Should we be talking about hangover ‘cures’?feature, 21/07/2021
About Dr Yiannis Kallis
Alcohol will no doubt be a popular party guest at many social events this year. However, many of us may not be aware of the damage even casual drinking can cause.
While everything from greasy fry-ups to high-end spas might seem a welcome fix, they’re unlikely to undo what we’re inflicting on our bodies when we drink to excess.
First of all, if you’ve found yourself drinking more – or less – during lockdown, you’re not alone.
With anxiety and loneliness at an all-time high for many people, it’s understandable that our relationships with alcohol may have changed.
“Lockdown has polarised drinking habits. Some have taken stock and reduced their consumption; others have used alcohol to fill their time,” Dr Kallis says.
After nightclubs and large gatherings return this summer, Dr Kallis also expects to see further changes in alcohol consumption by those who prefer to drink when socialising.
“I think there’ll be a few weeks, after the release from lockdown, when the social drinkers will start to drink more,” he continues.
“There’s a pent-up demand for socialising, and drinking typically comes with that. It's unusual to drink a lot on your own unless your relationship with alcohol isn't that healthy, but it’s easier to have many drinks when out with others at a bar.”
So, what can those who are looking forward to a few glasses of wine at a wedding this summer, or a long-awaited night out on the town, do to curb the consequences of drinking?
Can we “sweat out” the alcohol?
In terms of preventing a hangover, Dr Kallis advises that lowering our overall intake of alcohol and staying well-hydrated is the best solution.
However, in case a hangover arises, cardiovascular exercise the morning after a night of drinking is one of the best solutions.
“It increases your metabolism. Part of what you’re doing during a hangover is metabolising some of the toxins in the alcohol – such as the acetaldehyde – so by increasing your physical activity you may increase your general metabolism,” Dr Kallis says.
“Also, exercise does make you feel better [in general]. If you go for a run or a cycle, you get a wave of energy, even when you’re just tired – and you get all the endorphins that make you feel good.”
On the other hand, the idea of “sweating out the alcohol” is an abstract idea, rather than a physiological one. While alcohol is indeed soluble, it won’t come out in your sweat.
“The alcohol isn’t being sweated out of your system,” Dr Kallis clarifies.
“I think you have to be careful with things that encourage you to sweat excessively, because hangovers make you dehydrated already.”
Hair of the dog
Although Dr Kallis recommends a hearty breakfast, and even coffee, after a heavy night of drinking, certain things are off the menu.
“Caffeine can give you a stimulus and make you feel better, but it won’t necessarily counteract the toxins that are circulating because of the alcohol, and it may dehydrate you further.”
Since the worst hangover symptoms occur when the amount of alcohol in our blood is very low, or nearly zero, Dr Kallis suggests “hair of the dog” devotees should think twice about their chosen tipple.
“Go for a Virgin Mary, not a Bloody Mary. Drinking alcohol to avoid a hangover may work, to a degree, but all it will do is temporarily ‘top up’ alcohol levels and push back the point of hangover.”
“Fundamentally, if you're drinking alcohol to cure a hangover, you will inevitably run into trouble later down the line,” he adds.
Instead, what are some beneficial things to eat and drink the next morning?
“Make sure you drink plenty of fluids. Also take in some minerals – juice or clear soups are a good source – as you will often lose quite a lot of electrolytes when you become dehydrated,” Dr Kallis suggests.
Assessing the damage
It’s well-known that heavy alcohol consumption can do significant damage to our livers. Dr Kallis regularly works with patients who are concerned about how much they drink. In fact, much of his work involves looking after patients with alcohol-related disorders.
“I’m seeing an increase in the number of patients coming to me with alcohol-related liver disease a lot earlier in life than usually expected. The majority of people I’ve looked after are not alcoholics in a conventional sense – they are just people who regularly drink a bit too much, at social events or after work.”
“The idea that you have to be an alcoholic to get liver disease is a fallacy,” he concludes.
To help even casual drinkers understand if alcohol may be causing them harm, Dr Kallis recommends a FibroScan® at hospitals such as The London Clinic. This non-invasive and painless test can reveal any scarring or fatty change within the liver due to alcohol, providing patients with an opportunity to make lifestyle changes prior to any severe health impacts.
Any views expressed in this article are those of the featured consultant(s) and should not be considered to be the views or official policy of The London Clinic
Can running promote long-term knee health?feature, 24/06/2021
About Miss Homa Arshad
Unfortunately, joint and knee pain has always been a common side effect of running, and the sudden surge in its popularity has led to increased conscientiousness about those niggles and whether they could lead to a more serious, long-term issue such as knee osteoarthritis
At The London Clinic, there’s been an influx from patients and the press asking questions about the impact of running on our bodies. The answers aren’t always as disheartening as we might think. In fact, they can be quite the opposite.
First of all – the good news
“Running is good, safe and healthy,” says Miss Arshad. “It isn’t bad for the knees, per se. It has huge benefits for the whole body, and can actually be very good for the knees.”
Perhaps dispelling the greatest myth of them all, running can promote knee health in the long term. Instead, the issue lies in perception.
Running gets a bad name because people can injure and do damage to their knees, which damages the reputation of running itself. Instead, we should start thinking of running and injuring knees as separate entities, not intrinsically linked.
For instance, Miss Arshad continues, “It’s really important to address the myth that running causes arthritis, because the vast majority of people who run do not develop it. Even for runners who do develop knee problems, those problems will get better. A few may require surgery, but not many.”
Often, it can be an individual’s personal technique or equipment such as the wrong footwear that causes injuries. This can be prevented with training and guidance.
“If you’re doing a repetitive movement and loading the knee each time in a way that isn’t ideal there can be an excessive twisting of the knee that can do damage to cartilage,” Miss Arshad says.
For runners keen to seek advice on a running technique that helps to avoid injuries, Miss Arshad recommends speaking to a physiotherapist, such as those located at The London Clinic.
Meanwhile, runners can also visit a sports store with a treadmill, where experts can analyse their gait and ensure they are wearing the right footwear for their running style.
Tough terrain and running uphill
“When we run uphill,” Miss Arshad explains, “eight times our body weight passes through the front part of the knee.”
“There is a theory that impact [such as this] is bad for cartilage, but I don’t know of any study that has demonstrated that conclusively.”
Many people find more difficult terrain can give them negative symptoms. Likewise, certain runners, such as endurance runners, can develop problems if their goals take precedence over what they may be experiencing.
However, overcoming such obstacles is about understanding and listening to what our bodies are telling us, rather than following a certain set of rules.
“Running through pain and injury can obviously be very detrimental to the knees… I encourage patients to be guided by their experience,” Miss Arshad continues.
You may have heard different advice when it comes to supplements. Runners swear by the likes of glucosamine, ginger, turmeric and cod liver oil, but what are the facts?
“If people take them and feel better, that’s fine,” says Miss Arshad.
But in general, the majority of supplements have no proven benefits to running.
Miss Arshad does, however, recommend that everyone – runner or not – takes vitamin D, which has been proven to improve bone health.
A recovery mindset
Miss Arshad notes that the link between physical and mental health is becoming increasingly strong in orthopaedic surgery.
She regularly treats patients who have suffered catastrophic injuries from major accidents, and said that when it comes to recovery, the single biggest factor has nothing to do with age, weight or physical health. It’s about the patient’s mindset.
The same can be applied to runners.
“It’s actually their approach to life,” she says, “and whether or not they feel in control of their life and what is happening to their body. In terms of running, I think that’s very similar. The human mind is very powerful.”
Read the full article in Stylist.
Any views expressed in this article are those of the featured consultant(s) and should not be considered to be the views or official policy of The London Clinic
First deep brain lesion for tremor completed at The London Clinic
A patient with tremor has successfully undergone a pioneering form of deep brain lesioning surgery at The London Clinic. This is a first for a UK private hospital and a milestone in our hospital’s commitment to providing patients with access to the latest treatment technologies.
Consultant Neurosurgeons Professor Tipu Aziz and Mr Erlick Pereira performed the deep brain lesion on Thursday 3 June. Targeting a part of the brain called the thalamus, the surgery, called a thalamotomy, would improve the patient’s severe, disabling tremor.
Deep brain lesions are helpful to treat movement disorders such as tremor, Parkinson’s disease and dystonia, and complement deep brain stimulation as a surgical treatment offered by The London Clinic’s Centre for Movement Disorders. Deep brain lesions also treat pain, in particular cancer pain as part of therapies offered by The London Clinic’s Centre for Neuromodulation.
THE PATIENT'S EXPERIENCE
Thomas, a physicist by training, tells of how thalamotomy has profoundly improved his tremor.
“After a rapid and severe illness, a couple of years ago, I developed severe tremor, particularly in my right arm. It was worse if anxious and I could neither pick up a cup to drink nor brush my teeth.
"The condition meant that my brain was constantly generating shaking signals, so even when there was no physical cause, my arm was shaking. My balance was also affected with some tremor elsewhere in my body.
"I saw several neurologists. I considered deep brain stimulation and focused ultrasound surgeries with my neurosurgeon, Professor Aziz. I did not want an implant inside me and I was worried the effect of ultrasound would be only temporary, lasting a few months.
"The ultrasound procedure would also last several hours with my head shaved and a frame fixed to my head whereas the radiofrequency thalamotomy procedure took only half an hour, with no haircut and no pain.
"I was excited to get it done. There wasn’t any preparation involved other than having a few tests, as there would be with any surgical procedure. And afterwards, I didn’t even have a headache so there was no need to take the paracetamol prescribed. There was just a slight feeling of pressure but I was very comfortable and the dentist is certainly worse!
"I’m quite amazed. My tremor is now 90% improved just a few days after the procedure and it can take up to six weeks to benefit from the full effect. Right now, I can drink from a cup and eat my food and my mobility is still good.
"In terms of the effect of the lesion, it’s been life-changing. I would absolutely recommend this, because medication is a chronic condition management but this is a promising one-off treatment that should last life-long.”
WHAT IS DEEP BRAIN LESIONING?
Professor Tipu Zahed Aziz, founder and head of Oxford Functional Neurosurgery, professor of neurosurgery at the University of Oxford and consultant neurosurgeon at The London Clinic, provides a summary.
“Tremors are an uncontrollable shaking or trembling. Tremor most commonly affects the hands, but can also affect the arms, face, eyes, voice, trunk or legs.
"Tremor can be treated by medicines and even botulinum toxin injections. In those cases where drugs and injections do not give sustained benefit, functional neurosurgery becomes an option.
"The two types of effective surgery for tremor are deep brain stimulation and deep brain lesioning.
"In deep brain stimulation for tremor, electrodes are inserted deep into the brain in areas from the ventral intermediate thalamus to the caudal zona incerta. The electrodes are then connected to a pacemaker implanted in the chest. The whole procedure can be done with the patient asleep for their comfort.
"In deep brain lesioning, a small part of the brain is damaged to disrupt the abnormal tremor causing circuitry. This treatment was first done in the 1950s with various tissue damaging agents from absolute alcohol to liquid nitrogen dripped in.
"The most control is had from a technique called radiofrequency thermocoagulation. In this treatment, a probe is inserted into the brain and an electric current passed down it. High frequency currents relieve the tremor whereas low frequency ones check for side effects.
"After testing with different currents, the tip of the probe can be heated to 80 degrees for a minute to burn the abnormally functioning part of brain, creating a tiny stroke in a controlled fashion. Modern alternatives to radiofrequency thermocoagulation are MRI-guided focused ultrasound and gamma knife radiosurgery.
"However, the disadvantages of both compared to radiofrequency thalamotomy are that the procedure might take several hours, with the patient awake clamped into a head frame with a full head shave, and that the lesion might be less controlled in terms of benefits and side-effects and less permanent.
"At The London Clinic, Mr Pereira, Professor Nandi and I use a minimally invasive, low-profile technique where little hair is shaved, only a two centimetre incision is needed in the scalp and a two millimetre hole gently made in the skull.
"The procedure is done with a stereotactic frame fitted to the head and takes less than an hour. The patient is awake for deep brain lesioning in order for their movements and any side effects to be assessed before the lesion is made, but comfortable throughout and given light sedation if required.
"In Thomas’s case, his bad tremor in one arm and unsteady walk required careful assessment before and during surgery to obtain the good result we achieved.
"So far, things have gone extremely well. The operation went smoothly taking only about 40 minutes (a tenth of the time that ultrasound would) and we have been very pleased with the results. I will continue to be in regular contact with Thomas."
Deena Shah, Senior Product Manager Radiofrequency at Boston Scientific Neuromodulation EMEA, commented:
“We are delighted to have supported Mr Pereira and Professor Aziz for this first radiofrequency thalamotomy in a UK private hospital. We hope to continue to work with them and The London Clinic to increase access to and raise awareness of this important and potentially life-changing therapy.”
Mr Erlick Pereira, Lead Neurosurgeon for the London Clinic functional neurosurgery service and founder of functional neurosurgery at St George’s University Hospital, explained:
“With this additional very powerful surgery now in our armamentarium, The London Clinic offers a complete and comprehensive functional neurosurgery service for movement disorders and pain.
"We have 3T MRI, advanced neurologist and psychologist assessments and state-of-the-art equipment. We can do two deep brain stimulation surgeries in a day with each full surgery taking less than three hours, and regularly treat any patients from the UK insured to international self-pay."
Only a small proportion of patients are suitable for lesions and only a handful of neurosurgeons in the UK are trained to perform them. This makes it all the more important for us to offer this service. At The London Clinic we have particular interests in taking on complex cases, second opinions and revision functional neurosurgeries with a depth of expertise for two and even three consultant neurosurgeons to operate together, if necessary.”
- Essential Tremor
Abnormal shaking which can affect one or more body parts of arm, leg, head and even voice
- Parkinson’s disease
Degenerative condition due to loss of dopamine producing cells in the brain causing problems with slowness of movement, tremor, stiffness and balance
Abnormality of muscle tone due to abnormal brain circuitry. Cervical dystonia (spasmodic torticollis or stiff neck) is the commonest type, and is treatable by deep brain stimulation
Part of the brain with connections to both the basal ganglia controlling movement and the senses
Lesion in either the motor part of the thalamus to improve tremor or the sensory part of the thalamus to improve pain
Lesion in a motor part of the brain to improve abnormal movements and stiffness in Parkinson’s disease and dystonia
- Deep brain lesioning
Focused damage to a selected part of the brain to improve symptoms of abnormal movement, pain, epilepsy, depression or obsessive compulsive disorder
- Deep brain stimulation
Focused insertion of electrodes into the brain connected to an implanted pacemaker that delivers electrical signals to improve symptoms of Parkinson’s disease, tremor, dystonia and chronic pain
A day in the life of a physiotherapistfeature, 04/06/2021
About Charlotte Church
08:50 – arriving at work
Time for work! I find there’s always a buzz in the air around Harley Street each morning. Even after working at the Clinic for five years, I feel a great deal of pride when I think about where I work. It’s such a historical area of London and as a clinical professional there’s no other place I’d rather be.
After arriving at the Clinic, I first head to the staff changing rooms to put my physiotherapist uniform on. We wear navy blue trousers and a white tunic that displays both the Clinic’s logo and the logo for the Chartered Society of Physiotherapy (CSP), which reminds me each morning how lucky I am to be both a therapist and a carer for my patients.
09:00 – morning handover
My work day officially begins with a handover from my colleague in the digestive diseases unit with a hot cup of tea.
Our digestive diseases unit has been my main ward for the last few years. I’ve built some wonderful relationships with my peers located here. We look after complex patients and work together to ensure that their stay goes as smoothly as possible.
After this, the occupational therapists and physiotherapists then discuss our intensive care patients. Some of our most vulnerable patients are located in our intensive care unit so it’s important for our teams to work closely as part of a multi-disciplinary approach to ensure a successful rehabilitation for each individual.
09:30 – visiting my complex patients
Once our handovers have finished, the real work for me begins. I visit my most complex patients and work with the occupational therapists to create personalised weekly therapy plans.
My role involves helping patients who have experienced complex surgery regain their fundamental physical functions, such as their mobility, balance and strength. I am also respiratory trained, which means I look after patients who have complex airways, are receiving ventilation support, or are at risk of respiratory deterioration.
Since everyone is different, we take into consideration the individual needs, goals and desires of each patient by spending time with them and finding out what is important to them. Although I have quite a few years of expertise, I know that my colleagues at the Clinic all have different experiences and ways of working so I’m fortunate to be able to lean on them for advice if needed.
12:30 – time for lunch
Lunch time! And a perfect time to catch up with colleagues. There’s a real sense of ‘community’ at the Clinic and I often find myself bumping into senior staff members from different departments at lunch – it’s a good opportunity to informally catch up.
13:00 – team meeting
After lunch, my work continues and I pick up any last minute referrals from the wards.
Twice a month, the whole Therapies department meets and this gives me a chance to touch base with the Clinic’s dieticians, psychological therapists, front desk team and physiotherapists from other specialities.
Although due to the pandemic we are meeting virtually at the moment, these calls provide us with the chance to celebrate each other’s successes and help solve any issues others may be facing. This year has been particularly tough so I also make sure to check in on everyone’s wellbeing.
15:30 – clinical teaching and supervision
During the afternoon I might take part in clinical teaching and supervision. These sessions allow me to reflect, teach, learn and develop my knowledge to make sure I am aligned with the team’s overall objectives. As well as personal development, I find that these afternoons offer a chance to plan for future cases and innovations in how we treat our patients.
16:40 – wrapping up for the day
Towards the end of my day, I visit the Clinic’s Physiotherapy department on the sixth floor of our main building and meet with the Deputy Physiotherapy Manager to raise any issues, concerns or success stories from the day.
17:00 – leaving work
After handing over my cases to my colleague, I head back to the staff changing room to retire my uniform for the evening.
While changing into ‘civilian’ clothes, I take the time to start switching off mentally from work. I find that this helps me to relax and refresh after a busy day looking after patients, before starting all over again the next morning.
In May, staff from across The London Clinic joined forces to take part in Virgin Money Giving’s Captain Tom 100 Challenge. From collectively running 100km in 24 hours to swimming 100 laps of a local pool, our people are raising money equally for The Captain Tom Foundation and The London Clinic Charity, in support of our amazing Therapies team. You can still donate via our Virgin Money Giving page.
Any views expressed in this article are those of the featured consultant(s) and should not be considered to be the views or official policy of The London Clinic
Creating a centre of excellence in robotics
The London Clinic welcomed the arrival of our very first surgical robot, the da Vinci Surgical System, in 2005. As the first UK private hospital to offer robotic surgery for prostate cancer, the intention was to create a gold standard for robotic surgery right in the heart of Harley Street, the country’s leading medical district.
Since then, we have been home to each iteration of the da Vinci robot, including the latest da Vinci Xi, which has been in use since November 2020.
Additionally, we have introduced two other robots, the NAVIO Surgical System for orthopaedic cases and the AquaBeam Surgical Robot for prostate resection, becoming the only UK private hospital to house a trio of robots.
This month, we reached an exciting milestone with the da Vinci Xi, surpassing 10 successful colorectal cases on the new robot. The da Vinci Xi provides surgeons with an advanced set of instruments as well as an “intelligent” patient table, to use in performing robotic-assisted, minimally invasive surgery. The surgeon guides the robot remotely using a nearby console.
In the case of this latest colorectal surgery, the surgeon in question was Mr Manish Chand, a Consultant Colorectal Surgeon and Professor of Surgery based at The London Clinic, along with his partner, Consultant Surgeon Mr Jim Khan.
“For a number of reasons, the uptake of robotic surgery in certain fields has been slow within the private sector,” says Mr Chand. “Often, the robots have been limited to the field of urology; or there has been a lack of resources and training to perform robotic surgery.”
Each of these cases has delivered a variety of benefits compared to other forms of surgery, meaning better outcomes can be achieved for patients.
“There are a great many benefits to robotic surgery, which we are keen on sharing with our patients,” he continues. “Patients should know that there is often an alternative in robotics and that it may be a better choice than traditional open forms of surgery, particularly for more complex procedures.”
This recent milestone is indicative of The London Clinic’s ability to continue expanding robotic surgery into other fields, thereby allowing more patients who have previously been told they can only have open surgery to have minimally invasive surgery – and reap the many benefits of it.
For L.G., a patient who recently underwent colorectal surgery, it was the first time she had experienced robotic surgery.
“During my first consultation with Mr Chand at The London Clinic, he mentioned to me the possibility of having ‘robotic surgery’, which I had never heard of,” she says.
“Mr Chand explained to me very clearly how robotic surgery works and the benefits of it, including that it is less invasive and that it reduces the level of pain, the scarring and the recovery time. I am glad that we decided that robotic surgery would be the most beneficial option in my case and I could not be happier with the level of care I received.”
Speaking of the benefits of robotic surgery, Mr Chand adds, “Our patients have found robotic surgery to be hugely satisfying and comfortable. They have experienced little pain post-operatively, and have been able to go home quickly and safely when compared to other forms of surgery.
"We are also seeing a number of international patients enquiring for these procedures and recognising the expertise based at The London Clinic across many specialties.”
Building a centre of excellence
These advances in robotic colorectal surgery are the latest step in creating a centre of excellence in robotics at The London Clinic.
With the aim of advancing healthcare for the benefit of patients and the wider healthcare community, the mission is to continue further expanding this robotic offering into other fields of medicine.
Professor Prokar Dasgupta is a Urology Consultant and The London Clinic’s Robotics and Technology Lead, a position he has held since 2018. He works alongside an expert multi-disciplinary team, including consultants, nurses, anaesthetists and other specialists, to deliver top-quality care for patients.
“We have already established a world-leading programme in urology at The London Clinic, and I am thrilled that we are now extending tangibly into colorectal, the second biggest cancer,” he says.
“This is important progress, both for clinicians and their patients. Our aim is to continue building a centre of excellence in robotics, with the most advanced equipment that is available, in London’s leading medical district.”
Advancing healthcare for all: the vital role of clinical researchfeature, 20/05/2021
About Christine Topham
Firstly, what is a clinical research centre?
Put simply, a clinical research centre is a department or facility that supports research relating to healthcare sciences.
The London Clinic Research Centre (CRC) is a dedicated department responsible for managing and conducting clinical trials and other forms of research at the hospital. Our work is varied but can, ultimately, include determining the safety and efficacy of medications and treatments.
Our job is to oversee both the research projects themselves and the research participant’s journey. We also provide support to help researchers in running high-quality trials. This can lead to innovative treatment choices being brought to our patients, and can enable access to novel therapies that may not be available elsewhere.
What areas of research does the department cover?
Our Centre supports most types of research, covering the likes of oncology, orthopaedics and gastroenterology.
As well as providing research services for our commercial partners, The London Clinic’s charitable status means we can support academic work, which is very exciting. Of course, before undertaking each research project, we always consider its feasibility and if it is the right fit for the Clinic.
Our team also works in collaboration with commercial partners and the NHS to facilitate research delivery and can provide vendor support for specific requirements for a clinical trial. Vendor support means we would provide use of equipment at the Clinic, such as an MRI scanner.
Which clinical trials and other forms of research is The London Clinic’s Research Centre involved in?
We’re currently involved in 16 ongoing projects covering a variety of therapeutic areas.
One of them is in partnership with The Pancreatic Cancer Research Fund Tissue Bank. We’re helping to accelerate research into pancreatic cancer by analysing samples donated by pancreatic cancer patients and their close relatives. And we’re very proud of it!
This complex cancer has one of the worst survival rates of any forms of cancer. We’re hopeful that this crucial research will lead to better treatments and earlier diagnosis for pancreatic cancer patients.
What is the role of the patient/participant within a clinical trial and what type of processes would they experience during a trial?
The patients/participants are vitally important. Without their involvement in research we wouldn’t be able to move forward with new therapies or treatments.
Although the global need to develop a COVID-19 vaccine resulted in urgent clinical research and remarkably quick vaccine development, the preparation stage for a clinical trial before patients are involved takes a lot longer than people may think.
Likewise, the length of time for the clinical trial itself can vary greatly. An early, small-scale Phase 1 study, where we work with a small group of healthy volunteers, is relatively short. This time period would be very different to a late-stage, larger scale Phase 3 study, which is when we look for long-term outcomes by working with patients who have the specific condition we are hoping to treat.
In terms of the practical side of the experience, we’re in regular contact with the patient/participant. Before they take part, we walk them through a patient information sheet so they understand how things will work.
We explain what the research will involve, how many times they will need to visit the hospital, and any medication or device they will encounter – all the time answering any questions or concerns they may have. We try to make it a conversational process, providing them with any support they need.
Ultimately, participating in a research project gives patients a ‘voice’ as to what their care looks like. I believe taking part in a clinical trial can be quite an altruistic act. For example, we see cancer patients taking part in trials for new treatments when there are no other solutions available to them.
Has research by the department resulted in the development of new treatments for patients?
Clinical trials can take a long time, but we have some success stories! For instance, we were involved in a study for intra-operative radiotherapy (IORT). This is a new form of treatment for breast cancer and allows patients to receive surgery and radiotherapy in just one session.
This was a brilliant breakthrough as, usually, breast cancer patients are required to undergo quite gruelling radiotherapy after surgery. This new treatment method greatly reduces the treatment time and side effects, decreasing the overall impact on the patient.
Away from oncology related research, we’ve been involved in providing new insights into the impact of marathon running on hips, and have worked with Mr Dinesh Nathwani, a Consultant Orthopaedic Surgeon, on three orthopaedic studies involving devices used within the knee.
How has COVID-19 impacted work done by the department and the overall awareness for clinical research?
When the pandemic hit last year, all research was halted and our focus shifted completely towards COVID-related research.
Although as a designated COVID-free zone we weren’t able to support research that involved COVID-19 patients, we were able to take part in research that looked at the global impact of the pandemic and the effects it had on cancer patients undergoing elective surgery.
Due to the impact of the pandemic on the NHS, we’ve also helped by alleviating the bottlenecks of NHS research not related to COVID-19 by supporting study delivery. We’ve done this by working in collaboration with NHS trusts and providing various clinical trial services.
The COVID-19 pandemic has certainly increased overall interest in the societal benefits of clinical research, however many patients understandably aren’t very keen to visit a hospital at the moment. I am hopeful that over time this anxiety will reduce.
What are the department’s plans for the future?
We want to continue developing innovative treatments that may not be possible elsewhere by engaging more patients into research.
Hopefully, thanks to the success of the COVID-19 vaccine trials – and the publicity that came with it – interest in clinical research will continue increasing. Ultimately, our mission is to develop life-saving treatments for patients. The more awareness for that mission, the better.
Journey to a pain-free life: tackling complex regional pain syndrome
Complex regional pain syndrome (CRPS) is a widely misunderstood condition that causes persistent severe pain.
After being diagnosed with CRPS as a child, Ruby Chamberlain (now 21 years old) has suffered from increasingly debilitating pain that has prevented her from taking part in many of the everyday activities many of us may take for granted – including sleeping for more than 30 minutes at a time.
In this interview, Ruby kindly shares her personal experiences of living with – and raising awareness of – this mysterious condition and her hopes for life after lockdown following her spinal cord stimulation surgery at The London Clinic, which has significantly reduced her pain levels.
What were your initial symptoms and how were you first diagnosed?
The pain began in my left foot when I was around eight years old and gradually spread into my arm and back. I eventually felt pain in almost all areas of my body and had to become reliant on crutches and wheelchairs.
Due to my young age, doctors mistook my condition as ‘growing pains’. This meant my diagnosis of CRPS took three years, including visiting countless different doctors and pain clinics.
When I was 12, I attended a pain management course in Bath and found the support amazing. Although the pain in my back was still an issue, I felt like I was on the path to feeling better and was well enough to take my GCSEs and A Levels at school.
However, when I started university my condition declined. There were a few incidents during my second year when I couldn’t even get out of bed. I found this time at university particularly difficult as it felt like I was eight years old again, with this really scary pain that was now spreading throughout my hips, legs and feet. The pain was so bad that I couldn’t sleep for more than 30 minutes at a time.
After pushing through my second year, I moved to London to start a work placement as part of my degree, but I had to leave as the pain became debilitating. I couldn’t even sit upright for a few minutes at a time. I moved back in with my parents, who had to help me do everything including showering and going to the bathroom.
Can you tell us a bit more about complex regional pain syndrome?
Not much is known about CRPS, but for me I understand it as the ‘wires’ in my nervous system being crossed, meaning my brain can’t interpret pain properly. I imagine my brain is receiving a message from my body that says, “This is awful, this is awful, this is awful.”
Personally, it feels like being trapped inside my own body and not having any control whatsoever. Before my surgery I would have spasms every day through my back and legs and my family would have to physically hold down my legs.
Although the condition is fairly uncommon, I’ve connected with quite a few people my age online who have CRPS. Strangely, my cousin also has the condition, although for her it’s localised in her foot.
What impact has complex regional pain syndrome had on your life?
The impact on my life has been huge. Before my surgery, I couldn’t plan to do anything in advance because I didn’t know how I was going to feel. I would plan to meet a friend for a cup of tea and then feel awful on the day itself and have to cancel.
I’m a very sociable person so it was extremely difficult to accept that I wasn’t able to do the things other people my age were doing. When I put my mind to something I’m determined to do it, but CRPS meant I just physically couldn’t. It was exceptionally frustrating and had a huge impact on my overall mental health.
What led to you fundraising for your spinal cord stimulation surgery and were there any highlights during the fundraising period?
For me, setting up the GoFundMe to fund my spinal cord stimulation surgery was out of sheer desperation – it felt like the last chance. I’d worked so hard for my degree but I knew I’d have to drop out if nothing changed. It also felt like a race against time to find treatment before the pain spread further in my body and became even worse.
I’ve never been open about my health as I’ve always felt ashamed by it. Society often assumes that young people should be at their optimal level of health so it was hard for me to be vulnerable by explaining openly what I was going through and asking for people to donate.
After setting up a GoFundMe online, all I initially did was share the link on Facebook and Instagram. The response was overwhelming – so many people in the first two days donated very generously.
My friends and family were amazing during the fundraising period. It was tricky as our fundraising activities had to be done with the COVID-19 restrictions in mind, but we held virtual eating challenges and a drag competition, which even saw my dad – who is super masculine – compete!
The biggest highlight for me was reaching the full fundraising target. I used Twitter to ask people with large followings to share the GoFundMe link with their followers for awareness.
Towards the end of the fundraising process, I tweeted a YouTuber one day asking if they would share the link with their followers. A few minutes later I received a notification that said the YouTuber had anonymously donated the final amount I needed – I was over the moon.
What treatment did you undertake at The London Clinic and what did it involve?
I had spinal cord stimulation surgery, which means a pacemaker-like battery pack connected to electrodes in my spine is inserted under the skin in my waist.
Although the surgery was a big undertaking, it has massively exceeded my expectations. There isn’t a finite cure for CRPS so I still struggle with pain every day and I still have to manage my symptoms.
But the surgery has meant I am no longer reliant on my wheelchair and walking aids. In some parts of my body, my pain levels have fallen by 70%. It’s incredible.
My time at The London Clinic was great, especially considering my operation took place during a pandemic. My doctor, Dr Moein Tavakkoli, was so calm, which put me at ease from day one.
Due to COVID-19, I had to self-isolate before arriving at the hospital. After arriving, the staff made me feel at ease and the whole process was very efficient.
How does your generator work?
The generator has several settings for reducing pain, so after surgery we had to work out which settings worked best for me. To be honest, it was a gruelling process emotionally to work out the ideal settings for me, but now that it’s set up it feels like I’ve woken up in a new body.
I feel like I’m learning all over again what I can do and what my body can do, but I haven’t had to use a walking aid or wheelchair and I can even take the dogs out for a walk, which has proved to be a huge boost for my mental health.
I do have to say that there have been some funny moments during this whole experience. I have to charge the generator with a wireless charging pad and the noise it makes when it’s finished charging is very loud. It went off when I was at university and everyone thought it was a fire alarm!
What was the most challenging or unusual aspect you have faced while battling this condition?
The oddest aspect for me was the number of people who commented on how ‘lucky’ I was to rest at home when I was really unwell.
For me, being stuck at home with this awful pain reminds me today of the lockdowns we’ve all experienced during the COVID-19 pandemic, but without the ability to do something productive, or take up a new hobby such as yoga.
I hope that one benefit from these lockdowns and time working at home is that people will have a better understanding for those who have disabilities or are bed-bound – we have always lived like this and will continue living like this.
There are many aspects in the world that can be improved for those with disabilities but one main point for me is the need for flexible working offerings. I was forced to leave my work placement due to the pain, but having the option to work from home would have made a huge difference to my life.
How has the operation helped you and what can you do now that you couldn’t do before?
Although it sounds like a cliché, the operation has truly allowed me to live again – everything has changed. I feel like I now have all this time to think and just enjoy life. I’ve even started studying again remotely for my economics degree.
It’s also made a huge difference to my friendships and relationships as before my operation I was so poorly I couldn’t even hold a conversation with my friends. I didn’t realise how cloudy my brain had become due to the constant distraction of pain, so this treatment has allowed me to fully engage and interact with people again.
The lockdowns have obviously resulted in restrictions as to what I can do, but I’ve already loved being able to do things that other people might take for granted – yoga, dog walks and even just having the ability to sit upright for hours, not minutes!
What has helped you personally to get through your treatment?
My family has been incredible, along with my university housemates and best mates from home. Together, they’ve been an amazing support network and have kept me positive through all of this. For example, there might be a day when I’m not feeling well at all and they’ll say, “Sit down and we’ll cook you dinner.”
Since social contact has been restricted this year, my dogs have also given me the motivation to go out, even if I’m not feeling quite as well. I’ve used my dog walks as a way to track my progress by comparing the distances I can walk each week.
What are your plans for the future?
I have two big goals for the future. Firstly, I’d love to work in economic policy, so I’m hoping to move to London to live and work there over the summer or after graduation – there’s no way I’d be able to do that before the surgery.
My second goal is to raise awareness for invisible disabilities. I feel like the conversation about invisible disabilities is finally picking up so I’d love to be involved with this.
I’m also just looking forward to having some fun with my friends after this horrible pandemic is over. I think we all deserve that!
CRPS: a clinical perspective
Dr Moein Tavakkoli is a consultant at The London Clinic who has huge experience in managing patients with refractory pain, often of pelvic or spinal origin and undertakes pain procedures including spinal cord stimulation, peripheral nerve and sacral nerve stimulation. He is also Ruby's specialist.
Speaking about complex regional pain syndrome, Dr Tavakkoli shared: “Ruby came to me with a long-standing history of refractory neuropathic back pain, which remained stubborn to all other treatments.
“CRPS is a rare condition that occurs when minor trauma to soft tissue in the body causes sensation to nerves in that region. An individual’s tissue will heal from the trauma, but the sensitivity experienced to the nerves in that region will continue, transforming into pain signals received by the brain.
“The pain experienced is as ‘real’ as any other pain, but the mechanisms are different to that experienced by a broken bone, for example.
“The implant provided to Ruby can be thought of as a pacemaker for the spinal cord – it works by sending counteracting electrical signals to the brain through spinal cord simulation. The device will last for around 10 years, after which we would consult with Ruby to see if it is still needed as luckily the pain associated with the condition can reduce over time.
“It’s important to note that for those with CRPS and other chronic conditions, a reduction in pain isn’t the only thing that needs to change in order to improve someone’s quality of life.
"Over time, those who experience extreme pain will notice that their muscles become weaker due to lack of use, which is why we would also offer physiotherapy as part of a multi-disciplinary approach to help regain strength.”
Dying Matters: how can you be in a good place to die?
Dying is a fact of life. It happens to all of us. Yet, we often shy away from talking about it.
Experts, however, believe we need to start talking more openly about dying to ensure that we die in the best possible place.
Dying Matters Awareness Week is an important annual event that raises awareness about dying. Taking place from 10-16 May this year, it’s an opportunity for people to start talking about what would matter to them most when the time comes, and to explore options and start thinking ahead about how they would like to die. The first thing to realise is: this looks different for everyone – and it needn’t be morbid.
We spoke to experts around The London Clinic about why it matters to talk about dying and how we can ensure we are in a good place to die.
Carmel Gordon, Critical Care Outreach Nurse Consultant
As an outreach nurse, the number one question we ask is: “what’s in the best interest of the patient?” It’s our responsibility to talk openly and honestly with patients who are nearing or are at the end of their life, and to understand their wishes.
We can certainly treat symptoms, we can take patients to intensive care, but ultimately it’s about finding out what the patient wants – and sometimes that might just be to be comfortable. Our multi-disciplinary team is here to give each of our patients that personalised support.
I’ve worked at The London Clinic for 30 years, and I’ve been a nurse for longer still. My work has taken me all over, including to the Middle East. It’s incredible how dying is treated so differently between cultures.
Above all, dying shouldn’t be a taboo subject. Nobody lives forever and we must get better at talking about dying. Only then will we ensure our affairs are in order and our wishes are understood.
I’ve been privileged to have witnessed some incredibly beautiful, moving deaths. If we understand what the patient wants and we’re proactive, we can achieve anything! We’ve held a child’s first communion by a family member’s bedside. We’ve organised weddings in our oncology unit.
On one occasion, I was given the morning to source a wedding cake. I ran to our local Waitrose and, even at such short notice, the staff prepared the prettiest icing. People will really come together to ensure your wishes are met if they know them.
What we have to remember is that people who are dying are still living. Laugh with them, talk with them. Regardless of how scared you might be, they need you there.
Scarlett Nash, Palliative and End of Life Care Facilitator
I’ve spent over a decade working with hospices, hospitals and the community to address “the elephant in the room”. What often comes as a surprise to people, particularly later in their grief, is that their journey feels a lot easier when they are able to speak openly and truthfully to their loved ones who are dying.
When we refrain from talking about dying and we aren’t prepared, all our choices and the admin that comes with them, like financial affairs and funerals, are left to our loved ones.
The kindest thing you can do for your loved ones is to help them prepare for your death – and it doesn’t need to be all doom and gloom! You can have a laugh with them, break the ice. Why not use the next roast dinner to understand what your parents or best friends would want when their time comes?
We’re exceptional about talking about birth, the due date, the parents’ birth wishes. So why don’t we apply the same effort in making our wishes and preferences known in death? We should be celebrating each person’s life when they leave this world and give people an exit that’s aligned with what they would want.
For some, this will be in the writing of their wills combined with an advanced care directive and advanced care plan (effectively documenting your medical treatment and wishes). For others, this may be as simple as ensuring their favourite song is played at their funeral or the type of burial they would prefer.
People often don’t like thinking about dying, which I can empathise with massively! Life, after all, is about living.
However, modern medicine, no matter how advanced, can only help so much. Eventually, Mother Nature will have her way, so it is equally important to remain realistic and practical.
Many deaths I have supported have either been gradual or very sudden. Although what we die from remains out of our control, I have witnessed the most moving and ceremonious deaths, which were driven by the patients’ calm and measured attitude towards dying, and how engaged they were in their discussions.
Many families I have supported after their loved ones have died remain eternally grateful that they were accepting of their fate and, in turn, this helped their grieving process hugely.
From nursing the dying for so many years, I have recognised that there is such a thing as a “good death”. And so, I’d like to leave you with the words of Kimberley St John (age 32), a Palliative Care Nurse and best friend who died suddenly in July 2020: “None of us know how much time we have left. Use it wisely.”
Adrian Stones, Head of HR
Working for a hospital has really reshaped how I feel about dying. Prior to The London Clinic, I probably wouldn’t have given it much thought. Now, I recognise that everybody is going to die one day. Wouldn’t you want your death to be a good one?
I’ve been at The London Clinic for nearly six years. My role is to support our staff and direct the administrative side of our organisation. However, I am often required to be a witness for patients who are writing their wills. This can be emotional and challenging sometimes, but I’ve met some wonderful people and families through it. It’s a privilege, even just momentarily, to be there.
The important thing is that people have the agency to make these kinds of decisions; that they make them before they’re unable to. Supporting patients through this practical process has made me realise that I don’t want to wait until I’m in a hospital.
I’m already thinking about my living will and what I want to happen when I die. I’m planning on visiting a woodland cemetery soon that might end up being where my ashes are scattered. But it doesn’t need to be morbid. Why not make a day of it?
The more we talk about dying, the less painful it becomes. People sometimes like to avoid talking about it because it’s emotional – but those emotions exist and you’ll have to confront them one day.
What’s more, in encouraging your family to engage with your wishes about how you die, you’re helping them too. Educate yourself about what the options are. That’s going to put everyone in the best possible position.
I’ve always loved wine collecting and when my time comes I’d like to spend my final days enjoying it – anything leftover, people can have it my funeral. I wouldn’t like lots of palaver. A low-cost funeral with some really pretty flowers. When it’s my time, it’s my time.
Rachel Caesar, Psychological Therapist
In my role as a Psychological Therapist, the subject of mortality comes up often, as well as grief, loss and sometimes regret. It’s my role to listen and guide clients so that they can talk and explore these feelings openly and freely if they arise during a session. Clients are referred to me at The London Clinic, most often by clinical nurses, and I’ll arrange sessions with the patients to offer them support.
When I think about dying, it wouldn’t make sense to me to avoid talking about it. It’s part of all of our lived experience. In fact, talking about dying feels healthy. We can understand our own and each other’s wishes: how and where we want to die, even our plans for after death. Talking is about learning. I understand why it’s hard for people to talk about it.
As with any taboo subject, there’s a certain societal ugliness about dying which means people don’t feel they’re able to bring it up. I’m pleased when people can talk about things that are troubling them during sessions.
Unfortunately, not everyone is comfortable having conversations about dying, whether patients or even healthcare workers themselves. The Palliative Care team at The London Clinic are incredible in that they understand the emotional, spiritual and individual side of dying, rather than just the medical side, the need to cure. Their work is so valuable and complements my role as a therapist to ensure people get the best support.
I’d like for people to understand that talking about dying can be hugely helpful, whether you’re at your end of life or not. After all, death is not the opposite of life, but part of it.
The 100 Challenge: How therapies help to make "a life worth living"feature, 12/05/2021
About Carley Gee
The importance of therapy
Never has there been a period that more clearly demonstrates the need for therapy services than this last year.
The need we have most likely all felt for someone to view us as an individual and care for us in a holistic and personalised way has been overwhelming. Whether that be psychological therapies to support mental health or physiotherapy for aches and pains gained from working from home.
Carley Gee, Head of Therapies, helps a patient in July 2015.
Although these two forms of therapy may be familiar to many, we are also privileged to offer our patients aquatic therapy, occupational therapy, dietetics, complementary therapy, and speech and language therapy.
“A life worth living”
When considering a career in therapy, a family friend who is a doctor said to me: “You need to make the call, do you want to save a life or be a therapist who can make a life worth living?”
This really resonated with me and my own personal values and, ultimately, led me to the career path I have taken to date. I have never looked back.
And this is what The London Clinic’s Therapy services do every day – we make a life worth living through a wide variety of innovative services, processes and equipment. Not only for our patients, but in support of our staff and the wider community.
Dedicated support for our patients
One of the most rewarding aspects of my job is that my team members are amongst the few staff members who are with patients throughout their entire journey at the hospital.
We work on every clinical floor of the hospital and truly get to know our patients as individuals before, during, and long after their stay or acute episode of care.
Lisa Cullum, Aquatic Therapy Lead (left), and Charlotte Church, Senior Physiotherapist (right), in July 2017.
We place the patient at the heart of everything we do and work very closely with the hospital’s wider multi-disciplinary teams, providing a seamless journey for our patients across multiple Therapy disciplines if required.
This might include helping a patient improve their mobility after surgery, or by providing emotional well-being support for those who have come to the end of their cancer treatment.
We tailor-make our treatments to help set realistic and individual goals for each patient, and support them in achieving these goals.
But we don’t just treat symptoms and cure; we listen, prevent, educate, treat and empower the people we see.
The 100 Challenge
Along with continuing to help patients and improving patient care, one of the biggest goals for my team is to nurture our current and future talent, helping them to develop both personally and professionally. We’re the first to offer support to others to help them grow, but we also want to help the individuals in our team develop their skills for success.
We’re hoping that the money raised through our second annual fundraiser, the 100 Challenge, will help us do this.
Want to help? Our Physiotherapy team will collectively walk and run 100km in 24 hours on Friday 14 May 2021.
Interested in completing your own 100 Challenge? Learn more about the challenge and how you can help us reach our goal of £20,000 by reading this information document.
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