to deteriorate. In our opinion, large varicose veins very close to the surface of the skin are best treated by a procedure called Microphlebectomy which gives excellent cosmetic results very quickly. The skin is numbed by local anaesthetic, very much like a dentist’s injection and a micro-incision is made in the skin, slightly larger than a needle prick. The varicose veins are extracted with special instruments which do not cause pain and then the micro-incision is closed with surgical tape and no stitches are needed. Combination Treatments For many people, a combination of treatments is the most effective plan. For example VNUS Closure and EVL are very effective in dealing with reflux from the groin and this can be followed by Microphlebectomy for the varicose veins. For some people who have developed more varicose veins after a previous operation (so called “recurrent” varicose veins), Foam Sclerotherapy injections for the re-flux and Microphlebectomy for the surface varicose veins are the best combina-tion. These combination treatments are usually performed in one session to achieve rapid results with a minimum of inconvenience. Our team can provide all the latest treatment options and therefore we can tailor an effective treat-ment based on the precise nature of your vein problem and your particular cir-cumstances and requirements. All the procedures are performed in treatment areas regulated by the Care Quality Commission. You can be assured of the highest standards of hygiene and clinical care.

Microsurgery For some people, “surgery” is appropri-ate. At The VeinCare Centre, the remov-al of varicose veins is carried out under local anaesthetic on a “walk in, walk out” basis using microsurgical techniques and delicate instruments, thereby pro-ducing excellent cosmetic results.


What Treatments are available for thread Veins and Spider Veins? Thread veins on the legs, often known as spider veins or broken veins, are very common and can be very unsightly. In addition, they can cause ache, tired legs, itch and ‘burning’ discomfort. Symptoms are often worse at the times of a period for women or in warm weather. The veins can vary from fine red marks to larger purple or deep blue veins. They can cause significant cosmetic embar-rassment and many women will not wear short skirts in the summer months. The reason why people develop thread veins on the legs is not fully understood but important associations are he-redity, pregnancy and hormonal factors. They can also follow minor injuries. In many cases, they can be caused by deeper varicose veins and reflux. Many regard thread veins as simply cosmetic. However, they often cause symptoms and these symptoms are helped by treatment. In addi-tion, they often indicate that there is abnormal backflow (reflux) in the veins nearby. Once again, NHS treatment is not available for thread veins. Treatment To get the best results from treatment, it is very im-portant to have a proper assessment of the whole vein system in the leg to see if there is any connection between the superficial thread veins and the deeper veins. This is very important, because if there is a connection which is not treated, then back flow and high pressure will work against the treatment, making it less effective. At The Vein-Care Centre, we specialize in the treatment of varicose veins and thread veins on the legs and an ultrasound examination of the whole vein system is part of the consultation. Recent research has shown that nearly all thread veins have a ‘feeder’ vein nearby that also needs treatment. These veins are called reticular veins. As part of the consultation and examination, a careful search is made for these reticular veins.


After treating any underlying varicose veins or superficial venous reflux, an injection technique called Microsclerotherapy is used to treat the thread veins directly. A non-toxic chemi-cal is injected through a very fine needle directly into the vein. This irritates the lining of the vein causing the walls to stick together and prevent blood flowing through the vessel. Over a period of time the blood vessel is gradually absorbed by the body and disappears. After several treatments a 80-90% im-provement can be expected.

The ‘feeding’ reticular veins can be several centimeters away from the thread veins and they are usually invisible. We use the Veinlite system to identify the reticular veins for treatment. A high-energy halogen light beam is focused into the deeper part of the skin and the feeder veins can then be seen and injected.

These are different. Whereas thread veins on the legs are con-nected to veins, thread veins and spider veins on the face are often connected to small feeder arteries. The treatment of facial thread veins is also different. We use electro-coagulation to seal these veins rather than injections. The technique is rather like electrolysis. The results are usually very good and most people are very pleased.

Microsclerotherapy

Veinlite Facial Thread Vein

Our team of specialists at The VeinCare Centre are regarded as national experts on the treatment of thread veins and run training courses for doctors and nurses throughout the country.


Unsightly hand veins and hand ageing can be treated to give a more youthful appear-ance. As we get older, the veins on the backs of our hands enlarge, the hands become more "boney" and the skin may develop "age spots" or "liver spots". The specialists at The VeinCare Centre can improve all three aspects of the ageing hand without the need for surgery, hospital admission or general anaesthesia. The hand rejuvenation programme is performed on a "walk in, walk out" basis, with virtually no "downtime" and minimal in-terruption of activities. By using state of the art sclerotherapy techniques, collagen stimulating injections and skin depigmentation treatment, a youthful appearance can be achieved in just a few weeks. We have years of experience and as these before and after photographs show, the results can be dramatic. Typically, the final result is achieved in just three or four visits to the clinic. A tailored hand rejuvenation programme is formulated after an initial consultation and the precise details of the treatment are discussed in full.

Before and After Photographs

Hand Veins & Hand Rejuvenation


Other Vein Conditions

What is Deep Vein Thrombosis (DVT)? This is a clot in the deep system of veins. It is a potentially serious condition, as sometimes the clot can leave the leg and travel to the heart and lungs – an embolus. DVT is a potential problem after admission to hospital, major surgery, illness and periods of immobility. Other risk factors include smoking, oestrogen treatment, pregnancy and vari-cose veins.

What are Venous Ulcers? These are areas on the lower leg where there is a break in the skin. Ulcers may be small, about the size of a coin, or much larger, sometimes completely encircling the leg. They are painful and sometimes odorous open wounds which leak fluid. Leg ulcers can last for months or even years and can often be socially isolating. Most leg ulcers occur when vein disease – including varicose veins – is left un-treated. They can be triggered by a trivial injury in a vulner-able leg where the skin has been damaged by venous reflux. They are increasingly common amongst elderly people who may have had vein problems for some time. A leg ulcer will affect approximately 2% of the population at some time in their lives.

Compression Stockings Medical Compression stockings are an important aspect of the treatment of venous disease. The compression gra-duates in intensity from the ankles up, with the greatest sup-port at the ankles where swelling occurs and the lowest at the thigh. The result is reduced pooling and significantly im-proved blood flow back to your heart. They alleviate many of the symptoms of varicose veins and venous disease such as ache and swelling as well as preventing the complications of venous disease such as phlebitis and venous ulceration. In ad-dition, compression hosiery has been shown to reduce the incidence of Deep Vein Thrombosis.


Tips for avoiding vein conditions Varicose Veins Walk around as much as you can – don’t sit or stand in one place for long

periods of time To help the blood to flow easily, don’t cross your legs when sitting Don't sleep sitting in a chair Get up and stretch when on long journeys such as on a coach or plane Graduated compression stockings promote the flow of blood in the deep

veins of the legs. If you are diabetic or suffer with artery problems you should seek medical advice before using compression hosiery

Watch your weight Make sure you have a healthy diet, with enough fibre to avoid constipation Elevate (lift up) your legs if you have been standing still for a long time to

allow the blood in the veins to empty Don’t wear tight underwear or clothes Keep active by taking regular exercise Stop smoking Deep Vein Thrombosis Deep Vein Thrombosis (DVT) frequently develops during hospital admission. We believe that all patients should have a risk assessment and receive appro-priate measures to reduce the risk of developing DVT. An important aspect of prevention is the use of good quality compression hosiery. Pregnancy Pregnancy is a time when varicose veins may develop and DVT is a rare but im-portant cause of complications during and after pregnancy. Good quality com-pression hosiery can reduce these risks. Family History This is an important risk factor for the development of varicose veins. Someone whose parents both have varicose veins has roughly an 80% chance of developing the condition themselves. People with a strong family history may wish to consider wearing medical grade compression hosiery.


How do I make an appointment? The VeinCare Centre specialists see patients at: The Melbury Clinic in Holt Mill The Winterbourne Hospital in Dorchester The Harbour Hospital in Poole Litfield House Medical Centre in Bristol Locations and directions can be found on the website Self Referral Your can make an appointment direct by calling The VeinCare Centre on 0800 698 3467. The VeinCare Centre follows guidance from the General Medical Council (GMC) and with your consent and agreement will keep your GP advised about your con-dition and your treatment. GP Referral Dr Gajraj is pleased to receive referrals from your GP. You will then be contacted with an appointment. Referrals should be sent to : The VeinCare Centre Head Office The Melbury Clinic Holt Mill Dorset DT2 0Xl Fax 01935 873 952 Private Medical Insurance Those with private medical insurance should be referred by their GP as this is normally a requirement of the policy for reimbursement. Dr Gajraj is recognised as a qualifying specialist by all the major insurance companies but please check with your insurer before incurring any costs. Please quote Dr Gajraj’s GMC number 2648642 in communications with your insurer.


The VeinCare Centre offers excellent value for money

For self pay clients, The VeinCare Centre offers excellent value for money. For example at your initial assessment you will have a consultation, duplex ultrasound scan and de-tailed discussion of the findings and the treatment options all in one visit. This ‘one-stop’ approach saves you time and avoids the inconvenience of multiple clinic visits. A full report is sent to your family doctor and you will receive a copy. All this for £320. When you make comparisons with other clinics or private hospitals, do check what is included in the initial assessment. Some clinics for example will arrange a separate appoint-ment for your ultrasound scan and then a further appointment to discuss the results. Often these appointments are charged separately. These fixed price quotes for your treatment are fully inclusive. There are no hidden extras or surprises such as charges for bandages, stockings or medications. Your follow up consultation and scan after VNUS ClosureFAST or after Microphlebectomy at 6 weeks and 6 months are included. If any further minor treatments are required, such as injections or Mi-crophlebectomy, there are no additional charges. During your recovery, you will have access to telephone advice and support from your specialist and if you need to have an unscheduled appointment for any reason, no additional charges will be raised. Foam Sclerotherapy charges are fully inclusive for as many treat-ments as are required and a six-week and six-month follow up consultation and scan are in-cluded in the fee. As for the other treatments offered, you will have access to tele-phone advice and support from your specialist and if you need to have an unscheduled ap-pointment for any reason, no additional charges will be raised. The aim of our service is to achieve the best possible outcome for your vein condition so that your legs look and feel better as quickly as possible whilst providing excellent value for money. When making cost comparisons with other clinics and private hospitals, do check what services and treatments are included in the fee. The excellent quality of care provided by The VeinCare Centre is recognized by all the major private health insurance companies such as BUPA, WPA, AXAPPP, Standard Life and Norwich Union. De-pending on your level of cover, the fees are usually fully reimbursed. You are strongly advised to check with your insurance company before undergoing any treat-ment to check your level of cover and to be issued with an authorization number. Please en-sure that you have been referred to Dr Gajraj by your family doctor and that when inform-ing your insurance company you also quote Dr Gajraj’s GMC number 2648642.

The specialists at The VeinCare Centre are recognized by all the major health insurance compa-nies such as BUPA, WPA, AXA-PPP, Standard Life and Norwich Union. Please check cover with your insurance company.


First Appointment Foam Sclerotherapy £1495 one leg £2195 two legs VNUS ClosureFAST £3595 one leg £4595 two legs Laser EVL £3595 one leg £4595 two legs Facial Thread Veins Leg Thread Veins Sapheon Venaseal™ Hand Rejuvenation £2495

First Consultation for leg veins - £320 Includes Duplex Ultrasound Scan of both legs, full discussion of treat-ment options and formulation of treatment plan. Also includes a written report for you (and your GP if re-quested). £100 for Hand Vein Consultation Fully inclusive of all treatment sessions, scans, con-sumables such as bandages, one pair of medical com-pression stockings as well as a follow-up visit and treatment after 6 months (does not include first ap-pointment). Fully inclusive of the specialists’ fee, anaesthetic fee and facility fee. Also includes follow-up assessment and full duplex scan 6 weeks and again 6 months after treatment. Fully inclusive of the specialists’ anaesthetic and hos-pital fees. Also includes follow-up assessment and full duplex scan 6 weeks and again 6 months after treat-ment. £100 per electro-coagulation session. Up to 2 sessions may be required. Ultrasound scan not required. Free initial consultation with Specialist Nurse £400 per Microsclerotherapy session. Up to 4 sessions may be required. For large areas you will be advised if more than 4 sessions are likely to be required. The costs of the Sapheon Venaseal™ or "superglue" treatments are £3995 for one leg and £4995 for both legs. A tailored hand rejuvenation programme is formulat-ed after an initial consultation and the precise details of the treatment are discussed in full.

Fees correct as of 1st August 2014. Prices are subject to change without notice until payment received. Fees payable at the time of booking. Please see our terms and conditions. Written Quotations are provided prior to starting any treatment.


In addition to a general examination, the state of your legs, the extent of any varicose veins or thread veins and any leg swelling or skin change such as varicose eczema will also be checked and

Your first appointment at The VeinCare Centre What happens at my first visit? The consultation is thorough and unhurried. You will have ample opportunity to ask ques-tions and every aspect of your care will be explained to you.

Medical History

Medical Examination noted. Clinical photographs of your veins will be taken before and after treatment. These are part of your medical record at The VeinCare Centre and they remain confidential. You may be asked if these can be used for publication anonymously, but only with your written permission and should you refuse, this decision will be respected and it will not affect your relationship with your specialist.

Duplex Ultrasound Scan

Findings Report You will be given a full explanation of the findings and treatment options will be discussed to help you decide what would be best for you. You will receive a written report, which with your agreement will also be sent to your GP.

The consultation starts with your symptoms, general health, any previous treatment you may have had for your vein condition and also any medication you may be taking. You will have ample op-portunity to discuss any concerns that you have.

This is an essential part of the consultation. Sound waves are used to build up a picture of the deep veins, the superficial veins under the skin and varicose veins that may be present. The di-rection of blood flow in the veins is noted to diagnose sites and pathways or reflux.


AH had severe recurrent varicose veins which he had al-ready had stripped many years before. His brother had leg ulcers and he was worried that he too would develop them. He was treated by Ultrasound Guided Foam Sclero-therapy (see our website) 11

DC had very prominent and unsightly veins on her hands with loss of skin elasticity and the bones and tendons were very obvious. Her veins were treated by Foam Sclerothera-py to shrink them and then the collagen was stimulated by injections of Radiesse (see our website)

HM is a fit and healthy lady who developed varicose veins in her teens and was told they were simply cosmetic. Her legs ached and she could not wear dresses or shorts. She was treated by VNUS Closure - now her legs feel light and she has worn a swimming costume on holiday

DW is a very fit lady who enjoys walking. Her legs felt heavy and ached and she was treated by VNUS closure

EH had unsightly thread veins on the outside of her thigh which were treated by Microsclerotherapy injections

Before and After Photographs

The specialists at The VeinCare Centre routinely take before and after photo-graphs for all clients – they are confidential and form part of the medical rec-ord. Many other clinics use third party photographs in their brochures and on their websites.


PN is a keen footballer who was worried he would injure his veins. He is also self-employed so couldn't afford to take time off. He had VNUS and was back to work in two days and foot-ball in two weeks (see also website) AS was treated by VNUS (see website also) LC wouldn't go on holiday because of her veins – she was treated by a combination of Foam Sclerotherapy and Mi-crophlebectomy SG had thread veins on her thigh and was treated by Micro-sclerotherapy KE had thread veins on the face and was treated by Short Wave Diathermy

Before and After Photographs The VeinCare Centre only uses these images for promotional or educational ac-tivities with the expressed and written permission of our clients. Many of our clients are so pleased, they are very happy for us to publish the results and to appear in video testimonials (see our website).


What people are saying about Us and Our Service

“I am absolutely delighted with the foam sclerotherapy treatment provided by Dr Gajraj at the Melbury Clinic. I had unsightly varicose veins in my left leg for about 4 years and I had been put off treatment by the prospect of painful stripping surgery. When I heard about foam sclerotherapy, it sounded ideal. I had one session of injections and my leg looks tremendous. Recently, I was able to wear shorts on a holiday in France and I wasn’t at all conscious of my leg. The treatment and service that I received were excellent”. Mr S G, Minehead, Somerset “After noticing an article in the Somerset County Gazette explaining the treatments that you had available, I decided to contact you regarding the vein in my leg. This vein was un-sightly and I was extremely conscious of it. After my initial consultation with you, I opted for the foam sclerotherapy as it meant I was able to have the treatment without having any time off work. I found the treatment itself very quick, easy and completely painless, and was pleased that I was able to drive straight away afterwards. When I removed the stocking after the first week, I able to notice a difference immediately and was delighted with the result. Now, six months on, there is no sign of the vein that had bothered me for so long and I am able to wear shorts with confidence once more. I have already recommended the process to others and should I require any treatment in the future I will not hesitate to contact you. Thank you once again”. Mr K M, Taunton, Somerset “I am delighted with the results of the endovenous laser treatment performed on my left leg. Hav-ing the procedure under local anaesthetic was on the whole, painless, only a feeling compared to a bee sting every now and again. The results get better as the days go on. It is lovely to wake up in the morning and see a young looking, pain free leg again. My leg has not looked this good for many a year! Thank you once again.” Mrs J C, Castle Cary, Somerset “Thank you so much for treating the horrible thread veins on my leg. I was very self-conscious and wouldn’t wear shorts or dresses. After the injection treatment, I am now able to show off my legs again. I have already recommended several people to you”. Miss F D, Taunton, Somerset “I had varicose veins for 10 years. My left leg ached and the veins were getting worse and spread-ing. I am a self-employed driving instructor and taking time off work for a stripping operation was not an option. I had a VNUS operation done as a day case. I had treatment on Saturday and was back to work as a driving instructor on Monday! I didn’t need any painkillers afterwards. I am very pleased with the results. It has made a big difference to the way my leg looks and feels. I now have no ache and my leg looks normal. I would definitely recommend the treatment to a friend” . Mr G R, Taunton, Somerset “My leg used to swell and a few years ago I had attacks of infection. My mother had varicose veins that had turned into leg ulcers and I didn’t want the same thing to happen to me. I wanted some-thing done, but I didn’t want my veins stripped. My GP referred me to Dr Gajraj of The VeinCare Centre and he recommended laser treatment. It was really good! I didn’t need a general anaesthet-ic and I didn’t have any big surgical cuts. I didn’t need any painkillers afterwards and I was able to drive my car a couple of days afterwards. The unsightly varicose vein has gone and my leg feels great. I am really pleased and now I can get on with my life without being self conscious”. Mrs. H W, Dorchester, Dorset “My legs haven’t looked this good for years. Thank you Dr Gajraj for giving me back my self-confidence”. Mrs F P, Poole, Dorset





Documents

The VeinCare Centre clinic brochure August 2014