Mr Pisal Talks Gynae

Mr Pisal, Consultant Gynaecologist at London Gynaecology and the Whittington Hospital (NHS), spends almost all his time discussing and treating patients.  In this Q&A we learn more about Mr Pisal and what he thinks are the most important things to be aware of in women’s health today.

Why did you choose this specialism?

It was the pleasure and adrenaline of delivering babies into this world that attracted me to this field. It is amazing to be involved in somebody’s happiest moment.  Paradoxically, I don’t deliver babies any more as I focus more on oncology and key-hole surgery.

Describe a usual day in the life of a Consultant Gynaecologist?

My job involves seeing women with various health problems and making a diagnosis and arranging appropriate treatment. The most interesting part of my job is key-hole surgery. Women can have a major operation like hysterectomy (removal of womb) or myomectomy (removal of fibroids) through tiny incisions and recover within days. It is really satisfying. I am also an expert in colposcopy which is to do with assessment and treatment of abnormal smears.

What health issues do you think women should be more aware of?

I think women should be aware of screening in the form of cervical smears that are offered on the NHS. Nearly 1 out of 3 women do not have regular smears and that is a missed opportunity. It only takes 5 minutes to save your life and you owe it to your near and dear ones. Please book your smear today.

A lot of taboos have broken down around breast cancer, do women need to make similar checks for their gynaecological health? If so, what and how should they check themselves?

Women should have regular smears as requested by their GP. Six symptoms women should watch out for are: Bleeding after menopause, bleeding between periods, bleeding after sex, bloating, change in bowel habits and abdominal pain especially after the age of 45, pain during or after sex and any unusual lumps. It is best to see your doctor urgently if you are concerned.

What do you say to women who feel embarrassed about visiting the gynaecologist or their GP/nurse about gynaecological issues?

There is no need to be embarrassed at all. Doctors and nurses will always look after you with utmost sensitivity and gentleness. They often see anxious and nervous patients and it is normal to feel like that.

What is the most interesting thing you have seen in your career?

I once saw a woman who presented with ‘a bit of tummy ache’. She thought she was putting on weight in her middle age. On examination and scan, she was found to have a 55cm ovarian cyst weighing 19kg! Fortunately, the cyst turned out to be benign and the operation went well.

What are some of the most extreme cases you have dealt with?

We sometimes see cases of advanced cancers and feel sad about all the missed opportunities. It is so important to be health-aware and report any unusual symptoms.

What do you want women to know about your field and their health?

Be aware of what’s available. Have regular smears, always have a ‘full MOT’ at 50 through your GP or even privately.  Talk to other women and make them aware of what they should do. This is one of the most important uses of social media.  At London Gynaecology we package up healthcare services to make it easy for patients to understand what they might need whilst researching on the internet.

If you wish to know book an appointment with a consultant, please contact London Gynaecology on 020 10 11 700 or email [email protected].

Treating a Cervical Abnormality

Each year at London Gynaecology we see hundreds of women for abnormal smear management and whilst it can often be a worrying time in most cases treatment isn’t required.  However patients with certain grades of abnormalities do require treatment,  Large Loop Excision of the Transformation Zone is the procedure for removing abnormal cells from the cervix.  In the article below I aim to answer many of the questions that are asked by patients who need to have this treatment.

If you are concerned about an abnormal smear please contact us on 0207 10 11 700 or visit our specialist website London Colposcopy for further information.

What are the indications for performing LLETZ?

This procedure is performed for treatment of CIN2&3 and persistent CIN1.

What does the treatment involve?

As an experience, this treatment is very similar to the colposcopy procedure or smear test. It takes approximately 10 minutes.  After numbing the cervix with local anaesthetic, a wire loop is used to remove the abnormal cells. It is a quick and easy procedure and there is some discomfort, but no sharp pain. A nurse will be present during the procedure to assist you and the doctor.  The specimen is sent for histological analysis to confirm the grade of abnormal cells and whether they were completely excised.  This report is usually available within 10-14 days.

What anaesthesia is required?

LLETZ is commonly carried out as an office (outpatient clinic) procedure under local anaesthesia. Local anaesthesia is administered by using a dental syringe directly into the cervix. The cervix does not have many nerve endings and usually there is no pain during administration of local anaesthesia. The anaesthetic drug also contains adrenaline and you may experience palpitations or shakes or some dizziness as a result.  Occasionally, general anaesthesia or sedation may be required.  This procedure is then carried out as a day case procedure, where you will go home usually on the same day.

What precautions should I take?

If you are having it done under local anaesthesia, you will go home straight after the procedure.

Please do…

• Eat something before the procedure, there is no need to be starved.
• Bring somebody with you if possible.
• Take the day off work, you are usually able to go back to work the next day.
• Ask the doctor any questions that you may have before the procedure.

What activities should I avoid after treatment?

• Use of tampons
• Penetrative sexual intercourse
• Strenuous exercise
• Travel abroad

The purpose is to avoid risk of infection while the cervix is healing.  Strenuous exercise can sometimes cause the scab on the healing cervix to come off and start bleeding. Travel to remote destinations may mean unavailability of a qualified colposcopist should there be any problem and hence should be avoided. These restrictions apply for four weeks after treatment.

What should I expect after treatment?

• Bleeding: There is usually some bleeding which is less than a light period and lasts for up to seven days. Occasionally, it may last up to four weeks.
• Discharge: You may get some brown-black discharge from the healing cervix.
• Heavy bleeding: This is uncommon and please contact your doctor if the bleeding is heavier than a heavy period and lasts for over two hours.
• Discomfort: There may be some period-like discomfort and, if present, can be easily addressed by paracetamol or simple pain-killers.
• Next period: May be slightly unpredictable and heavier.

Signs of infection:

• Heavy bleeding
• Offensive discharge
• Lower abdominal bleeding
• Feeling unwell or feverish

What follow-up is required?

Your doctor may see you two weeks after the procedure to discuss the results and review your healing. A check-up in the form of smear, HPV-test and colposcopy is required in six months. If all these tests are negative, risk of recurrence is low. Follow-up after that will depend on your circumstances.

What are the short term or long term risks of this procedure?

Short term risks:

• Bleeding
• Infection
• Recurrence of abnormality (5-8%)
• Repeat treatment (5%)
• Cervical stenosis (2%)
• Long term (pregnancy related) risks:  After Loop treatment, there is an increased risk of pre-term (early) delivery. This risk is 7% for all women and goes up to 11% after treatment (4% increase in the risk). This increased 4% risk of pre-term delivery is between 31and 37 weeks, and the baby is unlikely to come to any serious harm. There is no increase in the risk of extreme prematurity (delivery before 31 weeks)or of increase risk for the new-born baby. There is also a slightly greater likelihood of needing a caesarean delivery.

How successful is the LLETZ procedure?

The LLETZ  procedure is about 95% successful and 1 in 20 women need a repeat procedure. A histology report from treatment, your individual circumstances and results from six-months follow-up colposcopy.

Launching with Pharmacierge

At London Gynaecology we strive to provide a first class service for our patients.  We recently launched Pharmacierge at our practice to extend our service right to the point of you getting your medicine. Pharmacierge are a seamless and efficient service which delivers your prescriptions straight to your door for a comparable cost to what you would pay in your local pharmacy for a private prescription.

Your prescription will be created for you in your appointment as usual, before it is sent to Pharmacierge. Pharmacierge will call you to arrange delivery and take payment. Your medicine is delivered to you the same day within London or the next day for the rest of the UK. All for a comparable cost of a private prescription and without a visit to your pharmacy.

We hope that Pharmacierge will enhance patients experience further as it will allow them to conveniently have their medicines delivered straight to them. For more information on Pharmacierge, please visit their website.

Charitable Giving to The Whittington Trust

Following Mr Pisal’s fantastic London Marathon 2018 effort in April we were able to present The Whittington NHS Trust with a donation of £14,000. The money was raised through kind and generous donations from patients, friends and colleagues, with London Gynaecology also contributing £5,000. This donation will go towards new hysteroscopy equipment for the better diagnosis of endometrial cancer. Mr Pisal has practiced at The Whittington Hospital for 16 years and is proud to be the gynaecological cancer lead.

Mr Pisal and Emma Orman, COO London Gynaecology, visited The Whittington Hospital to present the Chief Executive, Siobhan Harrington, with the donation. She said “we are very grateful for you completing the marathon and all of your training and fundraising which will make a real different to so many of our patients.”

Mr Pisal and the rest of the team would like to thank all of the kind patients, friends and colleagues who donated to this fantastic cause.

At London Gynaecology we believe it’s important to give back and support many charities throughout the year, especially those who raise awareness for women’s health and support those affected by women’s health issues. If you would like to read more about our efforts, please head to our charity page.

Over £13,500 Raised for Charity

Consultant Gynaecologist Mr Pisal completed the 2018 London Marathon in an impressive 4 hours and 9 minutes. It was a spectacular day for both runners and supporters and humbling to see so many charities being supported.

Mr Pisal has raised a total of £13,752.50for The Whittington Hospital to purchase equipment to better diagnose endometrial cancer. We are overwhelmed with the support and kindness from all of those who donated to this incredible cause.

Fundraising is still open so if you would like to kindly donate please head here.

Need to Book a Gynaecology Appointment?

We understand that having a medical concern may be worrying and booking an appointment with a private gynaecology clinic may be unfamiliar for many women. So as the first point of contact when a patient enquires, our administrator Aminah has put together some helpful points to think about ahead of making a call.

1. “What information should I have when making an appointment?”

When calling to make an appointment with one of our clinicians it is useful to have a couple of things to hand:

• Your referral letter from your GP (if you have one).
• Your availability.
• If you are an insured patient it is useful to have your insurance details including your membership number. Some insurance policies may not cover some procedures and tests. It is always advised to check with your insurer before making an appointment. They will be able to give you an authorisation code which indicates that they cover your appointment.
• If you are booking on behalf of someone else make sure you have the patients details to hand.
• Let us know if you have any access requirements or need a translator as this can be organised ahead of your appointment.

2. “What do I need to bring to my appointment?”

When you have your appointment with London Gynaecology there are a couple of things you might want to bring with you:

• Your referral letter with any previous scan reports and results that are relevant to the problem.
• You may bring your partner, a sibling or a friend to your appointment if for any reason you are worrying. All examinations are chaperoned and consultations can also be chaperoned by request.

3. “I am under 18, can I book an appointment at London Gynaecology?”

The minimum age for a patient to have an appointment varies by consultant:

• Mr Pisal or Miss Wilson minimum age is 16 years
• Miss Flemming minimum age is 14 years
• Mrs Pisal will see patients of any age

Any patient under 16 should make the practice aware when enquiring so we can contact the patient to understand more about their medical issue as it may be that the patient needs to be seen by another doctor. If you are under the age of 18 you must bring a parent or a guardian to your appointment. You must be over 18 to have an appointment at London Bridge.

4. “I can’t attend my appointment time anymore, what should I do?”

If you are unable to make your appointment it is best to let us know as early as possible so we can offer another patient the appointment. We can rearrange your appointment to a convenient time for you.

5. “How long do I have to wait for my appointment?”

We have 4 consultant gynaecologists at London Gynaecology so we are usually able to offer women an appointment within a few days and definitely within a week. If you require an urgent appointment we can usually see you the same day.

6. “I would like to read patient reviews, where should I look?”

If you are interested in reading about other patients’ experience with London Gynaecology, we have testimonials on our website. You can also find patient reviews on Google and on Doctify.

If you would like to book an appointment please don’t hesitate to call us on 0207 10 11 700.

Decoding HPV

Although as many as 75-80% of women (and men) get Human Papilloma Virus (HPV) during their lifetime very little is known about it. Mr Pisal talks to Get The Gloss about all things HPV, from the importance of attending your smear tests to fighting HPV with your immune system. Read the full article here.

If you have any questions or concerns about HPV, you can read more on our expertise page,or give us a call on 0207 10 11 700.

Mood Boosting Fitness and Nutrition Tips

January is home to short days, grey skies, and “Blue Monday”, supposedly the most depressing day of the year. It’s more important in this month to know what you can do to feel good. We all know that a balanced diet and fresh air should make us feel better, in this article, Nutritional Therapist Laura Southern, and Fitness Ambassador Ellie Baker, give tips on boosting your mood.

Boosting your mood with Nutrition 

As the saying goes, ‘you are what you eat’, so why not include foods in your diet which help boost your mood? Our Nutritional Therapist, Laura Southern, shared a few foods which are useful for helping support ‘happy hormones’ (i.e. serotonin) in the body.

Meat 

Meat, especially turkey, contains an amino acid called tryptophan which is a precursor to serotonin. Try replacing chicken breast with turkey in a stir fry, or turkey mince in a shepherd’s pie.

Carbohydrates

Complex carbohydrates such as oats or brown rice, are very important at keeping the blues at bay! Serotonin release in the brain is actually increased by carbohydrates, whereas protein rich food doesn’t have this effect. If you notice that you flag before lunch, have the carbs at breakfast, if you feel the need to binge at night, include a carb source at lunch and dinner.

Essential fats

Essential fats are found in foods such as oily fish, nuts, seeds, avocados, and coconuts. Essential fats are used in the brain to create neurones and enable neurotransmitters to communicate effectively ensuring a good balance of happy hormones – try to consume some ‘good’ fat with every meal, such as seeds on your breakfast, salmon at lunch, and good quality olive oil at dinner.

Veg, Veg, Veg!

Brightly coloured fresh vegetables contain a wide range of antioxidants which are essential for brain health, and they also contain B vitamins which can help reduce stress hormones and provide energy. Try and incorporate a range of brightly coloured veg at every meal.

Vitamin D

Don’t underestimate the importance of taking regular walks outside in the daylight and taking a vitamin D supplement, especially in the darker winter months!

Boosting your mood with fitness:

We asked our Fitness Ambassador, Ellie Baker, to share some tips she would give a friend who was suffering from a low mood.

“Often when you’re feeling down the last thing on your mind would be exercise, however once you get motivated, exercise can make a big difference because of the feel-good endorphins exercise  releases in your brain and also by simply taking you mind off of any worries.

So, I would say to my friend that you’re not alone in feeling down and would encourage and motivate them into making that first step in getting out there and letting off some steam while they exercise. Regular exercise in the long run can help you to gain confidence.”

Gardasil-9 Vaccination in Stock

We have the Gardasil-9 HPV vaccine in stock following the national shortage.  If you require HPV vaccination, contact us on 0207 10 11 700.

Common Cervical Health Questions

Every year in the UK around 3,000 women will be diagnosed with cervical cancer. As January is Cervical Health Awareness Month, Consultant Gynaecologist Mr Pisal shares answers to the frequently asked cervical health questions.

1. Many cervical cancer symptoms overlap with other conditions. What symptoms are distinct to cervical abnormalities and cancer? 

It is important to remember that cervical cancer is very rare especially in women who have had regular smears. Red flag symptoms would include bleeding after sex, bleeding between periods and persistent vaginal discharge. If you are concerned for any reason do not hesitate to see your GP or practice nurse for a quick check up.

2.What should women expect to happen for treatment following a diagnosis? What are their options?

More than half the cervical cancers diagnosed in the UK are very early (microinvasive or stage 1A) and are treated by local treatment by removing the cells. This treatment can be carried out either under local or a short general anaesthesia.

If the stage of cancer is stage 1B or more, more extensive surgery may be needed. This will depend on exact circumstances and other factors such as a desire for further fertility. If the cancer cells have gone outside the cervix, additional treatment with chemotherapy and radiation may be needed.

3. Is it possible for cervical cancer to develop during the 3 year cervical smear gap and how accurate are smear tests? 

Cervical cancer takes a long time to develop (approximately 15 years) which means that one would have five opportunities (smear tests) for detecting any abnormalities. This makes it safe to have a smear test every three years.

4. What are the options if a woman missed her HPV vaccination at 12/13 years old?

This is available privately in certain circumstances, please visit our pageon HPV vaccination.

5. Are their any support groups or networks you could recommend?

Jo’s Trustprovides invaluable support and reliable, validated information to women regarding cervical screening, abnormal smears as well as cervical cancer. It is an amazing charity and London Gynaecology has actively fundraised for Jo’s Trust over last 3 years.

If you have any concerns about your cervical health, don’t hesitate to contact your GP, gynaecologist, or practice nurse, and don’t forget to ensure you are up to date with your smear test. Call us on 0207 10 11 700or order your HPV DNA self-test kit here.