Ask the doctor - no appendix!

I had an operation recently in which my surgeon checked my appendix. I was shocked when he said I didn’t have one – is this common?

The appendix is often viewed as a vestigial organ, but it contains lymphoid tissue and acts as a reservoir for healthy probiotic bacteria to
replenish the gut after taking antibiotics. Absence of the appendix is thought to occur in only around one in 100,000 people. However, people who
have their appendix removed do not seem to come to any harm as a result.
Dr Sarah Brewer, Prima (Feb 11)

I’m having surgery on my knee next month, but I’ve read that deep vein thrombosis is a possible complication.
How can I stop this happening to me?

Deep vein thrombosis, or DVT, is a huge – but fortunately largely preventable – problem. DVT can cause a potentially fatal clot on the lung, called a pulmonary embolism. To put it into perspective, DVT and its complications kill 17 times more people than MRSA in the UK every year – and half of these cases happen while people are in hospital. These days, hospitals are very aware of the need for prevention and you should be assessed
for your risk of DVT when you’re admitted. It’s a common complication of being immobile for any length of time, and older people, women
taking hormones or those having surgery on their legs are at especially high risk. You’re likely to be offered preventive treatment, either in the
form of daily injections or medicine to reduce the chance of a blood clot. Several new medications have been developed
recently and good progress is being made at reducing the impact of this serious condition.
Dr Sarah Jarvis, Good Housekeeping (Aug 11)

I’ve been told that I need a carpal tunnel decompression. Is it always successful, and how long will I need off work?

Carpal tunnel release is the surgical loosening of a bony tunnel in the wrist, to relieve pressure on the median nerve. This helps to relieve pain, numbness, tingling or electric-shock-like symptoms in the thumb, index and middle fingers. The operation is often carried out under a local anaesthetic and light sedation. Nine out of ten people experience greatly improved symptoms following surgery, though recovery is gradual, and it can take several months or even a year to regain full grip strength. You will usually wear a post-operative splint for four to ten days until the sutures are removed. You may then wear a wrist splint or glove until the pain subsides, and may be advised to elevate your hand and perform exercises that move your fingers to minimise swelling and stiffness. Recovery time depends on the severity of symptoms, but pain in the palm of the hand is common for several months, and the average time off work is five weeks. People whose work involves bending and twisting of the hands and wrists tend to return to work later than those whose work does not involve particular hand movements. You should avoid heavy lifting and repetitive movements for six to eight weeks.
Dr Sarah Brewer, Prima (Feb 11)

I am having a cyst on my thyroid removed as it is producing too many hormones. Why do I need to take antithyroid drugs first? Do I really need surgery at all?

Before having an operation on your thyroid gland, it’s important to ensure thyroid function is normal. Having an overactive thyroid increases your heart rate and blood flow, both of which make a general anaesthetic and surgery itself more risky. If you have hyperthyroidism, you usually take antithyroid medication for four to six weeks before surgery. You may also take iodine for ten days before surgery to reduce the size of the thyroid and the blood vessels supplying it. A beta-blocker drug can reduce symptoms, such as a rapid heartbeat or trembling. Surgery is necessary because, although treatment can control an overactive thyroid gland, a cyst may continue to grow and restrict breathing if not removed, and it’s also important to examine the lump properly to find out the underlying cause.

Dr Sarah Brewer, Prima (Jan 11)

If you have an operation for suspected appendicitis, will the doctor still take out your appendix, even if it is found to be normal and healthy?

Appendicitis pain typically starts around the belly button. Once inflammation spreads through the wall of the appendix to reach its surface, the pain becomes localised in the lower right-hand side of the abdomen. Other conditions can mimic appendicitis, however. If a normal appendix is found during a classic appendectomy operation, it is almost always removed, unless bowel inflammation is present (such as Crohn's disease). Otherwise, if you develop appendicitis in the future, the diagnosis is likely to be discounted if a classic scar is present - doctors will assume it has already been removed. When the appendix is normal, the surgeon needs to look for other causes of your symptoms, and will examine your abdominal cavity for problems such as a twisted ovarian cyst, or inflamed fallopian tube - this may mean making a larger incision.

Dr Sarah Brewer, Prima (Aug 10)

I had laser eye surgery a few months ago to correct short sightedness. I'm pleased with my vision but have developed dry eyes. Is this due to the laser surgery?

Dry eyes are a common cause of eye discomfort, grittiness, burning sensations and blurred vision. It affects both sexes but is particularly common in women - especially after the menopause. Many things can trigger dry eyes, including using a computer screen, watching TV, driving, reading or concentrating - which tends to reduce your blink rate. Dry eye syndrome is also the most common side effect of Lasik laser eye surgery, although symptoms are usually temporary. Most people find dryness decreases after a few months, but a small number of people still experience dryness one year on. If symptoms persist, ask your surgeon for advice. Drops such as Clinitas Soothe (£6.49 for 20 doses) contain sodium hyaluronate, which draws water into the tear layer of the eye. A new treatment, Rohto Dry Eye Relief (£6.99 for 20 doses), contains hyaluronic acid plus tamarind seed polysaccharide, which helps to repair the surface of the eye. Both are available from Boots.

Dr Sarah Brewer, Prima (Apr 10)

I need to get my gallbladder removed because of a large stone. The surgeon says he will try to do it using keyhole surgery. What are the chances of me waking up and finding I've had an open operation?

The common way of removing the gallbladder is using keyhole surgery or laparoscopy, 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 seen as a failure of surgical
technique, but simply as safe practice. Conversion to an open operation occurs in fewer 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 (Apr 10)

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 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

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 netdoctor.co.uk

ADeep vein thrombosis, or DVT, is a
huge
– but fortunately largely preventable –
problem. DVT can cause a potentially fatal
clot on the lung, called a pulmonary embolism.
To put it into perspective, DVT and its
complications kill 17 times more people than
MRSA in the UK every year – and half of these
cases happen while people are in hospital.
These days, hospitals are very aware of the
need for prevention and you should be assessed
for your risk of DVT when you’re admitted. It’s
a common complication of being immobile for
any length of time, and older people, women
taking hormones or those having surgery on
their legs are at especially high risk. You’re likely
to be o ered preventive treatment, either in the
form of daily injections
or medicine to reduce
the chance of a blood clot.
Several new medications
have been developed
recently and good
progress is being made
at reducing the impact
of this serious condition.