Ask the doctor - surgery

Read expert medical advice with doctors' questions and answers from Prima, SHE and Good Housekeeping

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What are the rules about having cosmetic surgery on the NHS? My breasts have always been very big, and I'm so self-conscious about them that I've become round-shouldered because I hunch forward to hide them. My back and shoulders ache constantly and I have no self-confidence, but my GP says breast reduction is cosmetic surgery and can't be done on the NHS.

Cosmetic surgery isn't routinely available on the NHS, but there are several exceptions. These include correcting congenital abnormalities, such as cleft lip; improving disfiguring scars resulting from injury; and sometimes correcting physical problems that cause significant psychological distress. Ask your GP about a referral to a psychiatrist or psychologist who could assess you and support your request for a breast reduction to improve your mental wellbeing. Alternatively, since your posture causes you pain, you may be eligible on physical, not just cosmetic, grounds - a similar example would be unsightly varicose veins that cause severe aching in your legs.

Dr Sarah Jarvis, Good Housekeeping (Feb 10)

 

I have a horrible pain between my toes that has been diagnosed as a Morton's neuroma. My doctor is considering referring me to a podiatrist for surgery, but I had no idea they carried out operations and wonder if it's safe?

Although we often see them for very minor problems, such as verrucas or warts, podiatrists are qualified to treat a wide range of foot conditions, fit specialist insoles and carry out screenings for people at high risk of foot complications. They train full time for three years and have to be registered with the Health Professions Council, which guarantees their quality. Some podiatrists then train for several more years as specialised podiatric surgeons, which involves 10 years of training under close supervision. They are highly skilled and I refer patients to them for a variety of foot operations, including bunions and operations on trapped, enlarged nerves, which is what your neuroma is. So book your appointment with confidence!

Dr Sarah Jarvis, Good Housekeeping (Dec 09)

 

I have an ovarian cyst the size of an orange, which my specialist wants to remove (along with my ovary) in case it becomes infected. I've heard that it's easier to drain it under local anaesthetic. Should I question his advice?

Cysts are fluid-filled sacs. Ovarian cysts can be symptom-free, as in your case, or they may cause bloating, discomfort and a change in your periods. Occasionally, though, they can become twisted or ruptured, producing severe pain. Sometimes they're caused by other conditions such as endometriosis or polycystic ovarian syndrome (PCOS). In pre-menopausal women, cysts are formed as part of the normal reproductive cycle, when an egg is matured and released from the ovary. These cysts are generally small (measuring just 2-5cm) and tend to resolve themselves without needing treatment and require observation only. Larger ones, like yours, are more significant though. If you're over the age of 40, your one is likely to be a cystadenoma, which is quite harmless. However, the only way for a specialist to be sure that it is not a cancer is to remove it, as an exact diagnosis can't be made from a routine ultrasound scan and blood test. Draining the fluid off your cyst won't aid the diagnosis and it's likely that it might simply refill, leaving you back in the same situation. I suggest you talk to your gynaecologist about whether the operation could be done by laparoscopy (keyhole surgery) or if you would need a larger incision (a laparotomy). Depending on the size and position of your cyst, the surgeon may be able to conserve part of your ovary, without removing it entirely

Dr Louise Selby, SHE (Dec 09)

 

Surgery fears
I need to have my gallbladder removed because of a large stone. The surgeon says he'll try to do it using keyhole surgery, but what are the chances of waking up and finding I've had a conventional open operation?

The most popular way to remove the gallbladder is by keyhole surgery, which is attempted in 95 per cent of cases. If difficulties are experienced during laparoscopy, the surgeon will immediately convert to
an open operation. This is not a failure of surgical technique, simply
safe practice. Conversion to an open operation occurs in less than one per cent of operations for uncomplicated gallstones. If you have cholecystitis (an infected gallbladder), the associated scar tissue and thickening of the gallbladder means there is a five per cent chance of the surgeon converting to an open operation. Your surgeon can tell you about his or her personal statistics in this regard.

Dr Sarah Brewer, Prima (Oct 09)

 

How can I avoid MRSA?

As I'm soon to be admitted to hospital for an operation on my knee, I'm very concerned about picking up the superbug infection MRSA while I'm in there. Is there anything I can do to help stop me catching it?

MRSA (Methicillin-resistant Staphylococcus aureus) is resistant to traditional antibiotics, making it harder to treat than standard infections. It's usually passed on by human contact, though it can be spread by towels, sheets or clothes used by someone else who has it.
You can be an MRSA carrier without having any symptoms, which is why some hospitals screen patients before they're admitted, taking skin swabs and urine and blood tests, to keep the infection out of the
hospital. If you are an MRSA carrier, you may be given treatment before admission to eliminate the bacteria, in the form of an antibiotic cream and antiseptic wash. Once you're in hospital, follow simple hygiene: wash hands carefully after using the bathroom; wash them before and after meals and ask people to wash their hands carefully
before visiting you. Hospitals publish their MRSA infection rates at the Department of Health website at www.dh.gov.uk.

Dr Louise Selby, SHE (Sept 09)

 

Being a carrier for MRSA

I recently had a pre-operation assessment and was horrified to be informed that I was a carrier for the ‘superbug’ MRSA. I was given liquid to wash in and a cream to apply to my nostrils for a week and have now been told that it’s gone. I thought MRSA was always serious and often a killer.

Despite all the publicity, and the fact that cases of MRSA are undoubtedly rising in the UK, in the majority of cases it does no harm at all. Like you, many people ‘carry' it on their skins, and it causes problems only if it gets into the body - through a wound after an operation, for example. The treatment you had has a very high success rate in getting rid of the bug, and if you have the all-clear you can be completely reassured. Of course, in a hospital setting, it's a cause for concern, but it's still an extremely rare cause of death, particularly in younger people - say, under 75 years old - who are otherwise in good health.
Dr Sarah Jarvis, Good Housekeeping

 

MRSA concern

When I went into hospital for a routine check-up the doctors told me that they had found MRSA in my nasal passage, but no sign of infection. Since then I’ve heard that a deadly form of MRSA can affect healthy adults. Should I be concerned?

MRSA is a strain of the bacterium Staphylococcus aureus, a bug carried harmlessly by about one in three people. Problems with MRSA traditionally occur in hospitals, where people are vulnerable to infection.
Its resistance to most conventional antibiotics also makes it tough to treat.

I think the deadly strain you’re talking about is PVL MRSA. It does seem to be more virulent than previous strains of MRSA and isn’t confined to hospitals. But it is very rare in the UK, with just seven associated deaths in the last two years, so I don’t think you should worry. Simply washing your hands is the most important measure to help prevent contamination – invest in an antibacterial hand gel, such as NO-GERMS Instant Hand Sanitizer (available nationwide).
Dr Louise Selby, SHE

Do I really need a hernia operation? 

I recently developed a lump in my groin, and my doctor has told me I’ve got a hernia and I should have an operation. Is this necessary?

Hernias are caused by weaknesses in the stomach wall, which let some of the intestine poke through. The groin is the weakest point in your abdominal wall, which is why hernias commonly occur there. Although they don’t usually cause problems, they do tend to grow and can become very uncomfortable. There’s also a small chance that the bit of intestine poking through will get stuck and squeezed, depriving it of blood. At best, this causes severe pain. At worst, it can be fatal. That’s why we usually recommend hernias are fixed – the operation is fairly minor and very successful.
Dr Sarah Jarvis, Good Housekeeping

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The answers to specific problems may not apply to everyone and are not substitutes for professional medical advice. If you're worried, see your GP. For more information, visit www.netdoctor.co.uk