DR NRK PP New 2015My Profile

I had my graduation (MBBS) and post graduation in General Surgery (M.S.) from  Medical College,Thiruvananthapuram, Kerala, India and I have put in 44  years of professional experience. I am working as Senior  Consultant Surgeon in St. Thomas Hospital, Chethipuzha, Changanassery, Kerala, India since 1980. St. Thomas  Hospital is a 450 bedded major hospital in Changanassery offering services  in all disciplines of Medical and Surgical Specialties and  sub-specialties. The Institution is owned and managed by the  Arch Diocese of Changanassery (Roman Catholic). There are  many premier educational and charitable institutions managed by the Arch Diocese. The oldest and prestigious St. Berchman’s College (SB College) and Assumption College are some among our sister concerns. I am a Fellow of the Surgeons of India (FAIS), Fellow of the Academy of Medical Specialities (FIAMS). I am also blessed to be the first Fellow of the International College of Surgeons (FICS – PHLEBOLYMPHOLOGY) (Veins & Lymphatics).

Present position

Medical Director, St. Thomas Institute of Research on Venous Disease Since 2009
Medical Administrator, St. Thomas Hospital,Changanassery, Kottayam, Kerala

Transition to a Phlebologist

Varicose Vein  was one disease which I liked least to treat. I used to refer all patients approaching me for treatment of varicose veins of legs to other centers. The reason  was mainly  due to the very poor results following surgical procedures. Patients will most often report with either recurrence or chronic ulceration. Patients will go on pestering and this would finally lead to professional disrepute. It was during this phase, that one patient who was referred to a major center for treatment returned to me as he was treated only by conservative means. He was refused surgery as his physical condition was such that he could not be given any anesthesia or surgical procedures.He had nonhealing large ulceration over the ankle region for the past many years.

Moved by his pathetic condition and  his pleading for some help, I thought I should do something for him. It was at that time that I was doing endoscopic sclerotherapy for esophageal varices  and hence I thought, “why not I do the sclerotherapy on these veins as well”. But I did not know how I should do, how much sclerosant I should give, where I should give, what will happen to the patient if I inject the sclerosant into the large dilated veins, whether it will be fatal! The repeated request of the patient prompted me to inject the sclerosant in to his leg veins . I repeated the same procedure two or three times giving an interval of two days. Fortunately, by His grace, there was no adverse outcome. Over a period of 45 days his ulceration healed completely and the patient was very happy, no doubt, I too. This happened in 1995.

The patient was a catholic priest, staying very close to our hospital in a priest home. He is now in late eighties and maintains a good leg and is the living monument of my first successful attempt. This was the turning point in my life which in later years transformed me to become a full time Phlebologist, leaving aside all my other favorite surgeries. He was offering his services in a Church very close to a Medical College Hospital. He made it a regular practice to visit the hospital everyday identified the patients with venous ulcers  refer to me with a letter requesting me to offer the same treatment which he underwent. Later these patients after recovery from their ailment started bringing other patients. The cycle still continues.

While I could do the procedure on eight (8) patients in 1997, the number increased progressively year after year. My interest in the subject of venous diseases  made me learn more and more into the depths of the knowledge of venous diseases. Till 2002 I was using the plain solution of sclerosant and  it required multiple sittings. Following the advent of  Microfoam Sclerotherapy in 2001 (Tessari et al.), I started using the microfoam sclerosant from 2003. It was a real boon. Even then I did not know how it helped to heal the ulceration.

In 2006, Caggiati et al published a paper on the presence of MVV (Microscopic Venous Valves) in the smallest veins and the importance of MVV in the pathogenesis of Chronic Venous Disease (CVD) . This prompted me to search further into the great depths of  the etio-pathogenesis of CVD.  Newer dimensions and outlook on the disease were brought out.  Based on this an innovation in the technique got evolved, which in principle is the opposite of the contemporary techniques.  My concept of this new technique of Modified Microfoam Sclerotherapy (MMFST) was approved by the patients which is in effect a ‘Chemical Bombing’. 

In 2009, I was fortunate that my interest in venous disease was identified and appreciated by Padmavibhooshan Prof. M S Valiathan, National Research Professor, Govt of India and he introduced me to Rajiv Gandhi Center for Biotechnology (RGCB) and very soon we started working in collaboration on genomic as well as molecular studies and is in progress. It was a landmark  in my life and I got involved fully in the research work on varicose veins. A research institute was developed exclusively for venous diseases, the St. Thomas Institute of Research on Venous Diseases, where in parallel with research more than 3500 MMFST is done annually. Patients come from all over India and other places to get the benefit of our procedure. Most of the patients are in late stages of the disease (CEAP Class-4 to 6) and after repeated surgical interventions elsewhere.

In June 2012, one of my great dreams became a reality. That is the formation of  “Dr N Radhakrishnan Foundation for Research on Venous Diseases”  for an ongoing advanced research project to prevent varicose veins in the future generation. The Foundation is committed to offer Post-doctoral Research  Scholarships . The selection of suitable candidate and other related matters are entrusted with the RGCB. I am happy that the Foundation started functioning early 2013. The foundation has already allotted INR 10,00,000.00 (Rupees one million) in the first year itself. I am confident that in the coming years the Foundation can support more. This is my commitment to the future generation.

 I could bring out two books  on venous diseases. The first one, A reference book “A Treatise on Venous Diseases” : foreword written by Padmavibhushan Dr. M. S. Valiathan, National Research Professor, Govt. of India, got published in April 2014 by JAYPEE BROTHERS MEDICAL PUBLISHERS (P) LTD (New Delhi • London • Philadelphia • Panama) as a reference book. It is also available as e-book (http://www.jaypeedigital.com/Book/BookDetail?isbn=9789351522102&AspxAutoDetectCookieSupport=1). The second book is about my technique, ‘Modified Microfoam Sclerotherapy’ (DVD supported book) which is in the editing process. I hope my work with commitment and dedication will make revolutionary change in the current outlook and management of of Chronic Venous Disease.

“I shall be telling this with a sigh
Somewhere ages and ages hence:
Two roads diverged in a wood, and I—
I took the one less traveled by,
And that has made all the difference”
                                       ……Robert Frost