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16 January 2020

Professor Alister Hart, Consultant Orthopaedic Surgeon at The London Clinic, is overseeing a new health research study that is looking at whether marathon running is good for the knee.

The knees of a crowd of marathon runners

Using 3T MRI scanning technology, Professor Hart and the research team are finding evidence that taking up distance running rebuilds the health of certain essential components of middle-aged knees, even if the joints start off worn.

“We used 3T MRI scans of the highest resolution available so that we could accurately detect even tiny abnormalities in the joint’s tissues or signs of erosion. By middle age most joints have some level of wear and tear, so we needed to establish what their joints were like before they started running,” says Professor Hart.

Professor Alister Hart

Further reading

Further information

Request an appointment with Professor Hart. Alternatively, please call our friendly team on 020 7616 7693

Find out more about The London Clinic's 3T MRI scanning technology

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About Alasdair Jones

Alasdair is passionate about ensuring his patients benefit from the latest research in Physiotherapy, and is currently exploring the latest ideas in tendon injury.
View Alasdair Jones’s full profile

Now the Christmas food-festival has finished, is joining the gym the only option available if you want to get fitter this year? Getting fitter doesn’t mean you have to join a gym, there are plenty of options out there for everyone! Read on for some tips.

A patient being guided on an exercise bike by a physiotherapist

Some people love the structured nature of a gym program, and others need a personal trainer to motivate them, but some people simply want to know the fastest way to get fit.

If that’s you, then this bit might hurt…Really and truly, there is no quick fix!

The body responds brilliantly to repeated, consistent, gradually increasing load, and not so much to a sudden increase in intensity, or a massively increased total work throughout over a period of time. 

The best part about this is that you don't have to attack the gym, going hell for leather in January.

Instead, research has proven that you should choose something you enjoy, and set small, achievable targets so you get that sense of achievement regularly which motivates you toward the next goal.

Q. What iF you haven’t done exercise at all for some time? 

Here are two simple examples of getting a little fitter without joining a gym:

  • Going for regular walks in a pair of sturdy shoes, gradually building the time walked
  • Taking the stairs every time you have the chance to do so

Q: Is it better to reintroduce exercise gradually rather than booking a marathon in six months time?

I think everyone knows this is a no-brainer! It’s tempting to really push yourself, set enormous goals when every gym, every advert on tv or on social media is tempting you with cut price offers, a six-pack by February, or the fastest 10k time in six weeks.

But, however amazing an athlete you were, those muscles and tendons will have adapted to a less active lifestyle, and be ill prepared for an onslaught of pounding the streets (or treadmill).

If you want to avoid tendinopathies, muscle tears, stress injuries or experience serious de-motivation then you need to get yourself a proper plan in place.

This means seeking professional advice as to the current state of your health. You should also meet with a strength and conditioning specialist - they can help you to build a programme to reach your dream targets.

It’s all too easy to aim wildly at a marathon six months away, when you have no idea of your current strengths and weaknesses. 

Some people tell you it’s just a psychological battle – that’s simply not true. It’s both a psychological challenge as well as a physical challenge.

It’s always sensible to break up your exercise programme into bite-size chunks, each one just a bit chewier than the previous one. This will mean that you stay on at the gym, at your boot camp, in the swimming pool, on your Peloton, etc. 

And then next year, you can revise your goals again.

Q. Why do you think so many people join gyms in January but then stop attending?

I love the fact that there are so many people who clearly want to do something good for themselves in the New Year.

I think that the fitness industry tends to fail these new subscribers after their good January intentions have lapsed. This might be due to not helping people set realistic goals in the first place – without that, we’re setting people up to fail. 

Within physiotherapy, one of the key parts to our assessment is the shared goal-setting. The person (or patient) leads the conversation as to what they want to achieve, while putting realistic expectations in as part of the essential structure to stay motivated and deliver long-term success.  

Q. What are the best exercises can people do at home or in the office? 

The best exercises are those which anyone can do anywhere.

There’s no point in setting yourself a 100 squat daily challenge, if you’re not going to find the time to do it.  There’s no point in giving yourself a mile a day jog target, if you simply don’t make the time to get it done.

Very simply, any exercise is better than nothing, but in a perfect world, we should be encouraging people to get strong, and do something out of the ordinary.

It’s true that housework burns calories, and you might satisfy yourself with that. However, making minor changes, such as taking the stairs instead of the lift at work, or doing 10 squats every time before you sit down (at home or at work) can make big differences,

Again, the above depends on your goals. 

If you want to run faster, further and for longer, then simply doing press-ups isn't going to make much difference to you. Equally, if you want to lift 100kg, then going for a daily jog isn’t going to help much. 

The key is to:

  1. Work out what you want to achieve
  2. Set relevant goals to help you achieve it

This can be daunting, so a good physiotherapist can help you build a programme to help you succeed. They will show you examples of good technique, and guide the speed of your progress so you get the most out of every session.

Further information

The London Clinic’s physiotherapy team can help you with expert advice about how to be heathier and improve your fitness safely for the long-term. To find out more, please call our friendly team on +44 (0) 20 7616 7651 or email physio@thelondonclinic.co.uk.

Physiotherapy services

Sports and exercise consultants

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06 January 2020

Dry January has officially started and for many people, ‘going dry’ for the month offers an opportunity to take stock of their drinking habits as part of a wider approach to healthier living - especially after the excesses of the festive season!

Detail of a lady's hand over an empty wine glass

Going sober as part of Dry January focuses people’s attention on how much they’re drinking (and often why). 

Did you know, cutting out alcohol immediately impacts upon lifestyle - allowing for better sleep, focus, energy and more time for other things?

Weight loss is often an unintended although welcome benefit, as well. Some good tips to reduce consumption, include pouring smaller glass sizes and taking two or three ‘drink free’ days a week.

There are many reasons why people drink - helping them to unwind after a busy or stressful day is just one of them. If this is a daily occurrence, then you may end up regularly drinking more than may be safe in the long-term. 

According to Dr Yiannis Kallis, Consultant Hepatologist and Gastroenterologist at The London Clinic, a long term approach to our health and our drinking habits is really what’s needed. 

“Think about the long term solutions to lowering your alcohol consumption and plan to do it gradually,” he says. 

“The risks to health from excessive alcohol consumption tend to develop over long periods of time, but they are much more effectively managed and/or prevented, if there is early recognition that you may be drinking too much.”

According to Dr Kallis, the New Year is also a time where we should reflect on our diets and make exercise a key part of our routine.

Being active is beneficial in so many ways. It’s been shown to:

  • reduce blood pressure
  • aid a good night’s sleep
  • have a positive impact on our musculoskeletal system and mental health

Further information

  • Dr Yiannis Kallis is a Consultant Hepatologist and Gastroenterologist specialising in liver, pancreas and bile ducts disease
  • Read Dr Kallis’ top tips for a healthy liver in our feature
  • Read more about FibroScan - a simple, quick and pain-free way of detecting the early signs of long-term liver damage 
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About Dr Yiannis Kallis

Dr Yiannis Kallis is a Consultant Hepatologist and Gastroenterologist specialising in liver, pancreas and bile ducts disease. He performs the FibroScan test, and endoscopy.
View Dr Yiannis Kallis’s full profile

How important is diet to someone’s liver?

Food and nutrition has a big impact on your liver, especially over the long term.

The two most common liver conditions in the UK are alcohol-related liver disease and fatty liver. Alcohol-related issues relate to how much people drink and for how long they’ve drank for.

Fatty liver is associated with being overweight, having type 2 diabetes and high cholesterol. If not managed properly, fatty liver can lead to liver failure. There’s probably more awareness now around fatty liver amongst the healthcare community and the public.

Outline of a liver shaped with healthy food positioned inside

How should people approach their health in the New Year?

I encourage my patients to try and use the Christmas period to plan long-term solutions for the New Year, as after Christmas, people tend to have more motivation to make changes to their lifestyle.

Think about the long term solutions to improving your diet and lowering your alcohol consumption and plan to do it gradually.

Health campaigns like Dry January have a useful role to play in that. The real value of Dry January is for people to see how much they do drink.

Some of the apps are quite useful for tracking alcohol consumption as they allow you to see how much you drink and also how much alcohol costs. Cutting down on alcohol also helps you sleep better too. 

What are your top tips for a healthy liver?

My top tips are:

  1. If you drink, drink in moderation and monitor your consumption. You may want to use an app for a month to really see how much you drink – you may be surprised!
  2. Don’t forget to get regular exercise. Being active is beneficial in so many ways – it’s good for your blood pressure, for good sleep, good for your musculoskeletal system, your mental health and so on. Think about how you can make exercise a key part of your routine, not just in January, but all year round.
  3. Try and eat a healthy and balanced diet. The thing I would tackle most is the amount of sugar you consume, so be wary of fizzy drinks and sugary cereals. 

Further information

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24 December 2019

Nancy Huntley, Lead Nurse for Apheresis, explains more about her work during Christmas with patients donating stem cells and bone marrow and caring for those waiting for transplants.

Nancy Huntley at work in The London Clinic

“Christmas at The London Clinic is a special and busy time,” says Nancy, who works in the Haematology (blood cancer) Outpatient department.  

“The London Clinic is the busiest donor centre in Europe and the work to harvest stem cells takes on a special significance over the Christmas period.

The London Clinic works closely with Anthony Nolan, a blood cancer charity, to help people searching for a blood cancer donor match. For example, In December last year, Will Briant received an email that informed him he had come up as a potential match for a blood cancer patient in desperate need of a stem cell transplant. Will donated stem cells at The London Clinic.

“On the day of the harvest, the person donating is attached to a cell separator machine and immature blood cells called stem cells are removed,” says Nancy. “These cells are then taken by courier to the patient’s hospital, which could be anywhere in the world, including the USA and sometimes even Australia. This provides a lifeline for these patients and can result in a complete cure of their blood cancer.

“Additionally, we work with donors from the bone marrow registries (such as charity DKMS) if the registry has matched them with a patient requiring an unrelated bone marrow donation. I’ll be working over the festive period, which is a very rewarding time. I’ll also be spending time with my sons and extended family.”

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About Dr Naila Arebi

Dr Arebi's clinical practice is focused on Inflammatory bowel disease, constipation, irritable bowel syndrome and intestinal investigations including endoscopy and physiology testing.
View Dr Naila Arebi’s full profile

Do you notice changes to your patients’ behaviour at Christmas

People are aware of what’s coming and anticipate eating too much, and drinking too much. Some choose to hold on and splash out on Christmas Day and then there are those who moderate. It’s more a matter of attitude.

Do you think generally people are moderating more over Christmas?

Yes, I think people are more health-conscious and more knowledgeable these days. Also, as you get older your gut bacteria changes and therefore, the way your body handles food also changes, which in some cases means you might not be able to handle certain foods.

Are there certain foods that become more problematic as you grow older?

It’s harder to tolerate fatty foods, high calorific foods, and the quantity of alcohol intake. Some people find certain types of fruit and vegetable cause problems, particularly the ones that ferment a lot. There are of course people who have IBS (Irritable Bowel Syndrome) which means there is a gut sensitivity, also people with inflammatory bowel disease which is a different entity, as it creates an actual active inflammation of and damage to the gut.

Can anyone develop IBS at any point?

There are a few affiliated genes but the association isn’t that clear. It happens often after an infection in your gut, such as gastroenteritis, which you might get when travelling and this can leave people with IBS. But in 90% of cases of IBS there is no obvious trigger for it.

Can overeating and drinking at Christmas be harmful?

The acute effect is that it will make you sick, the chronic effect of over eating and over drinking, is that it can leave you feeling bloated and over-full, and that’s why people may then want to go on to a detox. It’s not going to do long term damage, but you don’t want to over-do it at Christmas because if you do, you won’t be able to enjoy it for over its entirety.  

What advice do you give to your patients about eating and drinking at Christmas?

For patients with IBS they generally have a sensitive gut where fibres make symptoms worse and there are two types of fibre; soluble fibre and insoluble fibre. The soluble fibre comes from vegetables like peas and Brussel sprouts for example, the insoluble ones come from grains and nuts, so just be mindful not to overdo it in those areas – everything in moderation.

Another way around it is to prolong the meals – don’t eat a large volume in a short period of time.

Turkey is very lean meat and is a healthy option, although the gravy around the turkey can be fat laden, so minimize the gravy. Enjoy your vegetables and roast potatoes – potatoes cooked in goose fat aren’t so healthy, but taste delicious! So again, everything in moderation.

Drinking can be a trigger if you have reflux, as it relaxes the muscle between the gullet and the stomach and so alcohol can make this worse. Wines can have histamines whereas spirits are a purer form of alcohol.

Sweeter drinks and foods can cause wind because there is more sugar for the bacteria to ferment. So if you’re going to have chocolate, try to have dark chocolate which has less sugar and real health benefits. 

What will you be doing for Christmas?

I will be in Malta and having a traditional Maltese Christmas dish, which is minced meat in a rich sauce cooked over two days and covered in puff pastry and it’s delicious! The main is traditionally turkey, but we might go for lamb this year, with red wine and for desert something lighter, like a lemon tart. We finish it off with a glass of sweet Italian wine and dark chocolate.

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About Dr Mani Naghibi

Dr Naghibi is trained in all aspects of gastroenterology and have clinical interests in nutrition, functional bowel disorders, conditions causing change in bowel habit and abdominal pain and reflux.
View Dr Mani Naghibi’s full profile

What advice would you give to your patients about eating and drinking at Christmas?

First and foremost, enjoy Christmas! It’s a time to indulge a little, be merry and enjoy a good meal with friends and family.

For those with a big appetite, I would recommend sticking to a healthy diet in the run-up to Christmas, including having alcohol-free days, and then you can relax and indulge a bit more on the day. 

What are your recommendations for people with a poor appetite, in particular oncology patients?

It depends on where you are in your journey. 

In the pre-operation stage, there is good evidence to suggest that a high-protein diet is good for maintaining muscle mass and going into an operation with good muscles is important for the recovery period.

Maintaining a good level of Vitamin D is also important, either through supplements or foods that are naturally high in Vitamin D, such as oily fishes. Also, if you are diabetic, then switching to a high-fat diet rather than a high-carb diet is advisable, in the lead up to the operation. 

During chemo and radiotherapy, you can have abnormal taste sensations, reduced taste sensitivity, or even a complete loss of appetite. Chemotherapy can affect your mouth and the tissues therein and swallowing can also become problematic. 

My advice is to look up recipes that are particularly high in energy but can be consumed in small quantities, so fatty foods, cakes and creams.

If you’re having difficulties with swallowing, have foods that are high in moisture instead of dry. Even if you’re choosing a meat, choose lamb or beef which are moister than turkey, for example. 

For the post-surgery group, focus on a low-salt diet, reduce intake of red meat, and reduce processed food which includes sausages, bacon and meat not cut up into chunks.

Increase or, take up regular activities and avoid having a sedentary life. It goes hand in hand with reducing sugars, because sugar leads to weight gain and obesity is a risk factor for a number of cancers.

Table showing a selection of Christmas dishes

How important is nutrition for our general health and how much does it contribute to other conditions?

Nutrition can impact upon every condition, from lung disease, to heart disease, to psychiatric diseases, to cancers.  We are finding out more and more that good nutrition and directed nutrition for each condition, has a central role in recovering and moving on from diseases. 

What advice would you give to your digestive patients around Christmas?

Digestive patients include those with gastroenterology issues, irritable bowel syndrome, people who tend to get diarrhoea and bloating, or those who might have carbohydrate intolerance.

Many patients are now aware of the low FODMAP (fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols) diet.

FODMAPs are short chain carbohydrates and sugar alcohols that are poorly absorbed by the body, resulting in abdominal pain and bloating. A low FODMAP diet particularly helps IBS patients with bloating, diarrhoea, general abdominal pains.

In general, high fodmap food stresses your gut.  

Some of the foods eaten over the Christmas period are naturally higher in FODMAPs (e.g. dried fruits or raisins, Brussel sprouts), so the advice would be to choose the foods that you know that have high FODMAPs that you really like, but have them in small quantities.

Potatoes, carrots and parsnips are low in FODMAP and good news for meat eaters, turkey is low in FODMAP, also. For vegetarians I would recommend regular tofu (not silicone tofu) as tofu has low FODMAP, also.

How detrimental is a Christmas diet to our nutrition and health?

It’s not really detrimental. If you usually follow a healthy diet and avoid food when you have intolerances or allergies, then actually one day off isn’t detrimental at all. 

If we are talking about the whole of the Christmas period, then that’s different. I would recommend portion control over the festive season, having alcohol-free days and try to avoid the high, densely energy-rich, fatty foods.

Further information

Dr Naghibi provides All-Inclusive Packages for colonoscopy, flexible sigmoidoscopy and gastroscopy, so that you can take comfort in knowing that you will pay one agreed fixed price that will not change.

Request an appointment with Dr Mani Naghibi and the services he provides. Alternatively, telephone Alice Martin-Lumbard: 0203 9076579 or email Naghibi-sec@gidoctors.co.uk.

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10 December 2019

We were delighted to host our annual Consultant Christmas soiree on Thursday 5 December, held to thank our specialists and recognise their invaluable contributions throughout 2019.

CEO Al Russell addresses the gathering

Held at the Royal College of Physicians, Chief Executive of The London Clinic, Al Russell, said: “Our success in 2019 can be attributed to two major elements. 

"First, the trust consultants have shown in us to care for their patients. Second, the dedication of our nurses and allied health professionals to earn that trust and consistently provide the very best levels of care.”

“Thank you to all of you for your hard work and commitment this year. I’m looking forward to 2020 with excitement and optimism.”

Consultant Orthopaedic Surgeon, Professor Alister Hart, who attended the event said: “Looking back at what has been a busy and a successful year, I’m thankful for all the support I received from The London Clinic, including from the specialist and dedicated nursing teams who play such an important role in coordinating the care our patients receive. 

"The highlight for me was the buzz from the consultants regarding The London Clinic’s positive future.”

Sukhy Jagdev, Head of Clinician Relationships at The London Clinic said: “It can be all too easy to focus solely on the future. But it’s just as important to pause, to look at what we’ve achieved, and take some time to thank everyone for their support.

We now have an experienced and super passionate team in place to continue to support our Consultant colleagues, and make 2020 an even better year.” 

Further information

To read more about the consultants who work at the  The London Clinic, please visit our Consultant directory, where you can find a leading specialist by speciality, condition or treatment.

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About Professor Tony Kochhar

View Professor Tony Kochhar’s full profile

During surgery 1 in 14 patients over the age of 65 suffer from covert strokes which, typically go undiagnosed as they do not present clinical stroke symptoms.

However, 42% of these cases risk cognitive decline within a year of their operation, according to a recent study published in The Lancet medical journal.

This isn’t the only risk factor, other complications may occur during surgery under general anaesthetic and recovery can be more painful and take longer. 

So what is the alternative?

Professor Tony Kochhar, Consultant Shoulder and Upper Limb Surgeonis providing patients with options, based upon their individual needs.

This is particularly beneficial for those over the age of 65, at cardiac risk, people who have other health factors to consider, or for those who simply prefer to be ‘awake’ during their surgery.

Which conditions are this surgical technique used for?

Interscalene is a highly selective nerve block which can be used for all types of upper limb surgery - both minimally invasive keyhole surgery and open surgery. 

A nerve block being applied to a patient (stock image)

What are the advantages of using this surgical technique over more traditional methods?

Regional anaesthesia can significantly reduce post-operative pain, thereby reducing the need for painkillers resulting in fewer complications and a shorter hospital stay. 

If you are able to do so, remaining 'awake' during surgery significantly reduces the risk of a covert stroke occurring, particularly in older or more vulnerable patients.

Who is suitable for this type of surgery?

  • Anyone who is concerned about feeling out of control because of being put to sleep
  • Those who are older, or who’ve had medical problems, heart trouble in particular and the risk of an anaesthetic worries them
  • Those who have previously had an operation under general anaesthetic and just felt awful afterwards – nauseous, lethargic, not sleeping properly, in lots of pain

In all these cases it wasn’t the operation, but the general anaesthetic which made them seek alternative options, more suitable for them as individuals.   

Are there side-effects to this technique?

As with any medical procedure some side-effects can occur, but these are typically mild and rare.  They can include:

  • drooping of the eyelid
  • flushing of the face
  • hoarseness of voice
  • shortness of breath (dyspnea)

If they occur they will only last for the duration of the block and then wear off as the nerves are no longer anesthetised.  

Are there specialist drugs used to help the patient stay awake?

No, the block in itself doesn’t make patients sleepy so they don’t need any additional drugs to stay awake.

However, they can opt to be sedated if they would rather not see the surgery taking place and this can be done using a mild sedative. 

How is the anaesthetic administered and does the patient feel pain?

We perform the injection of the local anaesthetic using an ultrasound machine which not only allows us to identify it has been correctly placed, but also to see the appropriate spread of local anaesthetic around the nerves. 

The anaesthetist constantly monitors the patient’s responses throughout the operation and will adjust the levels if there is any change in their responses. The patient shouldn’t feel any pain whatsoever during this surgical technique.

View from a patient

Michael Linnit, acclaimed theatre and musical producer and a patient of Professor Kochhar shares his experience:

Why did you choose to have your surgery under local anaesthetic?

I didn't know when I first saw Professor Kochhar that it was possible to have this surgery under local anaesthetic. 

When he discussed it and explained that it was possible, that he had developed and refined this technique, and that he would in fact recommend this for me, I chose to have it this way.

How was your experience of having the anaesthetic and operation?  

I remember it being a pleasant experience.  I was sedated and felt a bit woozy afterwards but I didn't feel the panic of not being able to move my limbs, as the anaesthetic was so localised and didn’t affect my movement.  

As the anaesthetic wore off the painkillers took over and there was a fuzing of the line between anaesthetic and painkillers which, made the experience more comfortable for me.  

I wouldn’t hesitate to recommend Professor Kochhar's practice.

 

Further information

To book an appointment with Professor Tony Kochhar please call: 020 7234 2771 or email: admin@shoulderdoctor.co.uk.

View our list of orthopaedics treatments.

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15 November 2019

The BBC News Channel’s ‘Click’ technology show features an interview with Dr Andrew Thillainayagam, Consultant Physician and Gastroenterologist about how new technologies can help people with food allergies.

Dr Andrew Thillainayagam

Over 9,000 people have been seen at The London Clinic’s specialist digestive health centre during the last year and Dr Thillainayagam is one of our digestive specialists available to provide advice about food allergies and intolerances. There are no waiting times for an appointment.

BBC Click interview

Watch Dr Thillainayagam’s interview with the BBC (from 16.10).

Further information

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