Ask the Doctor

Sunday 22nd January - Heartburn

Mr Peter Lamb is a Upper Gastrointestinal & General Surgeon at Spire Murrayfield Hospital.

Heartburn is a common symptom caused by the reflux of acid from the stomach into the gullet
(oesophagus). Most people are able to control their heartburn symptoms with medication. Some people with severe heartburn have symptoms that can’t be well controlled with medication or do not wish to take long-term medication.

These people may be suitable for anti-reflux surgery. Further assessment is required with an
endoscopy (camera test) to examine the gullet and stomach. The operation itself is called a
laparoscopic fundoplication.  This involves key-hole surgery to repair any hiatus hernia and to wrap the upper part of the stomach around the lower gullet, creating a valve to prevent reflux.

The operation takes about an hour and patients usually stay one night in hospital. People are able to stop their heartburn medication immediately after surgery and are given detailed dietary advice when they go home.

Studies have shown that laparoscopic fundoplication provides good long-term control of
heartburn and high levels of patient satisfaction.

Sunday 15th January - Erectile Disfunction

Mr Roland Donat is a Consultant Urologist at Spire Edinburgh Hospitals.

Erectile dysfunction (ED) may also be a sign of underlying general illness such as diabetes, high blood pressure or testosterone deficiency. Men with ED are therefore advised to see a doctor for a risk factor check.

Your doctor should also be able to advise you about the traditional first-line treatment options for ED. These treatments include tablets (eg Viagra), mechanical aids (vacuum pumps), medication applied to the penis (e.g. MUSE), and, rarely, surgery (penile implant). Traditional treatments are quite effective and most men will find a suitable treatment to allow them to resume sexual activity. However, they will usually require ongoing treatment.

There is now a novel treatment option for ED which improves the blood flow into the penis. ED 1000 uses low-intensity shockwave therapy and is a simple pain-free non-invasive treatment given in a series of short treatment sessions. ED 1000 does not help all patients, but it has the chance of curing about half of the patients with early erection difficulties (those responding to Viagra). ED 1000 also improves the erection quality in three out of four patients with advanced erection difficulties (those not responding to Viagra), to a level where they may get erections with Viagra.

Sunday 8th January - Fertility Concern

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

Each woman is born with a finite number of eggs in her ovaries. Over time, she will have fewer eggs and, in general terms, a woman younger than 35 has more and better quality eggs. Women over 40 tend to have poorer quality and fewer eggs.

Women can have tests for their ovarian reserve. Ovarian reserve testing is designed to identify a woman’s potential fertility so that she can decide whether to delay motherhood, consider fertility
treatment or consider preservation methods such as egg and embryo freezing.

Research has shown that the success rate from IVF treatment depends on a woman’s ovarian reserve. A combination of an ultrasound scan assessment of ovaries and a blood test for antimullerian hormone (AMH) allows an accurate assessment of a woman’s ovarian reserve.

Sunday 1st January - Painful Periods

Dr Paul Dewart is a Gynaecology and Obstetrics consultant at Spire Murrayfield Hospital.

Your symptoms suggest endometriosis, a condition that affects 10 per cent of women during their reproductive years.

It is a common condition which sees pieces of the womb lining found outside the womb. The contraceptive pill should reduce your pain and make your periods lighter. The fitting of a Mirena IUS is another effective way of treating heavy painful periods.

Some women with endometriosis continue to experience pain despite hormonal treatments or analgesics, in which case a key-hole surgical procedure, called a laparoscopy, may be required to
confirm the diagnosis.

It is often possible to treat the endometriosis laparoscopically, thereby reducing the pain and improving fertility for those women who are trying to conceive. Laparoscopy treatment is
normally carried out as a day-case procedure, requiring no overnight stay.