Vicky

Hi, everyone. We're just waiting for a few seconds for everyone to join. Good evening, everyone, and welcome to our webinar on varicose vein treatment. My name is Vicky, and I'm hosting this session. I'm joined by our presenter Consultant Vascular Surgeon, Mr Aaron Sweeney. This presentation will be followed by a question-and-answer session. So if you'd like to ask a question during or after the presentation, please do so using the Q&A icon, which is at the bottom of your screen. This can be done with or without giving your name. Please note this session is being recorded if you do decide to provide your name. If you'd like to book your consultation, we'll provide contact details at the end of this session. I'll now hand over to Mr Sweeney, and you'll hear from me again shortly.

Mr Aaron Sweeney

Good evening. Thanks very much for joining us. So I'm Aaron Sweeney, I'm a Consultant Vascular Surgeon. I qualified a long, long time ago, in 1992, and I was appointed an NHS Consultant Vascular Surgeon in 2002. Before I was appointed, I started having a look at lasers and laser vein treatment, and along with my very good friend and old colleague, Eddie Challoner, we started using lasers, particularly in the NHS. But also in the private hospitals around London, Kent has done quite a lot of those treatments. Now it's well over 10,000. It's probably closer to double that, and here at Benenden we do the largest number of laser vein treatments in the UK.

So I usually try my best not to talk too much. Many people have questions they want to answer. So basically I do a quick session telling you what varicose veins are. I'll give you a little bit about grading, because sometimes that comes up in people's referrals. Tell you a little bit about what the consultation involves. Then a few different treatment options, and then possibly the most important bit is the questions and answers. People often feel they're asking silly questions, but remember, most people know very little about varicose veins or their bodies or things that happen to them. So sometimes those questions can be really helpful.

So just a few bits The CQC rates us outstanding, which is pretty unusual for a hospital. We do a lot of varicose veins here and the hospital is essentially clean and virtually brand new. It's a very nice place to work for me, and hopefully to be treated if you choose to come.

So what are varicose veins? What do they cause? What do they look like? Do you always have to have big, chunky veins in your legs to have trouble? Well varicose veins, I think if you think of them. Think of your veins in your leg as a Christmas tree. There's a main vein that runs up the centre of your leg that's called your deep vein and that can easily drain a litre of blood per minute when you're doing a little bit of exercise, and if you're a cyclist or a Tour de France chap or girl, that can be many, many litres per minute pumping up your leg. So it's a remarkable amount of blood flow. That's the deep vein, but the side branches. So again, think of the Christmas tree. All those side branches coming in the bigger side branches are draining muscle. Mostly they have an advantage in that. They're surrounded by muscle, so they can give a little bit of squeeze and push the blood up your leg. The troublesome ones are your skin veins, and you have hundreds of these. They're little, tiny things, little blue things running all over your skin, and when we used to walk on all fours. Those veins are almost horizontal. But as we've decided to stand up, we've stretched them a little bit, and many of them become vertical, and they need little valves to keep everything going uphill, and if those valves break, the vein stops working correctly and starts to fill up so often, people start off complaining, not necessarily about visible varicose veins, but often about ankle swelling or a little ache, particularly at the end of the day. You may notice a few blue veins appearing, but that's not always the case. Sometimes people can have itchy, dry skin, particularly in the lower ankle. No obvious varicose veins, and that's because the varicose vein might be just a little bit under the surface. It can be very large, but you don't. Sometimes you can't see it. So that classic view of some big, chunky grapes around your ankle or around the calf. That's not always the case. Things that veins often produce an ache. sometimes a bit heavy and uncomfortable. Most people's varicose veins give them their most symptomatic in the evening. Often when you go to bed, they can have a restless leg type feeling, but normally, when you lie flat in bed for the whole night, gravity no longer causes too much trouble, so you tend to wake up in the morning feeling cured. And then, as the day progresses, all the symptoms return.

So there are a few grades, and I'll go through this quickly. One area is cosmetic thread veins. They're usually small little thread veins or spider veins that are treated with here with injections of sclerotherapy and that is where we inject a small chemical through and damage them; sometimes it takes a few goes, and we have a specialist doctor who does that all the time and gets some great results. Grade two are veins. You can really feel they're not that big. They don't cause any symptoms, but they are quite annoying. Often around the back of your knee, and again, these can be treated with sclerotherapy; sometimes, if they're big, we do small little incisions and remove them, but most times, again, these can be treated with sclerotherapy.

Grade three are the usual ones we see, and this is a particularly bad set of veins, but you might say, Well, those veins appear just around the knee. Where are they coming from? And often there's a vein running up the whole length of the leg just under the surface that's much bigger than those veins, and these just happen to be branches of that vein coming up onto the surface when they're big like that. Normally, you do some kind of operation for them.

Grade four is when your skin starts to get a bit damaged. So your grade three is a bit achy, but your skin is okay, and you can sometimes see the veins. Grade four is when your skin becomes a bit annoyed at the veins becoming enlarged, and sometimes your skin discolours; it nearly always happens in the lower part of your leg and your skin changes from being completely normal to being a little darker in colour, can be red, or you can have some eczema or itching. Sometimes, when they get this big, the veins get so big that they start to split and that is rather like a balloon being blown a little bit too big; it eventually goes and bursts, but varicose veins tend not to burst. It's rare for them to bleed, although they can do so, but most times they get so large, the wall of the vein becomes a little stretched, and too much becomes really inflamed. Inflammation of your vein is called phlebitis and sometimes that information can be so bad that you get a small amount of plot forming. That's a condition called thrombosis. The thrombus is the clot. And when you get clots in your leg, your body hates that and tries to dissolve them quickly, and that often produces a serious amount of pain. If your veins are causing skin damage and you do nothing.

Sometimes you can get some real trouble, such as ulcers or bleeding; I'll flash through these. They're a bit grim, but that's the worst-case scenario and often people with ulcers. When I ask them what has happened, they usually say for years they've had trouble with legs that have been swollen and skin that's been itchy, and they weren't really sure what was going on. They tried various potions and creams and hydrocortisone creams, and sometimes things got a little bit better. Then they got worse and then finally, after many years of that, they bang their leg against a shopping trolley or something like that, and they get an ulcer. But the actual problem probably took four or five years to develop, and it is fixable before you get an ulcer; even if you do get an ulcer, we can fix that. But it's a much, much more difficult problem, and people who have ulcers, they have them for an average of nine months, which is pretty miserable because they're quite wet and painful, and you require multiple dressings each week.

So just to let you know about consultations and assessments. If you choose to come here, you do see me. I examine you, and I do the ultrasound scan, and I do use an ultrasound scan, sometimes called a duplex ultrasound, and that basically maps out your veins and gives a very accurate view of where they're actually coming from. If you choose to have something done, we usually can give you options straight away. Most surgery is done under local anaesthetic, but you could choose a general anaesthetic if you wish and virtually everyone walks in, walks out. Most people following surgery say it was a little bit like going to the dentist. It was a bit scary beforehand. Once I got underway, it was nothing too much, and afterwards they're generally quite relieved and feel that it wasn't quite as bad as they were expecting. So varicose veins used to be a very, very common operation on the NHS. That doesn't seem to be the case anymore. But they were done quite badly. In many cases they were often done by the most junior doctor. I used to be that guy, and done at the end of an operating list, and it was a bit haphazard. Sometimes people had excellent treatment; other times I don't think it was necessarily brilliant since we started using ultrasounds all the time to assess veins. We've begun to realise that we can be a bit more accurate in diagnosing them and so, since these minimally invasive treatments have come about.

The whole thing is to try and reduce that risk of recurrences or pain following treatment. We normally now do things under local, as I mentioned, and although I'm going to talk a lot about endovenous laser treatment, there are a number of different, minimally invasive treatments. They are actually all work pretty well; they're all based on heat, and I think if I was choosing to have an operation, the thing I'd like to know is how many procedures a person does per year. As often Surgeons. If they start to do hundreds of procedures a year, it's nearly always because they like doing them, and most Surgeons like doing things they're pretty good at. So this picture is the inside of a person's right leg. So the commonest vein that I treat runs from the groin right the way down to the knee and I'm threading a little laser up the inside of that vein, so the old op used to be did a cut in the groin. You disconnected everything, and if you think of that Christmas tree analogy, you disconnected where the bigger, bigger branch joined the deep vein or the core of the tree, and then you put a stripper down a stripper. It's not what you think. It's actually a wire with a little balloon on the end, and you can pull out the vein completely. It was a bit brutal, and afterwards your body, as it was healing itself, sometimes produced loads of new veins. So quite often people had many, many operations, and each time they had an operation, a year or so later they ended up with more veins. The real trick with endovenous laser treatment, or any of the heat-based treatments, is that you slip the laser up the inside of the vein. Damage to the inside lining doesn't really damage anything on the outside of the vein, and the vein itself stops working when a vein is varicose. It's not working, anyway. You don't need it. In fact, it's doing the opposite of what it should be doing. It does not drain blood uphill; it sends it all back downhill. So when you laser the inside, the vein shrivels up, and your body is really good at recognising that that happens and then slowly dissolves the vein over the space of about weeks. You kind of notice it for the first week, or because it does feel like you've run too much or pulled a muscle. So we usually treat varicose veins with a laser that's sometimes-called endothermal ablation. As with everything in medicine, we try to come up with some interesting, more complicated names. But if you think of a laser, a laser is just a fancy way of burning the inside of the vein. But there are a few other different treatments. There's a thing called radiofrequency ablation. It's exactly the same thing. But instead of using a laser, you use electricity. There are some chemical techniques where, instead of using heat to damage the inside of the vein, you use a chemical. Sometimes you hear that called sclerotherapy. It's been around for hundreds of years before we did operations. That's how you treated veins. It was a bit brutal because veins become quite hard and sore afterwards, and I don't think it works quite as well for big veins. Foam sclerotherapy is a better treatment, and that's where you mix up the sclerotherapy solution into a foam. It kind of fills the vein and does actually work better; it certainly works for smaller veins, and I do use that a lot. But for larger veins, I prefer to use one of the heat treatments. I'll mention just treatments such as ClariVein and Glue. They have been around. Everyone is trying to make it a pain-free procedure, and indeed they are virtually pain-free. I just don't think they work particularly well. They seem to have higher recurrence rates, and the glue can sometimes cause inflammation inside a vein, so I don't use glue or ClariVein, and then finally, the Therma vein that's used by my colleague here, who specialises in thread veins and that is very good for treating thread veins in the face or the legs.

So if you laser your vein, what happens? Well, that's the one on the left that is kind of the normal-looking barracuda vein that I see sometimes a bit bigger than that. And if you just laser the vein in your thigh, a few weeks later that vein deflates a little bit, and a few weeks later it looks reasonably good. Now, if you've got good TV that's in HD, you'll probably notice you can still see some veins on the final picture on the right. So quite often, when I laser veins, I would also do a few small incisions called phlebectomies, and that's to basically speed up the process of getting rid of any of those veins that remain visible. I would say that if you had your vein lasered. Most people do feel like they pulled a muscle or had a bad day at the gym with a new gym instructor. It does feel a bit sore. Most people take a painkiller like Nurofen. It's very rare for people to feel absolutely nothing. I think weeks later, most people are back in the gym or playing golf or doing their normal daily activities without thinking about the vein too much. weeks later, I think it looks reasonably well, and you could probably pass it off as a normal leg if you were going on holidays, for example, and most people at weeks their symptoms have disappeared. So if it was itching or swelling. or pain, they have all subsided. So just to recap there, think of our veins. Think of a Christmas tree. The deep vein is the main trunk, and you've got loads and loads of branches. The tiniest branches are the ones that drain your skin, and because we've decided to stand, some of those are vertical, and for that reason alone, the little valves that are in those veins fail, and you don't fix them yourself. So once you get a varicose vein, you unfortunately keep it. People sometimes think that those veins are really useful and that we should keep as many as possible, but we have loads and loads of extra veins for our skin and once they become varicose, not only are they not working, i.e., they're not draining any blood from the skin. They're doing the complete opposite. So they're sending blood back down your leg. It overwhelms the other little skin veins nearby, and that's the reason why you get some symptoms, and for most people, swelling and a little ache are the only symptoms they get, and that's not particularly dangerous. You could leave that alone if you weren't too worried and it's only really when it gets itchy or sore that I would push people a little bit to have something done.

Vicky

Okay, thank you. That was a very interesting presentation, Mr Sweeney, and I'm going to take some questions.

So, first question, can other veins in the body become swollen in the same way as in the legs?

Mr Aaron Sweeney

The kind of you only get varicose veins in your legs. You don't get them in your arms, and so, you can get large veins in the arms and the hands. That's not unusual, but technically they're not varicose veins. So really, it should only occur in the legs. If you're asking me, can you get varicose veins in your pelvis? Some ladies suffer from a condition called pelvic congestion syndrome, where they essentially have some varicose veins inside their pelvis, and they can get bigger and smaller, depending on period time. Or if, for example, you're pregnant, you get a big surge in progesterone, and that's a progesterone when it should dilate everything to allow the baby to pass through, but it also dilates your veins. So if your question is, can you get other veins in your pelvis that are similar to varicose veins and produce symptoms? The answer is yes, and that's a condition called pelvic congestion syndrome. It's treated slightly differently, though.

Vicky

Lovely. Thank you. This person says Hi, I've got varicose veins on both legs, but I'm not fussed by the appearance of them at my age. Are they harmful if left?

Mr Aaron Sweeney

The simple answer is in your case. Probably not. So what I would say is that just having varicose veins doesn't mean that you need an operation. even if you were aching or a bit sore. You can wear compression stockings, although, to be honest, most people don't wear those. They're too difficult to put on. Break your fingers trying to get them on, so I don't think they're necessarily a brilliant option. So I usually ask people why they're having it done. You'd be surprised. The commonly held. The belief is that varicose veins are cosmetic. Virtually nobody comes to me with varicose veins for pure cosmetic reasons. Most people have had their veins for years or so. They've got other things to do with kids or grandchildren, or whatever, and then, finally, it starts to get sore, and nearly always that's in the middle of summer, when your veins dilate a little bit, start to get itchy and sore. That's when people usually come to me to have their veins treated, but they nearly always have had them for quite a few years before. If you're not particularly fussed by your veins, and they don't really notice them, and you've just spotted them looking in the mirror, or whatever. There's no particular reason to get worried. They're not a marker for deep vein thrombosis. Some people have been told not to fly because of varicose veins. That's all rubbish. None of that's your risk of a DVT in an aeroplane is tiny. It's somewhere in the well; it's much, much less than you think. It's certainly not close to one in a thousand or even one in a hundred. It's probably much less than that. So from a medical point of view, the reason for having your veins treated is because your skin is sore or you're in pain and if your skin isn't sore, hasn't changed colour, and they just happen to be incidental. You don't need to have them treated if you don't want to.

Vicky

Okay, I hope that was helpful and put your mind at ease. Next question. Should I avoid standing for long periods before treatment? I don't want to make my veins worse.

Mr Aaron Sweeney

It doesn't really matter, so it's very difficult to stay seated all day or to have your legs up, and I think if you're getting lots of ache when you stand still, most people just avoid doing that. There's nothing you can really do. Once they appear, they're there. You could try a flight sock sometimes that helps alleviate some of that ache. But to be honest, I think it is very difficult to avoid painful veins once they start giving you grief.

Vicky

Okay, thank you. Got a couple of questions from Martin here. So, one is, does having varicose veins removed. Improve his restless leg syndrome. Yeah, the answer to that is kind of so. If you came to me with restless legs, and I noticed you had a varicose vein, I wouldn't dream of doing an operation on your vein to relieve restless leg syndrome. No one is sure of the exact cause of restless leg syndrome, and just because you have a vein doesn't mean that's the cause. However, if you came with a varicose vein that was painful or your skin was damaged, and you happened to have restless legs, I would say to you, Probably it would go. So it's an interesting one; I hope that's a bit of a politician. Answer there. So what I'm really saying there is that I wouldn't dream of operating on someone who only had restless leg syndrome and tell them I'm going to fix you, but I can fix the pain, ache, and swelling, and virtually always that gets rid of that heavy or restless feeling, particularly if it occurs in the evening.

Vicky

That's great, thank you, and Martin goes on to ask, Are there any age or medical contraindications?

Mr Aaron Sweeney

No, particularly the oldest person I've operated on has been nearly 100. It just depends on who. The youngest was 12. I think so. There's a huge spread of ages. People sometimes say, If I'm on blood thinners, should I not have an operation? No, they often have people with blood thinners having bleeds from varicose veins and ice. They're one of the commonest groups of people that get them treated because it's a bit miserable if you're having. if you're bleeding from your varicose veins.

Vicky

I hope that was helpful, Martin. We've got another Martin here; he's got a question. Does high blood pressure increase the size of the affected veins?

Mr Aaron Sweeney

Again? Kind of particularly if you go on blood pressure tablets, some of them, such as amlodipine, often are brilliant at relaxing blood vessels to drop your blood pressure, but they certainly relax your varicose veins, so quite often people tell me I had these veins for donkeys of years, and then, all of a sudden, my GP. Put me on this because my blood pressure was high, and now look at my leg. It's really sore, so high blood pressure. Yes, it can. You get a bit of back pressure going down your legs, but it's nearly always the blood pressure tablet that gives you grief, and the question is, Well, what's more important sometimes, if your blood pressure is really high? You really do need to be on a blood pressure tablet, but it does quite often change your veins from being completely pain-free, and your skin being completely normal, just tips it over, and sometimes your skin starts to get itchy, or your ankles swell a lot.

Vicky

Okay, thank you. Hope that was helpful, Martin. Next question. Am I more likely to get numbness, pins and needles, or cold feet if my veins are removed?

Mr Aaron Sweeney

I would say to you that pins and needles. Cold feet and numbness are not things that are commonly associated with varicose veins, so it sometimes can be. Other conditions, such as Raynaud's disease, where your thermoregulation is a bit off, or even you can have problems with the nerves in your feet. Type of neuropathy. Remember, % of the population has varicose veins. but they're not all symptomatic, and sometimes it can be a bit confusing and a bit difficult to work out what the varicose veins are causing, but they don't usually cause pins and needles or numbness, and they can make your feet cold or warm just because the blood tends to stay there just under the surface, and when it's just under the surface, you can either lose a lot of heat quite quickly, or if it happens suddenly, they can sometimes feel a bit warm.

Vicky

Okay, thank you. Is keyhole surgery available for venous reflux for people with venous eczema? Yes, it depends on what you mean by keyhole surgery. So if you mean minimally invasive with me, threading things up the inside of your vein? Yes, it is the answer, and it's a very good way of getting rid of eczema. I find people with eczema nearly always have an operation, because you can kind of take a paracetamol for ache and pain. But itching drives people nuts, and there isn't really any decent cream that will stop that from happening. So that's one of the commonest reasons. People just basically insist on having an operation. Eczema, or itching, is one of those symptoms that people do not like to have. But the keyhole stuff. Yeah, most of the stuff I do is sometimes called keyhole surgery. If you think of it as not big slashes or scars, it's me trying to do everything through a little nick in the skin. That's probably about the same size as the scar you get left with after you have the sample taken.

Vicky

Lovely, thank you. Next question is from Jane, and Jane asks, does the saphenous vein from the inner thigh to the ankle generally need a general anaesthetic, and what is the recovery time for his?

Mr Aaron Sweeney

Okay, so if I say that, almost, I think it's 95 or 96 % of people I do, I do under local. So virtually everyone can have everything done under local anaesthetic. The people who have a general, it's because of their choice. So I like doing it locally. But I'm certainly not going to stress someone out if they're afraid of needles or feel it would be too much for them. So for most people, I do it under local anaesthetic, and there's no need for a general anaesthetic. I don't have a particular problem with them. It just takes you a bit longer to recover from that, whereas the whole idea of minimally invasive vein surgery is that you can walk in, have it done, and walk out. That doesn't mean you're completely asymptomatic, but it is a bit like a dental appointment in terms of timings and stress, and you kind of get back to your normal self quickly. I find general anaesthetic sometimes takes people a day or two to get over, and can be a little bit, I think, a little bit more uncomfortable, because when I do things under local anaesthetic, although you don't have to watch me doing anything. You do realise it's not quite as invasive as you think, and I think that plays a little on your mind and makes you realise that it shouldn't be particularly uncomfortable. So for most people, I do things under local, and they seem pretty happy with that. But that's not a hard and fast thing. So if you came to me and said, I want to be asleep. That isn't a problem.

Vicky

That's reassuring for you, Jane. Next question. I think, after the procedure, the leg is bandaged when the bandage is removed after days. Do you need to put any cream on the leg?

Mr Aaron Sweeney

No. Well, to be honest, bandages vary a bit anywhere between days and days. The only reason we put a bandage on is because I put a few sterile bits of gauze next to any little incision I make. I tried not to put you in a tight bandage. I don't think it makes that much difference. The most important thing after the operation is you're walking; that stops any complications. Really, once I do the operation, I have stopped using surgical stockings. So I ask you to wear a bandage for a few days, maybe, for some people occasionally, and then I ask you to unravel the bandage, which is a nonstick type of dressing. It's like very, very soft Velcro, and it comes off really easily, and once it's off, I ask you just to treat your leg as a normal leg, so shower normally; leave it open. It'll look a bit bruised and battered, and you can use whatever moisturising cream you like. Some people, if it's sore, use a little bit of Volt roll, gel, or ivy leaf type. Gel, it's entirely up to you, but I like you to be as mobile as possible and not spend ages trying to put compression stockings on, which never fit properly, anyway.

Vicky

Okay, thank you very much. Next question. I'm considering treatment, including follow-ups for thread veins. Can I drive after the thread vein treatment?

Mr Aaron Sweeney

Yes

Vicky

Right. Next question is from Steve. Steve says he's previously had treatment on both legs at the hospital they've appeared again. Is this normal? And would they need treating again for you?

Mr Aaron Sweeney

Sometimes people say to me, How likely is this to come back to bug me? So I say that operations we do about % of people come back within a year and show me something else, so it can be a small vein nearby. It is very rare for it to be a recurrence. Usually, when you laser a vein, it's gone, but occasionally you can get the odd vein popping up, and we do need to do an injection or something, very occasionally another operation, to fix it. I think if you look at the long-term effect if you had veins done. You've got a % chance of having another operation at some stage in the future. That's nearly always because another vein has appeared. You have quite a few veins, and when one goes, you're a little bit more likely to get another one as time progresses. It's rarely, though, a recurrence of the one that has been treated. But it's not one operation, and you never have any trouble ever again. I think sometimes they recur. The reason we scan you all the time is to try and make sure that at least the vein we're treating ever comes back, and most people only ever have one operation. The slight problem is people who've had their veins stripped before or have had an operation done elsewhere, and if it hasn't been done perfectly, they are often plagued with recurrences, particularly people who've had them stripped in the past; veins keep on appearing. So, although I will do those and maybe rectify a previous problem or fix a new vein. I'm always wary of telling people who've had their veins stripped before that they are fixed and are unlikely to come back. I think it's one of those things that pops back to give you trouble every decade or so.

Vicky

Okay, thank you. Hope that was useful, Steve. Following on from that. Somebody's asked. Are the follow-up appointments mandatory, or is that not necessary?

Mr Aaron Sweeney

So follow-up appointments. We actually asked everyone, Do they really want to come back and see us? and the answer for most people was, No, it's pretty obvious it's worked, and so we all felt that it was wrong to put in a charge for a follow-up appointment at the beginning. We thought it better to give people a decent deal of having their veins done. If some percentage of people didn't really want to follow up. So you can, of course, come back and see us. But for the most part I don't. I think you should. When I see you, I should consent to you enough to let you know exactly what should happen and I think it's weeks. Most people look down and go. Yeah, that's fine. If you have any trouble, you have mobile numbers that you can ring; those numbers basically come straight to me, and you're back straight away. If we think there's any problem. But for most people it progresses reasonably, straightforwardly, and at weeks you look down and go, And that's that sorted, so I don't. I don't think it's right to sort of add on an extra few quid onto a self-pay package when I know that most people don't really need to come back.

Vicky

Okay, lovely. Thank you. That's quite an interesting one. The next question is, how far down the leg do you treat? I can see veins that travel into my foot almost to the foot.

Mr Aaron Sweeney

Foot veins have to be a little bit careful because they have stretched, because the vein higher up is full. So it's called back pressure. Get onto the foot. If you get rid of that vein. Most of the foot veins will actually reduce. You can remove foot veins, but you have so many nerves in your foot that any time you step on your toe, you know exactly what that means, and that's because there are loads of pain fibres. So if you go removing loads of veins in the foot. It can be quite sore, and there's very little flesh in the front of your foot. So, as you're wearing your shoes, your trainers afterwards, it can take quite a few weeks for that to settle, so the most painful veins to treat are on the ankle and in the foot, so you can certainly have those treated, but I can sense you very carefully and tell you exactly what to expect, and for many people the veins deflate dramatically after the operation, anyway. So from a cosmetic point of view, they look pretty good.

Vicky

Great, lovely. I've got a couple more questions, and the next one is whether amlodipine was started about weeks ago. Almost straightaway my leg swelled on the left, where the vein is worse, half the dose with no improvement. They're taking other dogs for angina and blood pressure. The leg has all the symptoms I described earlier.

Mr Aaron Sweeney

Yeah, sometimes. Well, leg swelling. There are a couple of different reasons why you can have leg swelling. Sometimes it's veins, sometimes blood pressure, and sometimes it can be heart trouble or even kidney trouble. So it's a bit difficult to tell you exactly what I would say. Amlodipine does cause ankle swelling, and if you have veins that get bigger, having the dose is a nice idea if you can. But if that doesn't work. Sometimes you go on different blood pressure medication, and you can manage it. I wouldn't say fix it completely, but you can certainly manage it. So that's one of those ones. I might say to you to batch you back to the GP. Because they do know their stuff about various blood pressure tablets, and they're often pretty good at manipulating it to make sure that you don't have any symptoms kind of like.

Vicky

I've got time for one more question, Paul asks. I'm a keen cyclist. Would vein treatment keep me out of the saddle at all? And if so, for how long is this likely to be?

Mr Aaron Sweeney

So normally if I do an operation I tell people for the first week you feel like you've just played a football match the day before every day. It's a bit sore and achy. You wouldn't go for a run. Many people who are triathletes, for example, usually get back to cycling at two weeks, and they run at three, and they go to the swimming pool at three, because they're not embarrassed by the bruising by then. So cyclists tend to get decent, chunky varicose veins, and that's because of the particular position that you're cycling. It kind of creases things a little bit. So if you've got veins and you're a cyclist. They tend to be big. but I think it takes about two weeks to get back to a spinning class or go out for a decent cycle. Some people are exceptional; in a week they're away, it certainly won't do you any harm if you feel pain-free. But, I would say, depending on the vein, if you're one of the normal veins that I do, I would say in general, people take about two weeks off from doing their stuff and then they get back to normal speed moderately quickly. But I do think it takes. If you're training for things, I'd say it takes about three weeks out of your training schedule to go because of a vein operation, but you generally get back to the gym after a week doing other stuff. But I think it takes about three to really go for it.

Vicky

Lovely That's great. Thanks, Mr Sweeney. Sorry if we didn't answer all of your questions. You provided your name. We cannot see yours via email. So as a thank you for joining this session, we're offering 50% off the value of your initial consultation. There's a discount code there. Call back from your dedicated private patient advisor an email with the recording treatment, information, pricing, and loyalty reward points via email, and also stay a way to stay updated on upcoming news offers and events as well. So if you'd like to discuss further or book your consultation, our private patient team can take your call until 8pm. This evening. Well, all between 8am and 6pm, Monday to Friday, using the number on the screen.

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Mr Aaron Sweeney

Thanks.