London Bridge Hospital New Consultant List

TITLE
QUALIFICATIONS
DEPARTMENT
Dr Poopalasingam Balendran
Consultant Anaesthetist
MBMC MRCS LRCP
Anaesthetics
Dr Mark Esler
Consultant Anaesthetist
MBBS MRCP FRCA
Anaesthetics
Mr Sam Gidwani
Consultant Orthopaedic & Trauma Surgeon
BSc MBBS FRCS (Tr&Orth)
Orthopaedic Surgery
Dr Teresa Guerrero-Urbano
Consultant Clinical Oncologist
PhD FRCR MRCPI LMS
Oncology
Dr Shoab Hamid
Consultant Cardiologist
BSc (Hons) MBDS MRCP MD Cardiology
Dr Michael Heneghan
Consultant Hepatologist
MD M.MED.SC FRCPI
Hepatology
Mr Hasnat Khan
Consultant Cardiothoracic Surgeon
FRCS CTh FRCS MBBS
Cardiothoracic Surgery
Dr George Matthew
Consultant Anaesthetist
FRCA MBBS (First Class)
Anaesthetics
Dr Fariborz Neirami
Consultant Anaesthetist
MD FCARCSI
Anaesthetics
Dr Rose Ngu
Consultant Maxillofacial
Radiologist
BDS FDS RCS (Edin)
DDR RCR (UK)
Radiology
Dr Alexander Nieper
Sports Medicine Physician
MSc (SEM) FFSEM (UK) Sports & Exercise Medicine
BSc (Hons) MBBS (Hons)
FRCA DFRA (ESRA)
Anaesthetics
Dr Amit Pawa
Consultant Anaesthetist
Mr Simon Simpson
Practitioner in Psychotherapy Health Matters
GP Liaison Magazine
New Consultant List
NAME
Winter 2010 • Issue 7
Psychotherapy
London Bridge
Hospital
New Consultant List
Note: Please see our
website or Referrers’ Guide
for contact details of all
Consultants featured in this
magazine or contact the
GP Liaison Department on:
T: 020 7234 2009
INSIDE:
The New Service
The Latest Techniques
The Innovation
The Advances
Oncoplastic Breast Surgery • Extracorporeal Shock Wave Therapy (ESWT) • Rheumatology
• EMG/NCS Use • Keyhole Surgery • DEXA Scan • Remote Home Monitoring Service •
Cardiac MRI Scanner • Corventis Mobile Cardiac Telemetry System •
TWENTY
New Consultant List
Welcome to the winter edition of Health Matters Magazine, our opportunity to present articles from
our Consultants at London Bridge Hospital and connect with you in terms of the services that we offer
to support you and your patients.
Features
Introduction
A message from the CEO
Features
The first thing that I would like to mention is the GP education programme which is going from strength
to strength, with good attendances at both our Saturday and Thursday evening GP seminar sessions.
Our Saturday events in particular have proved immensely popular with over 180 attendees at our
Dermatology Seminar in September 2010.
p
Your feedback has specifically highlighted the expertise of our speakers, interesting topics and relevance
to primary care as the main reasons for attending. Our Practice Manager Forums are also proving
successful with the opportunity to network with fellow colleagues. We are also excited to be introducing
personalised hospital tours which will be available upon request and will be tailored to the GP’s interests.
Our GP Liaison Team is always available to help with any specific educational requirements and will be
happy to hear from you.
4
Oncoplastic Breast Surgery
6
Extracorporeal Shock Wave Therapy (ESWT)
For sports injury treatment
8
10 Minutes With...
Interview with Mr Simon Owen-Johnstone, Consultant Orthopaedic Surgeon
There may be many services at the hospital that you are not aware of. For instance, the Dialysis Unit
at London Bridge Hospital has been providing quality Dialysis to both NHS and holiday patients for
over 20 years. Our Dialysis Consultant has a worldwide reputation and our recently refurbished unit
offers patients high quality care within easy reach of the City.
These and many other services have stood the test of time. The key selling point for London Bridge
Hospital is the quality of its Consultants. We are located very close to some very eminent teaching Hospital
Trusts and I am delighted to say we are able to apply the same strict level of clinical governance and audit
which you might expect to find in a postgraduate medical facility. This environment allows our specialists
to feel comfortable that their standards are not in any way compromised and that they can develop their
practices in partnership with us.
9
Ten Topics in Rheumatology
10
EMG/NCS Use in Primary Care
11
Keyhole Surgery
For fractures around the shoulder
12
Remote Home Monitoring Service
13
Imaging Services Department
Introducing the DEXA Scan to London Bridge Hospital
The quality of our relationship with you and that of our referring GPs allow us to respond quickly to
feedback in order to meet your requirements and this is reflected in the membership of our Medical
Advisory Committee, which includes two GPs. Myself and all our staff, including Ward Managers and GP
Liaison Teams have ample time and opportunity to spend with our referrers to understand their needs
so that we can deliver better quality services for our patients.
I wish to thank you very much indeed for your continuing involvement
in the hospital, for the feedback you provide us and for the opportunity
to care for your patients. I hope very much that you will continue to
visit the hospital, attend our events and to regard us as partners in your
patient’s care. Please continue to feedback to me and to the GP Liaison
Team wherever you see an opportunity for us to extend our partnership
with you or indeed to improve what we offer. Please enjoy this magazine
and thank you as always.
15
London Bridge Hospital’s Dialysis Unit Relocated
15
Introducing London Bridge Hospital’s Online Registration Portal
16
Corventis Mobile Cardiac Telemetry System
16
New Cardiac MRI Scanner
17
Innovation Aids Recovery
London Bridge Hospital avoids blood transfusion and aids patients’ recovery
17
Endoscopy and Gastroenterology at London Bridge Hospital
18
London Bridge Hospital Refurbishment on Track
19
GP Liaison Team
20
New Consultant List
With kind regards and best wishes.
Yours sincerely
John Reay
Chief Executive Officer
TWO
Introduction
John Reay
ChiefExecutiveOfficer
GP Liaison Department
Tel: 020 7234 2009
Email: gpliaisonlbh@hcahealthcare.co.uk
DISCLAIMER NOTICE
Any publication included in Health Matters and/or opinions expressed therein do not necessarily reflect the views of HCA
International Limited (including London Bridge Hospital) (‘HCA’) but remain solely those of the author(s). The author(s)
have used reasonable endeavours in preparing this publication. However, the author(s) make no representation or warranty
with respect to the accuracy, or completeness of the contents of this publication and specifically disclaim any implied
warranties or fitness for a particular use. All of the information supplied in this publication is published without warranty, it
does not constitute legal or any other professional advice and the reader must satisfy themselves to its suitability for use.
The information contained in this publication is the exclusive property of HCA or is licensed to HCA and is protected by
copyright and/or other proprietary rights. This information includes but is not limited to the design, layout, look and feel,
appearance and graphics. Nothing contained in this publication may be reproduced, distributed or edited in any manner
without the prior written authorisation of HCA.
Features
THREE
Moving breast conserving cancer
surgery into the 21st Century
Oncoplastic Breast Surgery
Oncoplastic Breast Surgery
Oncoplastic Breast Surgery
Mr Anil J Desai
Consultant Oncoplastic
Surgeon
Secretary: Maria Parker
T: 020 7234 2246
F: 020 7234 2998
maria.parker@hcahealthcare.
co.uk
www.breastcancersurgeon.
uk.com
by Mr Anil J Desai
Surgery is the mainstay of treatments
for breast cancer. Women are
increasingly breast aware and most of
them will take up breast screening when
invited. As a result, the cancers detected
are increasingly small and breast
conserving surgery is feasible for the
large majority. However, mastectomy
seems to be the treatment of choice for
larger tumours. Overzealous resections
of tumours can sometimes result in
asymmetry, distortion or a disfiguring
appearance of the breast.
There has been a lot of interest
in breast reconstruction following
mastectomy in recent years. A disfigured
breast following breast conserving
surgery is just as psychologically
traumatising as mastectomy. This can be
a constant reminder to the patient of
the cancer diagnosis and the treatment.
Oncoplastic surgery offers breast
cancer patients hope of a normal life by
preserving their femininity. Employing
the principles of plastic surgery of the
breast, patients facing the prospect
of surgery for breast cancer can be
assured that the breast will be restored
to its normal form. In many instances,
the aesthetic appearance of the breast
can be enhanced at the same time
Fig.1
FOUR
Oncoplastic Breast Surgery
Fig.2
as carrying out the resection of the
cancer. From an oncological aspect, such
surgery allows resection of much more
breast tissue with wide margins and
reduces the need for reoperation which
often results in a mastectomy.
Oncoplastic surgery may combine the
principles of breast reduction, breast
uplift (mastopexy), volume replacement
through local parenchymal flaps or
flaps consisting of muscle or adipose
tissue. Simultaneous surgery on the
contralateral breast produces instant
symmetry, reduces the fear of the
cancer surgery and gives the patient
greater confidence and self-esteem.
The type of aesthetic technique
used depends on the appearance of
the breast prior to the surgery, the
location of the cancer in the breast
and the patient’s expectations. Often
it is possible to reduce the size of the
tumour by giving chemotherapy first
(neoadjuvant chemotherapy) and then
carrying out the oncoplastic procedure.
This further reduces the need for
mastectomy.
Badly positioned scars are also a
constant reminder of the disease
and deter the patient from wearing
suitable apparel for social functions,
Fig.3
swimming and hot weather. These
are important considerations if
the patient is to feel whole
again. Scars in breast conserving
surgery can be positioned around
the areola, inframammary crease
or axilla so as to be inconspicuous.
It is no longer acceptable to tell
patients to be grateful their cancer
has been removed. The onus is upon
the surgeon to ensure symmetry is
maintained.
While oncoplastic surgery aims to
preserve the contours and volume
immediately at the time of surgical
excision, patients will present with
defects and asymmetry following
surgery and radiotherapy. It is
possible to achieve symmetry
through the same techniques and
in many instances by Lipofilling, the
art of injecting fat into the breast
after harvesting it from other parts
of the body.
Oncoplastic surgery has moved
cancer surgery of the breast truly
into the 21st Century and removed
the fear of every woman facing the
prospect of treatment for breast
cancer.
Fig.4
Mr Anil J Desai is a Consultant
Surgeon with a special interest in
Oncoplastic and Reconstructive
Breast Surgery and Aesthetic
Surgery of the Breast.
Fig.1
Patient 1: Had a large tumour
in the upper inner part of right
breast. Underwent chemotherapy
to shrink it down, became
impalpable, wire localised for
surgery. Image shows postchemotherapy, pre-op.
Fig.2&Fig.3
Patient 1: 10 days after surgery cancer removed and both breasts
uplifted.
Fig.4
Patient 1: Three years after surgery.
Fig.5
Fig.5
Patient 2: Had a tumour removed
from right breast using breast
reduction technique (therapeutic
mammaplasty) and simultaneous
left breast reduction.
Fig.6
Patient 3: A recent case - tumour
removed from left breast by
breast reduction technique
and simultaneous right breast
reduction mammaplasty.
Fig.6
Mr Desai possesses 11 years
of experience as a Consultant
Breast Surgeon and has
carried out over 300 breast
reconstructions using implants,
LD flaps, LD flaps with implant
and TRAM flaps. He possesses
extensive experience in breast
enlargement, reduction and uplift.
Mr Desai completed training
at Charing Cross Hospital as
a Senior Registrar. He trained
in the North Thames region
acquiring over seven years of
breast experience and obtained
an MPhil in Molecular Biology
at the University of London.
He enriched his experience by
visiting various internationally
acclaimed breast units and
regularly attending conferences
on breast cancer, oncoplastic and
reconstructive breast surgery
and cosmetic surgery of the
breast. He has a busy NHS
practice in South East London
and is the lead surgeon at
‘Quality Assurance for London’
for breast screening.
Mr Desai passionately believes
that no breast cancer patient
need bear a visible scar of
surgery on the breast. He is now
available to consult at London
Bridge Hospital.
Oncoplastic Breast Surgery
FIVE
Dr Stephen Motto
BM Dip Sports Med
D M-S Med Dip Med Ac
FFSEM (Ireland) FFSEM (UK)
Sports &
Musculoskeletal Consultant
by Dr Stephen Motto, Sports Injury Diagnostics
What is Extracorporeal Shock
Wave Therapy (ESWT)?
Extracorporeal Shock Wave Therapy
(ESWT) is a relatively new technique
that uses shockwaves to treat chronic
conditions of the musculoskeletal system.
I have been using ESWT for nine years.
It is the same technology used to treat
patients with kidney stones in the 1980s
without surgery (Lithotripsy). This
treatment was subsequently applied to a
variety of musculoskeletal conditions and
the technology was refined in the 1990s.
I use a device called orthoPACE from
the Pulsed Acoustic Cellular Expression
(PACE) platform. This device generates
electrohydraulic shock waves that
have a biological activating effect
which regenerates hard and soft
musculoskeletal tissues such as bone,
tendons and ligaments.
orthoPACE utilises medium to high
energy acoustic or pressure waves to
focus treatment for tendinopathies,
chronic bursitis, some cases of tibial
periostitis (‘shin splints’) and may help
with delayed bone healing. The PACE
principle involves the induction of cellular
signals and factors including increased
angiogenesis that promote healing in
wounds and soft tissues.
We are trying to convert a chronic injury
into an acute one by mechanotransduction,
working synergistically with exercise
therapy. It also complements other
energy treatments provided, such as
Laser needle, Pulsed Electromagnetic
therapy and InterX (a sensory electrical
neuro-stimulation device).
What happens during ESWT?
Treatment is carried out in the Sports
Injury Diagnosis clinic at London Bridge
Hospital and takes about 20-30 minutes.
The patient is usually able to return to
work but should restrict activities during
the first week. Follow-up examination
and treatment take place at four-six
weeks, although further treatment may
not be necessary. Treatment may not be
covered by medical insurers.
Many patients experience an improvement
in symptoms almost immediately, while
others take two-three weeks to respond.
A few fail to respond with 10% or so
experiencing a transient aggravation.
There may be a transient reddening or
swelling of the area with some patients
experiencing a brief increase in pain.
Numbness or paraesthesia are less
frequent side effects.
Patient experiences
I recently presented some of my
experiences using shockwave therapy
at the 2nd Congress of the European
College of Sports and Exercise Physicians,
9th-11th September 2010, at Queen
Mary, University of London.
It is accepted that managing chronic
patella tendinopathy (‘Jumper’s knee‘),
prevalent in 7% - 40% of the athletic
population, is difficult with athletes
experiencing frequent setbacks and
recurrent pain and dysfunction for
many months. Two papers have found
shockwave therapy to be of some
success (see References 1 and 2) for this
condition, whereas in my hands the most
successful areas are in the treatment
of plantar fasciitis, insertional Achilles
tendinopathy, calcific tendinopathy of the
shoulder, quadriceps tendinopathy and
only of marginal benefit in tennis elbow.
I hope the introduction of orthoPACE will
address some of the shortcomings of its
predecessor (EvoTron). First impressions
are that it is less painful for the patient,
who seems better able to tolerate
treatment with the new device without
local anaesthetics. The new applicator
for orthoPACE delivers higher energy
densities at more superficial depths. The
hope is that conditions such as patella
tendinopathy and tennis elbow will
respond more favourably than with the
EvoTron.
A couple of successful applications
of ESWT at Sports Injury
Diagnosis clinic:
• A walker with a heel spur and a
one-year history of heel pain.
• A lady with Addison’s disease
and chronic Achilles tendinopathy
preventing her from working.
Dr Stephen Motto is a Sports
& Musculoskeletal Consultant
at Sports Injury Diagnosis, a
sports medicine clinic based at
St Olaf House in London Bridge
Hospital, with an additional clinic
at 31 Old Broad Street.
For further details about
Sports Injury Diagnosis, contact
Mrs Anne Sampson, Practice
Manager, on:
T: 020 7403 0330
Extracorporeal Shock Wave Therapy
Unparalleled
premium
healthcare
services
on your
doorstep
Designed to meet the fast-paced demands of
the Canary Wharf and Docklands community,
Docklands Healthcare offers an unparalleled
range of premium diagnostic imaging services
and healthcare.
Our imaging centre offers a convenient location
and minimal waiting times so any medical
concern can be swiftly addressed and the
highest quality treatment offered.
Diagnostic Imaging
We have a team of fully qualified and experienced radiographers
on hand with results assessed by leading consultants from
London’s top hospitals. Diagnostic imaging services include:
• GeneralX-ray
• MRIscanning
• Ultrasoundscanning
Orthopaedics
Our team of orthopaedic consultants specialise in the following:
orthoPACE is one of a number of
treatments offered by Sports Injury
Diagnosis clinic at London Bridge
Hospital. I assure you that whilst there
is no danger of me swimming the
channel, or running in the London
Marathon, I am committed to helping
elite and recreational athletes/patients
achieve their exercise and sporting goals.
References
1. Extracorporeal Shock Wave Therapy for patellar tendinopathy: a review of the literature. van Leeuwen, Zwerver, van den Akker-Scheek. BrJSportsMed 2009;43:163-168
2. Extracorporeal Shock Wave for Chronic Patellar Tendinopathy. Wang et al. Am J Sports Med June 2007; 35: 972-978
SIX
Docklands Healthcare
Extracorporeal Shock Wave Therapy
Extracorporeal Shock
Wave Therapy (ESWT) for
Sports Injury Treatment
•
•
•
•
•
•
•
Docklands Healthcare is conveniently located on the
ground floor of the Clifford Chance Building, Upper Bank
Street, next to Canary Wharf tube station (east exit).
For further information on Docklands Healthcare
please call 0844 800 0636
or visit www.docklandshealthcare.com
Arthritis
Cartilagerepair/replacement
Cartilagetearsinsideajoint
Highperformancehipandkneereplacements
Managementofligamenttears
Surgicalligamentreconstruction
Tendonitis
If onward referral is required, London Bridge Hospital ensures
convenient access to consultants from a wide range of other
specialties.
Docklands Healthcare is an outpatient diagnostic centre
in affiliation with London Bridge Hospital.
Rheumatology
10 Minutes With...
If you are interested in
attending next year’s ‘Ten Topics
in Rheumatology’ meeting
or if you would like more
information on rheumatology or
lupus, please contact the London
Lupus Centre at London Bridge
Hospital on:
T: 020 7234 2155
Mr Simon
Owen-Johnstone
10 minutes
with...
Consultant Orthopaedic
Surgeon
Prof Graham Hughes
London Lupus Centre
www.tentopics.com
Ten Topics in
Rheumatology
Mr Simon Owen-Johnstone, Consultant Orthopaedic Surgeon
1. Why did you decide to study
medicine?
Medicine is a fascinating blend of art
and science. It’s highly technical and
there is a lot of human interaction.
2. What made you pursue your
specialty?
Shoulders, elbows, wrists and hands
offer the challenge of complex
problems and elegant surgery.
3. What is the most rewarding
part of your job?
Undoubtedly it’s making people better.
It’s a privilege to be able to take a
person in discomfort or disability, work
out why, correct the problem with or
without an operation, and see them
recover to get a part of their life back.
4. What do you enjoy doing in
your spare time?
My wife and I make the most of living
in London; dining out, theatre, dance,
galleries, music, museums, culture,
architecture, even shopping.
5. What is the title of your best
read so far?
It is difficult to choose: Zadie Smith’s
EIGHT
10 Minutes With...
‘White Teeth’ is beautifully written,
but Dickens’ ‘A Tale of Two Cities’
captures Victorian London life
brilliantly.
6. If you could invite three people
to dinner, living or dead, who
would they be?
David Dimbleby for his current affairs
knowledge, my favourite comedian,
Dara O’Briain, and John Reay, London
Bridge’s superb Chief Executive
Officer.
7. What is special about where
you grew up?
Absolutely nothing: Leicester!
8. Where is your favourite place
in the world?
The British Virgin Islands, on a yacht
with my family, but Dartmouth is a
close second.
9. Who would you get to play
yourself in a movie?
Well, I thought George Clooney was
a good match, but my kids voted for
Rik Mayall...
Mr Simon Owen-Johnstone
specialises in problems affecting
shoulders, elbows, wrists and
hands, known collectively as
the Upper Limb. Mr OwenJohnstone’s NHS practice is
at St Bartholomew’s Hospital
and The Royal London, one of
the four Trusts in the London
Trauma Network, where
he is the Lead Clinician for
Trauma & Orthopaedics. Mr
Owen-Johnstone teaches on
postgraduate courses at the
Royal National Orthopaedic
Hospital, the Royal College
of Surgeons and the Royal
Society of Medicine. He
lectures regularly at GP and
Physiotherapy events through
London Bridge Hospital.
Mr Owen-Johnstone can be
contacted via GP Liaison at
London Bridge Hospital:
T: 020 7234 2009
or through his secretary,
Sangeeta, on:
T: 07949 782339
medicalsec@hotmail.com
Professor Graham Hughes
trained and qualified at The
London Hospital. In 1969,
Professor Hughes moved to
New York, spending two years
doing a Postgraduate Fellowship
at the Rheumatology & Lupus
Centre of Dr Charles Christian.
Professor Hughes became
a Consultant Physician at
Hammersmith Hospital
where he set up Europe’s
first dedicated Lupus Clinic in
1973. In 1983, he described the
clotting disorder now known
as Hughes Syndrome. In 1985,
he set up the Lupus Unit at St
Thomas’ Hospital.
In 1993, Professor Hughes
received the World
Rheumatology (ILAR) Research
Prize for the description of
Hughes Syndrome. He is also
a member of the American
Lupus ‘Hall of Fame’, and
Doctor Honoris Causa at the
Universities of Marseille and
Barcelona.
by Professor Graham Hughes
London Bridge Hospital is a key
sponsor of the annual ‘Ten Topics in
Rheumatology’ postgraduate meeting.
Held at St Thomas’ Hospital, the two-day
event is organised by Professor Graham
Hughes and Sandy Hampson from the
London Lupus Centre at London Bridge
Hospital.
The event has become one of the most
sought-after postgraduate meetings of
the academic calendar and is always fully
subscribed.
This year, London Bridge Hospital
and St Thomas’ team were joined by
guest lecturers from around the world,
including Professor Frederic Houssiau
(Belgium), Dr Claudia Fofi (Italy), Dr
Steve Binder (USA) and Professor A
Rosen (USA). Topics included new drugs
in lupus, the gut and arthritis, advances
in osteoporosis and clinical features
of the antiphospholipid (Hughes)
syndrome.
Guest speakers Dr Richard Horton,
Editor of Lancet, and Dr Ed Coats, who
made a televised trip to the South Pole
with Ben Fogle and James Cracknell,
gave interesting and highly entertaining
talks.
Presentations were given by leaders
in the rheumatology field, with topics
alternating between the highly ‘clinical’
and more ‘basic science’ topics.
The annual feature, Nightmare on
Lambeth Palace Road (the street
address for St Thomas’ Hospital),
featuring difficult cases for general
discussion proved very popular.
Such has been the success of ‘Ten
Topics’ that satellite meetings are
now held in Barcelona, Rome, Nice,
Buenos Aires and Asia – this year in
Singapore.
Next year marks the 25th Anniversary
of the London Ten Topics and will be
held on 30th June and 1st July 2011.
Mark the dates!
Cortisone Injections
NINE
Consultant Clinical
Neurophysiologist
Keyhole Surgery for
Fractures Around
the Shoulder
by Tony Kochhar
EMG/NCS Use
in Primary Care
by Dr Alistair Purves
Most GPs will be aware of the existence of departments of Clinical
Neurophysiology in their local hospitals, but historically not many have had direct
access. In my NHS practice at King’s College Hospital I have had open access to
GPs for some years – currently about 15-25% of my referrals are direct. I find
that the patients coming to us directly are essentially the same as those coming
from orthopaedics etc, and the rising proportion of GP referrals suggests that
those who refer are finding it a valuable diagnostic tool.
Dr Purves qualified at Cambridge
in 1981, and trained at
Addenbrookes Hospital and
the National Hospital for
Neurology and Neurosurgery.
He is a Consultant at King’s
College Hospital and provides
an extensive service in EMG
and conduction studies there
and in Kent. He has a particular
interest in the neurophysiology
of pain syndromes.
For more information on EMG
and NCS or to contact Dr
Purves’ secretary, please phone:
T: 01622 620910
Electromyogram and Nerve Conduction Studies (EMG/NCS) are concerned
with techniques looking directly at peripheral nerve and muscle function via
their electrical properties. We can characterise nerve damage or compression
problems, and can indicate the site of this as well as the severity. This is well
established for many of the common entrapment neuropathies such as CTS or
ulnar compression.
A new and important area exists in EMG/NCS where patients who present with
symptoms that appear to be neurological like tingling, numbness, pain, clumsiness
or weakness in an arm or leg, but where the distribution does not conform to
a standard pattern. A typical patient might have pins and needles throughout an
arm, weakness or unreliability of grip and poorly localised proximal pain. Spinal
imaging often fails to show any abnormality beyond some degenerative change
appropriate to occupation and age.
Due to the very neurological flavour of the symptoms there often remains
concern that there is nerve damage somewhere, and it is very helpful clinically
to demonstrate that there is no nerve compression or damage either in the
peripheral nerves, or in the brachial plexus or in the cervical roots. We often
find that patients who have neck and shoulder pain and who have some other
coexisting condition such as carpal tunnel syndrome (CTS), display atypical
symptoms, e.g. the sensory symptoms are often in the entire hand or even in the
‘ulnar’ fingers. We can show the separate components of a mixed picture that can
be clinically very confusing.
TEN
EMG/NCS Use
Some patients with what would
otherwise be called a pure pain
syndrome, such as fibromyalgia, do
also have neurological symptoms,
and neurophysiology is very
useful for reassuring patients
and doctors that there is no
underlying nerve damage. If there
is an abnormality, this then allows
an appropriate further referral to
be made – to rheumatology or a
pain specialist, or to orthopaedics
if there is a peripheral lesion such
as a CTS, or to neurosurgery, if
there is evidence of cervical or
lumbar root lesions.
Keyhole Surgery
EMG/NCS Use
Dr Alistair Purves
Fractures around the shoulder are usually
due to high energy impacts like those
often seen in contact sporting injuries.
These usually result in either a fracture of
the proximal humerus or of the glenoid
process of the scapula. Such fractures are
notorious for poor outcomes and long
periods of rehabilitation and often require
large open operations to fix the fractures.
The latest techniques involve using
keyhole surgery (shoulder arthroscopy)
to assist in debriding the fracture
fragments and under direct visualisation,
accurately reduce the fracture back to
an anatomical position. The advantages
of these techniques are that most
procedures can be performed via
minimally invasive techniques with a
reduced risk of infection, a faster recovery
rate and a better long-term outcome.
By remaining at the forefront of the
latest techniques and ensuring best
practice, Mr Kochhar has developed a
high quality and efficient shoulder service
for sports injuries and fractures, as well as
degenerative conditions of the shoulder
and upper limb.
Fig. 1 – Pre-op CT
Fig. 2 – Pre-fixation view
Via arthroscopy of his shoulder, the fracture
fragment was debrided and reduced
accurately and then via a mini open incision
from the front of the shoulder, a screw was
placed retrograde (from front to back),
securely fixing the fragment back onto the
rest of the glenoid fossa.
Fig. 3 – Retrograde screw
The fixation was solid and there was
an accurate reduction. The patient
was mobilised almost immediately. He
returned to a pre-operative level of
function within eight weeks. He has
returned to full sporting activities.
Case study 2
Fig. 4
A 44-year-old man was rugby-tackled and
sustained a minimally displaced impaction
fracture of the greater tuberosity.
Fig. 5
He underwent an arthroscopy of his
shoulder and under direct arthroscopic
visualisation the fracture was debrided.
Case study 1
Fig. 6
A 38-year-old gentleman fell over onto
his right shoulder whilst skiing. The
pre-operative CT scan demonstrates
a fracture of the anterior part of the
glenoid:
The fracture was securely fixed using two
suture anchors. These sutures were passed
through the fragments to result in a solid
suture repair of this fracture.
Fig. 1
Fig. 2
Fig. 3
Tony Kochhar
Consultant Shoulder &
Upper Limb Surgeon
Tony Kochhar is a Consultant
Orthopaedic Surgeon here at
London Bridge Hospital. He
is an expert in surgery of the
shoulder, elbow, wrist and hand.
He completed his training at
the Royal National Orthopaedic
Hospital in London. He has
furthered his shoulder and upper
limb training by working with
some of the best surgeons in the
world, having completed specialist
fellowships at worldwide centres
of excellence in New York and
the world-renowned Alps Surgery
Institute in Annecy, France.
By remaining at the forefront
of the latest techniques and
ensuring best practice, Mr
Kochhar has developed a high
quality and efficient shoulder
service for sports injuries and
fractures as well as degenerative
conditions of the shoulder and
upper limb. Mr Kochhar regularly
lectures on shoulder and upper
limb surgery at national and
international conferences and
training courses.
He has regular outpatient clinic
sessions here at London Bridge
Hospital on Tuesdays and Fridays
(both daytimes and evenings).
To make an appointment to see
Mr Kochhar, please contact the
GP liaison department at London
Bridge Hospital, or his secretary
on:
T: 020 3301 3750
Further information is available
on Mr Kochhar’s website:
Fig. 4
Fig. 5
Fig. 6
www.shoulderdoctor.co.uk
Keyhole Surgery
ELEVEN
Howdoesthe
patientbenefit?
T: 020 7234 2773
to book a DEXA Scan or for
more information.
• Remote follow-up provides
valuable clinical information
that cannot normally be
obtained until the next
scheduled clinic visit
Remote Home
Monitoring Service
at London Bridge
Hospital
Remote monitoring has recently
been introduced to the Cardiology
Department at London Bridge Hospital
with great success. Home monitoring
is a fairly new initiative introduced for
patients with implantable devices, such as
a pacemaker or defibrillator. It provides
a unique way to collect and download
diagnostic data from an implantable
device while the patient remains in the
comfort of their own home. This enables
the physician and GP to obtain nearly
the same information as a hospital clinic
visit, with just a few exceptions.
Sohowdoesitwork?
The system is able to function with a
small piece of equipment, roughly the
size of a home telephone. All the patient
needs is a power cord and telephone
landline to connect. The patients are
given a full demonstration and education
session in the clinic before taking the
communicator home. The device sits in a
convenient place in the home, usually on
a bedside table and is able to download
device information and send it securely
via the internet. This information is then
accessed by a Cardiac Pacing Physiologist
who interprets the results and produces
a report for the Consultant.
TWELVE
Remote Home Monitoring
Howoftenisinformation
downloaded?
The frequency of the information
downloads is decided by the Consultant
depending on the nature of the patient’s
device and medical history. For example,
a pacemaker patient is usually seen in
clinic once a year. With home monitoring
a Consultant may decide they would like
a download once every three months
for a periodic update. These scheduled
downloads provide the opportunity
for earlier detection, notification
and intervention of significant
events between scheduled Physician
appointments, thus offering a greater
level of comprehensive cardiac care.
WhatinformationdoesRemote
HomeMonitoringprovide?
In addition to the scheduled downloads,
there is also an alert system. The alert
system can be extremely useful in the
case of new onset atrial fibrillation. A
patient with a pacemaker or defibrillator
may suddenly develop atrial fibrillation or
a patient known to have atrial fibrillation
may have an episode for over 24 hours
without being aware of it.
With the alert system we are notified
of the event, possibly before the patient
• It can potentially reduce
inappropriate therapy
• Earlier pharmacological
intervention
• Increased peace of mind
and the assurance that
their Consultant and GP
can monitor specific device
information continuously
• Individually tailored
comprehensive cardiac care,
promoting early detection,
notification and intervention
of any potential cardiac
device related problems
begins to suffer any symptoms.
A medication change can then be
achieved by a GP follow-up almost
immediately after the identification
of arrhythmia, thus saving a trip to
the Consultant in hospital. Allowing
for an early detection can be very
advantageous for a patient’s wellbeing.
Another scenario occurs when a
patient with a defibrillator receives
a shock. If the patient is at home an
email, text, fax or phone call is then
initiated to the clinic to inform us of
the event. The Cardiac Physiologist can
then access the event information any
time of day via the secure website and
then speak with the Physician about
this event. Obtaining this information
in such a timely manner can be vital
to decide if the patient needs to go to
hospital, have a medication change or
in some very rare cases, sees that the
shock may have been inappropriate
and therefore needn’t worry. By no
means is it an emergency service
and the patient is aware of this when
they give permission to enrol in the
programme, however, it provides vital
information and the opportunity to
act before the next scheduled
Physician appointment.
Imaging Services
Remote Home Monitoring
Please call London Bridge
Hospital’s Imaging Services
Department on:
Introducing the DEXA Scan
to London Bridge Hospital’s
Imaging Services Department
London Bridge Hospital is pleased to announce the addition
of a bone density scan service
A bone density scan, known as Dual
Energy X-ray Absorptiometry (DEXA)
can determine the density of bones
and compare it to an average range
for patients of similar age, ethnicity,
gender and other factors. The difference
between this bone density and the
average is calculated and patients are
given a ‘T-score’ . The T-score, along
with lifestyle factors, can determine if
you have osteoporosis or an increased
risk of developing osteoporosis. DEXA
scans are also useful for monitoring
patients over time to observe changes
in bone density or if their treatment is
effective or requires changing.
If a T-score is between 0 and 1,
someone is said to be within the
normal range. If it is between -1 and
-2.5, they will be diagnosed with
osteopenia, which is the name for the
category of bone density between
normal and osteoporosis. Someone is
identified as having osteoporosis if his
or her T-score is below -2.5.
How does DEXA bone
densitometry work?
A DEXA scan is a fast, painless and
non-invasive procedure. The equipment
consists of a flat comfortable table with
an arm in the shape of a C suspended
overhead.
The scanner produces two X-rays of
different energies, one low, the other
high. The amount of X-rays that pass
through the bone is measured for each
beam and will vary depending on the
thickness of the bone. Based on the
difference of the two beams, bone
density can be calculated.
Bone Density Scan and Analysis
Patients are required to complete the
DEXA scan for 30 minutes and complete
the accompanying questionnaire.
The most common examination sites
are the fracture-prone bones i.e. hips
and the lower spine.
The Report
The DEXA system produces a report
instantly for the patient to take home.
Along with information they provide
about their family and medical history,
lifestyle and diet, the data derived
from the DEXA test will be used
by the reporting Nuclear Medicine
Physician who will determine if they
have osteoporosis or are at risk from
developing it.
This final report will aid GPs in deciding
whether the patient would benefit from
therapy.
Preparing Patients for Bone
Densitometry Scanning
Unless instructed otherwise, patients
must eat normally on the day of their
examination. However, they must avoid
taking calcium supplements for at least
24 hours prior to their appointment.
Patients must wear loose, comfortable
clothing – sweat suits and other casual
attire without zips, buttons, press studs
or any metal.
Other radiological examinations can
interfere with a DEXA scan. Patients
must inform their doctor or radiographer
when attending an appointment if they
have had a previous test. These include
a Barium Study (must wait six-eight weeks),
a CT scan with contrast, an MRI scan
with Gadolinium or a Nuclear Medicine
Bone Scan (must wait one week).
BENEFITS
• Fast and comfortable, only takes 30 minutes
• Simple and established X-ray method for
determining whether you have osteoporosis
or are at risk of developing osteoporosis
• No side effects experienced from the scan
• Painless, non-invasive, no injections
• Safe, low radiation dose, less than that of a
chest X-ray
Imaging Services
THIRTEEN
in the heart of the
City OF LONDON
Time is of the essence when it comes to medical treatment.
Set up to cater for the healthcare needs of City of
London professionals, and supported by London
Bridge Hospital, 31 Old Broad Street offers:
• Convenient, accessible private outpatient services
• Wide range of specialist ‘one stop’ clinics
• Consultations and diagnostic services
• Specialist consultants and nursing professionals
Updates
31 Old Broad Street
HEALTHCARE
E XC E L L E N C E
For holiday dialysis information
please call Megan, our holiday
dialysis administrator, on:
T: 020 7234 2933
For any enquiries or further
information about the Dialysis
Unit, please contact Helen
Cronin, Unit Manager, on:
T: 020 7234 2261/2085
London Bridge Hospital’s
Dialysis Unit Relocated
The Dialysis Unit at London Bridge
Hospital has been established for
almost 25 years and has a worldwide
reputation for the quality of care
provided.
It recently relocated to a new bright
and spacious unit that continues to
provide dialysis for patients who are
NHS sponsored, as well as overseas
visitors who are visiting for business
or pleasure.
London Bridge Hospital is an ideal
location for dialysis patients, with a
fantastic centralised location, within
easy reach of the City, adjacent to
London Bridge station and ample
attractions on offer to help them make
the most of their stay.
The Dialysis Unit also provides acute
dialysis and continues to run a 24-hour
nurse on Call rota.
Isolation room facilities are provided
for patients who are Hepatitis B, C or
MRSA positive.
Patients can receive a high standard
of care and treatment in comfortable
surroundings led by a very experienced
Unit Manager and a team of specialist
nurses.
The Renal Service at London
Bridge Hospital comprises of a
multidisciplinary team and includes
Renal Physicians (Nephrologists),
Dialysis Nurses, Renal Transplant and
Access Surgeons who deal with the
surgical needs of dialysis patients
and transplantations. The team also
includes interventional radiologists
who have expertise in the placement
of dialysis catheters, renal biopsies,
renal angiography and the management
of renal artery stenosis with balloon
angioplasties and stenting.
• State-of-the-art equipment
• Comfortable and discreet environment
• Appointment times to suit the patient.
Introducing London
Bridge Hospital’s Online
Registration Portal
London Bridge Hospital is pleased to announce the introduction
of an online registration portal allowing patients to register for
appointments from the convenience of their home or place of work.
Getting in touch
31 Old Broad Street, London EC2N 1HT
Tel: 020 7496 3522
Fax: 020 7496 3523
Email: 31oldbroadstreetlbh@hcahealthcare.co.uk
Web: www.31oldbroadstreet.co.uk
The Online Registration Portal reduces the need to complete
information on arrival, with patients simply checking the pre-printed
form on arrival and signing to verify and accept HCA’s terms and
conditions. Patients who are returning to the hospital have the
convenience of using an ‘auto-fill’ function that will enter their
information from previous registrations, saving time and hassle.
Patients can also save their online form and return to it later if
they don’t have all their information at hand.
www.registrations.hcahealthcare.co.uk
For further details, please contact
London Bridge Hospital’s Online
Registration Service on:
T: 020 7234 2107
Updates
FIFTEEN
Corventis Mobile Cardiac Telemetry System is a new
event monitoring device which recognises symptomatic
and asymptomatic cardiac abnormalities.
The process involves applying an
adhesive wireless monitor called a
PiiX on the left upper quadrant of
your chest and wearing it continuously
for seven days. The PiiX is waterresistant, permitting the patient
to wear it while showering. The
monitor is noiseless and hidden
conveniently underneath clothing
allowing the patient to continue their
normal activities comfortably. Each
Corventis kit contains three PiiX
devices meaning up to three weeks of
electrocardiographic (ECG) recordings
can be monitored.
The PiiX automatically transmits
the patient’s ECG recordings to a
transmitter device called a zLink
which is plugged into a standard
electrical outlet beside their bed. The
information is then transmitted to our
Cardiac Physiologists who analyse and
interpret all of the ECG recordings.
This report is then sent to the
For more information please call the
London Bridge Cardiology Department:
T: 020 7234 2265
Physician where treatment, if required,
can be further investigated.
The Corventis monitor can be used for
people who may experience symptoms
such as intermittent palpitations,
dizziness, light-headedness or near
syncope episodes, syncope, falls or
shortness of breath that might be
related to cardiac arrhythmias.
If a symptom presents itself, the patient
moves the Patient Trigger Magnet
along the surface of the PiiX. This
activation stores and transmits the ECG
and is then analysed by our Cardiac
Physiologists to determine whether
the symptom relates to any cardiac
arrhythmias seen on the ECG.
London Bridge Hospital is proud
to announce its new and innovative
Cardiac MRI service.
Our Cardiac MRI Scanner uses the
latest cutting-edge technology to
diagnose a range of diseases and
conditions including:
• Coronary heart disease
• Damage caused by a heart attack
• Heart failure
• Heart valve problems
• Congenital heart defects
• Pericarditis
• Cardiac tumours
Patients will benefit from this noninvasive procedure in comfortable
surroundings. All scanning is carried
out by experienced staff, fully-trained
in all aspects of diagnostic imaging.
The Cardiac MRI Scanner is situated
in London Bridge Hospital. Patients
possess easy access to all other
hospital departments for further
assessments, shared expertise
and collaboration with associated
Consultants.
Please contact MRI on:
T: 020 7234 2450
for more information.
SIXTEEN
News
News
News
New
Cardiac
Corventis Mobile MRI
Cardiac Telemetry Scanner
System
Innovation
Aids Recovery
Innovation at London Bridge Hospital avoids
blood transfusions and aids patient recovery
Perfusionists at London Bridge Hospital
have succeeded in reducing the number
of blood transfusions during operations
by recovering and recycling the patient’s
own blood.
Chief Perfusionist, Alan Rayner and
his team have combined a range of
specialised techniques along with the
latest technology to reduce damage to
blood, and more efficient ways of recycling
a patient’s blood during a major operation,
thereby reducing the level of blood loss
during and after operations.
“There are obviously situations where
transfusion is essential, or cases where
blood cannot be recycled, but for many
elective operations good preparation
and technique during the procedure can
reduce the need for donated blood and
recovery can be faster,” said Mr Rayner.
“However well matched blood is,
transfusions can result in increased time
spent in intensive care and recovery can
be delayed. By analysing the patient’s
blood clotting characteristics before an
operation, which can now be done at the
bedside, we can prepare for anticipated
bleeding,” he said. “We can also use the
autologous fibrin sealant produced from
a patient blood sample at the time of
surgery and apply it to tissue to reduce
bleeding and improve healing.”
“London Bridge is one of the first
hospitals in the country to use this
extensive range of techniques to reduce
bleeding and avoid unnecessary blood
transfusions. We are extremely fortunate
in having the very latest technology
and a tremendous team of Surgeons,
Anaesthetists, Perfusion Scientists and
Nurses and I can foresee many more
major procedures in cardiac, vascular,
urology, gynaecology and orthopaedic
surgery taking place without the need for
transfusions,” said Mr Rayner.
Cardiac Surgeon, Mr Graham Venn
and Consultant Anaesthetist, Dr Stuart
McCorkell, said that the pioneering work
of the London Bridge perfusionists had led
to better patient outcomes.
“The Perfusion Department has adapted
contemporary perfusion structures to
provide the best operative environment
during cardiac surgery,” said Mr Venn.
“This foundation, coupled with the
implementation of sophisticated
techniques for blood conservation,
together with detailed analysis of the
patient’s post-operative clotting profile,
has resulted in a ‘leading edge’ service
being delivered to our patients.”
Dr McCorkell agreed, “By providing cell
salvage, fibrin glues and growth factors
manufactured from the patient’s own
blood and highly accurate real time tests
of blood clotting, we are also able to
minimise the risk of exposure to the
hazards of transfusions to the patients.”
Endoscopy and Gastroenterology
at London Bridge Hospital
For more information or to book an
appointment, please call the Endoscopy
& Gastroenterology Unit on:
T: 020 7234 2642
London Bridge Hospital’s specialist
gastroenterology service treats disorders
of the digestive system. Through the use
of endoscopy techniques, we are able
to offer patients a minimally invasive
alternative to surgery.
An endoscopy requires only mild
sedation while a small, flexible video
camera is passed through the mouth
and into either the stomach or intestine
to allow the Physician to identify
problems in the gastrointestinal tract
and, in some circumstances, remove
abnormal growths.
At the Endoscopy & Gastroenterology
Unit, we pride ourselves on patient
privacy and dignity, as part of a rapid,
streamlined service. Equipped with the
latest technology, we can provide a
minimally invasive alternative to surgery
through innovative clinical services, such
as the first fully integrated Pelvic Floor
Assessment Unit.
Endoscopy services include colonoscopy,
gastroscopy, neurogastroenterology small
bowel enteroscopy and endoscopic
ultrasonography (EUS).
We are the only private hospital in the
south of England to use endobronchial
ultrasound (EBUS) fine needle aspiration.
EBUS is a minimally invasive approach
to the sampling of difficult to access
lymph nodes or central masses in the
chest. Lymph nodes as small as 5mm
can be sampled and the technique has
broad applications, including the diagnosis
and staging of cancers of the lung and
other cancers that are suspected of
spreading to the lymph nodes in the
chest. It is also useful in the sampling of
lymph nodes in lymphoma and noncancerous conditions such as sarcoidosis
or tuberculosis.
EBUS involves the patient being put
under conscious intravenous sedation; a
thin flexible telescope (bronchoscope) is
inserted via the patient’s mouth into the
lungs. Images of the region between the
two lungs (the mediastinum) are obtained
using an ultrasound probe attached to the
bronchoscope.
Other specialist techniques cover:
• Video capsule endoscopy
• High resolution oesophageal
manometry
• Bravo pH monitoring
• Anal rectal physiology
News
SEVENTEEN
The first phase of a major expansion
and renewal programme at London
Bridge Hospital has been completed.
The hospital is undergoing a £12 million
building programme which includes the
creation of two new state-of-the-art
operating theatre suites and a new
10-bed ITU.
The hospital now has seven operating
theatres and two new suites, which cost
over £6 million, and are equipped with
the latest Stryker telemetry and display
equipment.
The new £3 million Intensive Care
Unit will have three isolation bays
for critically ill patients who, apart
from their primary illness, may also
have serious infections when they are
admitted.
In addition, a new hybrid laboratory for
cardio-vascular treatments is being built
to complement the hospital’s existing
state-of-the-art catheter laboratories.
Many of the hospital’s patient rooms
have been redesigned and re-equipped
and by the time that phase two of
the work is completed in July 2011,
London Bridge Hospital will house over
130 beds, making it one of the largest
private hospitals in the UK.
The hospital’s main reception area
is being redesigned and the Emblem
House admissions and outpatients
centre has already been reconfigured
and renewed to provide better facilities
for patients.
A new physiotherapy facility is being
prepared close by the hospital’s main
building and staff facilities, including a
new restaurant, have also been built.
John Reay, Chief Executive Officer of
the hospital, said this major renewal
and expansion operation was driven
by increasing demand for complex
procedures. “We had simply run out
of space and needed to expand our
facilities in practically every area,” he
said. “London Bridge Hospital has some
of the finest Consultants and specialist
medical teams and the demand for
our services – particularly for more
complex treatments – has grown
steadily in recent years.”
“Most of the latest complex
procedures in cardiology,
cardiothoracic surgery, liver surgery,
gastroenterology and many more
specialties are carried out here
and we are very proud that some
procedures have actually been
developed here,” he said.
“It is vital that we remain
ahead of the game and
retain our reputation
as one of the best
equipped hospitals in
the country. There’s
more work to do and
I would like to thank
all our patients, our
doctors and our staff
for their patience while
this vital work has been
progressing,” said Mr Reay.
London Bridge
Update...
Due to ongoing refurbishments,
lifts on the east side of the
hospital will not be operational
during construction of the new
Critical Care Unit. London
Bridge apologises for any
inconvenience caused and all
efforts will be made to keep
noise levels to a minimum until
the refurbishment programme
is complete in July 2011.
EIGHTEEN
Updates
London Bridge
Hospital’s GP
Liaison Team
GP Liaison Team
Updates
London Bridge Hospital
Refurbishments on Track
The Referral Process
through GP Liaison
Patient
attends GP
consultation
For those of you who know us well, you
will be aware of how the GP Liaison
service can help you. However, for those
of you who may be unfamiliar with how
we work, our GP Liaison Team offers the
following support to our referring General
Practitioners:
Referral
recommended
Phone call
from GP/Sec
to GPL*
GP Liaison Assistant Team
• A dedicated phone line, 020 7234 2009, open from 8.30am
– 5.30pm, Monday to Friday for you, your secretaries and
patients.
• A fast, efficient appointments service. We can deal with
both named and unnamed referrals (i.e. Dear Consultant
Cardiologist).
Encrypted
email from
GP/Sec to
GPL
Fax from
GP/Sec to
GPL
GP directs
patient to
contact
GPL
GPL call
patient for
availability
• A helpful, friendly team ready to deal with any questions that
you or your patients may have about the Hospital.
• A promise to help you and your patients as much as we can,
even if this means making an appointment with a competitor.
GPL liaise with
consultants’
secretaries
GP Liaison Officer Team
A GP Liaison Officer dedicated to your area offers the following:
• Organising educational events on areas of interest to primary
care. These can be both large scale and bespoke smaller scale.
• Keeping you in touch with the Hospital and any new
developments/services.
Call patient
to offer
appointment
• A personal contact point at the Hospital for any issues
that may arise.
=
Appointment
made
Call the GP Liaison Team on:
020 7234 2009
or email: gpliaisonlbh@hcahealthcare.co.uk
Ensure all
paperwork with
secretary prior to
appointment
If you wish, we
can inform you
when appointment
is confirmed
Your Feedback:
We are constantly striving to improve our service offering.
We would be delighted to hear from you with any ideas as
to how we could do this. Please feel free to contact your
GP Liaison Officer.
Please note: To save you time, we only need the minimum
details when you contact us: the patient’s name, date of birth,
contact telephone number, the specialty to which you are
referring them and brief details of their condition.
*
GP Liaison Team
NINETEEN