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.

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.

How we can help with your overall health

Baird overall health

There are 60,000 miles of blood vessels in the body.
Pointing us toward a lot of answers.

VCU Health at Baird Vascular Institute is a multi-disciplinary collaboration of interventional radiologists and vascular surgeons. By working in tandem, we can use the most advanced imaging technology to give us the fastest, clearest picture of a patient’s peripheral circulatory system and vascular problems and diseases, pointing us precisely to the right diagnosis and treatment plan and procedures.

Because of our advanced diagnostic imaging capabilities and convenient location, many physicians refer patients to see us for outpatient evaluations and preparation for various surgical procedures that must be conducted in the hospital, as well as for follow-up examinations. Seeing us as an outpatient saves you many trips to the hospital – and leads to a shorter hospital stay.

Whether you’re referred to us by your doctor or want to talk with us directly about your concerns and needs, our physicians are always available for consultation appointments to listen, learn and talk about your condition and what we can do to help. Open and clear communication with your doctor and you is a crucial aspect of providing proper treatment and care. We work as a team.

Before your appointment, take a few steps in advance to make sure we have the best background information. During your consultation, we’ll talk through your concerns, review your medical history and make an assessment of your current situation. Once we make our diagnosis, we discuss different options to develop a treatment plan tailored to your individual needs. We make sure you understand every aspect of your care.

Our capabilities also allow us to handle the primary treatment of a number of other conditions that once often required prolonged hospitalizations. Today, our image-guided expertise makes possible primarily outpatient care of these conditions. Depending on the condition, certain procedures are handled at the hospital; in other cases, however, these conditions can now be handled completely on an outpatient basis – without a single hospital visit.

Making an appointment at the VCU Health at Baird Vascular Institute is quick and easy. We try to accommodate patients and referring physicians as efficiently as possible.

To schedule an appointment call (804) 828-2600 to speak to one of our scheduling associates, or send us an email.

Why now is the perfect time to get rid of your spider & varicose veins

baird fall leg vein treatment

Most people start to think about their spider or varicose veins right about the late springtime when the weather gets warm and they go to put on shorts for the first time of the year. That’s a natural reaction, but truthfully – right now – in the fall, is the very best time to have a procedure done on your leg veins.

We talked to Dr. Malcolm Sydnor about why you should consider having your leg veins treated now, instead of in the spring. “if you have spider or reticular veins on your legs, we will use a tiny needle in a process called sclerotherapy to inject those things to get rid of them.” Sclerotherapy involves using a tiny needle to inject individual spider veins with a solution that makes them shrink. As they shrink, blood is channeled to deeper veins, making the spider veins on the surface almost invisible. “Afterward,” he continued, “we are going to need you to stay out of the sun until those veins have totally resolved – otherwise you’re going to see pigmentation changes on the skin where those veins were.”

Dr. Sydnor continued, “If the sun hits those locations before they fully resolve, the blood cells that remain will release a pigment that you can see on your skin. It’s because of that reason that we like to perform the vast majority of cosmetic treatments retail for spider veins in the fall.”

“Other treatments such as endovenous thermal ablation, are not as affected by sun exposure because the vein is much farther under the skin,” he continued. Endovenous thermal ablation (EVTA) is an alternative to surgically removing varicose veins. The team uses ultrasound to guide a small catheter tipped with a laser or radio frequency emitter into the vein. The catheter delivers just enough laser or radio wave heat to cause the vein to close, collapse and seal shut, without affecting nearby tissue. The treated vein is absorbed by the body and disappears within a few months. EVTA not only treats your large varicose veins, but also eliminates many smaller unsightly ones.

Although we welcome patients any time of the year, ideally our physicians recommend a fall time frame so that the legs have plenty of time to heal before exposure to the warm summer sun.

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

Who are the best candidates for image guided tendon treatment?

baird image.guided candidate

Tendons are the tough, flexible bands of tissue that connect your muscles to the bones in your joints, working together to allow all the twisting, gripping, grabbing, bending and lifting in your busy life. But repetitive pounding motions can cause microscopic tears every time you use your tendon. As you keep at it, these micro tears do not have time to heal properly and, unless treated, can get worse, making you suffer for months or years. This condition is often called simply tendinitis (tendon inflammation), but usually is actually tendinosis, tendon tissue that has simply broken down from the overuse and micro tears.

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.

We talked to Dr. Jeffrey Elbich, who said, “The majority of the time, tendon pain goes away on its own with time, rest and ice – and reducing the activities that brought the pain in the first place. However, if the pain lasts more than 3 months, medical research suggests that it is unlikely to go away on its own.”

“If you’ve had pain more than 3 months and you’ve tried all the home remedies with no relief, you may be a good candidate for image guided tendon treatment,” continued Dr. Elbich.

If you’re frustrated with chronic tendon pain or have tried multiple treatment options, our image-guided tendon treatment – also called percutaneous tenotomy or fasciotomy – could be the treatment you need for rapid pain relief. Unlike other medical or physical therapies, this procedure safely removes the cause of the pain at the source, and unlike many traditional surgical procedures, it is far less invasive, requires far less recovery time – and has a much higher success rate.

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.

We then use an FDA-cleared device to remove the damaged tendon tissue. You don’t even need stitches. The entire treatment takes about 20 minutes.

You may be asking if image-guided treatment is right for you.

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.

How does having a port affect my daily life?

Baird Cancer Treatment 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.

Once you have a port, you may wonder how it will affect your day to day activities. We spoke with Richard Williams, RN, BSN, OCN at Baird Vascular Institute, who said to think of it as you would any medical procedure, “For the first few days, avoid any heavy lifting or strenuous activities.” Williams continued, “There are folks who like to hunt, or play tennis, or even have a job like a hairdresser where their arms move up and down frequently, for those folks we tell them they need to give the site a chance to heal, to let the skin start coming together and heal.”

Williams added, “We do ask people about their lifestyle and take that into consideration when placing the port. We can put the port on a different side if needed. All these things are discussed with the patient because we know they’re going to have this port for awhile.”

You can even travel with a port. Williams added, “If you do go through an airport scanner, it shouldn’t go off because there’s not metal in the port, but you can pull out a card that we’ll give you and show the agent what the ‘bump’ is in your scan.”

If you’d like to learn more about port and the procedure, we have a whole series of YouTube videos on the topic.

We’ll work with you and your health care team to choose the best long-term IV access option for your situation. Give us a call at (804) 828-2600 to discuss your options.

 

Why a port is a good idea

VCU Health Baird Port

From needle sticks and blood draws, from injections to IVs, everybody has had their shots. Usually, a pinch is all there is to it. But 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.

We talked to VCU Baird Institute’s Dr. Shep Morano about why someone might need a port.

“A port is a safe, reliable and low maintenance way to access a patient’s bloodstream,” said Dr. Morano. “Sometimes a port is recommended for patients who have used up all their peripheral veins, or doctors or nurses are having difficulty accessing their veins.”

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.

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

These ports can remain in place for several weeks or months and can help patients in many ways:

  • Fewer needle sticks to draw blood
  • Multiple IV lines accessible at one site
  • Lowered risk by reduced leakage, which is particularly important with chemotherapy agents that can cause tissue or muscle damage if they leak

Dr. Morano added, “The benefits of added safety, patient comfort, infection control, and ease of access make ports a great option for someone who needs long term central venous access.”

There are several types of long-term IV ports, the most well-known is the Port-a-cath. 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.

A peripherally inserted central catheters or PICC line is inserted into one of the large veins in the arm near the elbow. PICC lines are generally used for shorter periods (one to six weeks) and are easier to remove.

These types of catheters, such as a Central line, tunneled venous catheters or Hickman catheters, are inserted into a large vein under the collarbone or in the neck and leave the body through a separate exit point, usually the upper chest. A “cuff” secures the line, providing protection from infection and holding the catheter in place as your body heals around it.

We work with you and your health care team to choose the best long-term IV access option for your situation.