Healthmatters Essential Healthcare news and information Early Pregnancy Clinic The early stages of pregnancy should be an exciting time for you and your partner. However, it can also be a cause of anxiety, with little information being readily available during your first trimester. St. Anthony’s is now offering a specialised early pregnancy clinic. This consultant led service aims to provide advice and reassurance for women in the first 12-13 weeks of their pregnancy. The clinic is appropriate for anyone experiencing symptoms such as bleeding or abdominal pain and for those who have had previous unfortunate pregnancy outcomes. Summer 2013 Issue No.19 Inside Case study Keyhole procedure to relieve chronic heartburn Cystitis Rashmi Singh discusses symptoms & treatments for what can be a troublesome condition The service will be provided at St. Anthony’s on Saturday mornings and the tests included will be: • An Ultrasound scan by a Consultant Gynaecologist • Consultation with a Gynaecologist • Pregnancy test • Blood pressure test • Pregnancy hormone test (extra; if clinically appropriate) Gout Sanjeev Patel explains why gout should not be taken lightly The consultation will also provide the opportunity for you to discuss any problems you may be experiencing in a confidential and welcoming environment. Advice can also be provided regarding diet and medication which is allowed, or best avoiding during pregnancy. A detailed report of the scan findings and the consultation outcome will be given to you at the end of your appointment and results can also be sent to your GP at your discretion. Occasionally a follow up appointment may be required. This will be indicated and can be arranged at your convenience. For further information or appointments please telephone our Outpatient Department on 020 8335 4678/79. Looking to the future page 2 Health Matters is published by the Marketing department of St. Anthony’s Hospital. If you have any suggestions, requests or need follow-up information, please email philipcook@stanthonys.org.uk or telephone 020 8335 4557. www.stanthonys.org.uk 22386_Healthmatter_summer_v2.indd 2 20/06/2013 11:39 Looking to the future You may be aware that changes are afoot at St. Anthony’s. As previously announced by Sister Veronica, Provincial of the English Province of the Daughters of the Cross, the Charity which owns the hospital, the Sisters, who are Trustees, feel they can no longer shoulder this responsibility and are looking for new owners to take the hospital forward. Preparations are already underway for this momentous step in our 109 year history, several significant parties have already expressed interest in taking up the baton and a formal tendering process is likely to take place later this year. It is the expressed hope of the Sisters and of the management and staff of the hospital that a new owner will be found that is willing and able to preserve the unique ethos and culture of St. Anthony’s with its focus firmly on the needs and interests of the patient. In the meantime, it is business as usual. Rest assured that St. Anthony’s will still be setting the standard for hospital care for many years to come. The League of friends of St Anthony’s Hospital Shop Sells greeting cards, sweets and toiletries and is in need of more volunteer helpers. If you can spare 2-3 hours occasionally, please contact the LOF chairman Derek Poulter on 020 8330 5795 New consultants at St Anthony’s Dr Pauline Swift Mr Paul Hamilton Mr Peter Barry Dr Jonathan Clague Consultant Physician & Nephrologist, St. George’s University Hospital. Consultant Orthopaedic Surgeon, Epsom & St. Helier University Hospitals. Consultant Breast Surgeon, Royal Marsden Hospital. Clinics: Alternate Thursday Mornings Adult foot and ankle surgery, trauma surgery. Sports injuries, forefoot surgery including bunions, arthroscopy, reconstruction and arthroplasty Consultant Cardiologist, Royal Brompton & Harefield NHS trust. Interventional Cardiology, Electrophysiology and Cardiac Devices. Dr Emanuela Campalani Consultant Dermatologist, Epsom & St. Helier University Hospitals. Clinics: Alternate Thursday Mornings Mr Pandelis Athanasias Consultant Gynaecologist, Epsom & St. Helier University Hospitals. Minimal access surgery, Menorrhagia Clinics: Alternate Monday Evenings & Saturday Mornings Dr Anton Bungay Consultant Gastroenterologist, Kingston Hospital Clinics: Alternate Monday Evening Clinics: Ad Hoc Mr Tahir Ali Consultant Vascular Surgeon, St. Peter’s Hospital. Vascular & Endovascular Surgery Clinics: Ad Hoc Clinics: By Arrangement Dr Ansuman Saha Consultant Cardiologist, East Surrey Hospital. Special interest in Cardiac imaging Mr Stephen Black Dr Min Htut Consultant Vascular Surgeon, St. George’s & St. Helier Hospitals. Aneurysms, Carotid Disease, Venous Problems. Consultant Neurophysiologist, St. George’s Hospital Neurophysiology, Electromyography. Clinics: Alternate Monday Evening Clinics: Alternate Thursday Mornings Consultant in Pain Management, St. George’s Hospital. Mr Ravindu Kamdar Dr Zoe Astroulakis Clinic: Ad Hoc Consultant Cardiologist, Croydon University Hospital. Cardiac devices, Arrhythmia, Heart failure. Consultant Cardiologist, St. George’s Hospital. Interventional Cardiology, Radial approach. Clinics: By Arrangement Clinics: Ad Hoc Clinics: Ad Hoc Dr Andrzej Krol Clinics: Ad Hoc 22386_Healthmatter_summer_v2.indd 3 20/06/2013 11:39 Case study: Keyhole procedure to relieve chronic heartburn Patient: Mike Head Consultant: Mr Dhiren Nehra, General and Laparoscopic Surgeon, St Anthony’s Hospital For Mike Head, 49, who lives in Banstead, a family meal out was a nightmare. “I had to watch what I ate otherwise I would pay for it later,” he said. He was suffering from acute heartburn or acid reflux, which had started in his 20s but worsened over the years, despite being prescribed drugs to help the condition. He had to follow a bland diet “which meant cutting out bread, dairy, fried food, curries and alcohol. I even cut out lemonade and fruit juices because the repercussions were too painful,” he said. He had to give up playing rugby, one of his passions “as I thought it would be difficult doing a rugby tackle with me doubled up with griping stomach aches so I became a spectator,” he said. A self employed electrician, Mike also works as a Flexkom franchisee (www.flexkomincome.com) helping to rejuvenate the high street through mobile Apps. His wife, Michelle, works part-time as a pre-school administrator. They have two daughters, aged 21 and 15 and a son, 16. In January 2012, Mike was ill six times a month with dizzy spells “like I was drunk which, of course, I wasn’t as I didn’t drink alcohol. At night, lying down in bed was most uncomfortable. I couldn’t sleep and was crawling to the bathroom in the middle of the night unable to stand as the room was spinning and I was throwing up. My drugs were being changed constantly. I had to keep working as I’m self employed. By the next morning, I would be tired but I would be ok. During the day, I managed to keep going with the bland diet and drugs which kept the acid down.” His wife told Mike he was cranky and miserable “and I was,” he says. “If we went out for a family outing, I would have a dizzy spell and have to go back in a taxi and go to bed, so life wasn’t much fun. I looked at my Dad, who’s 86 and suffers from heart problems and the cocktail of drugs he has to take and I thought I want one less drug in me when I’m older.” He was referred to Mr Dhiren Nehra, General Surgeon at St Anthony’s. Mr Nehra says “Mike Head’s account of his reflux symptoms is typical of patients that are referred to me for surgery. His symptoms were severely affecting his quality of life. Whilst most patients with mild to moderate symptoms can be controlled with Proton Pump Inhibitors (PPI) medication such as omeprazole, when one has a significant hiatus hernia such as in Mike’s case then the reflux can be severe. Patients begin to experience regurgitation and are unable to enjoy even normal foods or the occasional alcohol. They are unable to carry out normal activities such as bending down or sports and even sleep is affected. In his case I was able to recommend that he undergo surgical treatment. 22386_Healthmatter_summer_v2.indd 4 “Prior to surgery I carried out an oesophageal manometry (pressure study) and 24 hr pH (acid) test which involves insertion of small tube through the nose. This confirmed that the pressure in the ‘valve’ at the bottom of his gullet was low and the pH test confirmed increased acid in the gullet.” Mike was told he suffered from a hiatus hernia (where part of the stomach protrudes through the diaphragm and up into the chest) and would require keyhole surgical treatment called a Laporoscopic Nissen Fundoplication. Mr Nehra explains “The operation involves closing the wide opening in the diaphragm with two or three stitches and the top of his stomach was then wrapped around the lower end of the gullet to give it some strength. The operation is done by three or four keyhole cuts of less than 1cm and patients recover within two to three days. Initially some difficulty in swallowing solids is to be expected due to swelling of tissues but this settles down after a few weeks.” Mike says, “Mr Nehra put my mind at ease. He explained the operation in detail in layman’s terms so I had a reasonable appreciation of what was going to happen. St Anthony’s was relaxing, the nurses were caring and attentive and nothing was too much trouble,” says Mike. “After the operation I was put on a liquid diet and any solids were cut up small as I couldn’t swallow. I remained in hospital for two days after the procedure.” At home, Mike convalesced for a week eating mainly soup, yogurt, porridge and liquid-based foods. “I couldn’t go back to my usual diet until the valve had learnt to work properly,” he said. “I started to do light work, looking at prospective jobs rather than doing them. I couldn’t crawl around in lofts or do heavy lifting for a couple of weeks.” Mike describes the operation as “a life changing moment” as he can now eat anything. “It’s wonderful to be able to eat an ice cream and know it won’t hurt me later on. I enjoy having an occasional whisky. Once I started eating normally again, my confidence came back as a person. It’s made so much difference to my daily life – I can sleep at night and not wake my wife. Our family meals out are now a real pleasure.” Mr. Nehra has also been appointed to participate in a trial by manufacturers of a new device designed to reduce heartburn in severe cases where the Nissen Fundoplication procedure is not appropriate. Known as the LINX system, the device consists of a series of titanium beads linked together, each with a magnetic core. This acts as a sphincter around the oesophagus with the magnetic force keeping it in a closed position. However, during swallowing, the device expands to permit food and liquid to pass through. Implanted by keyhole surgery, the procedure is less complex than Nissen Fundoplication but has the drawback that it is not compatible with having a Magnetic Resonance Image (MRI) scan. 20/06/2013 11:39 Most episodes of cystitis are short lived and last just a few days. General measures include maintaining a high intake of fluid and taking painkillers such as paracetamol or ibuprofen. Cystitis Cystitis literally means “inflammation of the bladder” but the term is commonly used to describe a urinary infection involving the bladder. It can be a very painful and unpleasant condition for many patients. Who Gets Cystitis? It is very common in women, with most women experiencing at least one episode of cystitis in their lifetime. Some women can be prone to recurrent cystitis. Men can also get cystitis but this is unusual and may be associated with an underlying urinary tract problem e.g. prostate enlargement. Although cystitis can occur at any age, it is particularly common in pregnant women, women who have been through the menopause and in sexually active women. What Causes Cystitis? A bacterial infection of the urine is the commonest cause of cystitis although it can be due to other causes such as radiotherapy or other inflammatory conditions of the bladder. The presence of fevers, shivers, vomiting or pain in the lower back region may suggest a more severe infection involving the kidneys. How Is The Diagnosis Made? The diagnosis is usually made on the basis of the symptoms. Your GP may ask you to provide a fresh urine sample which can be tested with chemical strips known as “dipsticks” which can further help with confirming the diagnosis. The urine sample can also be sent for formal analysis to a laboratory. This gives more detailed information regarding the type of bacteria responsible for the infection and the antibiotic that can be used to treat it. How Is Cystitis Treated? Cystitis occurs when normal bacteria from the gut enter the bladder via the urethra (the passage through which urine flows out from the bladder) and this infects the urine. Compared to males, the female urethra is shorter and is closer to the anus hence the increased incidence of cystitis in females. Most episodes of cystitis are short lived and last just a few days. General measures include maintaining a high intake of fluid and taking painkillers such as paracetamol or ibuprofen. “Cystitis relief” sachets that can be bought over the counter in pharmacies can also ease the symptoms. Avoiding sexual activity until the infection has settled is advisable. Some people may be more susceptible to cystitis if they have an underlying illness e.g. Diabetes or a urinary tract condition which impairs the normal emptying of the bladder or have a permanent catheter (artificial tube for bladder drainage). The above measures alone may be adequate to settle cases of mild cystitis. For moderate or severe symptoms, antibiotics will be necessary. Your GP will usually prescribe a short course of 3-5 days, rarely longer. What Are The Symptoms Of Cystitis? Who Needs To See A Urologist? Once bacteria infect the urine, the lining of the bladder and urethra becomes irritated and inflamed. This results in the classical symptoms of cystitis: a painful burning sensation in the urethra when passing urine, an intense urge to frequently pass urine and pain in the lower (pubic) area of the tummy. Other symptoms can include visible blood in the urine, cloudy or offensive smelling urine. In more elderly patients, the symptoms may be less typical and may simply be confusion, weakness and falls. In the vast majority of cases, cystitis is a self-limiting uncomplicated condition that settles promptly with treatment. However, in some patients recurrent cystitis (more than 3 episodes a year) can be a problem. In such cases, further tests and assessment by a Urologist may be recommended by your GP. 22386_Healthmatter_summer_v2.indd 5 Cystitis in males or complicated urine infections associated with heavy bleeding or other concerning symptoms may also warrant a specialist opinion. 20/06/2013 11:39 The Urologist will usually arrange an X-ray and ultrasound scan of the urinary tract to look for any underlying predisposing cause e.g. kidney stones or prostate enlargement and to assess how well the bladder empties. In addition, a camera inspection of the inside of the bladder (known as a cystoscopy) may need to be performed under local anaesthetic. How To Prevent Cystitis? There are a number of self-help lifestyle measures that your GP and Urologist can help you with e.g. maintaining a high fluid intake, regular and complete bladder emptying every 2-3 hours, urinating immediately after sexual intercourse, wiping from front to back after going to the toilet and using just water or unfragranced soap to clean the genital area. Avoid wearing tight, synthetic underwear. In some patients certain foods or fluids can trigger cystitis e.g. spicy food, coffee and alcohol. Taking cranberry juice or tablets has been shown to help with prevention of recurrent cystitis. Regular intake of cranberry juice or tablets can prevent recurrent cystitis E.coli - the commonest bacteria that causes cystitis Red, inflamed bladder lining due to cystitis Normal bladder lining Troublesome recurrent cystitis can also be managed with either standby self-start antibiotics that the patient keeps at home or a prolonged period (3-6 months) of a low dose of antibiotic. In sexually active women, taking an antibiotic immediately after intercourse can be very effective prevention. Your Urologist will advise on the best antibiotic regimen for you. Miss Rashmi Singh is a Consultant Urological Surgeon who has clinics at St Anthony’s on alternate Monday mornings. Her special interests are urinary tract infections, kidney stone disease (including keyhole and laser surgery), urinary and prostate disorders, bladder pain and incontinence problems. 50+ Show –London Olympia, 11-13 July We exhibited for the first time last year and the excellent response and feedback we received has encouraged us to return for a second visit! St Anthony’s will be returning to exhibit at the 50+ show again this summer, which will be held at London Olympia from Thursday 11th to Saturday 13th July. The 50+ show is an increasingly popular exhibition with a wide range of exhibitors. If you would like to attend, we have a limited supply of free tickets (normal entry price £10). To apply, please send your name and address to James Smith via marketing@stanthonys.org.uk Miss Rashmi Singh, Consultant Urological Surgeon Come and visit us at our stall or visit the show’s Health Zone, at which we will be providing a variety of basic health checks and tests! Physiotherapy refurbishment Our Physiotherapy department has recently undergone a complete makeover. We have created 3 separate, fully enclosed treatment rooms in order to provide better privacy for our patients. Laminate flooring provides an hygienic and user friendly surface for exercise and rehabilitation. Our Physiotherapists can now offer their specialised services in an environment which allows them to maximise the benefits they can provide to patients. Services offered by the department include a full range of Physiotherapy services for sports injuries, neck and back pain, soft tissue and joint problems, as well as rehabilitation following Orthopaedic surgery. We also offer specialist hand therapy, physiotherapy for vertigo, sports massage, acupuncture, aquatic physiotherapy and podiatry to allow for a well-rounded and comprehensive service. The Physiotherapy department can respond quickly and services are available from early morning through to evening. Please contact the department on 020 8335 4589 for further information or appointments. 22386_Healthmatter_summer_v2.indd 6 20/06/2013 11:39 Gout For some reason we find gout to be humorous. People find gout difficult to take seriously, perhaps due to the perception that you must be having a rich diet and excess alcohol to suffer from it. However all the evidence now shows that the number of people with gout is increasing, and that this stereotype no longer applies and probably never did apply. The reason for the increasing incidence is uncertain but may reflect trends in diet, increasing obesity, alcohol intake and increasing numbers of people with chronic kidney disease as they live longer. The diagnosis can be difficult to get right and should not be underestimated as patients can be inappropriately exposed to drugs they may not need. Acute podagra (gout of the big toe joint) can be confused with other causes of acute foot pain and skin infection and whilst it has a high association with the probability of gout is not diagnostic in all patients. The gold standard for diagnosis is finding uric acid crystals in the fluid taken from an affected joint. It is a mistake also to diagnose gout simply on the basis of a high blood uric acid level as the majority of patients with this finding do not have gout. 5th of February of this year with doctors from the Primary Care Rheumatology Society also raising concerns as to why the condition is poorly treated. There are no easy answers but being aware of the possibility of the diagnosis and seeing a GP or a specialist who understands the condition and its treatment is a good start as the misery of attacks of gout can be stopped with simple medication. References Warburton L GP Education Nov 2012 http://www.inspirerheumatology.org.uk/images/GP_Nov_2012_Gout.pdf Recent guidelines for GPs http://www.inspirerheumatology.org.uk/images/Gout_guidelines.pdf Dr Sanjeev Patel, Consultant & Senior Lecturer in Rheumatology The good news however is that seeing a rheumatologist (specialists in the diagnosis and management of arthritis), should allow patients to get a diagnosis and treatment. Acute attacks of gout can be treated with steroids, colchicine and anti-inflammatory drugs. In some patients, drugs to lower uric acid can be used although this is usually life long. The standard drug for lowering uric acid is allopurinol although in the last few years doctors also have another option called febuxostat that is approved for use in the NHS by NICE. Patients however still find treatment of gout unsatisfactory. The people’s oracle of health, The Daily Mail published “Gout’s no laughing matter - So why don’t GPs take it seriously?” on the International Nurses Day Nurses at St Anthony’s celebrated International Nurses Day on Tuesday 14 May in honour of Florence Nightingale, the founder of modern nursing, born on the 12 May 1820. Sister Myriame Lawley ICU Sister and Training Facilitator, explains: “Every year the nurses take over our conference centre for the day and during their breaks they can enjoy having a ‘makeover’ by The Body Shop, their nails done or a massage. There were stalls selling various items, from jewellery to handmade greeting cards and a free raffle, with prizes of cakes, wine and vouchers to thank the nurses for all their hard work.” Every year a themed cake is made to commemorate the special day. “This year there was a big ‘C’ on the cake standing for Care and Compassion,” says Myriame. The nurses were joined by students on placements, as every year St Anthony’s takes on up to 12 student placements at a time and 22386_Healthmatter_summer_v2.indd 7 these can be anything from four to nine weeks. Quite a few of the students, once qualified, return to the hospital in full-time roles. Sian Daws, student nurse, was at St Anthony’s Hospital for a nine week placement. She is studying a BSc Honours degree in nursing at Kingston University and the placement is part of the course. “I’ve been made to feel welcome and part of the team. I would definitely consider coming back here to work,” she says. “As part of the placement, I learnt about ECGs, how a heart works and post operation care. I watched a pacemaker fitted in the cath lab and saw open heart surgery, which was amazing.” Myriame says “The students on placement are given a mentor when they get to the ward and they learn with supervised practice. While they’re here they have a wide range of experiences and plenty of opportunities to learn and achieve the competencies set by the University and the NMC (Nursing & Midwifery Council).” 20/06/2013 11:39 Email Newsletter We would shortly like to commence sending an email newsletter in addition to the current printed and digital version, available on our website. If this method of communication would be appropriate or useful for you, please send your email address to marketing@stanthonys. org.uk. Please be sure to mention if you would still like to receive a printed copy or whether you are happy to be removed from our Awareness Evenings Our free public awareness evenings will recommence with an autumn series. Please be sure to book your places as soon as possible to avoid disappointment. Autumn 2013 Thursday 12th September – Osteoporosis Dr Nina Agarwal, Consultant Rheumatologist Thursday 17th October – Breast Cancer Awareness Mr Peter Barry - Consultant Breast & General Surgeon Thursday 7th November – Diabetes: The Risk of Peripheral Vascular Disease printed mailing list. Mr Stephen Black - Consultant Vascular Surgeon There will be a period of time in which we will All meetings start at 7pm (doors open at 6.30) and last for about one hour. collect email addresses before we produce the first email newsletter and your patience during this time would be most appreciated. To book a place please visit our website or email marketing@stanthonys.org.uk (this helps us to send you a reminder a few days before) or telephone 020 8335 4556. Al fresco dining at St. Anthony’s Work on the courtyard has been completed just in time for the long awaited summer and patients, staff and visitors have not been slow to take advantage of the first rays of sunshine to enjoy their meals outside. The floor of the courtyard has been raised to the level of the Restaurant and the Reception area to make it more easily accessible for people in wheelchairs. Meet the consultant Name: Mr Michael Jarrett Position: Consultant Laparoscopic General and Colorectal surgeon based at Kingston Hospital. He deals with various aspects of general and colorectal surgery including hernia repair (inguinal, femoral, umbilical, incisional), gallbladder removal (laparoscopic cholecystectomy), upper and lower GI endoscopy (camera examination of the gastro-intestinal tract), haemorrhoids, bowel cancer, rectal prolapse and sacral nerve stimulation for faecal incontinence. 22386_Healthmatter_summer_v2.indd 8 Mr Jarrett trained at both Oxford and Cambridge Universities and received a DM from Oxford and the Arris and Gale Lectureship from the Royal College of Surgeons for his research into sacral nerve stimulation for faecal incontinence and constipation. Whilst training he played first class county cricket for both universities, which he continues to try to play for pleasure, time allowing. Mr Jarrett holds regular clinics at St. Anthony’s on alternate Monday mornings and alternate Thursday afternoons. For further information or appointments please contact his private secretary on 020 8543 9924. 20/06/2013 11:40 Raynes Park Health Centre We are pleased to announce that St. Anthony’s will shortly be opening a satellite outpatient consulting suite in Raynes Park. The suite is located in the newly built Lambton Road Medical Centre at Raynes Park and will allow the hospital to increase significantly the number of clinics it can offer while also being a highly convenient location for the local community in Raynes Park and West Wimbledon. We anticipate that clinics will commence at this new centre in the Autumn. Top Marks in Patient Care! The hospital recently received an unannounced visit from the Care Quality Commission (CQC), which carried out a routine inspection to ensure that essential levels of quality, safety and patient care are adhered to at St. Anthony’s. The results which we received back were glowing, with patients informing inspectors that our staff were ‘very caring’, ‘excellent’ and even ‘fabulous’. A comment was also made to say that the nurses ‘can’t do enough for you, in a good way.’ In fact, on leaving, one inspector reported to our Matron that there was no point in them staying any longer as they would ‘only hear more of the same’ if they did! Analysis of our patient questionnaires for the past year shows that over 98% of you rated our overall nursing standards as either ‘excellent’ or ‘good’ and 99.3% of patients would recommend St. Anthony’s to a friend or relative. First and foremost we would like to thank those of you who took the time to return your patient questionnaires to us. This is not just an opportunity for the hospital to congratulate itself on a job well done. We review every aspect from the questionnaires which indicates that we could do better. The information you provide is fundamental in helping ensure that all patients enjoy as comfortable a stay as possible at St. Anthony’s. On our patient questionnaires, we have recently noticed a number of comments which specifically ask that the ethos of the Hospital be continued into the future. This is a feeling shared by the Sisters and staff, who realise that we must strive to preserve the environment which makes St. Anthony’s so special. The local community has played such a key role in the creation and continued success of both St. Anthony’s and St. Raphael’s, and any opinions you would like to express would be greatly appreciated. Further information on the future of St. Anthony’s is available via the News & Events page of our website, which also provides contact information, should you wish to make your opinions known. Should computer access be unavailable to you, the address for our Trustees is: The Congregation of the Daughters of the Cross of Liege 29 Tite Street, London SW3 4JX Healthmatters St. Anthony’s Hospital, North Cheam, Surrey SM3 9DW. Tel: 020 8337 6691 22386_Healthmatter_summer_v2.indd 1 20/06/2013 11:39