For Jeri Phillips of Spotsylvania, what began as a doctor’s appointment to discuss spider vein treatments led to the discovery of a potentially dangerous blood clot – and a genetic condition that increases her susceptibility to forming clots. She later learned that the condition affects both her children.
Phillips’ story illustrates the value of vascular training and a radiology background in treating vein conditions, noted R. Donald Doherty Jr., MD, an interventional radiologist with Virginia Interventional & Vascular Associates (VIVA).
He estimated that nearly 90% of patients referred by other physicians to VIVA for spider vein treatments have an underlying venous condition that should be addressed before treatments begin. In Phillips’ case, that condition was potentially life threatening. Even in less dramatic cases, failure to treat an underlying condition can impair results.
“If you ignore the underlying condition, you won’t resolve the [cosmetic] vein problem. For example, you can treat spider veins but they are going to come back if you do not address the underlying problem,” he said.
Phillips’ case also demonstrates how local healthcare providers collaborate with each other to improve care for their patients, Dr. Doherty added.
An Unexpected Finding
Phillips’ experience began with surgery on her left knee in the Spring of 2008 to repair torn ligaments and injuries to the medial meniscus caused by a skiing accident. Her surgery was followed by physical therapy. Phillips noticed her left leg and knee were often swollen during her recuperation but there was no pain or redness, she recalled.
In the Fall of 2008, recovered from her surgery, Phillips consulted with local dermatologist Terri P. Morris, MD, PhD, of The Dermatology Center about treatments to improve the appearance of spider veins. Dr. Morris examined Phillips’ legs and concluded some of the veins could not be treated successfully with saline injections, a type of sclerotherapy. Dr. Morris referred Phillips to VIVA.
“Dr. Morris is highly skilled at screening her patients for vein procedures, and consulting with vascular specialists on cases that require their expertise,” VIVA’s Dr. Doherty noted. “Patients benefit from collaborative relationships like these among local medical specialists.”
VIVA physicians are interventional radiologists and vascular surgeons who are board-certified, fellowship-trained specialists in treating vascular conditions. They offer a variety of vein treatments, depending on the patient’s condition, including EndoVenous Laser Treatment (EVLT®) and radio frequency ablation. Many of the treatments are same-day procedures performed in VIVA’s offices near Lee’s Hill.
One of the most important steps when assessing a patient for vein treatments is a thorough ultrasound performed by a registered vascular technologist, Dr. Doherty explained. When Phillips arrived at VIVA, Vascular Technologist Stephanie Nichols performed a painless 30-minute ultrasound of the deep veins of the leg to evaluate the direction and quality of blood flow. The test also examined more superficial veins, noting their size and interconnections. Dr. Doherty then assessed the results.
“I remember Dr. Doherty coming into the room afterward and saying, ‘Did you know you have a blood clot in your left knee?” Phillips said.
Having determined the clot was not immediately life threatening, Dr. Doherty referred a surprised Phillips to specialists at Hematology-Oncology Associates of Fredericksburg. Phillips said Christopher N. Vaughn, MD, prescribed three months of the blood thinner Coumadin® (warfarin) to dissolve the clot. In a follow-up visit to VIVA, physicians determined the blood clot had dissolved, and they advised Phillips to wear compression hose toreduce the risk of swelling and future blood clots.
If the clot had not been detected and treated, Dr. Doherty said, there is a chance it may have led to a pulmonary embolism, which can be life threatening. Untreated blood clots can also cause chronic leg swelling and other conditions such as phlebitis.
Hematology-Oncology Associates also performed tests that determined Phillips has a single gene of Factor V Leiden, which increases her chances of forming abnormal blood clots. The National Institutes of Health estimate that 10% of patients with Factor V Leiden, like Phillips, experience abnormal blood clots.
“Because of it, whenever I have surgery or a long trip I need to get a shot of Lovenox® (enoxaparin) beforehand. It’s a temporary blood thinner,” Phillips said.
Fast-forward to 2010. Phillips, her husband, and two children were excitedly planning a six-week trip to Germany in the summer of 2011, coinciding with her husband’s business travel there.
Knowing her own need for precautions before long trips, Phillips took her son Justin and teenage daughter Jenna to a pediatric hematologist for testing. Like Phillips, her son has a single gene of Factor V Leiden. Her daughter has two genes, one from each parent, which further increases her risk of abnormal blood clots and requires additional precautions, Phillips said.
Phillips gave herself an injection of Lovenox® before the flights to and from Germany, and walked the aisles of the plane every three to four hours. Since her children were young and had never experienced a deep vein thrombosis, the hematologist said they did not need medication but should make sure to move about the airplane cabin, like their mother.
The family’s trip to Germany was free of major medical events and a high point for the family. Today Phillips is a project manager for Susan Carol Associates Public Relations, which assists VIVA and its parent group, Radiologic Associates of Fredericksburg, with external communications.