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FOAM SCLEROTHERAPY
I was recently asked if I have started using “foam sclerotherapy” in my practice. The answer is I have used it in the past but stopped doing so more than 5 years ago.
My reason for stopping was because, in the literature, there are a significant number of patients who get stroke like symptoms when treated with foam if they happened to have a patent foramen ovale. – PFO-
This is a small hole in the heart which about 1 in 5 people in the general population have. Most people don’t even know they have the condition. It is usually harmless.
Foam sclerotherapy involves taking some of the solutions I already use to treat veins and making a foam by mixing the solution with bubbles of air. This makes the solution adhere better to the vein walls giving better rates of closure. There is good research to show it likely does work better than straight solution.
However in some patients [with PFOs] the bubbles can go though the foramen –hole
in the heart- and end up
lodging in the blood vessels in the brain. This can, and does, cause stroke like symptoms which are clearly alarming to the patient and the doctor.
For that reason, although I personally never had a patient experience this problem,
I stopped using foam. In addition there is still a lot of debate about how to standardize the sizes of the foam bubbles
From a research point of view there are many very capable physicians around the world
who use foam and teach that it is basically safe. They have research to show this. Many are leaders in their field.
However until I feel more comfortable about this problem I will not be using foam. I just don’t want to expose my patients to the risk of having stroke like symptoms even although in most cases those symptoms go away totally.
Most of the veins treated with foam can also be treated by other means. In
my practice I use combinations of traditional sclerotherapy and ambulatory phlebectomy.
At this time I will continue to do that.
t t.
Nov 2009
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H1N1 Influenza
Nov 2009
I have just returned from a 3 day educational meeting at the Mayo Clinic, in
Rochester,
Minnesota.
Amongst the many presentations I heard was one from Dr Gregory Poland, who is an infectious diseases specialist at the Mayo. Like so many at that clinic he is a national, and world, leader in his field.
After hearing his presentation I can tell you there is simply no question in my mind that once vaccine becomes available, [unless there is an absolute contraindication against it],
EVERYONE SHOULD GET AN H1N1 IMMUNISATION
He gave detail after detail of reasons why. A few that I remember are
- Of the first 18 pregnant women in
USA to get ill with H1N1 6 died!
- In the recent outbreak in
Manitoba every ICU bed and ventilator was being used in
Winnipeg..
- By the end of Oct 2009 1000 people- including 100 children- had died from H1N1 in
USA. At the same stage last year that number was 7
- The delay in vaccine production is due to the fact that the process of making it takes 6 months and there are really no short cuts to producing it.
- There is no real difference in the way H1N1 vaccine is made compared to flu vaccines of previous years. In fact if it had occurred just a few months earlier it would have been in this year’s seasonal vaccine. It is going to be in next year’s seasonal vaccine in the Southern hemisphere which is being prepared now.
- in a recent study in London, Ontario, 14 percent of the nursing staff who got H1N1 got it from other staff members and not patients.
- young babies under 6 months of age do not have an immune system that reacts to the flu vaccine. Their only protection is to “blanket immunize” which means everyone around the child should be immunized to stop it being in contact with the virus
His facts and advice are EVIDENCE BASED [not anecdotal] so be reassured. - The vaccine for H1N1 is very very safe.
By a huge amount you are more likely to die from H1N1 [or kill someone by giving it to them] than you are to get seriously ill from the vaccine.
Even if you don’t consider getting it for yourself consider getting it to protect your friends, relatives, children or colleagues at work.
Dr Terry Trusdale and Dr Paisley Trusdale have both had their immunizations. All my Vein Clinic staff who are in contact with patients have been immunized for their, and your, protection.
Please do the same and get yours when the vaccine becomes available.
H1N1 can be a very serious disease and you can get it.
Terry Trusdale
Nov 2009
6 Nov 2009
VISITING ST. JOSEPH’S HOSPITAL
Starting 6 November 2009,
St. Joseph’s Care Group will be screening all visitors entering their facilities.
The only access to
St Joseph’s Hospital will be off the South side parking lot.
Anyone attending an outpatient clinic, including my Vein Clinic, or visiting a patient, will be screened upon entering the hospital for flu like symptoms, and asked to wash their hands before entering.
If you are unwell , and in particular have a cough, fever or flu like illness,
I would request you
cancel your appointment, and rebook when you are well..
For your own health, and the protection of others, Dr. Trusdale recommends you be immunized against the H1N1 flu .
Dr. Terry Trusdale, Dr. Paisley Trusdale and all Vein Clinic staff have been immunized.
tt
Information re Northern Travel Grant Forms posted October 2009
Many patients arrive at my clinic with Northern Travel Grant Forms from their physician asking me to sign Section 4 "Specialist"
On the back of that form you will see that the doctor who is consulted has to be a specialist certified by the Royal College of Physicians and Surgeons - the
Royal
College certifies specialists such as surgeons, cardiologists, gynaecologists etc.
Be reassured I have a full licence to practice medicine in
Ontario, and have since arriving in
Canada in 1975. The
College of
Physicians and Surgeons of Ontario issues such licences. - the
Royal
College and the College of Physicians and Surgeons are different entities.
My post graduate training is in Family Medicine throught the College of Family Physicians of Canada . I currently hold CCFP certification
This means that, although I have limited my practice almost exclusively to treating varicose and spider veins since 1996, I am not a certified specialist under the rules of the Northern Travel Grant
I am also asked why the claim cannot go though
St Joseph's Hospital. My Vein Clinic is not affliated with St Josephs. I rent space from them but supply my own staff. The clinic charts are mine and do not stay at St Josephs. It is my Clinic not St Josephs.
It is therefore my understanding that patients coming to my Vein Clinic are not eligible to get a Northern Travel Grant even when I do procedures such as sclerotherapy or ambulatory phlebectomy, and even if the patient is referred to me.
By a quirk of the system, when I arrange special duplex ultrasound scans of the leg - not the simple ultrasounds I do at my regular clinics- travel grants are permissible. In that circumstance I am the referring doctor and sign Section 3 and the consultant is the radiologist who reported the scan later
t t 2009
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