Could the EndoBarrier be the next weapon of mass reduction?

Endobarrier

In this post, Dr Aruchuna Mohanaruban tackles the most asked questions about the EndoBarrier – a medical device for the treatment of type 2 diabetes and obesity.


UK obesity rates have continued to rise at an alarming rate, with figures higher than any other developed nation. Strongly associated with obesity is the increased susceptibility to developing type 2 diabetes (T2DM) which currently affects 3.2 million of the UK population. Bariatric surgery – a type of surgery aimed at inducing weight loss – usually by altering the stomach and/or intestines has revolutionised the treatment of these conditions and can lead to a 60% remission in diabetes. However, with demand for this type of surgery outstripping supply, there is a greater need to develop non-surgical alternatives to combat the ever-rising obesity and diabetes epidemic. (more…)

“You don’t defibrillate asystole…” and other arguments with creatives

It is a favourite pastime of anyone who works in healthcare to scoff at the mistakes we see when medicine is portrayed on film. From the back-to-front chest X-ray on Scrubs to the miraculous success rates of chest compressions in soaps we love to mock. However, for the last four years I have been working with various TV programmes to try to inject a degree of realism without dampening the drama.

This started with Holby City when I helped out on set, making sure that operating scenes looked realistic and that the actors could pass off as surgeons. This was my introduction to the tension between realism and plot. Being a medical drama, Holby had the budget and resources to try and get things right, but even they couldn’t keep viewers interested if they showed a lovely routine list of day cases where nothing goes wrong!

Holby led to me being approached by Eastenders,  which was a different type of work. With 6–8 million viewers every week, this is a show with massive reach. They have a surprising number of storylines involving medicine, ranging from characters with chronic health problems, through to the massive set piece car crashes and explosions. Even with the minor stuff, when they get it wrong they face a slew of complaints from the public and charities. Often Eastenders will want me to come up with injuries or illnesses that fit a story arc. For example, they will want someone stabbed, look like they are going to die, but then get better and be out of the hospital in seven days. This is normally straightforward, apart from making sure they aren’t reusing stuff from previous years!

Working on longer running storylines is more interesting, the most exciting of which was Phil Mitchell’s liver transplant story on Eastenders. They came to me wanting a way to rejuvenate Phil, who had become a belligerent drunk who had lost his sparkle. I suggested a storyline that took him into liver failure and then showed a long climb back to health, with a liver transplant as the final redemption. However, this was a story fraught with public health issues. It was well established that when the famous liver transplant recipient and footballer George Best started drinking again organ donation rates fell. (more…)

Would you give the gift of a kidney to a stranger in need?

 

As far as generous Christmas presents go, donating your kidney seems for many at the extreme end. However, for a few lucky kidney disease patients, this is the gift of a lifetime. Known as unspecified or non-directed altruistic kidney donation, this form of live organ donation is on the rise, and could potentially wipe the waiting list if more stepped forward. I met Frank Dor, a consultant transplant surgeon and Head of Transplantation at Imperial College Healthcare NHS Trust, who has carried out hundreds live organ donations.

The waiting game

Frank receives a phone call notifying him that a kidney from a deceased donor has been allocated to one of the recipients at Imperial. This single kidney is in high-demand as there are around 5,000 people on the UK NHS Blood and Transplant (NHSBT) waiting list for a kidney; some waiting for up to five years. Unfortunately, a few hundred of these will die in the meantime for lack of one.

These patients have chronic kidney disease, meaning they have lost their kidney function so dialysis three times per week becomes the norm. However, life on dialysis is debilitating, difficult and time-consuming. “Dialysis is merely a way of keeping people alive, it’s just a temporary measure that can never fully replace the kidney function,” Frank tells me. “Eventually patients on the waiting list get to a point where they start to lose hope and stop making plans for the future”.

The long-term solution is receiving a kidney transplantation, of which there are two types – living and deceased. Transplantation provides patients with the opportunity for a longer and better quality of life, with patients typically gaining 10-20 years of life compared to dialysis. However, the odds for receiving one are not favourable: there are 1,500 patients on dialysis in Imperial College Healthcare NHS Trust but only around 200 of those get transplanted every year. There is a huge gap between supply and demand nationally and internationally. (more…)

Lung volume reduction – new hopes and missed opportunities in COPD


COPD, chronic obstructive pulmonary disease, has traditionally been thought of as an irreversible and somewhat hopeless condition. Many patients with COPD may be missing out on the possibility for a dramatic improvement in their condition. They deserve better.

COPD, is a common and important condition. There are 1.3 million people with a diagnosis of COPD in the UK and it’s now the third leading cause of death worldwide. The main symptoms are breathlessness, cough and sputum production.

The term COPD encompasses a range of pathological processes, usually caused by smoking or inhaling other noxious materials. It includes chronic bronchitis – inflammation and damage to airways as well as emphysema – destruction of the lung tissue itself and damage to the blood vessels in the lung. In emphysema the walls of the alveoli (air sacs) break down. The lung tissue loses its elasticity and becomes baggy, and air gets trapped in the lungs making breathing uncomfortable. In some people the condition is caused by alpha one antitrypsin (A1AT) deficiency; the inherited lack of a defensive enzyme, which makes their lungs much more vulnerable.

There are treatments including inhaled medication, pulmonary rehabilitation and flu vaccination, and for people who continue to smoke, smoking cessation is the most effective. Despite the best standard care the condition is progressive and conventional treatments cannot so far reverse the underlying process. (more…)

How to PREPARE for surgery and speed your recovery

PREPARE for surgery

All types of surgery require preparation and, afterwards, recovery time. But according to the oesophago-gastric cancer team at Imperial College Healthcare NHS Trust, undergoing major surgery is like running a marathon. The PREPARE for Surgery programme, designed by the team, ‘trains’ patients for surgery based on their individual needs. It looks at different factors important to focus on before and after a procedure, including physical activity, diet, psychological wellbeing and medication management. Here clinical nurse specialist Venetia Wynter-Blyth explains how the programme helps patients adopt the good habits needed to aid their recovery.

The PREPARE for Surgery programme is all about treating a patient holistically and looking at the whole picture. We know when someone is due to have surgery, the psychological side of preparation is just as important as the physical side; so we work hard as a team to strike the right balance and have a positive impact on our patients’ post-operative outcome.

Once we know someone is going to have surgery for oesophago-gastric cancer, we invite them to our PREPARE clinic. We assess every patient in clinic and establish their ‘baseline’ measurements. This gives us a benchmark to improve on over the four to six weeks it takes to complete the programme, and prior to the patient’s surgery. Our surgical team makes sure they schedule procedures with enough time for patients to benefit fully from PREPARE. (more…)