Ask the Doctor - September Scotland on Sunday columm

Sunday 25th September - Knee Injury

Leela Biant is a Consultant Orthopaedic Surgeon at Spire Edinburgh Hospitals

The cartilage lining the joint cannot repair itself. If left untreated, it can be a cause of discomfort and early onset arthritis. There are surgical techniques that form a ‘scar’ over the damage, but this may degenerate within two years. Cartilage cell transplantation is the best option for durable results, and regenerates the cartilage surface. A sample of the patients’ own cartilage cells are grown in the lab, loaded onto a matrix mesh and implanted into the injured area of the knee. The implanted cells repair the damage, reduce knee pain and improve function.

Sunday 18th September - Osteoarthritis

Morag Lunn is a Physiotherapy Knee Specialist at Spire Edinburgh Hospitals.

Osteoarthritis is incredibly common. Most people cope extremely well with their symptoms, although some may require an orthopaedic opinion. The classic symptoms of osteoarthritis include joint pain, stiffness and swelling. These can all lead to lower limb weakness. Current evidence shows that a combined approach to treatment has most success in managing the symptoms of osteoarthritis.

Even though your joints may be stiff and sore, some form of physical exercise is vital in order to increase muscle strength, improve joint flexibility and allow you to keep doing normal day-to-day tasks. Maintaining a healthy weight will reduce the pressure on all your joints, not just your knees.

Advice regarding pain relief, joint protection and pacing strategies can help prevent flare-ups of pain that are common with osteoarthritis.

By making some simple changes, there is no reason why you shouldn’t continue to lead an active lifestyle. A Physiotherapist can help you achieve this.

Sunday 11th September - Bowel Control

Miss Mhairi Collie is a Consultant Colorectal Surgeon at Spire Murrayfield Hospital.

Problems with continence are common but often not discussed because of the embarrassment  factor.

It is a particular problem for women who have had difficult deliveries. Often the problems start later in life, around the menopause. It used be said that women had to just accept it as a fallout from childbirth, but nowadays there can be medical or surgical solutions.

Surgically, sometimes the pelvic floor needs a reconstructive operation for a prolapse. Other times everything is in the correct place, but just not working very well. In these cases a procedure called Sacral Nerve Stimulation (SNS) can be life-changing. It involves a simple operation (done as a day case) to insert a small wire through the lower back, attached to a kind of pacemaker, which improves the brain’s awareness that the bowels need to open.

SNS also has an effect on the bowel itself, preventing leakage. Before a permanent stimulator is inserted, a temporary wire is tried out for two weeks to be sure that the symptoms improve.

Sunday 4th September - Fertility

Dr Joo Thong is a Consultant Subspecialist in Reproductive Medicine at IVF Scotland, based in Spire Shawfair Park Hospital.

The success rate for women from IVF treatment drops after the age of 35. This is due to the ovarian reserves, associated with the number and quality of eggs remaining in the ovaries. As a women gets older, the ovarian reserves decrease.

There are two widely used methods of assessment for your ovarian reserve. Firstly, a vaginal ultrasound scan of the ovaries allows measurement of resting follicles (2-8mm diameter), this can be used to determine the quality of your eggs and an antral follicle count which gives an indication of the quantity of eggs remaining. Secondly, a blood test for Anti-Mullerian hormone (AMH), which is produced by cells around the resting immature eggs, correlates with your ovarian reserve. A high AMH level suggests good ovarian reserve and vice versa. The AMH blood test and antral follicle count are both reliable assessments.Having a good ovarian reserve suggests higher chance of success in natural conception or with the use of IVF. Those with low ovarian reserves who are experiencing difficulty in conceiving may benefit from IVF treatment.