An Interview with John Kingsley, MD, FACS
Talking with Dr. John Kingsley can only be described as a singular pleasure. Congenial, amusing, and passionate about his work and his life, he embodies the true American spirit: the focused pursuit of excellence, intense curiosity, and the drive to be the best one can be for the sheer joy of it.
During this hour-long interview, in which he opined with unbridled energy about veins, ambition, patient care, innovations in technique he has developed, teaching, and why he loves taking care of his patients.
So, Dr. Kingsley…can you give us a 30-second crash course about veins that we can actually understand and stay awake for?
Of course I can! Veins and arteries are the freeways of our circulation systems, keeping oxygen-rich blood flowing from heart to extremities and oxygen depleted blood flowing back toward the heart. Veins have one-way valves and if they’re not working the way they’re supposed to, blood efficiency is compromised – causing the veins to enlarge and become congested with blood. Spider veins and varicose veins are the result, and pain is often a key symptom. Standing for long periods of time doesn’t help and can make the legs heavy, tired, achy, hot, itchy, cramped, throbbing, and restless. If left un-treated, dark skin changes develop from the mid-calf to the foot secondary to blood pigment staining. The skin tightens over time much as a glove. Ultimately the skin around the ankle can break down into very painful ulcers. The most common symtom is pain and swelling, a heavy and tired sensation in the legs, as blood and serum congest the tissues.
Vein disorders may not be obvious to our patients or to their doctors, and may go untreated for many years. Vein problems are not a vanity issue, but rather a health issue. The good news is that nearly all vein problems can now be treated, even if our patients are on blood thinners or have other significant medical problems.
Why do so many people develop problems with their veins?
Vein problems are most often caused by a genetic predisposition, which means the condition runs in families. For instance, if one of your parents has varicose veins, your risk is 40% greater of developing them and if both parents have it, your risk level goes up to 90%. Pregnancy also brings it out – in fact, the ratio of women to men with vein problems is 4 to 1. One pregnancy increases your risk 26%, which rises to 60% after four children. Pregnancy weakens the veins not so much from baby pressure but from the high level of the progestin hormone.
Obesity is a significant risk factor, too; for a large abdominal girth places an increase in pressure and regurgitation of blood and fluid down the saphenous veins. While women are at greater risk in early life, males have a higher risk of developing vein problems after the age of 55. Standing for long periods also greatly increases your chances of developing varicose veins.
What is the average age of your patients?
They range from 30 to 60 typically, but I have ttreated patients as young as 16 and as old as 90. Patients are healthy for longer years now, and many wish to not continue to suffer leg pains and unsightly veins. Plus the modern treatments are so very safe and painless, unless the patient has a severe medical condition, most will tolerate the treatment very well.
Which vein disorders do you primarily treat?
The most common vein disorders in the world today are varicose veins and spider veins, with leg pain and leg swelling frequently associated. Nearly always there is an underlying vein circulation problem, and the most common problem is called venous insufficiency caused by great or small saphenous vein incompetency - meaning the valves in these veins do not close properly, and allow blood and serum to regurgitate backward down our legs.
Treating these problems is now fairly simple, although fairly sophisticated to the doctor. To the patient, there is rarely the necessity for an incision, and the procedures are completed using laser fibers and ultrasound guided access to the abnormal veins. Our goal is to eliminate the leaking veins, and allow our body to direct blood flow into the deeper muscle veins which are always normal and with normal valves.
Describe your initial consultation with new patients.
About 40 new patients undergo consultation in our vein clinics each week. Before they arrive, they receive in the mail quite a lot of information in addition to two DVD's which are very instructional. If they watch the DVD's, most of our patients are quite knowledgeable. Upon arrival to the clinic, each patient undergoes a venous ultrasound test to determine the status of the superficial and the deep veins. We examine the leg veins for clots, size of the vein, abnormal vein patterns, and for valve function. Following the ultrasound, the doctor consultation is completed, including a detailed examination and discussion with the patient. If treatment is indicated and necessary, the patient is give a procedure date before leaving the office.
How do patients pay for vein treatment?
Medicare and all of the indemnity insurance companies now cover the procedures, with the exception of spider veins. We have full time personnel who handle insurance matters on behalf of our patients, by the way. It’s a process and our patients don’t have to take it on, because someone’s handling it all the way through. We pre-determine coverage for our patients, and we let them know if and how much out of pocket costs might be necessary based upon their insurance policy. Our spider vein charges vary, but are usually $200 per leg which is quite inexpensive, for the treatments require time and special solutions and very skilled physician assistant employees.
What are the most commonly asked questions about vein treatment?
Do these procedures work? Do the vein problems come back? What about pain?
Veins treated with laser technology have an extremely high success rate and open up again only 3-5% of the time. The introduction of micro phlebectomy procedures to remove varicose veins was a terrific advance in the treatment of serious vein disorders. The pre-op ultrasound mapping of vein problems improved the accuracy and success of treatment. That means we can see what we’re doing before we do it. We’re not just aiming and guessing. We know which veins need to be shut down and exactly where the work needs to be done. We target the problem veins and it’s incredibly precise and effective.
In our Alabama and Atlanta vein centers, we use the CoolTouch 1320nm yag laser to eliminate abnormal saphenous veins, and our patients enjoy a better than 99% success rate. The patient is sedated during the procedures, so there is no pain during the treatment.
In fact, with the techniques we use, our patients usually sleep through most of the operation. We are now using physician anesthesiology in our vein center, improving even further the safety and pain free procedures. At least 40% of my patients experience no pain whatsoever afterward. For the remainder, pain is described at an intensity level of 1 – 5 on a scale of 10 and is easily managed with a short course of medication. In other words, my patients get what I most want them to have: a painless procedure that works…and a brief, recovery period in which we can keep them comfortable.
Spider veins – the tiny veins treated with sclerotherapy – are a different matter. They’re dissolved with a solution and often require maintenance treatment every 1-2 years. But the treatment is simple and the patients are very satisfied with their outcomes. It’s a quick procedure and patients tolerate it beautifully.
Describe the recovery process following vein surgery.
We want our patients to chill for the most part on the day of the procedure. They may walk, but only place their operated leg to the floor to balance. By the second day afterward, our patients may walk in a normal fashion, although they still have a fairly bulky leg dressing in place.. The only down day is the actual day of surgery. Surgical dressing is removed the second night and compression hose are worn beginning on the third day, which is when most people return to work. Driving is allowed with caution of course. Moderate leg discomfort, especially in the inside of the thigh where the vein is closed, may last for several weeks, and the second week may be the most intense. Ibuprofen usually takes away the discomfort.
When you think about it, this is remarkably quick in terms of getting back to normal life. These laser procedures are fantastic: they work and they get people back to a higher quality of life almost immediately. It’s extremely gratifying to have the privilege of doing the work I get to do.
Tell us, why did you choose to specialize in the treatment of vein disorders? It’s been called one of the most difficult arenas of medicine. Why were you drawn to it?
Innovative technology was developed about 12 years ago, and I saw clearly that these advances were the ones I’d been waiting for: that they would benefit the lives of countless people who suffer from vein disorders – if the procedures were performed by highly trained surgeons. I’d already been a vascular surgeon for many years, and chose the specialty originally because of the challenges of it. It’s extremely precise work, and the anatomy, physiology, and surgery aspects of the field compel me still, with each patient I see, to do the best that can possibly be done.
With vein disorders, there’s almost no margin for error - which is to say that a single misplaced laser fiber can result in a major complication. I personally enjoy the challenge of the diagnosis and the treatment procedures, and I enjoy assuring that our patients receive the very best care possible in the world. My staff is terrific, many have worked with me for several years and are highly trained.
How did your early years shape your desire to succeed?
I was a strong kid who had a tough childhood. I lost my father as a teenager and, as a result, had no financial resources to fall back on. It didn’t take me long to get the picture: if I wanted to make something of my life, it was up to me to make sure I did it. I would have to take care of myself. This kind of tough appraisal of reality might be hard for some, but for me it was the catalyst that enabled me to be highly motivated from an early age. I also had a kind of idealism that spurred me on. I wanted to do something meaningful with my life, and I wanted to do well. The challenge was first to survive and become educated, the rest was a fierce desire to be the very best. Because of my tough early years, I still cannot rest on laurels, I continue to work and teach and learn to be the best.
So, I worked hard and ended up putting myself through college and medical school. I also learned that being successful doesn’t mean having an easier life. In fact, the better you do in life, the more challenges you will continue to face. My drive to succeed never stops – even now – and though I’ve developed what highly respected specialists in the field, have called, the best vein practice in the world.
I didn’t try to make it that way [successful]; I just wanted to do right. I’ve always watched and worked and learned and looked for the next opportunity to grow. The status quo is unacceptable to me. I want to be the best there is no matter what I do. As a result, I’m always studying …always a student. I read all the time in my specialty…journals, articles, and so forth – to stay fresh, to keep current. I always want to know what’s going on.
Why did you choose a career in medicine?
Even in high school, the idea of medicine intrigued me. The human body is the most precision-based organism there is. No one in my family had ever been in the field of medicine before. But, I loved the intrigue of the human body, and the challenge to learn how it works. I also had some dexterity advantages. For instance, I wrote left-handed and was encouraged as a boy to use my right hand. Over time, I developed ambidexterity – the use of both hands – to a high degree.
It’s been a huge advantage for me in performing surgery…lets me work from more directions! I recall teaching residents when I was director of the vascular surgery program in a teaching hospital. They couldn’t get over the fact that I was switching back and forth from one hand to the other and, needless to say, they weren’t able to perform a surgical procedure that way, so I had to adapt to the reality of others in order to teach them how to do the work. But, for me, it’s great.
You have one of the largest practices in the country. How did it grow so quickly and successfully?
I was the first in the area to set up a practice that specialized in the treatment of veins. And I am fortunate in that I had a thriving referral base from other doctors due to the vascular and arterial-related cases I’d been doing for years. Even now, in the entire United States, there are only 3500 Board Certified vascular surgeons – and only eight of them are in the Birmingham area. Doctors are usually good people, and they want to refer their patients to the best specialists they can find.
So, when I started a practice dedicated to the treatment of veins, I had a strong, ready referral base. Doctors I had worked with for years sent their patients to me. They trusted me, and the feedback they got from the patients I treated led to a rapidly growing patient base. The field of vein work is now quite competitive, for seemingly one or two doctors in each town is now a vein doctor. For some reason, doctors enter the field thinking the work is easy. Unfortunately, that is not the reality. Vein work is quite sophisticated. I now treat many patients who come to me after being treated not so well by other doctors. I must correct untreated and not so well treated problems. My practice continues to be very busy and very successful, for my approach to competition is simply to be the best. Patients seem to find out.
Tell us about your center, which has been described as state-of-the-art and patient-friendly.
The Alabama Vein Center is an ideal environment, for patients and for those of us who work here. It’s 7000 sq. feet of space situated on the mezzanine level of the City Center mall complex of Vestavia Hills. Patients like to come here. We have spacious waiting rooms, four modern operating rooms, and an excellent diagnostic ultrasound facility with the latest ultrasound machines for diagnosis and for use during procedures. Our patients have comfortable tables with tempurpedic mattresses on the procedure beds. We have a modern conference room for patient education, and standard examination rooms and support equipment.
We also have Zeke Eldridge (BSRT, RDMS, RVT), one of the most highly credentialed and experienced sonographers in the U.S. and he’s our lead ultrasonographer in the Birmingham office. Ultrasound is highly dependent upon the technologist, and we’re fortunate to be able to work with the best of them.
The Atlanta Vein Center opened in December of 2008, and it’s quickly become a respected and popular vein specialty facility for our Georgia patients. There’s no other specialty vein center in Atlanta offering the spectrum of care we offer or the experience we have treating vein patients. The Atlanta center is in Lithia Springs, a suburb of Atlanta. We have 4000 sq. ft. of space there that includes two modern operating rooms and all of the support equipment and diagnostic technology we need to run a top-notch vein program. Patients from every part of the city and surrounding areas are finding us, and the reputations of our doctors bring more new patients to us all the time.
Satellite Clinics The satellite clinics really started in response to requests from patients and from our referring physicians. We established those clinics for the convenience of our patients, and we have opened several already: Our vein clinics in Tuscaloosa and Oxford, Alabama are very busy, and we are going to build out a state of the art office soon in Tuscaloosa with modern treatment rooms. We have clinics in Montgomery and Cullman, Alabama, and are exploring expanding these clinics as well. Once these are well established, we shall look to open a clinic on the gulf coast, for we receive many requests to do so.
What are your goals for your practice?
I want to sustain what I have built with my colleagues – to continue to be the best vein center there is. We’ve been the best for a long time, and there are solid reasons for this. We do it full time, unlike most practices that treat vein conditions. We focus on vein disorders and we are fiercely dedicated to giving the best possible treatment in this one area. We don’t need to do 20 different things; we just want to keep growing and learning and doing the best work with vein disorders. Our patients appreciate this, I can tell you. And we do many correction surgeries to take care of patients who didn’t get the precise treatment they needed somewhere else. They come to us, and we know what they need and we make sure they get it.
Tell us about the Alabama Phlebology Training Institute
My colleague, Jim Ingram and I founded the Alabama Phlebology Training Institute in 2003. The idea is to pass on what we know works…to enrich the specialty. Since it opened, we’ve trained over 250 physicians and their associated nurses, sonographers, and other assistants. Physicians and staff in training get to observe and participate in a full time phlebology specialty practice. They come for a week or two. Approximately 50 endovenous laser ablation operations are performed each week, and numerous related procedures are happening simultaneously or at separate times. We designed our training programs to fit the needs of physicians seeking advanced knowledge in the field of phlebology. The training doctors and staff are taught what to look for when they’re evaluating candidates for certain types of treatment, and they witness procedures being done using the most advanced techniques and equipment to correct vein disorders.
Thank you, Dr. Kingsley.
Thank you!
