Ask the Doctor - July columns

Sunday 25th July - Neck surgery

My mother suffers from neck pain and has been diagnosed with cervical degeneration. What is it? Elizabeth, Edinburgh

Mr Ioannis Fouyas is a Consultant Neurosurgeon at Spire Murrayfield Hospital.

Cervical degeneration (wear and tear in the neck) is a very common condition affecting most of us at some point in our lives. It is frequently related to strain of the supporting muscles or wear and tear of the discs that connect the individual bones (vertebrae) that form the spine, resulting in neck pain. On occasions the nerves that emerge from the spinal column or the spinal cord itself can be squeezed by the degenerate discs, causing arm pain, clumsiness in the hands and leg stiffness. The symptoms subside - most frequently - spontaneously, with the help of pain killers and physiotherapy. On occasions when the arm pain persists, an operation releasing the pressure from the nerve can be very rewarding. Finally, progressive functional deterioration affecting the hand dexterity, ability to run or walk on uneven surfaces will necessitate an operation in the neck too. Thankfully this is an uncommon scenario. 

Sunday 18th July - Facial rejuvenation

I’m 50 this year and I’m interested in freshening up my face. What are my cosmetic surgery options? Maureen, Longniddry

Mr Awf Quaba is a Consultant Plastic Surgeon at Spire Edinburgh Hospitals.

There are many ways of rejuvenating the face, ranging from simple 15-minute out patient procedures with virtually no down-time required, to complex surgical operations requiring a hospital stay.

Begin with a face-to-face consultation with a Consultant Plastic Surgeon. They will outline your options, which may include injectables (fillers and Botox), lasers, chemical peels, volume restorations by fat/stem cell grafting or various surgical procedures such as face, eye and brow lifts. The plan will take into consideration your medical, social and psychological background as well as your expectations.

Rejuvenation can be achieved entirely by non surgical means. However, it is important to note that certain ageing features such as advanced hooding and bagginess of the eyes and conspicuous jowling can only be effectively solved by surgery.  Surgeons try to limit the extent of the cuts and site them in the least conspicuous areas. Not infrequently, a combination of procedures (surgical and non surgical) are recommended.

Sunday 11th July - Shoulder injury

My GP thinks I may have ‘shoulder impingement’, what is this and how can it be cured? Karen, Livingston

Dr Sunil Sharma is a Consultant Orthopaedic Surgeon at Spire Murrayfield Hospital.

Shoulder impingement is a condition where tissues within the shoulder are ‘pinched’ resulting in pain and discomfort. Acromioplasty is often used to treat this condition. Surgeons shave part of the acromion bone on the point of the shoulder. A ligament over the top of the shoulder is cut, and injured tissues are removed. The same procedure is used to treat minor tears in the rotator cuff.
Acromioplasty can be carried out using an arthroscope. This slender instrument has a camera on the end that allows surgeons to work without making big incisions in the skin. For shoulder impingement, acromioplasty has good results. It is less invasive than open shoulder repairs, and patients can often go home the same day as surgery. Every patient is different so treatment will vary between individuals, however a specialised orthopaedic surgeon will be able to advice you on the best procedure for your condition.

Sunday 4th July - Weight management

I’ve been trying to diet for years but nothing works. Should I have a gastric band fitted? Callum, Edinburgh

Mr Bruce Tulloh is a Consultant General and Upper Gastrointestinal Surgeon at Spire Edinburgh Hospitals.

This is really two questions: should you undergo weight loss surgery, and should you have a gastric band (as opposed to a balloon, bypass, sleeve gastrectomy or duodenal switch).

Surgery is expensive and potentially dangerous so your obesity-related health needs to be bad enough to justify the risk.  National guidelines state that you’d need to have a Body Mass Index (BMI) over 40 AND have completed at least one supervised dieting program AND demonstrate commitment to the lifestyle changes and long-term follow-up that is required for a good outcome.  Surgery can also be offered to people with a BMI as low as 35 if they also have obesity-related diseases such as type 2 diabetes, high blood pressure, high cholesterol or sleep apnoea.

As for the choice of operation, this is something best discussed with your surgeon.  There are pros and cons for each operation and different procedures suit different people.  There are many factors to take into consideration, including eating behaviour, past medical history and patient preference.  Geographical location is also important, as post-operative follow-up is more difficult if a lot of travelling is involved.