What are the risks of an IVC filter?

baird IVC filter risk

One of the services we offer our patients is IV filter placements. Inferior vena cava (IVC) filters are small metal devices placed in patients at risk of developing blood clots or deep vein thrombosis in the legs or pelvis; the clots can break off and cause pulmonary embolism, the lodging of an embolus, such as a blood clot, in the lungs. Your doctor may recommend an IVC filter for conditions such as deep vein thrombosis (DVT), pulmonary embolism, trauma immobility or recent surgery or childbirth.

Recently, IVC filters have been a topic of conversation on whether they’re safe or not. We talked to Dr. Brian Strife about IVC filters and here’s what he had to say.

“IVC filters have been placed for the last several decades, developed initially in the 1960’s,” he said. “Originally, they were designed as permanent devices, meaning the filter would be placed in the patient’s vein, and it was designed to remain in place for the life of the patient.”

In the last few years, retrievable filters were developed. They have a hook or some other component to the filter where a physician could grab it and remove it. “Over time, what we learned is that some of these filters were prone to develop problems in a very small number of them,” said Dr. Strife. “The problems included migration, or movement of the filter, fracture or breaking of the filter, and then clotting of the filter.” Those are the 3 main complications that we often hear about with inferior vena cava filters.

“When the filter itself develops a blood clot,” he continued, “it can block the main vein, the IVC, this can lead to significant pain and swelling in the lower extremities. Also, the filters themselves, being made out of metal, over time the metal can stress and fatigue. The filter can break, pieces of the filter can migrate into the patient and damage adjacent organs. Very rarely, pieces of the filter can break off and go to the heart and lungs.”

The filters, whether they are permanent or retrievable types, are meant to stay in the patient for a long time. The filters are made out of stainless steel or some kind of metal alloy that is designed to withstand years of being inside a human body. It’s a rare occurrence that the filters have any problems at all.

“Although these complications are extremely uncommon,” said Dr. Strife. “It is a source of patient anxiety and we often receive a number of phone calls from patients asking if they should have their filter removed to avoid these complications.”

“In 2010, the FDA recommended that physicians who placed these filters, and physicians who follow patients with these filters, make an attempted to consider IVC filter retrieval when the filter is no longer needed,” he continued. “Sometimes that’s a tough question to answer, because we don’t necessarily know which patients are best suited to have a filter in for the rest of their lives. When a patient calls our office and says ‘I have an inferior vena cava filter and I’d like to have it removed,’ we typically have the patient come in for a consultation, discuss why they have the filter in the first place, and try to make an informed decision on whether retrieval is appropriate for them or not. Sometimes, that’s a very easy question to answer, sometimes we need to do additional tests and consult with other physicians before making that decision.”

If you need an IVC filter, our would like to talk to us about one you currently have, call us at (804) 828-2600 to discuss your options.

Conscious Sedation

baird conscious sedation

One of the first questions that our patients ask us when they are scheduled for a procedure is, “Will I feel pain?” This is an understandable concern for someone getting ready to undergo a minimally invasive procedure, especially if it’s their first time having a medical procedure performed. Minimizing pain and discomfort is one of our primary concerns here at BVI. We want to do everything possible to ensure that our patients have a positive experience during their visit which is why we use conscious sedation during many of our procedures.

What is conscious sedation?

Conscious sedation is when a combination of medicines is administered to help you relax (a sedative) and to block pain (an anesthetic) during a medical procedure. Conscious sedation is safe and effective for people who need a minimally invasive procedure. Here at BVI, these medicines are given through an intravenous line (IV) by one of our nurses under the direct supervision of a physician. You will begin to feel drowsy and relaxed very quickly. You may fall asleep, but you will wake up easily to respond to people in the room. You may be able to respond to verbal cues. You will be monitored throughout the entire procedure by our medical team to make sure that your blood pressure, heart rate and oxygen levels stay within safe limits.

The medicine will wear off quickly and recovery after the procedure is generally very fast. After conscious sedation, you may feel drowsy and not remember much about your procedure including any associated pain. Afterwards, you will feel sleepy and may have a headache or feel sick to your stomach. During recovery, your finger will be clipped to a special device (pulse oximeter) to check the oxygen levels in your blood and your blood pressure and heart rate will be monitored. You should be able to go home 1 to 2 hours after your procedure.

Is conscious sedation the same as general anesthesia?

No. General anesthesia (also known as deep sedation) is when you are administered drugs that put you in a totally unconscious state. Under general anesthesia, you have no awareness of the procedure or your surroundings at all. General anesthesia is usually reserved for more complex and lengthy procedures or when your provider deems in necessary. General anesthesia also comes with higher associated risks. Only licensed anesthesiologists or nurse anesthetists are able to administer general anesthesia. Recovery times are usually longer than conscious sedation and may present more unpleasant side-effects. BVI does NOT use general anesthesia.

Before the Procedure

Be sure to tell us if you are or could be pregnant. We also want to know what medicines you are taking, even drugs, supplements, or herbs you bought without a prescription. A day or two before the procedure, one of our nurses will contact you to go over pre-procedural instructions. This generally includes:

  • Not eating or drinking six hours prior to the procedure
  • Be sure to have someone accompany you to the procedure. You will not be in any shape to drive home
  • Discussion of any lab work that will be required prior to your procedure
  • Arrive at the time instructed

You will be given an instruction packet with more detailed information prior to your procedure. And as always, if you have any questions you can give us a call at (804) 828-2600 to talk with one of our providers. Conscious sedation is a safe and effective way to minimize pain and anxiety for our patients.

4 questions you may have about ports

VCU Health Baird Port

Many conditions, such as cancer treatment, long-term IV medication or kidney dialysis, require frequent or constant access to your veins. Repeated needle sticks in the same area can be hard on you and hard on your veins. That’s why we specialize in placing vein access ports, so that doctors don’t have to stick you with a needle or restart an IV line every time you need treatment. That makes care easier — and your life easier.

For long term IV access, placing a semi-permanent catheter such as a “port-a-cath,” chemotherapy port or IV access port into a large vein in the upper arm or neck can make treatment easier for patients undergoing treatments that require frequent or constant vein access such as:

  • Chemotherapy or anti-cancer drug infusions
  • Hemodialysis
  • Long-term intravenous antibiotic treatment
  • Long-term intravenous feeding
  • Repeated drawing of blood samples

Unlike most other types of catheters, a port-a-cath is implanted completely underneath the skin. This type of port allows you to bathe and swim without the risk of infection. Port-a-caths can remain in place for months or even years.

If you’ve been told you need a port, you may have questions – here are 4 questions people want to know.

Is having a port painful? Having a device implanted under your skin can seem frightening to many people as is concern for ongoing pain. As with any medical procedure, you can expect some pain after the insertion, but ongoing pain is minimal, and relative to each individual patient’s level of pain tolerance. We talked to Dr. Shep Morano about ports. “You’ll notice that you can see and maybe even feel the reservoir of port area under the skin,” said Dr. Morano, “you can also sometimes feel and see part of the catheter as it runs over the clavicle and into the vein into the base of the neck.” For most people, he continued, “They don’t even notice the port after a while, it just becomes part of their body and it doesn’t bother them or even notice it that much.”

What is a cancer port pillow? A cancer port small pillow with a strap is sometimes used to cover seat belts, purse handles, cross body bags, or other straps that may rub against the port. They can be handmade or found at several online retailers.

Can my port get infected? Just like any other medical device, certain precautions must be taken to care for your port. We wrote a blog post a while back on port care, but the best thing to remember is follow the instructions from your physician and care team, and be sure to contact us if anything seems out of the ordinary.

What is a cancer port tattoo? When we went to research questions related to ports, a cancer port tattoo was something that was frequently searched online. Like many life experiences, some people commemorate their cancer journey through body art like tattoos. A cancer port tattoo is simply a tattoo that uses artwork to cover or minimize the appearance of the scar where the port was placed. Whether or not to have one is a deeply personal choice, but many cancer survivors view their tattoo as a badge of strength, or a symbol of renewal and hope.

If you need a port, or have questions, call us at (804) 828-2600 to discuss your options.

Could I be at risk for PAD?

Baird PAD risk

Vascular diseases range from diseases of the arteries, veins and lymph vessels to blood disorders that affect circulation. Among the most common types of vascular disease are peripheral vascular disease (PVD), peripheral artery disease (PAD) and coronary artery disease. The terms peripheral vascular disease and peripheral artery disease are often used interchangeably, but we discuss both here. Many of the problems we diagnose and treat involve peripheral vascular disease in one degree or another.

The most common type of peripheral vascular disease (PVD) is peripheral artery disease (PAD). Like the blood vessels of the heart (coronary arteries), your peripheral arteries (blood vessels outside the heart) also may develop atherosclerosis. Over time, the plaque buildup narrows the artery, causing increased pressure in the blood vessel. Eventually, the inside of the artery narrows so much that it restricts blood flow and less oxygen is delivered to the tissues, causing a condition called ischemia, an inadequate supply of blood that causes tissue damage.

If a fragment of this plaque from any part of the body breaks loose and clogs one of the arteries supplying the heart itself, the result is a heart attack. If a fragment breaks and blocks an artery going to the brain, a stroke will result. Narrowing of the arteries that supply the kidneys with blood can cause high blood pressure and kidney failure. Any tissue that does not have an adequate supply of blood and oxygen will, over time, become permanently damaged and die. That it is critical to diagnose and treat peripheral vascular diseases before it becomes a more serious problem.

In the early stages of PAD, symptoms include cramping and pain in the legs and buttocks, indicating poor circulation in the legs. Other common symptoms include fatigue, heaviness and discomfort during exercise or activity. These symptoms generally go away when the activity stops or you are resting. This is called “intermittent claudication.”

PAD affects about 8 million Americans. Atherosclerosis can start as early as the age of 20, and becomes more common as one gets older. By age 65, about 12 to 20 percent of the population has some degree of vascular disease. The exact cause is unknown, but several risk factors are known to accelerate the formation of fatty deposits, or plaque, in the arteries:

  • Smoking
  • Family history of vascular disease, angina, heart attacks or stroke
  • Being overweight
  • An unhealthy diet
  • Lack of exercise
  • Diabetes
  • Being male
  • High blood pressure
  • High cholesterol levels
  • Stress

Early diagnosis is critical, as people with PAD have a four to five times higher risk of having a heart attack or stroke. Unfortunately, PAD often goes undiagnosed as symptoms are often mistaken for something else.

If you want to learn more about peripheral vascular disease (PVD) and treatment options, wish to discuss symptoms or problems you may be experiencing or if your doctor has recommended that you see us for a vascular test, please contact us at (804) 828-2600 or email us.

Image Guided Tendon Treatment for Tennis Elbow

Baird tennis elbow

“Excruciating.” That’s the word every active person uses to tell us about the pain of “runner’s heel” (plantar fasciitis), “tennis elbow” and other tendon injuries. That little twinge you felt on your daily jog or practicing your forehand has now become a knife-sharp sting in the exact same spot with every step or every swing you take, every day. It’s impossible to ignore the pain…and you shouldn’t. Tendon injuries need attention. Sometimes, rest, therapy and a change in activities may ease the pain…but often the damage is permanent, and only gets worse.

Until now. Using precision ultrasound imaging guidance and a minimally invasive treatment, we can delicately remove the damaged tendon tissue and get you back to the activities you love in a matter of weeks – with little to no pain.

We’ve talked several times about image guided tendon treatment for plantar fasciitis, but what about tennis elbow? We spoke with Dr. Jeffrey Elbich about the difference in the procedure.

Q. Tell us about the difference in the image guided tendon treatment procedure on the elbow vs. on the heel?

A. The procedure is quite similar; patient positioning is essentially upright in a chair as opposed to lying down. It seems to be a less sensitive area compared with plantar work, but I still give IV medicine (moderate sedation) to maximize comfort. The  procedure time a slight bit quicker because it’s usually smaller treatment zone.

Q. How big is the incision and where is it?

A. The incision is approximately 2-3mm over the lateral (outside) elbow.

Q. What’s the recovery time?

A. For the outpatient procedure, there will be some post-procedural discomfort and swelling expected for a few days, you’ll have some lifting restrictions for about 2 weeks. A patient can expect pain relief an average of 1-2 months after the procedure.

Q. What has the patient reaction been afterward?

A. We’ve had good results with the elbow treatment ~90% success.

Q. What does your ideal patient for this type of treatment look like?

 A. Any individual that has had pain localized to specific location on elbow (lateral epicondyle), going on for more than four months, despite conservative measures and at home remedies. An office visit will confirm the pain location, as well as ultrasound to see if there is targetable tissue.

The treatment requires only a local anesthetic and a tiny incision, and is virtually pain-free. We use a targeted application of ultrasound energy to break down the damaged tendon tissue while leaving surrounding healthy tissue untouched.

Is image-guided treatment right for me?

If you answer yes to these questions, it may be time to discuss our image-guided tendon treatment.

  • Have you given up any activities due to tendon pain?
  • Have you been suffering for three months or longer?
  • Have you taken multiple steps to get rid of your pain without lasting success?
  • Are you tired of masking the pain or enduring it rather than treating it at the source?

Call us at (804) 828-2600 to discuss whether image-guided treatment is the right option for you.

What is reflux in the veins?

baird reflux

Most people associate varicose veins with prominent, swollen, twisted, and ropelike veins wrapping their legs, often dark blue in color – and often quite painful. These are symptomatic varicose veins. They develop over time, with factors such as age, family history, pregnancy, weight gain, and prolonged standing all possible contributing factors. They’re caused by weakened valves in the leg veins that flow blood back to your heart. When the valves weaken, blood pools and builds pressure in the leg veins, causing them to swell, expand and twist as the walls of the veins are weakened – and the weakened valves and veins are prone to clots or hemorrhaging, which is why treatment is so important.

We talked to Dr. Malcom Sydnor about varicose veins, and what the term “reflux” means. “When people have varicose that are large or substantial that is almost always a result of reflux,” said Dr. Sydnor. “What reflux means is that all the blood your body should flow in your lower extremities from your feet, back to your heart and lungs were it picks up oxygen and gets redistributed back through your body.”

“But sometimes the saphenous veins in the legs, which have valves in them to keep the blood flowing north,” he continued, “have valves that become leaky and have problems and then the blood starts falling south instead of moving north.”

“When that happens it’s like an upside down tree – it kind of blows out all the rest of the veins that are supposed to be feeding into it, and that’s actually what you see on the surface with spider veins, reticular veins, and varicose veins.” Dr. Syndor continued, “So, reflux in the legs is when the blood flows south instead of flowing north north the way supposed to be. When that happens, the blood becomes engorged when it sits down in your legs. You can get ankle swelling, you can get pigmentation changes, all because you have a bunch of deoxygenated blood that sitting down there and it’s not getting the chance to get back to your heart and lungs to pick up oxygen the way it should be.”

To treat more serious varicose vein problems, we offer several effective and minimally invasive solutions. After diagnosis, we will discuss your options so you can choose the treatment that best suits your needs. Although effective, no varicose vein treatment, whether surgical or minimally – invasive, can prevent new varicose veins from developing in the future. Most health insurance plans cover treatment of significant symptomatic varicose veins, but some consider treatment of spider veins as cosmetic surgery.

Call us at (804) 828-2600 to discuss your options. You may decide that beautiful legs and pain free legs are worth it.

Who’s at risk for varicose veins?

Baird whos at risk for varicose

Varicose veins are enlarged veins in the legs near the surface of the skin, ranging from tiny to large. Spider veins are small, surface veins, which, while embarrassing, are relatively minor.

Varicose veins are easy to see, especially when you stand up. If you have signs of a deep vein problem like DVT or plan to have treatment for spider veins or symptomatic varicose veins, you may need more tests, such as a vascular ultrasound exam.

We talked to Dr. Brian Strife about who may be at risk for varicose veins. “Varicose and spider veins may have a familial component or an inherited component,” said Dr. Strife. “We often take a family history when interviewing new patient to see if other members of their family suffer from abnormal or painful leg veins.”

Particular situations may also contribute to varicose vein risk. Dr. Strife continued, “Women who are postpartum may have an increased appearance of abnormal veins in the legs, as well as people who have an occupation that requires prolonged standing may be at risk of developing abnormal leg veins.”

Advanced age and obesity can also contribute to an increased risk for varicose veins. Varicose veins may also be a sign of a blockage in deeper veins called deep vein thrombosis (DVT), a serious, sometimes deadly condition in which blood clots forming in your leg veins can break loose and move to your lungs, blocking blood flow (pulmonary embolism). It is always a good idea to talk to your physician if varicose veins appear.

The good news is that most insurers typically cover treatment of the more serious, symptomatic varicose veins. If your diagnosis indicates that you need a specific treatment, our staff will submit all relevant information to your insurance company for pre-authorization, or provide you with the approximate cost of treatment.

Call us at (804) 828-2600 to discuss your options.