Two in One

Cardiology and vascular care available at one practice.

When she’s not tending to the patient she cares for three times a day, seven days a week as a private nurse, Nadine Fraser can usually be found teaching health care to medical assistants and patient care technicians at Southern Technical College in Orlando.

Nadine Fraser underwent RFA treatment on her leg and feels better.

Nadine Fraser

If you don’t find her there, then she’s probably administering vaccines to school children, conducting an intake evaluation for someone planning to move into a skilled nursing facility, rehabilitation center or assisted living community or possibly preparing someone’s taxes.

“I do a lot of different things because I don’t like to be bored,” says the 54-year-old registered nurse. “I’m very passionate about health care and about the care people receive, so I stay pretty busy. But I like being busy.”

Looking after her own health is among the many things that keeps Nadine busy. Over the past couple of years, she’s been busier than she would have liked to have been, thanks in part to a cardiac issue that runs through her family.

“Many of the aunts and uncles on my mother’s side have had heart valve replacements due to an insufficiency in the backflow of oxygenated blood, and about a year ago, I was having a few more heart palpitations than usual,” Nadine reveals.

“I needed to have that checked out, and during that process, the doctors asked me if I had any other issues that were bothering me. I said I have very bad varicose veins and told them that I also have this chronic  painful phlebitis that happens.

“I told them that, because of all that, I haven’t worn dresses in years, other than inside the house. I never wear shorts either and mentioned that I’m on my feet all the time and that my legs had become achy and bothersome.

“That’s when they told me their practice is a full-service cardiology and vascular care facility and that they had someone there who could help me with my legs as well. After that, they set me up with an appointment to have my legs looked at.”

Thorough Evaluation

The practice Nadine visited is Heart and Vascular Care, where Pradip B. Baiju, MD, an endovascular specialist and interventional cardiologist, works with Robyn Kempf, PA-C, who specializes in the evaluation and treatment of venous disorders of the legs.

While under the care of Dr. Baiju, Nadine was diagnosed with and treated for atrial fibrillation, which is a quivering of the heart that can lead to the formation of blood clots and cause a stroke, heart attack or other heart complications.

She was then handed over to Robyn for a thorough examination of her legs, where there are two systems of veins – the deep veins in the middle of the leg and the superficial veins near the skin’s surface.

These deep and superficial veins are low pressure systems. The exam uses ultrasound to evaluate the competence of the deep and superficial veins. After treating the superficial veins, the deep veins take over the return blood supply from the extremities.

That examination revealed insufficient valves and bloating in two of the superficial veins in Nadine’s right leg and a blood clot that ran the entire length of the longest superficial vein in Nadine’s left leg.

Out of fear the clot might travel to the heart or lungs, which could prove fatal, Robyn immediately prescribed a blood thinner called COUMADIN® that treats and prevents blood clots and is often prescribed for patients diagnosed with atrial fibrillation, or A-fib.

Robyn then treated the problem veins in Nadine’s right leg, both of which had become enlarged due to a breakdown of the one-way valves that open and close and assist with the flow of blood through the vein and to the heart.

When these valves break down, the result is a condition called venous insufficiency, which allows blood to reflux, or leak, backward down the vein, where the excess blood causes swelling and interferes with the proper circulation in the legs.

Modern Medicine

At Heart and Vascular Care, Robyn uses modern, advanced techniques to treat venous insufficiency, the most common being a minimally invasive technique called radiofrequency ablation (RFA) that shrinks and permanently seals the affected vein from the inside.

“We begin RFA by applying a local anesthetic, then make a small puncture, usually below the knee, and insert a small tube called a sheath into the vein,” Robyn describes. “We then insert a specialized ablation catheter and advance it to the affected area.

“We put fluid and numbing medicine all along the vein and apply controlled heat to the affected sections down along the vein. The heat results in ablation of the vein, where the vein thickens, collapses and seals permanently.

“When we’re finished, we withdraw the catheter and place a small bandage over the puncture site. The leg is then wrapped in a compression bandage, and patients typically return for a follow-up ultrasound exam two days later.”

This follow-up is done to ensure the problem veins are sealed and that there are no blood clots in the deep veins of the legs. The bandages are removed, and patients are instructed to wear compression stockings during the day for two weeks.

Robyn treated only Nadine’s right leg because it’s relatively dangerous to perform an ablation on a leg that has a fresh clot in it. Nadine’s plan is to return this year for another ultrasound evaluation of the left leg. If the clot has resolved, she will proceed with treatment.  Meanwhile, she’s enjoying the results of the treatment on her right leg.

“They started with the great saphenous vein on the right leg, and they ablated that,” Nadine says. “The healing on that one was a little slow because of the Coumadin, but otherwise, I had no great issues with the treatment.

“Then we went back in and did the shorter saphenous, which runs from about the knee down into the back of that right leg. I’ve had great success with that, and now, my right leg feels amazing. I have much less swelling, and there’s no discomfort or pain.”

Nadine says she was fortunate to have found a practice that treats patients for both cardiology issues and vascular problems and was extremely pleased with the care she received for her conditions.

“Everyone there is great,” Nadine exudes. “And Robyn does a great job in her specialty. She’s really good with the ablation treatments. I also like her demeanor. She’s very casual and personal and makes a point to really get to know you.

“At the same time, she tells it to you straight and in language that anybody can understand, and she’s not in a hurry to jump into doing some procedure that may not benefit the patient and might cause them further problems down the road.

“She’s willing to be patient and takes her time with everything, which is great. Some physicians are more about getting the procedures done and getting patients in and out, but they’re not like that at Heart and Vascular Care. They do exactly what’s right for each client.”

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