Ask the Doctor - December

Sunday 26th December - Ultrashape

Mr Mark Butterworth is a Consultant Plastic Surgeon at Spire Edinburgh Hospitals.

It is obviously important to maintain a healthy lifestyle and diet but it is well recognised that despite this, some areas of fat deposits will not reduce despite ones best efforts.

There are means to try to reduce these troublesome areas by non surgically destroying the fat cells. We use a focused ultrasound technology, Ultrashape™, to do this.

Ultrashape involves a course of usually 3 treatments where the area to be treated is pulsed with high energy focused ultrasound. This destroys a layer of fat cells approximately 1.5 cm under the skin. The body then removes the dead cells and uses the fat as energy. On average a 4cm circumference reduction is seen after the 3 treatments.

The treatment is usually pain free but can be uncomfortable. For 4 -7 days afterward the treatment we would recommend a low calorie/low fat diet to enable the body to use the fat from the destroyed cells as energy. Treatment takes approximately 1 hour and there is no “downtime” after the treatment. Other than diet you can resume your normal lifestyle immediately.

Sunday 19th December - Ganglion Cysts of Wrist and Hand

Mr Chris Oliver is an Orthopaedic Surgeon at Spire Edinburgh Hospitals.

Ganglions are the most common type of hand swelling.  They contain a thick clear liquid which is the body's lubricant in joints. Ganglion cysts can grow from any joint or tendon tunnel. The cause of the ganglions is generally unknown. They tend to be smooth and round, change in size from time to time and occur at characteristic locations in the hand and wrist. They can be painful. Most ganglion cysts can safely be left alone.  Many disappear spontaneously and many others cause little trouble. Initial treatment is often an explanation, and a waiting period to see if the cyst will disappears without intervention. If the ganglion persists the cyst can be removed as a daycase procedure. Simple aspiration with the use of a needle has a high recurrence rate.  The risk of recurrence after surgery is far less then aspiration, at around 20%. For this reason, many patients benefit from this surgical procedure.

Sunday 12th December - Radiotherapy

Professor Ian Kunkler is a Radiation Oncologist at Spire Edinburgh Hospitals.

About 70% of patients with early breast cancer having a sufficiently small  a lump for it  to be locally excised rather than require a mastectomy. This is normally followed by a course of radiotherapy over a few weeks as an outpatient.Beams of Xrays directed at the breast aims to sterilise any residual cancer cells in the breast.

Mature studies show that radiotherapy is a highly effective treatment, reducing the risk of breast cancer returning in the breast within 5 years by a factor of 4 or 5.  An important additional benefit is that radiotherapy also the risks of death from breast cancer.

Some patients with larger breast cancers or where is there is evidence of cancer at several different sites in the breast will require removal of the breast (mastectomy). Not all patients will require radiotherapy after this form of surgery. Only patients at higher risk of recurrence are advised to undergo radiotherapy. For such patients radiotherapy reduces the risk of recurrence at the site of original surgery by 60% and confers an additional 9-10% survival benefit. For patients are lower risk of recurrence, the need for radiotherapy is being studied in an international trial based in Edinburgh. In future it may be possible to identify a molecular ‘signature’ on the cells of a patient’s breast cancer. This may help in the selection of patients most likely to benefit of radiotherapy.

Sunday 5th December - Female Incontinence

Dr Simon Nicholson is a Consultant Gynaecologist who specialises in surgery for female urinary incontinence and prolapse.

The next option would be to consider surgery.  The operation that we perform is a Tension-free Vaginal Tape (TVT).  During the procedure, a tape is inserted through a small incision in the vagina and two very small skin incisions.  The tape supports the bladder, preventing downward movement and stopping leakage of urine with coughing, sneezing and exercising.  The surgery is normally performed under a general anaesthetic.  The procedure takes 20-30 minutes and you are home from hospital within 24 hours of surgery.  Recovery is quick.  You are usually able to drive within a week and back to work within two weeks.  The operation has a 90% cure rate.

Some women will need bladder investigations (urodynamics) prior to the operation to be certain of the cause of leakage and to exclude any problems with bladder emptying.