Health Matters - London Bridge Hospital...FOUR Services on Offer London Bridge Hospital Services Critical Care Critical Care FIVE To fi nd out more about the Critical Care Service

New Consultant ListTWENTY

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New Consultant ListLondon Bridge Hospital

NAME TITLE DEPARTMENT

Dr Jonah Chieza Consultant Anaesthetist Anaesthetics

Dr Chris Meadows Consultant Anaesthetist Anaesthetics

Dr Benjamin O’Brien Consultant Anaesthetist Anaesthetics

Dr Manish Raval Consultant Anaesthetist Anaesthetics

Dr Michael Douek Consultant Breast Surgeon Breast Care Surgery

Dr Gabriella Pichert Consultant Medical Oncologist Cancer Services

Dr Christopher Willars Consultant Intensivist Critical Care

Dr Fiona Child Consultant Dermatologist Dermatology

Dr Shefali Rajpopat Consultant Dermatologist Dermatology

Mr Nicholas Eynon-Lewis Consultant ENT Surgeon ENT Surgery

Mr James Gossage Consultant General Surgeon General Surgery

Mr Daniel Lanes Consultant General Surgeon General Surgery

Dr Robin Ireland Consultant Haematologist Haematology

Mr Graham Smith Consultant Oral & Maxillofacial Oral & Maxillofacial

Mr Paul Allen Consultant Orthopaedic Surgeon Orthopaedic Surgery

Mr Panamoottil Anil Kumar Consultant Orthopaedic Surgeon Orthopaedic Surgery

Mr Max Edwards Consultant Orthopaedic Surgeon Orthopaedic Surgery

Mr Paul Gill Consultant Orthopaedic Surgeon Orthopaedic Surgery

Mr Mark Phillips Consultant Orthopaedic Surgeon Orthopaedic Surgery

Dr Manpreet Gulati Consultant Radiologist Radiology

Dr Anmol Malhotra Consultant Radiologist Radiology

Dr Hema Purushothaman Consultant Radiologist Radiology

Dr Hema Verma Consultant Radiologist Radiology

Dr Michael Robson Consultant Renal Physician Renal

Dr Ronan Breen Consultant Respiratory Medicine Respiratory Medicine

Dr Simon Bowman Consultant Rheumatologist Rheumatology

Dr Toby Garrood Consultant Rheumatologist Rheumatology

Dr Jonathan Rees Consultant Rheumatologist Rheumatology

Dr Christopher Hughes Consultant in Sports & Exercise Medicine Sports & Exercise Medicine

Note: Please see our website or Referrers’ Guide for contact details of all Consultants featured in this magazine or contact the GP Liaison Department onT: 020 7234 2009

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Health MattersSummer 2012 • Issue 10

INSIDE: The Technology New Techniques The Care The Procedure

London Bridge Hospital Services • Critical Care • Shoulder Surgery • Groin Pain Knee Problems and Surgery • Kidney Disease • Low FODMAP Diet Endoscopic Microdiscectomy • Consultant Interview • Educational Programmes

Welcome to the Summer edition of Health Matters – our opportunity to present articles from our Consultants at London Bridge Hospital, and to connect with you regarding the services we offer to support you and your patients.

London Bridge Hospital is currently nearing completion of a major £15 million development project; with the hospital gaining a new hybrid lab, and expanding the state-of-the-art Critical Care Unit to a brand new 15-bedded unit with 10 single patient rooms. These facilities allow our Consultants to perform more complex diagnostic and treatment procedures, and gives them the ability to provide the very highest levels of patient care.

In addition to the development of London Bridge Hospital, we have also been selected aspreferred bidder to run Guy’s Hospital Nuffi eld Health Centre and the private unit in thenew Guy’s Hospital Cancer Centre which will allow us to develop a leading cancertreatment centre.

I wish to thank you very much indeed for your continuing involvement in the hospital, for the feedback you provide us with, and for the opportunity to care for your patients. Without this, we would not have been able to develop the hospital so that it can offer the services it does today.

Among the large array of specialties we offer at London Bridge Hospital, one area that has developed signifi cantly over the years is our Orthopaedic Services. We have access to someof the leading specialists and surgeons from London’s top teaching hospitals. Our Consultantsare able to offer patients a tailored treatment plan to deal with any situation.

Our GP Liaison Team always acts on the feedback that you give us at our Educational Eventsand meetings. This feedback has led to the development of the very fi rst London BridgeHospital iPhone application which contains information on our Consultants and our appointment booking facility. We hope that this application will allow you even easier access to the services we offer at London Bridge Hospital. As always I hope you enjoy this magazine and thank you for your continued support.

With kind regards and best wishes.

Yours sincerely

John ReayChief Executive Offi cer

Features

IntroductionTWO

John ReayChief Executive Offi cer

DISCLAIMER NOTICEAny publication included in Health Matters and/or opinions expressed therein do not necessarily refl ect 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 specifi cally disclaim any implied warranties or fi tness 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.

GP Liaison Department Tel: 020 7234 2009

Email: [email protected]

THREEFeatures

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4 London Bridge Hospital ServicesCutting Edge Diagnostic Expertise for GPs and Patients

London Bridge Hospital ‘has an app for that’

5 Critical CareSpecialist Care for Critically Ill Patients

6 Shoulder SurgeryRebuilding Separated Shoulders

7 Groin PainThe Complexity of Groin Pain

8 Knee ProblemsDigital Gait Analysis

10 Knee SurgeryBiological Knee Replacement

12 Kidney DiseaseKidney Referrals – Assessing Individual Patients

14 Irritable Bowel SyndromeThe Low FODMAP Diet

16 New TechniquesEndoscopic Microdiscectomy

18 10 Minutes with...Interview with Dr Balvinder Singh Wasan, Consultant Cardiologist

19 Educational ProgrammeProviding Education for GPs

20 New Consultant List

Intr

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A message from the CEO Feat

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Services on OfferFOUR

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Cri

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FIVECritical Care

To fi nd out more about the Critical Care Service at London Bridge Hospital, please contact the GP Liaison Department on

T: 020 7234 2009 or visit www.londonbridgehospital.com.

The London Bridge Hospital iPhone app is free to download, and is available from the App Store. If you would like to

fi nd out more information about the iPhone app, please contact the GP Liaison Department on T: 020 7234 2009

London Bridge Hospital

‘has an app for that’

Cutting Edge Diagnostic Expertise forGPs and Patients

and Docklands Healthcare whichwill provide the following benefi ts:

• Cardiac scanning

• More complexscanning techniques

• Shorter examinationtimes – improving thepatient MRI experience

At London Bridge Hospital, wetake pride in providing the cuttingedge treatment and diagnostic equipment required to assess our patients. We have upgraded the X-ray processing equipment at City of London Medical Centre, enablingfaster turnaround of patient results;we have recently also completedan upgrade on the MRI scannersat City of London Medical Centre

London Bridge Hospital Outpatient Services provide outstanding carefor patients at the following centres; 31 Old Broad Street, Docklands Healthcare, City of London and Sevenoaks Medical Centres. These centres provide easily accessible and welcoming outpatient consultation and diagnostic services. All of our centres are utilised by leading Consultantsfrom London’s teaching hospitals.

With the increased use of technology and the growing demand to access information and internet services whilst on the go, London Bridge Hospital has devised an iPhone application specifi cally for GPs. The app provides an accessible platform for GPs to swiftly access information on our renowned Consultants, and provides a direct link to our GP Liaison Department.

According to OFCOM Technology Tracker, over 84% of smartphone owners go online via their phones each week. London Bridge Hospital has developed an app

to assist GPs who rely on their iPhone for accessing information and internet services when not based at their PC.

The London Bridge Hospital app is free to download for the iPhone, and holds a wealth of information about our Consultants and their specialties. It enables GPs to instantly search for Consultants who practise at London Bridge Hospital and the hospital’s outpatient diagnostic and treatment centres across the City.

The app can be used to search by specialist name and by specialty, where

Consultants matching the search term will appear, along with their full profi le including contact information.

GPs can also contact London Bridge Hospital’s GP Liaison Team directly through the app to refer patients and enquire and book appointments for consultations or treatment. There is also a page with detailed information about London Bridge Hospital and its services.

To fi nd out more about London Bridge Hospital and our outpatient centres, please visit

www.lbhoutpatients.co.uk or call the Imaging Department on T: 020 7234 2773

Critical Care UnitThe Critical Care Unit at London Bridge Hospital has expanded to a 15-bed unit, 10 of which are in single rooms. The state-of-the-art unit has been equipped with the latest technology to provide advanced and constant care to critically ill patients.

The unit has 10 isolation rooms, one of which is a sophisticated and dedicated respiratory isolation room and 12 of the unit’s total 15 beds provide Level 3 care. In addition, the unit provides continuous support, observation and care for patients following high risk or complicated surgical interventions and medical conditions, requiring either High Dependency or Intensive Care. The unit’s multidisciplinary team provides a number of additional services crucial to critical care, which include non-invasive and advanced medical ventilation, modern continuous haemo-dynamic monitoring systems and different modalities of renal replacement therapy.

The individual patient rooms enablethe hospital to offer an enhancedone-to-one treatment service, which can aid recovery time and provides privacy for the patients. The individual rooms also allow for increased infection control benefi ts for patients.

Each of the new rooms is fi tted with revolutionary electronically powered SmartGlass windows. At the fl ick of a switch, the clear glass becomes opaque,

providing privacy when needed. The SmartGlass also enables staff who are in a separate room to see their patients from room to room.

In addition, the unit has gone live with an electronic documentation system, IntelliVue Clinical Information Portfolio (ICIP). This is a cutting edge solution deployed by HCA International. This system collects data directly from the bedside devices, and displays them in an electronic user interface in comprehensive graphs and charts. It enables Intensive Care staff to document, disseminate and evaluate patient information quickly and easily, replacing most of the paper documentation in the Critical Care Unit.

The expansion of the Critical Care Unit designates London Bridge Hospital as the largest private critical care provider between its location in Southwark and the South East of England, including Kent, East Sussex and West Sussex.

Multidisciplinary TeamThe unit is staffed by a dynamic and motivated multidisciplinary team, with Consultant Intensivists who provide 24-hour cover, allowing comprehensive and uninterrupted Consultant care at all times.

The Consultant Intensivist is supported by a Critical Care Resident Medical Offi cer (CCRMO) qualifi ed to Anaesthetic Registrar Level-equivalent, who is on-site 24 hours a day. At all times there is a qualifi ed Critical Care Nurse on duty with Advanced Life Support Qualifi cations. The remainder of the team comprises pharmacists, physiotherapists, dietitians and nurses specialised in the management ofacute pain.

Critical Care SupportIn addition, the hospital provides a range of specialist support services for critical care patients, including cardiac surgery, liver transplants and neurosurgery. The patients in the Critical Care Unit also have 24-hour access to the hospital’s modern and effi cient Radiology Department, and when appropriate, referral to Consultants from all medical and surgical specialties across London Bridge Hospital.

ICNARCThe Critical Care Unit participates in the audit and research programme carried out by the Intensive Care National Audit Research Centre (ICNARC). ICNARC’s aim is to foster improvements in the organisation and practice of critical care in the UK.

Critical CareLondon Bridge Hospital

The Critical Care Unit at London Bridge Hospital provides the highest level of dedicated, continuous, specialised care to critically ill patients with a variety of medical or surgical conditions who require complex multi-organ support.

Shoulder SurgerySIX

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SEVENGroin Pain

The Complexity of Groin Pain

www.sportdoclondon.co.uk

Groin pain can be a difficult problem for patients and their clinicians. Part of the problem is that the location of the pain is often a poor indicator of where the pathology lies. Additionally, when the pain becomes chronic, multiple pathologies can be generated; adding a further layer of complexity. It is very important to make a clear diagnosis, and we should seek to look beyond merely labelling the problem as a ‘groin sprain’. There are many causes of pain in the groin, but approximately 50% of groin pain may be attributed to pain generated by the hip joint; a surprise, perhaps, for younger patients. As in any medical condition, the history will give us many clues. It is extremely important to rule out sinister ‘red flags’, such as night pain, severe pain on loading the leg, weight loss or systemic symptoms; and we need to be on the lookout for conditions which may occur in certain age groups, such as slipped epiphysis in teenagers.

Common causes of groin pain besides the hip include those generated by the lumbar spine, pubic overload (osteitis pubis), iliopsoas and adductor tendon pathologies and stress responses in the femoral neck in runners. Abdominal wall hernias/conjoint tendon and rectus abdominis sheath problems may cause pain which is a little higher in the groin, and less commonly, younger patients can avulse the rectus femoris from its proximal attachment at the anterior inferior iliac spine. Many of the cases we see of ‘pubic overload’ (osteitis pubis), and bony stress responses, occur because of inadequate lumbar pelvic control and poor gluteal conditioning. Sportsmen and sportswomen love to train for their sport, but may neglect to carry out the conditioning work necessary to prevent injury. A trained eye can spot the problem, and correcting these faults helps to prevent a recurrent pattern of breakdown. Finally, testicular tumours and avascular

necrosis can present insidiously and we need to be mindful of these conditions.

A large proportion of patients who suffer with groin pain as a result of hip pathology have an underlying condition known as ‘Femoral Acetabular Impingement Syndrome’ (FAI). This is essentially a problem resulting from a tear in the acetabular labrum, usually caused by repetitive trauma due to a ‘bump’ or ‘CAM’ on the head neck junction of the femur; which may be familial in terms of its inheritance. This can cause groin pain which is worse with exercise, sitting or standing, and the pain can be brought on by putting the patient in the ‘impingement position’ of hip flexion + internal rotation + adduction. In the long term, we believe that the tear in labrum causes changes in the acetabular articular cartilage next to it, and over many years, this may lead to osteoarthritis in the hip. FAI can affect people of all ages, and is often missed in 30-40-year-olds. Taking a careful history, and carrying out a thorough examination can help identify the likely cause. Imaging, such as MRI arthrography of the hip, can help confirm the underlying diagnosis (as X-ray cannot rule out FAI), but it should be remembered that imaging needs to be interpreted in light of the history and examination of findings. FAI may require treatment with hip arthroscopy surgery, but in some cases injection therapy and robust physiotherapy or osteopathy may be enough to get a person back to full activity. Sports physicians are ideally placed to identify the underlying cause of unexplained groin pain, and are skilled in directing the rehabilitation necessary to resolve the problems.

Acromioclavicular Joint (ACJ) injuries, or a separated shoulder, is an injury that can occur in contact athletes, whether they come into contact with another player as in rugby, or with the ground when coming off a bicycle at high speed.

Injuries are classified into 6 types; the less serious types 1,2 and 3 are treated in a sling, analgesia and physio. Type 3 may need surgery if it continues to be painful. The more displaced injuries, types 4, 5 and 6 require early surgical reconstruction.

RM is a 30-year-old male who is a very keen triathlete; he was on a training ride when he came off his bicycle trying to avoid a car. Landing on his shoulder, he suffered a type 5 ACJ injury. After consultation, we decided to proceed to surgical stabilisation to allow him early recovery and a rapid return to sport.

The Surgilig™ is inserted to reconstruct the coracoclavicular ligaments, that usually stabilise the end of the clavicle through a mini-open incision. It is made of double-braided polyester with a weave design that acts as a scaffold encouraging tissue in-growth. Surgilig™ is looped around the coracoid, and then passed behind the clavicle where it is secured with a 3.5mm bicortical screw and washer. The Surgilig™ implant has one hard loop for screw fixation, and one soft loop which surrounds the coracoid.

Following surgery, the patient uses a sling for the first couple of weeks to allow tissue healing, and rehabilitation is started at two weeks. Full training is started at 12 weeks and full contact sport at 5 months. RM regained a full range of movement by 6 weeks and was undertaking cycle and swim training at 12 weeks.

We have recently published the largest series of ACJ reconstructions using the Surgilig™, with a 94% patient satisfaction rate and early successful return to sport.

Carlos, AJ, Richards, AM and Corbett, SA (2011), Stabilization of acromioclavicular joint dislocation using the ‘Surgilig™’ technique. Shoulder & Elbow, 3: 166–170.

Mr Andrew Richards and Mr Steve Corbett are specialist shoulder and elbow surgeons who have a particular interest in sports injuries. They provide a team approach to the management of their patients as part of the Fortius Clinic at London Bridge Hospital.

Rebuilding SeparatedShoulders

www.fortiusclinic.com

Reconstruction of the acromioclavicular joint using the Surgilig™

Mr Andrew Richards

Consultant Orthopaedic Surgeon

BSc (Hons) MS FRCS (Tr&Orth)

Guy’s and St Thomas’ NHS Foundation Trust

Secretary: Hollie Jones

T: 020 3195 2431F: 020 3070 0106

[email protected]

www.fortiusclinic.com

Mr Steven Corbett

Consultant Orthopaedic & Trauma Surgeon

BSc PhD FRCS FRCS (Tr&Orth)

Guy’s and St Thomas’ NHS Foundation Trust

Secretary: Sally Hargreaves

T: 020 7234 2689 F: 08717 335 056

[email protected]

Dr Spencer-Smith qualified in 1995 from St Bartholomew’s Hospital, and trained in Sports Medicine at Bath University. She has worked with an extensive range of different sports, treating patients ranging from Olympians and Paralympians to the occasional exerciser. She was a Sports Physician at the 2002 Commonwealth Games, and has worked with GB rowing, track and field sports, marathon, endurance and outdoor adventure sports. She developed an MSc Programme at Bangor University, and is a keen lecturer.

Dr Spencer-Smith specialises in the diagnosis and treatment of all musculoskeletal conditions, whether acquired through sport or otherwise. She has expertise in groin, hip, knee and ankle conditions, overuse injuries, and injuries affecting the shoulder and spine. She has a particular interest in helping people recover after surgery, or those who have failed to recover despite previous treatment.

Dr Spencer-Smith is ideally placed to assess and direct treatment. Many injuries can be successfully managed through physical rehabilitation and ultrasound guided injections, but can also swiftly coordinate surgical referral and post-operative care.

Dr Catherine Spencer-SmithPhysician in Sports

& Exercise Medicine MBBS DRCOG MRCGP MSc Sport & Exercise Medicine MFSEM(UK)

Private only

Secretaries: Christine Milton and Sue WintersT: 020 7483 5372F: 020 7900 2032

[email protected]

Kne

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NINEKnee Problems

Currently, patients with osteoarthritis of the knee are assessed on the basis of history and examination, X-rays and possibly MRI scans. In most cases, any assessment of dynamic knee function is by simple observation of the patient walking into the consulting room, or at most walking down the corridor. It would be quite unusual, if not unheard of in current orthopaedic practice, for a gait analysis to be obtained.

This situation is accepted as the norm both within the NHS and private practice. However, with the advent of digital gait analysis systems, there is a case for change. Low cost routine gait analysis can now be undertaken as part of routine clinical examinations.

How can this help?

Firstly, the dynamic or functional assessment provided by gait analysis gives a very valuable insight into the severity of the condition. A full range of movement when examined on the couch can be deceiving. The range of knee movement during normal walking is far more informative, as I will demonstrate in the case report opposite.

Secondly, digital gait analysis provides an objective and permanent record, enabling careful comparisons to be made before and after interventions. The accuracy of measurement is far superior to the human eye, the results are readily understandable and this can form a useful basis for discussion with the patient.

Summary

Major advances in digital gait analysis techniques now enable an objective functional assessment to be carried out before and after treatment. This technique is equally of value in assessing the results of injection therapies, physical therapy and surgery. I have no doubt it will prove extremely useful in assessing treatment response in patients with osteoarthritis. In the elderly, improvements in gait either by physiotherapy or other forms of treatment can reduce the incidence of falls. This provides an objective way of assessing improvement, or indeed deterioration.

The same technique is just as valuable in the treatment of athletes. More information is available on our website.

Digital Gait Analysis In the diagnosis of early osteoarthritis of the knee

Mr Glyn Evans is a Knee Surgeon based in Central London who treats young adults with sports-related knee injuries and older patients with early wear and tear, or established arthritis of the knee. He qualified in Cardiff in 1975 and then trained in Liverpool and Edinburgh. He was appointed to the Academic Orthopaedic Unit, Southampton, as a lecturer in 1984 with a major interest in external fixation of tibial fractures. He became an NHS Consultant in 1990 and worked at St Mary’s Hospital, Isle of Wight, Treloar Hospital, Alton and, more recently, Royal Hospital Haslar, Gosport.

Mr Evans has been performing knee arthroscopies and knee replacements since 1985. During his first decade as a Consultant, he did several thousand joint replacements, including hips and knees and developed an early interest in partial knee replacements using the ‘Oxford Knee’. In 2004, he decided to concentrate solely on the investigation and treatment of knee disorders and was appointed to the London Knee Clinic at London Bridge Hospital. Since then, he has performed between 250 and 300 knee operations per year including Anterior Cruciate Ligament (ACL) reconstructions, partial/total knee replacements and correction of bone deformities (osteotomies).

Mr Glyn Evans Consultant Orthopaedic

& Knee Surgeon MB BCh FRCS (Edin)

Private only

Secretary: Carole Segger

T: 020 7407 3069F: 020 7407 3138

[email protected]

www.londongaitanalysis.com

EIGHT

Knee Motion Analysis is available on request at London Gait Analysis based in St Olaf House, London Bridge Hospital. For appointments and further details please call

T: 020 7089 9038 or see www.londongaitanalysis.com.

CaSe Study

An elderly man had previously had a total right knee replacement, and was beginning to have pain and functional impairment in his previously normal left knee. X-rays of the left knee demonstrated early medial compartment osteoarthritis.

Clinical examination revealed a mild limp and a minor reduction in passive knee flexion to 135 degrees; about the same as the right knee that had previously undergone knee replacement.

Gait analysis was carried out, and the figures opposite show the movements of the left knee in blue and the right knee in green. The motion of both knees has been superimposed for comparison. The first gait analysis (Figure 1) revealed quite a reasonable gait pattern in the right knee that had previously been replaced, but a significant deficit in the left knee. You can see that peak left knee flexion in the swing phase is only 48° compared with 54° in the right knee. There is also early heel strike on the left side, and peak knee flexion of the left knee in the stance phase is only 12°; no more than in the right side that has undergone a total knee replacement. Normally you would expect around 20°.

After consideration of the available data, a single injection of 6ml of a hyaluronan, a synovial fluid supplement was given. This was the only form of treatment provided.

A month later the patient was reviewed. At this stage, he had complete relief of pain and gait analysis was repeated. Not surprisingly, right knee function remains almost the same. However, left knee flexion in the swing phase had been restored to normal at almost 60° and more importantly, there had been a substantial improvement in the stance phase. The left knee achieved an entirely normal 20° of flexion during weight bearing. This is important, as this flexion during the stance phase of gait is what provides the ‘spring’ in our step. It’s what drives us forwards. The normal timing of the gait cycle had also been restored with heel strike occurring about midway through the gait cycle on both sides.

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Figure 1Gait analysis before treatment

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Figure 2Gait analysis after treatment

Knee Problems

Knee SurgeryTEN

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ELEVENKnee Surgery

As technology continues to advance, the armamentarium of procedures available for dealing effectively with damage inside in the knee joint continues to expand and improve. The number of people participating in regular exercise and sport is increasing, and people are living longer and staying more active into their later years, with higher expectations. Therefore, the number of people presenting to knee surgeons with significant joint damage to their knees is increasing. It has been estimated that the number of people needing knee replacements is set to increase by over 600% by the year 2030.

Knee replacement surgery is highly effective, with patient satisfaction rates in the region of about 90%, and with 95% of artificial knees working effectively after 10 years, and 80 to 85% still being fine after 20 years. However, the younger a person is when a knee replacement is put in, the more impact and the more movement cycles the prosthesis will be subjected to; hence, a faster rate of wear and tear. Furthermore, the younger a patient is, the longer they will live and therefore the longer they will need their new knee to last. This is a ‘double whammy’: if someone has a knee replacement when they are in their

50s then there is about a 50% chance of the joint failing within their lifetime, compared to a risk of only about 5% for patients having joint replacements in their 70s. This explains why knee surgeons are reluctant to put knee replacements in younger patients unless it is an absolute last resort.

The meniscal cartilages are elastic shock absorbers sitting in the middle of the knee between the surfaces of the bones of the femur and tibia. Meniscal tears are very common, and although about 25% of tears can actually be repaired if caught quickly enough, 75% cannot, and these tend to end up needing to be trimmed. Removal of torn meniscal tissue via a knee arthroscopy has an excellent short-term success rate. However, in the longer term, the more meniscal tissue is damaged and lost, the less of a shock absorber is left in the knee, and the more wear and tear the joint will develop. The articular cartilage in the knee is the smooth, glistening, white layer of tissue that covers the surfaces of the ends of the bones, making the surfaces very low friction. Without a functional meniscal cartilage shock absorber, these articular cartilage surfaces are subjected to increased pressures and increased wear and tear, and it is the erosion of this articular cartilage to eventually expose bare bone in the joint

that is the cause of the arthritis that can develop in the knee joint.

Up until recently, there were very few options available for younger patients who had developed early osteoarthritis in the knee, secondary to previous cartilage injuries and cartilage loss. However, we are now able to replace missing meniscal cartilages using artificial bioabsorbable scaffolds (for partially missing menisci), or an entire meniscal cartilage can be replaced by meniscal allograft transplantation. This surgery is complex, and is only being carried out on a regular basis by a very small number of knee surgeons in the UK. Although it is a difficult surgery, it carries a success rate of about 85% at five-year follow-up for decreasing patients’ pain, increasing their function and keeping them going (and delaying the need for further surgeries).

Missing patches of articular cartilage can now also be replaced using a variety of different techniques. One of the newest of these is the use of chondrotissue® articular cartilage grafts to resurface exposed areas of bare bone in the knee, getting new cartilage to re-grow into the scaffolds, which are then absorbed.

Biological Knee ReplacementThe next step in soft tissue reconstructive surgery of the knee

Ian McDermott is a Consultant Orthopaedic Surgeon in the London Sports Orthopaedics Group, based at 31 Old Broad Street, and operating at London Bridge Hospital. He specialises in Knee and Hip Surgery including Arthroscopic Surgery, Sports Injuries and Joint Replacements.

Mr McDermott is an Honorary Professor Associate at the Brunel University School of Sport & Education. In 2004, Mr McDermott was the youngest ever surgeon to be elected as a Council Member and Trustee of the Royal College of Surgeons, and he is also a Fellow of the Faculty of Sports & Exercise Medicine.

In 2003, Mr McDermott was awarded the President’s Medal of the British Association for Surgery of the Knee (BASK) for his research into meniscal repair. In 2004, he was awarded a Master of Surgery higher degree for his work on Meniscal Transplantation. He is also the Honorary Secretary of the UK Meniscal Study Group.

Mr Ian McDermott Consultant

Orthopaedic Surgeon MB BS MS FRCS (Orth) FFSEM (UK)

London SportsOrthopaedics

Secretary: Chloe Lilley

T: 08445 617 157F: 020 7496 3596

[email protected]

PATIENT’S NORMAL MEDICAL COMPARTMENT

Normal Medical

Meniscus Normal Cartilage on Tibia

Normal Cartilage on Femur

PATIENT’S DAMAGED LATERAL COMPARTMENT(PRE-RECONSTRUCTION)

Bare Bone on

Tibia

Missing Lateral Meniscal Cartilage

Bare Bone on

Femur

‘BIOLOGICAL KNEE REPLACEMENT’ RECONSTRUCTION OF LATERAL

COMPARTMENT

Chondral Graft on

Tibia

Lateral Meniscal Allgraft Transplant

Chondral Graft on

Femur

The very newest concept in soft tissue reconstructive surgery of the knee is to combine these techniques for meniscal cartilage replacement and articular cartilage replacement, with the so-called ‘Biological Knee Replacement’, for knees where one would otherwise previously have had to resort to artificial knee replacement surgery. This kind of surgery is aimed at younger patients with severe joint damage who have severe symptoms, but who are deemed too young for a knee replacement. The concept was first popularised by Dr Kevin Stone, a leading knee surgeon in San Francisco. However, in the UK

we are fortunate in that many of the newer surgical technologies (such as Autologous Chondrocyte Implantation or chondrotissue® grafting) do not yet have FDA approval and therefore cannot yet be used in the US, but they do have approval for use in the EU which puts UK surgeons at an advantage over our US counterparts.

Mr McDermott is a leading pioneer in the field of meniscal transplantation and articular cartilage replacement surgery, being the first surgeon in the UK to combine these to perform a ‘Biological Knee Replacement’.

www.sportsortho.co.ukCaSe StudyA 30-year-old female presented with increasingly severe pain and swelling in her knee, restricting her activities. She had previously torn a meniscal cartilage when she was a teenager, with the torn cartilage having been surgically removed. Investigations confirmed complete loss of her lateral meniscus, with widespread erosion of the articular cartilage on the lateral femoral condyle and the lateral tibial plateau, with large areas of bare bone exposed. The patient’s knee alignment was normal and the joint was stable.

After detailed imaging plus an arthroscopic evaluation of the joint, the decision was made to proceed with a ‘Biological Knee Replacement’. The missing lateral meniscus was replaced with a donor meniscus, by meniscal allograft transplantation. At the same time, the areas of bare bone in the knee were resurfaced with chondrotissue® articular grafts. The patient was in hospital for just one night post-operatively, and her knee was protected in a brace and with crutches for the first six weeks, followed by a six-week course of physio rehab. The patient then spent

the next six months performing carefully controlled exercises in the gym.

The patient was reviewed nine months post-op, and an MRI scan confirmed that the lateral compartment of the knee looked almost as good as new, with a new lateral meniscus and with a good layer of new articular cartilage covering the end of the femur and the top of the tibia. The patient was able to walk normally, with no pain and no swelling; she was going to the gym regularly, and was advised that she was well enough to return to full normal activities. To date, one year post-op, the patient is still 100% happy, symptom-free and active.

SummaryThe field of soft-tissue reconstructive surgery in the knee is continuing to develop, with novel and exciting technologies becoming available on an ongoing basis. The surgical options available continue to expand, although careful appropriate patient selection is vital; as is choosing an appropriate surgeon with the experience and expertise necessary to deliver these complex techniques.

Kidney DiseaseTWELVE

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THIRTEENKidney Disease

Which patients with kidney disease need to be referred ?

The use of eGFR reporting, rather than just serum, creatinine has been widely adopted as a measure of kidney function. Chronic Kidney Disease (CKD) is divided into stages with CKD1-2 having an eGFR > 60ml/min but proteinuria, haematuria or other structural evidence of kidney disease, CKD3 having an eGFR < 60ml/min and CKD4 an eGFR < 30 ml/min. This has led to significant numbers of people becoming aware that they may have CKD and it is important to reassure, monitor or refer them as appropriate. Many are older people, and it is estimated that 40% of the UK population over 75 has CKD3-5. Clearly, nephrologists do not need to see everyone with CKD, and most can be monitored in primary care, with attention to cardiovascular risk, which is increased in CKD.

A key question, therefore, is who needs to be referred? NICE guidelines have been developed, and are designed to help identify those at high risk of progression, and those likely to develop end-stage kidney disease. This includes most patients with an eGFR < 30 ml/min and those with a progressive fall in GFR. It is important to appreciate that CKD can only be diagnosed when previous results are available. A patient who is found to have abnormal renal function, should be suspected of having acute kidney disease until proven otherwise.

prevent permanent kidney damage and a need for long-term dialysis. This is usually initiated following a renal biopsy which can be performed at London Bridge Hospital. Careful monitoring is required in order to achieve the right balance between damping down the immune system enough to treat the disease, but not enough to cause infections. Dr Robson has established a specialist clinic in the Renal Unit at Guy’s & St Thomas Hospital for patients with lupus nephritis, vasculitis and other forms of glomerulonephritis. He has developed protocols for first-line therapies, and achieves excellent results with low infection rates. He also gives newer treatments to patients that have failed to respond to more standard therapies.

It is vital to identify those patients with an active disease such as glomerulonephritis. With the widespread recognition of CKD, there is a real danger that people with an acute and treatable kidney disease will be labelled as having CKD. Some features suggesting the possibility of glomerulonephritis, and indicating a need for referral, are listed below:

• Isolated proteinuria (urine protein creatinine ratio >100 mg/mmol)

• Proteinuria and microscopic haematuria (urine protein creatinine ratio >50 mg/mmol)

• Features to suggest an underlying systemic illness, e.g. joint pains, weight loss, fevers, haemoptysis, rashes

Glomerulonephritis is a group of diseases in which the immune system attacks the kidneys. Types of glomerulonephritis where Dr Robson has particular interest are Systemic Lupus Erythematosus (SLE), Anti-Neutrophil Cytoplasmic Antibody (ANCA) vasculitis. These are both systemic diseases in which kidney involvement may be the major feature causing morbidity. In the early stages GFR can be normal, despite the presence of significant inflammation and ongoing irreversible damage; with proteinuria and haematuria being the only signs of kidney disease. Both of these conditions need urgent treatment with drugs that suppress the immune system in order to

Kidney Referrals – Assessing Individual Patients

Dr Michael Robson began his medical studies at Oxford University, where he obtained a First Class undergraduate degree, before moving to London for clinical studies. He trained in nephrology at King’s College and Guy’s Hospitals. Following the award of an MRC clinical training fellowship and research into glomerulonephritis, he gained a PhD from Imperial College in 2000. He has been a Consultant Nephrologist at Guy’s and St Thomas’ since 2002. His clinical practice covers all aspects of renal medicine including nephrology, dialysis and transplantation. He has a particular expertise in lupus, vasculitis and glomerulonephritis, but is happy to see and treat patients with any form of kidney disease. In addition to clinical activities, Dr Robson runs a laboratory-based research programme in glomerulonephritis. He was awarded a Wellcome Trust Intermediate Fellowship in 2002, and his research has continued with competitively awarded funding from a number of sources. He has published many original research papers, and is seeking to understand disease mechanisms and identify new possibilities for therapy.

Dr Michael RobsonConsultant Nephrologist

BA (Oxon) MBBS PhD MRCP

Guy’s and St Thomas’ NHS Foundation Trust

Secretary: Kate Gill

T: 07925 856 001F: 08721 117 747

[email protected]

www.robsonrenal.co.uk

Histology from renal biopsy specimens. The left panel shows a glomerulus from a patient with ANCA vasculitis. Most of the glomerulus has been replaced by a cellular ‘crescent’. The right panel shows a glomerulus from a patient with lupus nephritis with inflammation on the left-hand side of the glomerulus, whereas the right-hand side of the glomerulus is unaffected.

Wheat, garlic, onions and prebiotics

FRUCTANS

Products made of animal milk – cows, sheep and goat

LACTOSE

Some fruits, honey and jamsFRUCTOSE

Some fruit and sugar-free products

POLYOLS

Baked beans and chickpeas

GALACTO-OLIGOSACCHARIDES (GOS)

ROME III CRITERIA* (LONGStRetH et aL 2006)

Recurrent abdominal pain or discomfort** at least 3 days per monthin the last 3 months associated with 2 or more of the following:

1. Improvement with defecation

2. Onset associated with a change in frequency of stool

3. Onset associated with a change in form (appearance) of stool

* Criteria fulfi lled for the last 3 months with symptom onset at least 6 months prior to diagnosis. ** Discomfort means an uncomfortable sensation not described as pain. In pathophysiology research and clinical trials, a pain/discomfort frequency of at least 2 days a week during screening evaluation for subject eligibility.

Irritable Bowel SyndromeFOURTEEN

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FIFTEENIrritable Bowel Syndrome

A relatively new diet therapy known as the low FODMAP diet, fi rst developed in Australia, is now fast becoming a renowned therapy in the management of IBS in the UK. The ‘low FODMAP’ diet is an acronym for a diet low in fermentable oligosaccharides, disaccharides, monosaccharides and polyols; which are more commonly known as fructans, polyols, galacto-oligosaccharides, fructose and lactose. The diet therapy is segmented into two parts; a) the low FODMAP diet, involving restriction of fermentable carbohydrates and b) a reintroduction phase, used to help identify foods contributing to an individual’s symptoms.

The low FODMAP diet involves the avoidance of fermentable carbohydrates for a period of eight weeks. Though symptom relief can be experienced earlier, individuals need to allow up to eight weeks for the diet to take effect. During the eight weeks a trained dietitian supports patients, encouraging optimal compliancy and a healthy balanced diet. (Refer to Figure 2 on the right).

On completion of the eighth week, a review appointment is carried out to reassess patients’ symptom profi les and dietary intake. On achieving satisfactory relief from bowel symptoms, patients are taught the reintroduction phase of the diet therapy. This process enables patients to trial restricted fermentable carbohydrates and identify foods that are contributing to the onset of their IBS symptoms. The reintroduction method also enables patients to gauge the quantity in which these foods, otherwise known as ‘triggers’ can be consumed without provoking symptoms. This process prevents long-term unnecessary restriction of foods and encourages a varied, balanced diet without the aggravation of bowel symptoms.

Studies to date have found the low FODMAP diet to be ‘more effective than standard dietary advice for symptom control in IBS’ (Staudacher et al 2011) and has been encompassed within the British Dietetic Association’s (BDA) guidelines for the management of IBS in adults (BDA, 2010). The use of the low FODMAP diet is now part of the recommended second line diet therapy, which follows the initial NICE guidance, which focuses on the

adjustment of fi bre, fat, fl uid, caffeine and alcohol intakes.

A recent study comparing the effectiveness of the low FODMAP diet against the standard therapy, found that 76% of patients following the low FODMAP diet reported satisfactory relief from their symptoms, compared to 54% of patients who had been following the standard therapy. Similarly, signifi cantly more patients found relief from bloating, abdominal pain and fl atulence when following the low FODMAP diet, compared to those following standard therapy advice alone.

At London Bridge Hospital (LBH), our trained specialist dietitians have been teaching the low FODMAP diet since March 2010, and have recorded promising results.

On analyses of our fi rst 50 patients to complete the diet therapy, 76% of IBS patients reported satisfactory relief from their symptoms on following the low FODMAP diet. In comparison, only 24% of these patients answered ‘no’ to the question ‘do you currently have satisfactory relief of your gut symptoms?’ when asked on patients’ review appointments. Possible reasons for this statistic include patients’ low compliancy with the dietary restrictions, or the infl uence of other contributing factors to the patients’ IBS symptoms, such as stress or anxiety.

The results analysed to date at LBH indicate that IBS patients are achieving a reduction in their symptoms on following the low FODMAP diet, and the Dietetic Department continues to teach new referrals this seemingly successful diet therapy in the management of IBS.

The Dietetic Department at LBH are continuing to follow the development of this diet therapy and equip members of their team with the appropriate training.

The aetiology of IBS is not yet fully understood; however, diet, lifestyle and psychological factors are currently deemed to have a contributing role towards symptoms. Interestingly, up to two thirds of IBS patients believe that their diet infl uences their symptoms of IBS.

An IBS diagnosis results from the exclusion of other potential conditions or diseases such as Coeliac Disease and Infl ammatory Bowel Disease (IBD). Figure 1 demonstrates the ROME III criteria, which is often used to explain to patients how their set of symptoms fi ts in with an IBS diagnosis. This is after ‘red fl ags’ (see NICE 2008 Irritable Bowel Syndrome

in adults: Diagnosis and management of Irritable Bowel Syndrome in primary care) are investigated and other more serious types of diagnosis have been ruled out. (Refer to Figure 1 below).

The symptom profi le of IBS patients can be very diverse; though patients are often classifi ed with their primary symptom e.g. diarrhoea predominant, constipation predominant or alternating (episodes of fl uctuating constipation and diarrhoea). Associated or supportive symptoms of IBS should also be recognised and would typically include some of the symptoms opposite.

Other symptoms also reported by IBS patients include excessive fl atulence, nausea, backache, lethargy and bladder symptoms.

Treatment of IBS can include a variation of the administration of medication (i.e. antispasmodics, anti-diarrhoeals, laxatives or anti-depressants), lifestyle changes and diet therapy.

New diet therapy for IBS

Irritable Bowel Syndrome (IBS) is a functional bowel disorder; meaning there is an impaired gastrointestinal function with no identifi ed structural disturbances to the gut or biochemical pathology. IBS has an estimated prevalence of 10-20%, and forms around 40-60% of gastroenterologists’ referrals.

Dietetic outpatient clinics are held on a daily basis at the London Bridge Hospital and appointments are accessible via a referral from GPs and Consultants. For further information, please contact Louise Gankerseer (Specialist Dietitian)

T: 020 7234 2282 or email [email protected].

Figure 1

Figure 2

aSSOCIatedOR SuPPORtIVe

SyMPtOMS OF IBS

Group of Fermentable Carbohydrates (FOdMaPs)

Examples of foods & drinksrich in FOdMaPs

• Less than 3 bowel movementsper week

• More than 3 bowel movements in a day

• Hard or lumpy stools(BSC type 1-2)

• Loose or watery stools(BSC type 7)

• Straining during a bowel movement

• urgency to open bowels

• Incomplete evacuation

• Presence of mucus with stool

• abdominal distension/bloating

Figure 4Compares evaluation of abdominal discomfort on initial appointment and that after the low FODMAP diet

Evaluation of abdominal discomfort on initial appointment

Evaluation of abdominal discomfort after the low FODMAP diet

Figure 3Compares evaluation of bloating symptom on initial appointment and that after the low FODMAP diet

Evaluation of bloating symptom on initial appointment

Evaluation of bloating symptom after the low FODMAP diet

The Low FODMAP Diet

Key None Mild Moderate Severe

6%

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40%

42%

2%

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48%

12%

6%

2%

44%

48%

12% 10%

36%42%

New TechniquesSIXTEEN

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Endoscopic Microdiscectomy

London Neurosurgery Partnership

On behalf of the London Neurosurgery Partnership, Mr Irfan Malik is very proud to bring the technique of Endoscopic Microdiscectomy to London Bridge Hospital. He is the fi rst surgeon in England to offer and perform this technique. This development is part of the ongoing commitment of the London Neurosurgery Partnership to introduce the latest techniques to improve patient care, while ensuring that before its introduction each technique has been vetted for its effi ciency and safety.

Endoscopic MicrodiscectomyEndoscopic Microdiscectomy is a new technique that completely avoids the need for open surgery in suitable cases. The procedure has several advantages in those patients that are suitable for the intervention.

Firstly, as opposed to a several centimetre incision (5cm to 10cm on average) in even the smallest conventional microdiscectomy, the endoscope allows the whole operation to be performed through an incision no bigger than a needle puncture.

Secondly, because the endoscope is far more gentle and precise as a technique, there is much less tissue damage and scarring. This means that the incidence of subsequent pain (both muscle and wound) is much less; indeed most patients are able to go home the same day.

Thirdly, again because of the precisionand gentleness of the system, it isvirtually bloodless.

As the whole procedure is literally performed through a needle punctureit is usually done without the need for general anaesthesia, using sedation and local anaesthetic alone; which avoids the risks inherent in general anaesthesia.

The ProcedureThe patient is positioned either on their side or lying on their front and because of the sedation used and the tiny needle incision required, feels no pain duringthe whole procedure.

The surgeon guides the endoscope tothe surgical area where the offending disc is to be found under X-ray guidance. At this point, while viewing the whole procedure via a high defi nition screen, the surgeon is able to remove the protruding disc under constant observation.

The Evidence

The endoscopic surgery technique and equipment used by Mr Malik on behalf of the London Neurosurgery Partnershiphas been developed and validated in Germany over the last fi ve years and early studies confi rm a success rate of over93%; which comparesvery well to themore conventionalopen techniques. 1 & 2

Mr Malik is the fi rstsurgeon to performthe technique inEngland, havingundergone extensive

training in Germany and subsequent supervision here in London with the same German team, before practising the technique independently. He has had the technique vetted and approved by the governance committees of both King’s College London NHS Trust and London Bridge Hospital, and following many successful cases undertaken within the NHS, he is now offering the technique at London Bridge Hospital.

1 Alfen FM et: Developments in the Area of Endoscopic Spine Surgery. European Musculoskeletal Review, 2006.

2 Iprenburg M: Percutaneous Transforminal Endoscopic Discectomy (PTED). 19th Annual Meeting of the International Intradiscal Therapy Society, 2006.

The London Neurosurgery Partnership

The London Neurosurgery Partnership is a unique concept in the provision of neurosurgical care. Comprised of a team of eight Consultant Neurosurgeons all of whom are recognised super-specialists in their area of expertise, the aim is to ensure that every patient seen by the group is matched with the Consultant Neurosurgeon with the best training and expertise to deliver the individualised and state-of-the-art care each patient deserves.

Working as a team also ensures that patients can access high quality neurosurgical care at all times, from a Consultant who will be familiar with their treatment plan, at a location convenient to the patient. When appropriate, advice and treatment is delivered by a team of Consultants.

The London Neurosurgery Partnership has access to all of the latest neurosurgical technologies including the CyberKnife© and Gamma Knife© for radiosurgery; which allow conventional open surgery to be omitted completely in some cases, and minimally invasive techniques for both Cranial and Spinal Neurosurgery when this is not possible. A key aspect of making use of such cutting edge technologies is the decision making process involved. This is best achieved by a group of clinicians who are used to working together as a team, to ensure that the latest technology and techniques are used appropriately, based on the latest clinical guidelines.

Dorsal view

Lateral view

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After completing his neurosurgical training in Pakistan, Mr Irfan Malik underwent advanced neurosurgical training at The Royal Hallamshire Hospital and the University Hospital, Coventry & Warwickshire between 2001 and 2006. Following this, he obtained his FRCS (SN) and then enhanced his experience by completing fellowships in Complex Spine and Epilepsy surgery from the University Hospital, Coventry and King’s College Hospital, London.

His specialist interests include the assessment and treatment (both surgical and non-surgical) of all spinal conditions including degenerative, traumatic and malignant spinal disorders. He is an expert in the use of minimally invasive techniques for spinal surgery and disc replacement surgery for the treatment of neck and back pain, arm pain and sciatica.

He is the fi rst surgeon in England to offer and perform Endoscopic Microdiscectomy.

In addition to this, together with his London Neurosurgery Partnership and King’s colleague, Mr Richard Selway, he provides a comprehensive service for the treatment of epilepsy.

Mr Irfan Malik Consultant in Minimally Invasive Spinal Surgery

(Keyhole)MBBS FRCS FCPS FRCS (SN) MSc

Secretary: Rebecca Cottrell

T: 020 7034 8978F: 020 7034 8720

[email protected]

SEVENTEENNew Techniques

10 Minutes with...EIGHTEEN

10 M

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1. Why did you decide to study medicine?

I always preferred the sciences when I was at school. My brother was at medical school when I was in my teens and I was fascinated by his stories when he came home. I don’t think I ever seriously considered any other career.

2. What made you pursue your specialty?

I did three cardiology attachments in the first 18 months after I qualified and thoroughly enjoyed every minute of every job. I was very fortunate to work for, and with, some very inspirational people and that shaped my future.

3. What is the most rewarding part of your job?

The knowledge that the vast majority of what we do makes a difference. Frequently, that is not often appreciated immediately by patients – for example diagnosing and successfully treating hypertension, or encouraging smokers to stop. As an interventional cardiologist, I perform procedures on acutely ill patients, such as those having heart attacks. Rescuing a life-threatening situation is probably the most rewarding aspect of my job

4. What do you enjoy doing in your spare time?

I was fortunate to have the opportunity to compete in a variety of sports in Hong Kong and my passion for sport has never left me. I love taking my son and daughter to football and cricket matches and I follow most sports with enthusiasm. I am usually lucky enough to be able to spend time with my wife and our kids at the weekend when we go cycling or play tennis together, or see what’s on at the cinema.

5. What is the title of your ‘best read’ so far?

A book called ‘Bounce’ by the Olympian and Times journalist, Matthew Syed.

It explores (and supports) the theory that expertise in any field can be achieved by practice, at the same time largely dispelling the concept of ‘natural ability’. It predominantly looks at sports but also provides examples from a wide range of fields such as medicine, firefighting and chess.

6. If you could invite three people to dinner, living or dead, who would they be?

My son suggested Luis Suarez and Patrice Evra, but could not think of a third person! I’m not sure I would enjoy the atmosphere so I would invite Charles Darwin, John McEnroe and Michael Jackson. Ideally, it would be Darwin after he wrote ‘On the Origin of Species’, McEnroe after he won Wimbledon for the first time and Jackson after ‘Thriller’ was released.

7. What is special about where you grew up?

I grew up in Hong Kong, which was (and still is) the most fantastic place. There is always something going on. It’s a cliche, but the city really never sleeps. Growing up there was great as it was a diverse melting pot of nationalities and cultures. I attended a truly international school with students from all continents. You are never more than a walk or short bus or tram ride away from most things.

8. Where is your favourite place in the world?

No prizes for guessing – Hong Kong! I lived there for 18 years before I came to medical school in the UK and it is home to me.

9. Who would you get to play yourself in a movie?

I guess it would depend if George Clooney or Brad Pitt could carry off wearing a turban! Seriously, Art Malik plays a very convincing Sikh in the current version of Upstairs Downstairs and I would be happy and honoured if he was given the role.

Dr Balvinder Singh Wasan qualified in Medicine from Imperial College (St Mary’s) in 1994, attaining Membership of the Royal College of Physicians (London) in 1997.

He trained in Cardiology in the North West Thames region, achieving his completion of specialist training in 2004. He was appointed as a Consultant Cardiologist to Queen Elizabeth & St Thomas’ Hospitals the same year. He was awarded the Fellowship of the RCP in 2008. His specialist interests are all aspects of coronary artery disease, from screening to prevention to intervention.

Dr Balvinder Singh Wasan

Consultant Cardiologist BSc MBBS FRCP

Queen Elizabeth and St Thomas’ Hospitals

Secretary: Rosemary Gray

T: 020 7234 2255F: 020 7234 2998

[email protected]

Consultant Interview

10 with...Dr Balvinder Singh WasanConsultant CardiologistM

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Why should you attend?

• Gain certificates and earn CPD points

• Ask the experts your questions

• All events are FREE of charge

• Get take-home tips

• Sharpen understanding

• Meet Consultants from London’s top teaching hospitals

NHS eVeNtS

We’re now online!

Now, you can view information about previous and upcoming events online at www.gpseminar.co.uk. As well

GP Liaison at London Bridge Hospital –

Providing Education for GPsLondon Bridge Hospital is continuously striving to meet GPs’ needs. Each year, we run a comprehensive Educational Events Programme covering both clinical and non-clinical topics. These sessions are aimed at GPs and cover topics/conditions which you see every day in your surgeries.

date tOPIC audIeNCe VeNue SuBtOPICS

Tuesday Dermatology Update Private GPs London Bridge • Skin Infections 15th May • Management of Dry Skin Conditions

Saturday Sports Medicine NHS & Glaziers Hall • Management of Tendon Injury in Sport 26th May & Orthopaedics Private GPs • Evidence-based Spinal Surgery Update • Foot Deformities

Saturday Diabetes & NHS & Glaziers Hall • Glucose Levels and Diabetes Drugs 16th June Cardiology Update Private GPs • Prevention of Cardiovascular Disease • Atrial Fibrillation

Saturday Oncology Update NHS & Glaziers Hall • Tumours of the Liver and Pancreas 30th June Private GPs • Lymphoproliferative Disorders • Treatment for Breast Cancer • End of Life Care

Wednesday Women’s Health Private GPs London Bridge • The Role of HPV in Genital Disease 18th July Update Hospital • HRT – Risks and Benefits

Saturday Effective NHS NHS GPs Glaziers Hall • Practical Advice to GPs on How to 15th Sept Commissioning Achieve Success Within Your CCG

Tuesday Neurology & Private GPs London Bridge • Visual Symptoms: An Ophthalmological 18th Sept Ophthalmology Update Hospital and Neurological Perspective

Saturday Dermatology NHS GPs Glaziers Hall • Causes and Treatment of a Red Face 6th Oct Update • Assessment of Pigmented Lesions • Acute Dermatology Presentations

Saturday ENT & Respiratory NHS GPs Glaziers Hall • Snoring and Sleep Apnoea 10th Nov Update • Managing Dizzy Patients • Respiratory Medicine

Wednesday Men’s Health Private GPs London Bridge • Prostate Cancer Diagnosis & Risk Stratification 21st Nov Update Hospital • Sexual Dysfunction Associated with Cardiovascular Disease

Saturday Ten Topics in NHS GPs Glaziers Hall • Clinical Aspects of Rheumatology, including 8th Dec Rheumatology Diagnosis and Therapeutic Advances

NINETEENEducational Programme

as this, we have posted webcasts of some seminars for those of you who were unable to attend, including our recent Orthopaedic Update which was very successful.

How to register

FaX – If you have received one of our event brochures in the post, you can simply complete the reply-form and fax it back to 020 7234 2019.

ONLINE – You can register to attend through our seminars’ website www.gpseminar.co.uk, on the ‘Forthcoming Events’ page.

EMAIL – Send an email to [email protected] listing the events you would like to attend, along with your name, GMC number and practice address.

For more information, or if you have any queries regarding NHS events please contact Deirdre Loon, GP Liaison Officer on 020 7234 2572.

PRIVate eVeNtS

To register for any private GP events, or if you have any queries, please contact Louise Kemp or Clare Brammar, GP Liaison Officers, on 020 7234 2051 or email them at [email protected] or [email protected].