Ask the Doctor - April Scotland on Sunday column

Sunday 24th April - Mammograph

Dr Melanie Smith is a Consultant Radiologist at Spire Murrayfield Hospital.

A mammogram is an X-ray of the soft tissues of the breast, and attempts to improve and refine this technique led to the development of digital mammography.

In performing a digital mammogram the procedure and images produced are similar to having a conventional film mammogram performed. The digital mammogram differs in that it uses detectors to capture and convert the X-rays into a digital image. The resulting digital image can be manipulated electronically which is where the advantage comes in.

The diagnostic performance of the digital process is as good as conventional mammography and indeed superior to it in certain groups, notably women under 50, premenopausal women and women with dense breast tissue.

The digital image has led to the growth of other techniques such as 3D mammography, which promises improved diagnosis in the future. Mammography remains the best method for early breast cancer detection, and early detection saves lives.

Sunday 17th April - General Anaesthetic

Dr Douglas Duncan is a Consultant Anaesthetist at Spire Murrayfield Hospital.

Many patients fear general anaesthesia more than surgery itself, but for most patients the anaesthetic is very safe indeed.

Anaesthetic training in the UK has long been recognised as world class. All anaesthetics in the UK are delivered by doctors. Training is far reaching and lengthy.  Further education after training is essential for continued consultant practice.

Anaesthetic techniques are designed to minimise risk to patients and each anaesthetic is
tailored to the meet needs of the patient. Drugs used during anaesthesia are by necessity very potent, but side effects are largely predictable and the most problematic drugs have been removed from modern practice.

Anaesthesia equipment rarely fails but, if it does, it is designed to “fail safe”, with back-up systems in place. Monitoring systems provide your anaesthetist with detailed information about the interaction between you and your anaesthetic.

Your anaesthetist will be happy to discuss the risks and benefits of anaesthesia with you prior to your procedure. For more information, visit www.rcoa.ac.uk.

Sunday 10th April - Drink Fears

Professor Jonathon Chick is a Consultant Psychiatrist at Spire Edinburgh Hospitals.

Taking four to six weeks off work, and entering a programme where a lot of selfdisclosure
will be expected is quite daunting.

Such programmes can have good results, especially if they link the individual to “12-step” after-care. But many people with serious alcohol problems can be helped by out-patient treatment alone.

Those who are regularly drinking more than 15 units a day may need a short course of medication for relief of withdrawal symptoms.

In collaboration with a physician and perhaps family too, a plan for abstinence can be devised. A relapse-prevention medication can be tailored in. If drinking has been to relieve anxiety or stress, psychological techniques may be required; for others who have tried and failed to stop before,
a medication which acts as a deterrent to drinking alcohol may be prescribed.

Out-patient treatment alone will not be sufficient for some of the most severely affected, but today there is a range of treatments which are well worth looking into.

Sunday 3rd April - Bladder Control

Dr Sanjay Kallat is a Consultant Obstetrician & Gynaecologist at Spire Edinburgh Hospitals.

Vaginal prolapse is a common finding in older women and is caused by lax ligament and muscle supports in the pelvis. The primary cause can often date back to childbirth many years ago.

A lump is noted in the vagina affecting either the bladder on the front or the bowel on the back wall. It can result in a variety of symptoms including urinary urgency, incontinence, difficulty emptying the bowel and difficulty with intercourse.

Treatment plans should be tailor-made individually and justified on the basis of clinical findings, effect on lifestyle and restriction to daily activity.

Conservative treatment options include physiotherapy for pelvic-floor exercises, bladder retraining, anticholinergic medication and vaginal pessaries.

Surgical options include insertion of a synthetic tension-free vaginal tape under the bladder neck or a pelvic-floor repair to rebuild supports in the pelvis. A vaginal hysterectomy may sometimes be necessary.