Nic Coury

Ivan Garcia June 22, 2017

While awaiting an afternoon appointment with a patient, Dr. Eric Mowatt-Larssen sits back in his cushioned chair looking content. He’s in a good mood partly because he’s set to travel to Nicaragua for a week in July.

But Mowatt-Larssen’s trip won’t be a carefree summer vacation. Instead, the bulk of his time abroad will be spent treating patients suffering from varicose vein disease. He’s traveling as part of an elite eight-person team of certified vein doctors from the United States and Italy.

The team of expert phlebologists will be hosted by the Fara Foundation, a nonprofit established by Texas-based Fara Coffee to aid communities where the company’s coffee beans come from.

While staying in Matagalpa, Nicaragua, Mowatt-Larssen expects to work 11-hour days and treat upwards of 850 patients throughout the week. The patients are of all ages and travel from a large region for medical attention, but one thing most of them share is that they’re impoverished – Nicaragua is the second-poorest country in the Western Hemisphere behind Haiti – and they suffer from severe symptoms of varicose vein disease like leg ulcers and damaged skin. To treat them, Mowatt-Larssen will do one roughly hour-long procedure after the other.

The work is intensive, but the tangible results are why the doctor developed a love for phlebology. He spoke with the Weekly at the Monterey practice he opened in 2012, Vein Specialists of Monterey.

Weekly: Why did you decide to specialize in veins?

Mowatt-Larssen: I was a medical director at a hospital in Virginia, and during that time, varicose vein disease came to my attention. I was interested in laser ablation, which has been replacing the surgical removal of veins as a way to treat varicose vein disease. I started working with another doctor at the hospital who knew more about it, and soon I transitioned into vein medicine. Duke University recruited me in 2007, and while there I co-wrote a textbook, Phlebology, Vein Surgery, and Ultrasonography.

What about phlebology appeals to you?

I love how helpful the diagnostics are; you can actually see the anatomy and where the problem is. And the laser ablation procedures are almost always successful, which is comforting, because I’m someone who needs to be successful. I also like how phlebology is old, yet it’s new. The ancient Greeks talked about varicose vein disease, but the treatments have rapidly evolved and we are much more accurate now.

What’s a misconception people have about varicose vein disease?

Most people still think that if they want to treat their varicose veins, they have to get surgery to remove the veins and go through an uncomfortable recovery. But the reality of today is that with the laser ablation procedure, you can get your veins treated and be walking the next day.

What are the biggest challenges of treating patients in a rural clinic within a developing nation?

There are power outages nearly every day, so you have to be ready to improvise and overcome challenges at a moment’s notice. But really, facing that has helped me become more agile.

What’s the difference between treating varicose veins at your practice here as opposed to in Nicaragua?

My patients here are often treated over a few months, which gives us time to fine-tune how the veins look and feel. But in Nicaragua, the patients usually get one visit and I’m only there for one week, so different strategies are needed. Patients with varicose veins here in Monterey have some discomfort or might want to improve the look, but over there it’s simply about saving the function of the veins and legs.

What’s your favorite part of working at the Fara Clinic in Matagalpa?

I feel very fortunate to treat so many people in a short amount of time who wouldn’t get the care they need otherwise. I collaborate with world-class doctors and immerse myself in the community and it provides for a fresh perspective. I get to visit a country and engage with the people in important ways, instead of just being another tourist.

VEIN SPECIALISTS OF MONTEREY is seeking donations of compression stockings, which improve vein circulation after treatment, toothbrushes and stickers to give to children who visit the Fara Clinic. Donations can be dropped off at 977 Pacific St., Suite B, Monterey. 646-8346.

There is a perception that varicose vein treatment is very debilitating and takes a long period of recovery. In decades past, surgeons used to do varicose vein operations in hospitals under general anesthesia. The surgeon would put a stripping device into the vein and pull it out, stripping the vein as the device exited the body. These operations aren’t the standard of care anymore. Now we have ultrasound and thin laser fiber technology to perform treatment in a doctor’s office, under mild sedation and minimal invasion. This makes the treatment so much more safe, since we have eliminated general anesthesia, and the painful and slow recovery of the past. Thank goodness for advancements in science and technology!

Here is an example of a laser ablation that we were doing in Nicaragua. The patient is not sedated or on pain medicine of any kind.

We are so pleased and honored to be able to contribute to the Fara Foundation’s efforts to help patients in Nicaragua. They have recently been profiled on CNN.

For the English language video click:

https://fb.watch/5ToAVsDz3O/
For the Spanish language video click:

http://edition.cnn.com/videos/spanish/2017/02/02/vls-campaa-prevencin-cncer.cnn

Eric Mowatt-Larssen, MD, FACPh, RPhS profile

Eric started out his career life as a Navy SEAL platoon commander, training and leading sixteen SEALs on missions in the Middle East and the Mediterranean.  After getting out of the Navy, he attended medical school at the Medical College of Virginia, and then residency in emergency medicine at Geisinger Medical Center in Pennsylvania. He was certified by the American Board of Emergency Medicine and became Director of Emergency Medicine at Culpeper Regional Hospital in Virginia.

Eric became interested in phlebology because of a family history of varicose veins affecting two of the most important people in his life – his mother and his uncle.  His uncle is a renowned World War II Norwegian resistance fighter and outdoorsman and entrepreneur – and a major role model. Both Eric’s mother and uncle had vein stripping back in the 1960s and experienced a lot of postoperative pain. Eric started training under Dr. Craig Feied, former president of the American College of Phlebology, working particularly closely with nurse practitioner Joyce Jackson.  He was certified by the American Board of Venous and Lymphatic Medicine in 2008 and CCI (Registered Phlebology Sonographer) in 2010, both on the first ever exams.

In 2009 Eric joined the Duke Vein Clinic, working in the Department of Vascular Surgery as an Assistant Professor of Surgery. He treated vein patients, trained Vascular Surgery and Interventional Radiology fellows, and did vein research. With colleagues from Duke he edited the textbook Phlebology, Vein Surgery and Ultrasonography, published in 2014 by Springer Publishing.  He has had multiple articles published and given many lectures regarding vein disease to national and international medical audiences.

Eric left Duke in 2012, lured by the mountains, ocean, and private practice opportunities in Monterey, California.  He is now in solo physician practice.  “Ultrasound is the eyes and ears of a vein specialist, essential in diagnosis, treatment and evaluation of treatment results. Treating vein patients without good ultrasound is like flying blind and deaf,” Eric says. Last year he seized the opportunity to do humanitarian vein treatments in Nicaragua at the Fara Clinic with his wife and two sons and several international colleagues led by Dr. Nick Morrison.

When he is not practicing medicine, Eric can be found, predictably, in the ocean or the mountains. He especially loves surfing and hiking with his family. Afterwards he might play guitar songs and tell stories.

We treated 846 patients, another 104 didn’t show up because they couldn’t afford the transportation costs to reach us for their free treatment. The need is great.

Please click on the link to read the full article in Veins and Lymphatics  http://www.pagepressjournals.org/index.php/vl/article/view/vl.2015.4851/pdf_8