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FOOTPRINTS
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The Specialist hands you a slip of paper: MRI. Doppler ultrasound. A genetic panel. Maybe more, depending on what they ordered.
You leave with an appointment card and a birthmark you already knew was there.
If you’ve sat in that waiting room wondering whether your doctor is overreacting, you’re not alone. Dawne and Will sat there too — more than once, decades apart, still half-asking the same question.
All that, for a birthmark. You almost want to laugh. Almost.
Here’s what’s actually happening. And part of the price of understanding is words.
There are diagnostic models behind all of this — two that we are aware of that vascular specialists use worldwide. The Hamburg Management Categories model and the ISSVA Classifications framework. The latter one is necessarily complex, because what it’s classifying is complex.
But the logic underneath these can be understood: sort by what the blood is doing first — flowing normally, or not — then by which vessels are involved, add which genetic drivers show up, and whether the condition travels alone or with a syndrome.
When Will first saw these models laid out, he felt relief. It made sense. He remembered biology class — the Animal Kingdom charts, the Periodic Table, six layers of hierarchy deep, more acronyms than he could hold in his head at once. More on this in subsequent notes and essays, by necessity.
Anyway, that’s why the slip of paper says what it says. An MRI finds venous malformation deeper than the skin can show. Doppler tells slow-flow from fast-flow, ruling shunting in or out.
None of it is looking for a Port-Wine Stain. It’s already visible. What these tests are hunting is what the Port-Wine can’t say out loud: the architecture underneath it.
“A picture may speak a thousand words, but in our case a thousand words explain the picture“— a variation of this expression you’ll read on our website.
What you can see on the outside does not tell you what is happening underneath. These studies do.
This isn’t hypothetical. So many born rare are treated for what is visible, before anyone confirmed what was fully there. A specialist working through this framework today is doing something that wasn’t possible for prior generartions.
So — we’re not overreacting. We’re doing the job right.
Where do we go from here? Once we know what’s underneath, there’s a decision waiting: whether to say yes to a treatment, and when. That’s next.