Booking An Appointment
Appointments can be booked by:-
Contacting Priory Hospital directly on 0121 446 1638 (Outpatient Bookings)
Contacting Wolverhampton Nuffield Hospital directly on 01902 793269 (Outpatient booking)
Contacting Linda Hamilton (Personal Assistant), Sharon Astbury or Margaret Jordan (Administrative Assistants) on 0121 446 1674 or 07585 668327.
An appointment will be arranged to suit you, in the first available slot.
Consultations Days and Times
Consultations are held at:-
BMI THE PRIORY HOSPITAL
Telephone: 0121 446 1638 (Out Patient Bookings)
||10:00 - 12:00 Medico Legal|
||15:00 - 17:15|
||09:00 - 12:00 and 15:00 - 17:30|
NUFFIELD HEALTH WOLVERHAMPTON HOSPITAL
01902 754177 (Main Hospital)
01902 793269 (Outpatient booking)
||10:30 - 13:30|
|13:30 - 15:30 Medico Legal|
What to expect at your initial consultation
I understand that the first consultation with a new consultant can be quite daunting and in an effort to help with this process, I have detailed below what to expect at your initial consultation.
Following formal introductions, I will give you an opportunity to explain your problem and symptoms. I will need to know the history of your current condition. I will also need to gain some understanding of your clinical profile and to achieve this I will discuss your past medical history, family history, social history and ask you to provide the details of any medication you are taking as well as any allergies you may have.
After this discussion I will carry out a complete spinal examination. It will be necessary to look at your spine carefully and you will be asked to remove some items of your clothing to allow me to complete this examination. This will enable me to assess the shape and balance of your spine. It should be emphasised that a chaperone will be in attendance throughout your consultation and examination and your privacy and dignity will be respected at all times. Once the examination has taken place I will discuss his findings with you.
If you have any previous imaging this will be reviewed with you and the next steps agreed. However, without previous imaging it will be necessary for you to undergo imaging in the form of an MRI and X-rays of your spine in the standing position. This could take place at either The Priory Hospital/Wolverhampton Nuffield Hospital, or at Heath Lodge Clinic, Solihull, where there is access to an open MRI scanner. After the imaging referral a follow-up appointment will be arranged to discuss the results of the scans and imaging. At this stage an initial diagnosis and management plan will be discussed and agreed with you.
If at any stage you feel uncomfortable during your consultation or examination, please make your feelings known to me.
We do hope that this information will help you to feel more at ease about what to expect at the initial consultation. However, if there is anything else we can do to help, please do not hesitate to let us know.
Follow Up Consultation
Once your imaging has been completed a follow up consultation will be arranged and I will go though your imaging with you in detail and explain all the management options.
Your GP will be kept informed of all your consultations, any planned investigations or surgery by a clinic letter, sent directly following your consultation. In many instances spinal conditions can be managed with spinal injections and if this is the case I will explain what will happen.
If you need a procedure, I will discuss it with you in detail, including the procedure and what it involves. If you have private medical insurance I will give you the procedure code, which will be required by your insurance company to ensure authorisation for funding the operation. I will explain the risks and any possible complications, how long you will need to be in hospital for and what to expect after the procedure.
It may be necessary for you to attend a pre operative assessment clinic at the hospital. This will take place approximately 1 week before your operation and be arranged for you with a specialist pre assessment nurse.
The Reservation Team at the Priory Hospital will send details of your admission to hospital to you in a timely manner, prior to the procedure.
On the day of the operation you will need to starve from midnight prior to being admitted the following morning. You are however allowed sips of water until 6:30am. As I usually operate in the morning, you will be admitted onto the ward at about 07:00am. On admission both Dr Da Silva and I will see you in order to go through the consent and talk you through the procedure and what to expect immediately after the operation.
A post operative follow up will be arranged for you 3-4 weeks following your procedure.
It may be necessary for a graduated return to work programme after your operation and this will be discussed with you at your post operative appointment.
If your procedure is on a Tuesday
If your procedure is on a Tuesday morning, you will need to be nil by mouth from midnight for both food and water.
You will need to come to the hospital by 8am and be taken up to the ward shortly after to be admitted by the nurses. Dr da Silva and I will see you after 8am to go through the procedure and tell you what to expect during and immediately after the procedure.
Spinal injections are performed as a day case procedure usually at either BMI Priory/Wolverhampton Nuffield Hospital under a light general anaesthetic. The procedure will be discussed with you once it has been agreed that an injection is required. Instructions for your admission will be received from the Reservations Team. This will include your admission time and any instructions regarding being “nil by mouth”.
What to expect on the day of the injection
On the day of the injection you will need to have been starved ‘nil by mouth’ from midnight. On admission Mr Ishaque and Dr E J Da Silva will see you in order to go through the consent and talk you through the procedure.
You will then be taken down to the anaesthetic room where you will greeted by the theatre team and all the necessary checks will be performed for your safety. At this stage Dr Da Silva will place a small cannula in the back of your hand to allow him to deliver the anaesthetic agents during the procedure.
You will then be walked into the theatre itself and shown how to climb onto the operating table in order to get comfortable.
I will then mark your back with a marker pen using the x-ray machine to guide him regarding the entry point for the spinal injections. I will then clean your back using standard surgical iodine and the procedure is carried out using a sterile technique.
You may feel a slight sharp sensation like a pinch which last a few seconds before Dr Da Silva administers the intravenous general anaesthetic which is the local anaesthetic being placed at the needle entry point but often you will already be asleep at this point. You will not feel the actual spinal injection which is much more comfortable and safer for yourself and Mr Ishaque, as he can be sure you will not move at a crucial point during the injection.
Please be aware that if you are needle-phobic (very scared of needles) then Dr Da Silva can make sure that you will not even feel this initial injection just under the skin.
Mr Ishaque routinely performs an epidurogram using either Omnipaque or Niopam in order to confirm correct placement of the spinal needle after using x-ray guidance in two planes, taking x-rays from both side to side and from front to back.
Once you have had your injection you will be helped back onto your bed and transferred to the recovery suite. As you have had an epidural injection it is standard practice to monitor your blood pressure for about half an hour before being sent back to the ward.
Once back on the ward you will be able to eat and drink in order to get your blood sugar levels up and you will be asked to rest for 90 minutes to allow the sensation to return to your legs and the effects of the general anaesthetic to wear off.
Usually you will be discharged by about 3pm and you will need to be picked up, as you will not be fit to drive on the day of the injection.
What to expect after a spinal injection
Immediately after the injection it is not unusual to have a slight increase in back pain but often the leg pain is immediately relieved. I would advise you take a few days off after the injection to rest and during this time it is important to keep taking your anti-inflammatory (Diclofenac, Ibuprofen or Naproxen) medication as well as any painkillers. It is fine to drive the following day but I would limit journeys to less than 40 minutes. I have had a number of patients who have flown short haul within 1 week of the injection which although is not recommended, is possible provided you keep well hydrated, keep mobile during the flight and keep wearing your compression stockings to reduce the chances of a deep venous thrombosis (DVT) and more importantly a Pulmonary Embolism (PE). In the weeks immediately following the injection I would advise you to walk regularly as your symptoms allow and to avoid any strenuous exercise and in particular excessive bending, lifting or twisting. Swimming is an ideal exercise as you are supported and if you can’t swim then walking widths in the pool at progressively increasing depth provides increasing resistance helping to build strength and stamina.
In the majority of cases any discomfort associated with the injection should have passed within 2 weeks and the effects of the steroid should be becoming more apparent. I usually advise patients to wait 4 weeks before starting physiotherapy, which will also help with the longer-term recovery.