Dr N Radhakrishnan Foundation for Research on Venous Diseases

Millions of people the world over, from infants to pretty aged, suffer from various types & stages of diseases of the Veins.  It may be congenital malformations or Primary Varicose Veins or other acquired diseases of the veins. Varicose Veins of the lower limbs are the commonest among them. Many view this with different perspectives.

The four units that constitute the Circulatory System are the Heart, the Arteries, the Veins and the Capillaries. They are primarily intended to provide adequate nutrients and oxygen to the tissues and to remove the carbondioxide and the other waste products and finally to facilitate recycling. Capillaries have a very vital role in establishing the microcirculation at the tissue level. The heart, the arteries and the veins are basically developed from the very same component. But the quality varies; the best for the heart, better for the artery and average for the vein. There have been lots of scientific developments and refinements in the management of heart diseases, medically as well as surgically. In the field of arterial diseases also, there have been commendable achievements as well. But unfortunately, the veins remained totally ignored except for some changes in the instruments used for venous surgeries. We are still behind centuries behind!!!

Diseases of the veins can be mainly classified into three.

  1. Congenital Malformations: Anywhere from head to foot; in the internal or the external organs
  2. Varicose Veins: The commonest one, usually affects the superficial veins of the lower limbs
  3. Deep Vein thrombosis (DVT): It is the block in the main vein of the leg due to thrombus (clot) formation and the associated problems (VTE), which may manifest itself as severe breathlessness and even death.

The commonest and the easily identifiable disease is the varicose veins of the lower limbs (leg). This would constitute about 95% of the diseases of the veins. The veins become dilated, elongated and tortuous like snakes and hence they become easily visible. Generally, everyone is most concerned about these big veins (both patients as well as doctors). The smaller veins remain usually ignored; of course, at times treated for cosmetic purpose. For fear of the severe bleeding and the ensuing death, patients approach the doctors for elimination of larger veins. But the treatment of Varicose Veins is never meant only to eliminate the veins for these reasons. The major problem of varicose veins of the leg is the development of Chronic Venous Disease (CVD) which is characterised by very slow serial changes occurring over the lower third of the leg and foot with the final outcome of dreadful, non-healing, eroding ulcers in the vicinity of the ankle region. This ultimately creates aversion to all including the patients themselves, with immense psychological upsets and even the tendency to commit suicide. The agony of cancer will end within months or in one or two years and never more than five years, but CVD will put them to suffer and pull on for several years (15-20 years) without killing patient.

The treatment of the varicose veins is, no doubt, surgery. It can never be cured by medicines. It is surprising that we still hold on to the primitive knowledge and  practice treatment modalities, which are centuries old. When we look back, for the last one century, what progress could we achieve? Virtually nothing, except that some refinements of the instruments were made. From the very crude methods of surgery using the knife and vein strippers, the minimally invasive procedures like Laser Therapy (EVLT), Radiofrequency (RFA) and Sclerotherapy (MFST) came into being, which could avoid ugly looking scars and prolonged hospital stay. Even after these innovations, no one cared for the reappearance of veins at the same site or development of further deterioration which end up in non-healing ulcerations. It is a pity that these patients after repeated surgeries, abandoned by doctors, were left to fate! They moved from hospital to hospitals with the hope of getting some relief. The cause of recurrence and the deterioration following all these surgical interventions were never re-investigated or studied in detail. Against this back ground, a particular incident in 1995, prompted me, a person who totally disliked varicose veins and Piles treatment, to do Sclerotherapy on a patient with very advanced stage of varicose ulcer and to work into the depths of this problem which finally helped me to find out newer dimensions regarding the outlook of this disease process and to evolve newer principles in the management of this disease based on physiological laws by intensive research over a period of years. Accordingly, in July 2009, I was able to establish a Research Institute, in St Thomas Hospital Chethipuzha, Changanassery, Kerala, exclusively for Venous Diseases. This was officially inaugurated by Prof. M.S. Valiathan on 07-04-2010 and blessed by Mar Joseph Perumthottam, The Archbishop of Changanassery Archdiocese and Mar George Kochery, Apostolic Nuncio, Zimbabwe, Africa. The gracious presence and blessings of Padmabhooshan Justice K.T. Thomas, (Rtd. Supreme Court Judge of India) added glory to the function.

The establishment of the Research Institute was also incidental. It so happened one day, during a casual discussion with Padmavibhooshan Prof. M. S. Valiathan, (National Research Professor, Govt. of India), he got very much fascinated about my work in varicose veins and the large volume of patients successfully treated over a period of more than 12 years. We discussed in detail about the different observations, especially the genetic importance of the disease. He suggested me on the detailed genomic studies. He only introduced me to Rajiv Gandhi Center for Biotechnology (RGCB), Thiruvananthapuram, Kerala and this later helped us to join hands with them. Now our Research Institute is working in collaboration with RGCB.  Prof. M. S. Valiathan is my mentor and guide. I adore him.

As a result of this association, we could work on the detailed genetic analysis of this disease in about 6500 patients and is in the final stage. I have to respectfully remember two great personalities who are always with me to guide and support; Prof. Dr. M. R. Pillai, Director of RGCB & Prof. Dr. C.C. Kartha, Professor Eminence, Cardiovascular Disease Biology & Molecular Medicine, RGCB.  At this Center we have treated, as on this date, more than 18,000 patients. It has developed into a centre treating around 3500 patients every year with an Out-patient attendance of average 150 per day. Patients come from all over India and abroad, not on advertisement but only on knowing from patients about their successful experience. Patients recommend other patients for treatment!!!

The new block of this Institute was inaugurated by Prof. Dr Mathew Varghese, Emeritus Professor of Surgery, M.G. University, Kottayam, Kerala who was my professor. His blessings and guidance are always there to boost up my morale.

In June 2011, I was invited to Durban, South Africa by the world renowned Vascular Surgeon, Prof. John V. Robbs (Former President of the Vascular Surgeons’ Society of South Africa) to speak on the “Newer Outlooks & Trends in the Management of Varicose Veins”  to the vascular surgeons in Durban. It was very well appreciated. This was followed by another presentation at the Nelson Mandela Academic hospital, Mthatha, SA, organised by the Walter Sislu University and invited by Prof. Lizo Mazwai, former President, College of Medicine, South Africa.

Our Institute, St. Thomas Institute of Research on Venous Diseases is now a referral Center (Tertiary Care Center).  Cases are being referred from all major hospitals and consultants. Honouring the request of  all my teachers and colleagues, I was able to write a book, “A Treatise on Venous Diseases” which is already published by an international Medical books publisher, M/s. JAYPEE BROTHERS Medical Publishers (P) Ltd. The next book, detailing the technical aspects of Modified Microfoam Sclerotherapy is also getting ready.

Realizing my dedication for the care of the patients and in promoting advanced scientific research in medicine, God showered on me with lots of blessings in the form of several “Awards of Excellence”, which includes six National and three International.

In return to our commitment, determination,  dedication and commitment, we are fortunate that our research work for the identification of the gene responsible for the disease became fruitful and that this noble work was officially approved and presented to the world.  In the next phase of our work, we presume that we will be able to make some genetic modification so that the future generation can be freed of the miseries of the Chronic Venous Disease.

http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0090682 .

It was my strong desire and ambition that the research work initiated by me should continue uninterrupted. Our life is too short. Hence we have to make plans in advance. We should not live for our own well-being.  We have to help our fellowmen. The medical profession is one with high dignity and sanctity. We are deputed to this sacred profession, to offer relief to the suffering and share with them. On 15th June 2012 my dream became fruitful-My dream of forming a Research Foundation. Nothing in this world is immortal. Human being is also no exception. I will also be called back at any moment. Before that, let me contribute something for the already suffering and the one waiting in the track. The aim of this Foundation is to promote advanced research in the field of venous diseases, to give a helping hand to the sufferers of this disease and to effectively prevent the occurrence of this disease in the future generation. The Foundation will offer scholarships to post-doctoral fellows interested in advanced research on venous diseases. The selection of the candidates will be done at RGCB on merit by inviting applications on All India basis.

With the best hope of fulfilling my promises, even in my absence, to all of you and to free the future generation from this perpetual curse, I hereby humbly dedicate this offering at His feet.

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