01 Feb 2012
Health in the Workplace

Health in the Workplace: The Fit Note Explained

February 2012 brings you the fourth instalment of ‘Health in the Workplace’, produced in conjunction with – the Office Space Search Experts, and Consultant Surgeon and Health Expert, Mr Mike Dilkes.

In 2010, Search Office Space was made aware of a new medical statement issued by GPs. The ‘Fit Note’ (which was introduced on 6th April 2010) has replaced the ‘Sick Note’ which many of us have used several times in the past due to illness or poor health preventing work. However, many employers and workers are unaware of the fit note and the changes that come with it, so today, Search Office Space and Mr Mike Dilkes will explain everything you need to know.

What is the Fit Note?

The official term is ‘The Statement of Fitness for Work’, however most establishments have adopted the ‘fit note’ abbreviation. This medical statement is a form given to workers by their Doctor or GP when your health affects your ability to work.

What Does the Fit Note Include?

The fit note is likely to include advice from your doctor concerning how you may be able to return to work, rather than why you should refrain from work. It therefore offers a range of new options which employers can take into account, hopefully leading to your speedy return to work:

  • Revised flexible working conditions
  • A trial or phased return to work
  • Amended duties
  • Workplace adaptations
  • The fit note will also provide general details of the functional effect of the individual’s health condition.

Why Have the Changes Been Made?

The fit note provides employers with information that will help them ensure your swift return to work, as the note will provide advice on what you can, rather than what you can’t do. For many employees, work is hugely important in terms of income and health, as prolonged absence can cause its own set of problems, such as loss of confidence, isolation and de-skilling. The fit note also allows employers to develop a better working knowledge and relationship with the employee, line manager, GP, occupational health and HR departments. Furthermore, the fit note aims to save £240million over the course of 10 years as it reduces the period of statutory sick pay.

Understanding Your Fit Note

Although the fit note is primarily for advice on helping you get back to work, there are two options that your GP must choose from:

  • You are ‘not fit to work’
  • You ‘may be fit to work’

The latter option is when the GP will provide further information to your employer to help them ensure your swift return to work. If the first option is chosen, your illness or injury is deemed too server to work under any circumstance for a stated period of time.

Reviewing Your Fit Note With Your Employer

If your GP has stated that you ‘may be fit for work’, you will need to agree certain terms with your employer concerning your return to work:

  • What support you will receive
  • How this will happen
  • How your pay may be affected if your hours or duties have changed

However, in some cases, your employer may not be able to accommodate your new needs. If this is the case, you will not be able to return to work until you have fully recovered. You can therefore use the fit note as if your GP had stated you were ‘not fit to work’ and will not need to obtain a new note.

“Evidence suggests that there are economic, moral and social arguments that prove work is one of the most effective ways to improve one’s health and well-being. Today, within the current economic client, there is growing awareness that long term unemployment or absence from work is harmful to individuals’ physical and mental health. This is why the ‘fit note’ is so important, as it aims to get people back to work in a prompt fashion” says Mr Mike Dilkes.

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17 Jan 2012
Health in the Workplace

Health in the Workplace:Preventing Back Pain and RSI

January 2012 brings you the third instalment of ‘Health in the Workplace’, produced in conjunction with Search Office Space – the Office Space Search Experts, and London Laser Clinic’s Consultant Surgeon and Health Expert, Mr Mike Dilkes. This month, we aim to bring you some expert advice on how to prevent back pain, repetitive strain injury (RSI) and some top tips for looking after your joints or any soft tissue injuries.

“Did you know that back pain and musculoskeletal disorders are the UK’s second and third major causes of long term sickness and absence from work?” says Mike Dilkes. For employers, this is a worrying fact as the ill-health of your staff can affect your business hugely. It is also important for workers to understand that there are measures you can take to prevent injury or sickness of this kind.

Many people assume that back injuries only occur in workplaces associated with manual labour, as heavy lifting is often involved. However, back injuries can, and do, affect workers in all industry sectors. “Bad posture or sitting at your workstation for long periods of time can contribute to back pain, joint problems and RSI due to keyboard and mouse use in a set-up which is not ergonomically sound. One of the best ways of prevention is to manage pain before it strikes” says Mr Dilkes.

Search Office Space and Mr Dilkes suggest these top tips:

  • Take short breaks away from your desk and ensure you take a lunch break away from your computer.
  • Regular stretching exercises can be done at your desk which also helps muscular pain and circulation.
  • Asses your posture – is your chair at the optimum level so that you are sitting upright rather than hunched over your keyboard?
  • By ensuring the arm of your chair is level with your desk means that your arm will be in line with your mouse and reduce the risk of RSI.
  • Try to vary your role each day so as to prevent fatigue and reduce stress levels which could cause you to hold your body in a rigid fashion.
  • Bend your knees, place feet shoulder width apart and keep your back straight when lifting heavy objects. Tightening your abdominal muscles when lifting will also prevent any excessive force on your spine.
  • Lastly, if you do feel a twinge, or the beginnings of any type of pain, inform your employer sooner rather than later, as the necessary rehabilitation techniques can be put into place.

“Repetitive strain injury (RSI) affects an estimated one million people in the UK and is the major cause of absence from working environments, which means employers have it in their best interest to help staff minimise the risk of injury or pain.  Another top tip for joint or soft tissue injuries is to follow the ‘RICE procedure’ which involves Rest, Ice, Compression and Elevation of the injured limb. After two days of this treatment, heat can also be applied to the injury which will encourage blood flow and help speed up the recovery process” says Mike Dilkes.

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24 Dec 2011
Ear Nose and Throat Blog

Merry Christmas and Best Wishes for 2012

Merry Christmas and Best Wishes for 2012 from everyone at LLC

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22 Dec 2011
Tonsil Problems

Tonsil Problems – Summary Tonsillitis

Tonsillitis

Bad sore throats – true tonsillitis in adults is a very painful condition, often leading to the need to take time off work or studies to recover. It generally lasts for at least 5 days and can be triggered by glandular fever in teenagers. In children, it is associated with repeated upper respiratory tract infections, large adenoids, glue ear (hearing loss), ear infections. Tonsillitis can also be linked to other diseases such as psoriasis, bowel problems, joint aches, lethargy and possibly ME. Treatment: In adults, we recommend general anaesthetic inside-out laser vapourisation tonsillectomy, where the tonsil is vapourised using the scanned carbon dioxide laser, sometimes using a microscope and micromanipulator. In our experience of over 400 cases treated there has been a bleeding rate of less than one percent, 70 percent of patients did not need to change their diet postop, since pain levels were low, and lasted for around 7 days. This is a daycase procedure, an inpatient stay of 6 hours is recommended. We feel that it is much less painful than dissection tonsillectomy, which is the commonly used technique, little changed over 40 years. Because a small amount of tonsil tissue is left behind, there is a slightly higher revision rate a year after surgery, when compared to dissection tonsillectomy. Treatment: In children, bipolar, non laser dissection is used, since young children generally have little problem with dissection techniques. Children are kept in overnight to minimise risks post-operatively. Local anaesthetic is used after the operation before the child has awoken, in order to minimize postoperative pain. More Information: For more detail, including local anaesthetic tonsil reduction, please click on the conditions treated, tonsil problems, then laser tonsillectomy menu-tab above. Prices: Start at £800 inclusive.

 

Quinsy

 

quinsy.gifEven more painful than tonsillitis, this is an abscess on the inside of the tonsil, causing spasm of the jaw muscles, ear pain and almost complete inability to swallow. It is usually on one side only, and is often triggered by tonsillitis. Treatment: We recommend general anaesthetic inside-out laser vapourisation tonsillectomy, where the tonsil is vapourised using the scanned carbon dioxide laser, sometimes using a microscope and micromanipulator. Vapourisation is extended into the abscess cavity to exteriorise it so that repeated infections cannot occur.

Picture shows a left sided quinsy, the numbers mark the point of cute pus aspiration when drained.

 

Tonsilloliths

Smelly white lumps produced from the back of the mouth, they have a cheesy consistency and are produced from cracks and crevices in the tonsils. They can be associated with bad breath and recurrent sore throats, or a persistantly sore throat – chronic tonsillitis. Treatment: Local anaesthetic spray to numb the surface of the tonsil, followed by laser vapourisation. Approximately 50% of the tonsil on each side can be removed using this technique, which takes only a few minutes. If it is performed on 2 or 3 occasions a significant (90%) removal can be acheived, similar to that of other techniques, and this can be effective in treating tonsillitis as well.

 

Tonsil cancer

A tonsil which is enlarged on one side, painful, sometimes with ear pain, bleeding and swallowing problems, might be cancerous and needs to be looked at urgently. Initially a biopsy and a CT scan are the minimum requirement, to be followed by definitive treatment, which could be chemo-radiotherapy, radical surgery, laser resection or photodynamic therapy.

To view pricing information for this procedure, click here.

If you are interested in the technical information relating to this condition and its treatment by laser, click here to be redirected to the “doctor’s version” of this page.

 

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22 Dec 2011
Health in the Workplace

Health in the Workplace: Top 10 ways to De-Stress

This is the first in a series of articles relating to Health in the Workplace, produced in conjunction with Office Space Search Experts, Search Office Space.

Each week Search Office Space will discuss key issues associated with health, well-being, and working life – because after all, health is of the upmost importance.

Search Office Space have teamed up with London Laser Clinic’s Consultant, Mike Dilkes, to provide some expert advice on the subject.

This week, we focus on the top 10 ways to de-stress at work.

1. Positive Thinking

“Stress stems from negative emotions, so adopting a positive outlook is key to controlling stress levels”, says Mike Dilkes. It’s the tried and tested method of believing that ‘the glass is half full’ which can get us through stressful times. One of our top tips at Search Office Space is to write down three things from each working day that you are grateful for. This will help you appreciate what you have, rather than the ‘bad’ things that you may have been focusing on.

2. Active Lifestyle

You may have heard people say that exercise can reduce stress levels, and this is no myth. “Physical activity can alter your state of mind and allow you to identify the root causes of your stress” says Mr. Dilkes. Exercise also releases endorphins which generate a feeling of well-being, which will reduce stress further. It may be hard to fit in exercise depending on your job, but even the little things like getting away from your desk at lunch time and taking a brisk walk will help you to clear your head and unwind. One of the best forms of exercise to help combat stress is yoga, as there are specific breathing and meditation techniques involved.

3. Connect with People

A good support network is crucial for reducing stress, after all, ‘a problem shared is a problem halved’. Whether its colleagues within your office, or friends and family, they will each have a different view point on the situation and can provide you with an ulterior perspective, and hopefully a solution to your feelings of stress.

4. Time Management

One of the reasons you may be feeling stressed is because you have too much to do in very little time. However, no matter what industry you’re in, your working method should be based around quality, not quantity. Mr. Dilkes’ advice is to “Prioritise your work – concentrate on the most important tasks, and leave the least important tasks to the end of the day”.

5. Make Time for Yourself

In the UK, we have the longest working hours in Europe, with a typical day starting at 8.45am and finishing at 6pm. The Search Office Space top tip is to put aside two evenings to focus on yourself – whether it’s a hobby or just a night off, don’t feel the need to work overtime, it’s unlikely that you will do anything productive if you are already stressed. You should also try to ensure that you take a lunch break away from your desk – whether its 15 minutes or one hour – getting away from your computer or working environment can do you the world of good.

6. Avoid Bad Habits

Unhealthy habits like smoking or drinking alcohol will not solve your problems. At best they provide a temporary solution, which could in fact lead to new problems in the future. Mr. Dilkes says that “women are often better than men at coping with stress as they rely on their support network, rather than turning to ‘avoidance behaviour’. Try to tackle the cause of your stress rather than avoiding it all together.” Search Office Space’s top tip is to make a herbal tea, rather than a caffeine based drink. Even the act of making a drink for yourself allows you a moment of reflection and relaxation, so why not give it a try.

7. Challenge Yourself

By challenging yourself; you are being proactive, rather than passive. Set yourself a goal, or learn a new skill. “Activities such as volunteer work could also help stress levels subside, as you will become more resilient and confident – which in turn, helps you deal with stress.” If you feel that you don’t have enough time for volunteer work, Search
Office Space suggests that you set yourself a mini-challenge of helping out a colleague, or doing someone a favour every day. The effects can only be positive, as you will be helping someone in need, which will also boost your emotions and overall well-being.

8. Acceptance and Control

“Loss or lack of control is one of the main causes of stress in the workplace. However, in some cases, situations are beyond your control. Once you accept this, your stress levels may be easier to deal with” says Mr. Dilkes. Instead of focusing on the problem which cannot be controlled, think about aspects of your life that are within your control, and make the most of these.

9. Relaxation

There are some simple relaxation techniques that can be done on your lunch break, or even at your desk space. Deep breathing is a proven technique to help you de-stress. Mr. Dilkes suggests “by taking slow, steady breathes in through your nose, and out through your mouth can be very relaxing. Tensing and stretching your muscles, such as your
shoulder blades can make you aware of whether you are holding yourself in a tense way. Once relaxed, you will immediately feel the difference”.

10. Keep a Diary

Keeping a diary or creating a list regarding the situations, people or places that make you feel stressed may provide you with some solutions, as patterns begin to emerge. For example, the commute to work maybe stressful, but by leaving 10 minutes earlier, you may find that something changes with the typical journey. Expressing your
emotions is also important, whether it’s writing them down, or discussing them out loud, this can be a cathartic method. “There is always a solution to your problem. Sometimes it may not be obvious, but once you have undertaken some of these tips to de-stress, it may become clearer. Adopting a positive outlook is the best way to overcome stress, and it might be easier than you first imagined” – Mike Dilkes, Consultant Surgeon.

 

 

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22 Dec 2011
Health in the Workplace

Health in the Workplace: 15 Ways to Avoid Getting Sick this Christmas

2011-December-22

This is the second instalment of ‘Health in the Workplace’, produced in conjunction with Search Office Space – the Office Space Search Experts, and London Laser Clinic’sConsultant Surgeon and Health Expert, Mr. Mike Dilkes.

This week, we aim to bring you some expert advice on how to avoid getting sick over the Christmas period. Flu cases usually peak between December and March so now is the best time to boost your immune system and stay healthy with our top 15 tips.

  1. Avoidance
    Avoiding colleagues, friends and family who are unwell may sound like common sense, but it’s often harder than you may think. Many office space environments use air conditioning which recycles air – some of which may be carrying germs. This is unavoidable, however, there are certain things you can do which will reduce your risk of getting sick. “Avoid sharing food, cups, cutlery and towels which may be carrying bacteria and viruses”, suggests Mr. Dilkes.
  2. Wash Your Hands
    “Did you know that good hand hygiene reduces the spread of illness by 20%? The most important times to wash your hands are after going to the bathroom, before preparing food and if you come into contact with someone who is sick, or touch something that they have previously handled” says Mr. Dilkes. Our top tip is to carry antibacterial hand sanitizer gel or wipes so that you can stay clean while on the go.
  3. Use Your Elbow
    This may sound strange, but when sneezing or coughing, try to use your elbow rather than your hands to shield your face. This reduces the likelihood of spreading germs, as others will be less inclined to come into contact with your elbow in comparison to your hands. “One cough can spread 10,000 infectious viruses over 20 feet” explains Mr. Dilkes, so covering your face is very important.
  4. Get Plenty of Rest
    Mike Dilkes recommends getting “an average of 7-8 hours’ sleep per night. If you are tired and run-down, you will be more susceptible to catching a cold or virus.” The holiday season is often full of social events and parties, but maintaining a healthy body means that sleep and relaxation is of the upmost importance.
  5. Keep Hydrated
    Drink plenty of water to avoid dehydration. “If you are dehydrated your attention and concentration can be reduced by 13%, which could lead to stress – another factor which increases the likelihood of getting unwell” Says Mr. Dilkes. Drinking water should always be part of your daily routine as it helps boost your immune system.
  6. Eat Healthy Food
    A balanced diet helps keeps you strong and healthy, but there are also certain food products which can boost your immune system and help you avoid getting sick. Christmas time is full of unhealthy temptations such as chocolate and party nibbles, so before you over-indulge; remember to eat plenty of fruit, vegetables and wholegrain. Mr. Dilkes suggests “eating live yoghurt may increase your energy levels and calcium intake, along with garlic and mushrooms which contain antioxidants and increase white blood cell activity, thus improving your chances of fighting infections”.
  7. Vitamins
    Increasing your dosage of certain vitamins can help you to avoid getting sick this Christmas. Vitamins A, B6, C, D and E, along with minerals such as zinc and iron can all boost immunity. “One of the best ways to increase your vitamin and mineral intake is to supplement your diet with a multivitamin – especially around Christmas, as you are more likely to be eating a less varied diet with rich, fatty food” says Mr. Dilkes.
  8. Herbal Remedies
    If you want to avoid paracetomol, asprin and flu medicines, you could opt for some tried and tested herbal remedies which can help keep your immune system strong, reduce stress levels and are safe for children. “Echinacea and elderberry extract are natural antibiotics which can help treat the common cold, sore throats and flu symptoms as they contain properdin, a chemical which activates the immune system” says Mr. Dilkes.
  9. Take A Sauna
    This is a common way to reduce stress and relax after hard day at the office, but saunas and steam rooms can also help you avoid getting sick. Mr. Dilkes reveals, “The heat and steam means that your body temperature is raised, causing you to sweat out toxins and relive muscle pain.”
  10. Exercise
    “Research suggests that regular and moderate exercise can help your immune system fight infections, along with heart disease, type 2 diabetes, osteoporosis and cancer” says Mike Dilkes. Even if you are feeling under the weather, light exercise (20-30minutes per day) will help you sweat out any toxins that may be causing your symptoms before they develop into a full blown virus.
  11. Reduce Alcohol Intake
    Although Christmas is a time for celebration; try not to over indulge on alcohol. Mr. Dilkes suggests you “alternate every alcoholic drink with a soft-drink or a glass of water, which will help to stay hydrated. You should also avoid drinking on an empty stomach.” Our top tip is to drink a cup of Dandelion tea each day which can help detoxify the liver.
  12. Keep Your Workspace Clean
    “Viruses can survive on surfaces for up to 72 hours, so ensuring your workspace is clean is of the upmost importance. Research has revealed that some desktops harbour 400 times more bacteria than a toilet bowl!” Says Mr. Dilkes. By wiping your computer keyboard and mouse with antibacterial wipes can help minimise the probability of getting sick this Christmas. Surfaces including your mobile phone may also harbour germs, so remember to clean the buttons and screen regularly.
  13. De-Stress
    Deadlines maybe building up toward the end of the year, but there are many ways to avoid stress. We also suggest you get your Christmas shopping out of the way early on, as the stores will be less busy, making it less likely to come into contact with those who are contagious.
  14. The Flu Jab
    If you are over the age of 65 or have a condition such as diabetes, asthma or liver disease, you are eligible for the flu jab each year. “This vaccination can help prevent flu, but remember to bear in mind that it can take 21 days before you achieve immunity, so make sure you contact your doctor early on in the winter season” advises Mr. Dilkes.
  15. Practice Prevention
    Christmas is a time of good will towards others and you can do your bit by staying in bed if you feel unwell. “In general, you will be contagious for 24 hours before developing symptoms, then for up to five days once the symptoms have developed. So in some cases you may have unknowingly and unwillingly infected your colleagues, but make sure you get plenty of rest if you do contract the virus, as the symptoms will be prolonged if you continue to work” says Mr. Dilkes. However, if you have carried out all of our top tips, it’s likely that you will avoid getting sick this Christmas!

 

 

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22 Dec 2011
ENT Diary

London Laser Clinic – The Week of an ENT Consultant

Monday.

Early start. A very nasty cancer case in the NHS. The tumour was growing through the skin and up to the bottom of the skull. The medical students had a great anatomy lesson as we took out the whole tumour, skin and surrounding tissue. The plastic surgeons then came in and reconstructed the whole area, including the facial nerve, which makes the face move. Afterwards went for a pint with my senior trainee, then home for spag bolognese.
Tuesday
Early start again, 6 operations, 2 laser uvulectomies for catarrh, throat clearing, 2 nose unblockings, again using the laser for part of the surgery, a total thyroidectomy for multinodiular goitre, and a microlaryngoscopy and laser biopsy for a voice box tumour. Good news, both vocal cords were working normally at the end of the thyroid op, and the calcium levels werent affected, as I had managed to preserve the parathyroid glands, something which is not always possible, with the best will in the world.
Afternoon clinic, busy again, quite a few catarrh patients coming through. One chap was still a bit stuffy 4 weeks after nose unblocking surgery. Thankfully it all looked good, the stitch inside was just taking longer than usual to dissolve. 2 of my secretaries came along after for a business meeting. Went for a pint with them afterwards, then home for baked potato beans and cheese, and home made jam roly poly.
Wednesday
The start of my paternity leave, the baby is due in 2 days. I still went in for the morning, there was a lot of normal admin to catch up on. Had a coffee with two of my consultant colleagues, then home. Off to Brighton for fish and chips on the seafront, and to pick up a baby changing unit. In the evening I took one of the theatre sisters I work with out for dinner, with 2 of her colleagues. She was retiring after many years service. Nothing else was planned for her.
Thursday – A Day Off !
Friday
Started today at 10, a minor procedure, ear suction for wax, on a premier league footballer. He scored the next day, so Im taking credit for it. Then a nose unblocking operation on  another  premier league footballer, laser turbinoplasty, then another of the same operation on a chap with sleep apnoea and snoring. Both went well, they were home 8 hours post op so they have the weekend to recover, back to training/work on Monday. Then a clinic, quite quiet, a lot of ear wax suction being done at the moment, before people go away on winter breaks. My old fellow from last night, whose bleeding nose I had packed then sent home, came back. Great result, there had been no more bleeding, he had slept well, and looked much better. This sort of thing really knocks elderly people’s confidence. Was able to re-cauterise with silver nitrate sticks. At the end I was able to tell him I was pretty sure there would be no more bleeding, and that he should go out for dinner that night – he had cancelled a number of evenings due to his fear of having an embarassing bleed. Another 9 year old child who needed his tonsils lasering, and several other cases with general ENT problems. Was finished by 330, so I went to meet hundreds of other ENT surgeons at the December Royal Society of Medicine meeting. This was followed by a few drinks at The American bar of the Savoy Hotel, then home.
Saturday
I dont normally work on Saturdays, but a special case was going on. The UK’s first Da Vinci robotic removal of throat cancer. My colleague from another hospital had asked me to go along to help. Completely fascinating, Im a convert, and really think this machine can help my patients, including some non-cancer ones, perhaps to reduce the lingual tonsils in sleep apnoea patients. I wasnt paid for this, but it was worth its weight in gold. Finished at 4, and went off to meet my mother and father for dinner.
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27 Nov 2011
ENT Diary

London Laser Clinic – ENT Consultant Diary 23rd November 2011

Still busy. Ward round at Barts 8:30, I have 6 in patients at the moment. They are all Head and Neck cancer patients, mainly post ops, they are all doing variably OK, but its a slow process, getting over major head and neck cancer surgery. Clinic from 9, its supposed to finish at 1130 so I can go straight to the cancer meeting, which runs from 1130 to 2pm, but they have overbooked the clinic so I run late, which means the meeting runs late, and then the afternoon one stop neck lump clinic runs late. 4 new cancer patients, including a man in his 30s from Poland, near the Ukraine border. He had thyroid cancer, probably as a sequel of being in the radiation cloud from Chernobyl all those years ago. At the time he was given Iodine supplements to stop the body absorbing the radioactive iodine, which is concentrated in the thyroid gland. Clinic finished at 530, then off to meet my accountant in a pub, The Bree Louise near Euston Station, a great old fashioned boozer.

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27 Nov 2011
ENT Diary

London Laser Clinic – ENT Consultant Diary 22nd November 2011

A busy day again, operating at 8, quite an interesting private list, 1st case was someone with veins on her nose – I lasered these with the KTP-Aura system. Good result. Then a tonsillectomy in a child, a revision tonsillectomy in an adult, along with drainage of an abscess cavity in the base of the tongue, then 2 laser turbinoplasties using the Holmium YAG laser. I really like this technique, I think its safer and easier than turbinectomy, and just as good for unblocking the nose. Finally a laser tonsillectomy under local anaesthetic – using numbing spray only. This was for a lady who was getting a lot of tonsil stones.

Off to clinic straight after the list, picking up a painting I had bought at an exhibition here a few weeks ago. This Hospital, The Hospital of St John and St Elizabeth, has St John’s Hospice within, so there are often charity events like this. 16 patients in the clinic, a fairly interesting mix of ear, nose and throat problems. Finished at 4, then met my partner’s brother, we drove to Bedford to pick up my campervan, which had just had some work done on it.

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27 Nov 2011
ENT Diary

London Laser Clinic – ENT Consultant Diary 21st November 2011

Operating all day at barts. Its a 12 hour session, from 8 am til 8 pm. 2 major cancer cases, one of them didnt finish til 1 am, that was a tonsil cancer for which we had to split the jaw in half, swing it to the side, remove the cancer then reconstruct the hole with tissue taken from the forearm, the latter done by the plastic surgeons who got going at 3 pm.
The other major case was another tonsil cancer in an HIV postive lady. We tried to use the Holmium YAG laser to get this out. unfortunately the cancer had spread since the staging scans, and wide removal wasnt possible. So she will need radiotherapy and chemotherapy.
A third cancer case was a more straightforward lasering of early voice box cancer, took about 20 minutes. He went home the same day. The other 2 went off to the high dependency unit. It shows the advantages of catching cancer early. Met my lady at Kings Cross station on her way back from Ely at about 8pm, I left the plastic surgeons getting on with it.
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