VARICOSE VEIN ADVICE SHEET PRIVATE DAY CASE Mr Paul O Byrne

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1 VARICOSE VEIN ADVICE SHEET PRIVATE DAY CASE Mr Paul O Byrne What are Varicose Veins Varicose veins are enlarged swollen veins. Most varicose veins are found in the legs. They are generally caused by a weakness in the valve system of the veins and exacerbated by successive pregnancies, occupational standing and hereditary history. Vascular Lab Mr O Byrne may request at your consultation a Vascular Doppler Ultra Sound Scan. His secretary will be in touch with you regarding an appointment for the scan. This scan will accurately map the leak/s causing your varicose veins and if indicated it will also check the deep veins as well as the arterial circulation of the leg for hardening of the arteries. Mr O Byrne will review the results which will determine the type of surgery you require. Complex cases who have had previous vein surgery may require a more detailed Duplex scan which will be discussed and requested at consultation. Preparation before Surgery You must have nothing to eat from 12 midnight the night before your procedure unless otherwise advised. For your comfort you may drink water only up to one hour before your admission time. This will prevent dehydration and keep your mouth moist. (Please also refer to blue Patient Information Leaflet). Please order as soon as possible from Ballinacurra pharmacy in Limerick on , 2 pairs of Full Length Anti Thrombotic stockings to allow for wearing them day and night and washing them. The pharmacist will measure your leg (or take the measurements over the phone) to ensure the correct size is ordered specifically for you. Please bring one pair of stockings with you on your admission day. These stockings minimise the risk of Deep Vein Thrombosis (D.V.T.) occurring. It is important to let us know if you or any member of your immediate family has a history of D.V.T. s or Pulmonary Embolism (P.E.) and a risk assessment will be done. Ladies, if you are taking HRT or the oral contraceptive pill (OCP), please inform your Surgeon who will advise about stopping this medication prior to your surgery. If you are taking Aspirin please continue this medication. Patients on Plavix will need to stop taking this medication 2 weeks prior to their surgery. Patients on Warfarin will need to stop 1 week prior to surgery and you will require an INR blood test on admission. If you are taking any other medication to thin your blood e.g. Pradaxa please inform your surgeon or contact the nursing staff on /490582, who will advise you about stopping this medication prior to surgery. Your Surgeon will advise you when to re start your medication post operatively. It is recommended that you bring loose fitting shoes or slippers, as you will have a heavy bandage on your leg post surgery. For your comfort, please wear loose fitting underwear to prevent the elastic causing pressure on the groin wound. Please have a bath or shower on the morning of your surgery. Please refrain from using oil on your legs or in your bath water prior to surgery as oil dispels the antiseptic skin prep and

2 makes it inefficient as well as interfering with the adhesiveness of the wound dressing and steristrips. All patients unless contraindicated will receive an anti clotting injection under the abdominal skin pre operatively. Mr O Byrne may decide that you may need these injections post operatively if you have a personal or family history of clotting defects. One of the Anti Thrombotic stockings will be applied to your un operated leg. You must leave this on day and night until you have your bath on day 7 after your operation. What happens during Surgery? The operation is normally carried out under Intravenous Anaesthetic and local anaesthetic to the leg. The anaesthetist will insert a small tube called a cannula into your arm and the anaesthetic is given through this. It will make you feel very relaxed and you will sleep through the operation. You will also be given some local anaesthetic in the groin region and down the leg along the path of the veins that are being removed. The procedure itself will take minutes. The operation involves surgically correcting the leak between the deep venous system and the superficial skin veins of your legs. The feeding vein from the groin is usually dealt with by either endovenous laser or surgical ablation. The varicose veins are then dealt with by micro phlebectomy laser or injection. This is the best technique to prevent the development of varicose veins in the future and will leave very little scarring. The small skin punctures may be covered with steristrips and there are normally no external sutures required. The procedure after Surgery You will be transferred back to your bed to sleep off the anaesthetic. Please Do Not get out of bed unless accompanied by a nurse. Although you may feel fine lying in the bed, you may feel faint or sick when you first get up. When you are more awake you will be offered tea and toast, usually one-hour post surgery. When you awake after your surgery you will find your leg will be bandaged with several layers which will remain in position for 48 hours. These are applied to prevent bruising and oozing of the leg. However when you are at home if you are experiencing pain and discomfort caused by the bandage, or if your toes are blue and cold, try to loosen it by either placing your hands inside the bandage to stretch it or cutting the sides of the bandage. If this does not relieve the pain or discomfort please remove the whole bandage. Before discharge you will be escorted for two short walks and encouraged to do deep breathing, isometric and circulation exercises while you are on bed rest. You should also avoid standing still and crossing your legs when sitting. If you require a medical cert please ask your nurse to arrange one before discharge. Mr. O Byrne will see you before you are discharged and he will discuss your operation with you and answer any questions you may have. You will be given a prescription for painkillers, please take them as prescribed. An appointment will be given to you for your post operative review with Mr O Byrne. Patients for review in Freshford Kilkenny will be contacted by Mr O Byrne s private secretary in Freshford. Her contact number is

3 You will need to be escorted in the lift down to the front door. You will need to sit in the back seat of the car with your legs elevated. When you get home you are advised to go to bed having the end of your bed elevated (this can be achieved by placing a few books/blocks to the height of approximately 12 inches under the legs at the end of the bed). Bed elevation is only necessary for the first two days following surgery. When getting out of bed please sit up gradually and rest at the edge of the bed before standing as you may feel very weak if you get out of bed too quickly. If you do feel faint lie down and elevate your legs. Day one You may get up, get dressed and rest on the couch for the day having your legs elevated on some pillows. You are instructed to take three long walks indoors around the house, one in the morning, afternoon and night and continue your ankle exercises for your circulation. Day Two Remove your bandages down to the skin including the dressing pads, which may have some old bloodstains. The outside layer of bandages is the most difficult to remove as it is a self - adhesive layer. Carefully lift and separate the outer brown layer from the other layers. Cut the bandage with a scissors straight down the front from the top to the end just above the toes and open it out at either side to remove it. The other layers will unravel easily. You may have a dressing in your groin, if so, do not interfere with this. You may or may not have steri-strips down along your leg, do not interfere with these if present. Do not be alarmed when you see your leg, it will be quite bruised and lumpy but will settle in one to two weeks following the surgery. Also you may have some numbness or tingling sensation; this is also considered normal and will settle in a few weeks. You must now put on the other Anti Thrombotic stocking and wear this day and night until you have your bath on day 7 post op. You must do a one-mile walk; otherwise you are to rest as much as you can. Anytime you sit down you must elevate your leg on a chair. Day Three Onwards You are instructed to walk 1 to 3 miles daily and to return to your normal household activities gradually, avoiding standing for long periods. We recommend you wear loose fitting underwear for the first week following your surgery especially at the groin to avoid pressure at the operation site. You must not shower or bath for the first week to prevent your dressings getting wet. This reduces the risk of infection and scarring, thus promoting healing. Driving is not advised for 3 4 days after surgery due to the restrictions of the bandages. Short, urgent essential trips in the car may be made once bandages are removed. You are advised to take a trial drive off the main road initially to ensure you are confidently in control of the car. If you do not feel confident you are advised not to drive.

4 Day 7 Today you are advised to have a savlon bath. If you have steri strips on the leg you must lie on your bed with your leg elevated in order to remove your steri strips, this can be done before or after your bath. Please put the Anti Thrombotic stockings back on after your bath and continue to wear them day and night until you are two weeks post op. Please wash stockings every 2-3 days as per manufacturer s instructions. You need to continue the savlon bath for the next 7 days. If you are having your second leg done a week after your first leg, you must remember to avoid getting this leg wet. You must also increase your walking from one mile to three miles or more daily and to continue your walks for six weeks as this promotes the venous return via your deep veins. Ladies will be required to have a savlon bath for two days only on days 7 & 8 to prevent thrush, after this salt baths or use essential oils (tea tree oil is an antiseptic) for the remaining five days. If your occupation requires standing for long periods of time, it would be an advantage to wear a below knee support stocking when at work. The support stockings can be obtained from your pharmacist where you will be measured for your specific size and style. (Mediven for ladies and Mediman for men). The class and grade will be determined by the surgeon and will be stated on the prescription. If you feel you will require support stockings please ask Mr. O Byrne on the discharge round to prescribe them for you. A full return to sporting activities and employment is usually feasible two to three weeks after the operation. Those remaining thread/spider veins can be treated by Microsclerotherapy 6-8 weeks after your operation. You can ring Barringtons Hospital on / for an appointment If Microsclerotherapy is required it is advisable for patients to bring in 70 denier support tights on day of your treatment. Please ask Mr O Byrne s secretary for the advice sheet for this procedure. Possible complications of surgery Bruising Bleeding Haematoma Phlebitis Infection Clots to leg or lungs Please contact Mr O Byrne or your GP immediately if you are experiencing any of the following; Leg swelling Calf tenderness or pain Severe calf pain when standing on Tip Toe (positive Homans sign) Chest pain Shortness of breath If you have any queries or concerns after your surgery please contact Barringtons Hospital first floor nurses station on or second floor nurses station on

5 For enquires regarding admission times or dates for surgery / reviews please contact the Administration team on or In the unlikely case of an emergency Mr. O Byrne is available on a 24 hour mobile number

6 POST OPERATIVE DEEP BREATHING AND ISOMETRIC/CIRCULATION EXCERCISES Deep breathing exercises After an anaesthetic it is important to take some deep breaths to minimise the retention of secretions in the lungs. During normal activity, our bodies do this automatically, so take 3-4 deep breaths every 20 minutes until you are up and about after the operation. Circulation exercises In the initial recovery period, your circulation tends to slow down. Maintain good circulation by doing these exercises: Pull toes and feet towards you, and push away again. Repeat x 10. Tighten your buttock muscles, hold for 5 seconds then release. Repeat x 10. Repeat these exercises every half an hour in the recovery period, until you are up and about. Static quadriceps exercise Sit upright with your operated leg in front of you. Bring your toes towards you and press your knee down into the bed by tightening your muscles. Hold for 5 seconds. Repeat 10 times. Straight leg raise Sit with your operated leg out in front of you, and your other knee bent. Tighten your thigh muscles and lift your leg 6 inches off the bed. Hold for 5 seconds and lower slowly to the bed. Repeat 10 times

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