Letter to patients from Christian Barnick July 2020

Dear patients of Homerton Endometriosis Centre,

My apologies if you did not receive my previous correspondence from March where I outlined what I thought was likely to happen to the endometriosis service at the Homerton, and that I would be in touch again once the Corona virus crisis was over.

Well the crisis is not yet over, but restrictions are starting to ease. At the Homerton we now have two in-patients with proven Covid-19 in the whole hospital. The numbers in the community have also dropped dramatically and Public Health England inform us that less than 1:20,000 people tested in London are positive for the virus. We need to remain vigilant and to protect ourselves from this unpredictable disease, however, we also need to resume our service and to offer you the treatment, advice and support that you deserve.

We have reopened out-patient clinics, but we are restricting the number of face to face consultations. We are performing far more telephone consultations for advice, support and medical treatment. Our nurse specialists are giving injections where needed and we have restarted our operating lists.

All of this is being done in an environment designed to minimise the possibility of any risk to you and the staff at the hospital. Entry to the hospital is strictly regulated, visitors are restricted, traffic through the hospital has been reduced, out-patient appointments spaced out and all women are sent advice regarding their appointment and what measures to take to stay safe.

Women having surgery will have this in the Day stay unit which has been reconfigured. This part of the hospital is separate from the main hospital and a number of measures have been put in place to ensure that it is Covid protected. When you are offered a date for surgery you will be sent strict instructions regarding self -solation and testing which you must follow in order to be eligible.

As a result of all these measures we have restricted access to operating theatres. Our patients will need to wait longer for their surgery than we had hoped. I would again like to apologise for any difficulties that this will cause you.

Thank you for you continuing patience, we really are doing our best to get the service and your treatment back on track safely. I expect that the current restrictions on our practice will soon relax further and that our service can return to something closer to what you deserve.

Stay vigilant and keep well. All the best to you and your family and I hope to catch up with you very soon.

 

With Kind regards

 

Christian Barnick FRCOG
Consultant Obstetrician and Gynaecologist
Homerton Endometriosis Centre Lead

Letter to patients from Christian Barnick March 2020

Dear endometriosis patients

I am writing to you personally as lead of the endometriosis centre, to update you on the effect of the Covid -19 pandemic on the services at the Homerton Hospital. The effect of this pandemic in the UK has become much clearer over the last weeks. As a result the Government has taken extraordinary measures to Save Lives and Protect the NHS by advising everyone to Stay Inside.

Despite these actions we are expecting a huge influx of patients into the NHS requiring respiratory support over the coming weeks.  There is an expectation that the NHS in its current format will find it difficult to deal with this.

At the Homerton we are taking action to prepare the hospital and to dramatically increase our capacity. This means that we have to reconfigure the way the hospital facilities are used. We also have to change the way all the doctors in the hospital work. All our current activity must focus on treating emergencies. All routine activity has been postponed, including outpatients and elective surgery

The clinical activity within the Endometriosis Centre is suspended. All new appointments and follow ups, apart from Gonapeptyl injections, are cancelled. All surgery will be delayed.

I am truly sorry.

As a team, we work so hard to provide the excellent treatment you deserve, and it is heart-breaking to have to put this service on hold. I have heard from many of you about the suffering you have already endured, waiting for treatment of your endometriosis. I cannot imagine how distressing further delays to this will be, In the current situation, we simply have no other option but to postpone your treatment.

.I would like to personally apologise for the delay to your treatment and the difficulties that this will cause. Managing the coronavirus pandemic is likely to change hospital and GP services for some months. You will be contacted with a new out patient appointment, or date for surgery, when services return to normal.

Stay safe. All best wishes to you and family and look forward to seeing you once this is all over. 

With kind regards, 

Christian Barnick FRCOG
Consultant Obstetrician and Gynaecologist
Homerton Endometriosis Centre Lead

Endometriosis

Our team understands the difficulties you face living with endometriosis and chronic pelvic pain, quality of life, and you will be fully involved with all decisions regarding your treatment.

Our surgeons are experts in laparoscopic surgery to manage all grades of endometriosis ranging from mild disease to the most severe form involving the bladder and bowel. We also have access to dedicated Pelvic Pain clinic and Homerton Fertility Centre if further expert opinion needed.

The HEC operates an outpatient clinic with a comprehensive patient centred approach to the care of women with endometriosis and pelvic pain.  You will have the support of an endometriosis specialist nurse throughout your care in the hospital and in the community.

The British Society of Gynaecological Endoscopy (BSGE) has recently set up accredited centres for the laparoscopic treatment of advanced endometriosis to enable high standards of care to be delivered to women with endometriosis. We have recently been certified as an accredited centre by the BSGE. In line with these requirements we run a nurse-led follow-up service to audit and assess our outcomes of surgery.

What will happen at your first clinic appointment
At the first appointment, you will be given the BSGE pelvic pain questionnaire to help us understand your problems and to find the most appropriate treatments. It may also help you to formulate your thoughts on your symptoms and the way in which they can affect your quality of life.

Then a detailed history will be taken by the specialist doctor about your symptoms and the extent to which your lifestyle is being affected. This will help to build the basis upon which the treatment will be planned. 
A detailed treatment plan will be made at this visit; information will be given about endometriosis and available treatment options. At this appointment you will have the opportunity to discuss your treatment and any concerns.
Any necessary investigations will be arranged (ultrasound scan and blood tests) and a laparoscopy (looking inside the abdomen) or hysteroscopy (looking inside the womb) will be arranged.
Where appropriate a further appointment will be made to discuss the results of the investigations and plan the treatment.

What do we offer
There is a fortnightly clinic consisting of experienced Consultant Gynaecologists, two Clinical Nurse Specialists, Senior Specialist in Endometriosis and Gynaecological Ultrasound Scan that can perform scanning to plan your treatment. The nurse specialists run additional clinics on a regular basis.

Women are invited to attend for an initial assessment in one of the clinics where all the options for treatment are discussed. Investigations are arranged and the patients are given information with regards to treatment options. At the next visit the results are reviewed with one of the medical staff and the opportunity is given to ask questions and make a decision about preferred treatment options.

We participate in the national database to contribute to the pool of information with regards to the laparoscopic surgical treatment and follow up of patients with endometriosis. Please be assured that the information you provide will be kept confidential. This data will be anonymised in accordance with Data Protection legislation and entered into a central database together with the results of clinical examination and any tests that you may have. The findings and results of any surgical intervention that you may have will be recorded and assessed, as will any responses to follow-up questionnaires.

Treatments available

Hormone treatments
The aim of hormone treatments is to limit or stop the production of oestrogen in your body. If your pain is related to your menstrual cycle putting your body into an artificial state of pregnancy or an artificial state of menopause may help you.

Some of the hormone-based treatments we use are:

  • Progestogens (e.g Norethisterone)
  • The combined oral contraceptive pill
  • Gonadotrophin-releasing hormone (GNRH) analogues (Zoladex / Gonapeptyl)
  • Laparoscopic surgery
    Laparoscopy (also known as keyhole surgery) is commonly used in the treatment of various problems which include

  • Endometriosis
  • Hysterectomy
  • Ovarian cysts
  • Fibroids
  • Adhesions (this is where internal organs are stuck to each other)
  • It may also be used to help diagnose the cause of your symptoms and this is called a diagnostic laparoscopy.
  • You will usually be able to go home on the same day as your surgery.
    For more extensive surgery, patients have an overnight stay in hospital and are discharged later after review.

  • Pain management
    Learning to manage your pain rather than the pain managing you is a very important factor in your care, you will be given advice on how to take medications in conjunction with other treatments and lifestyle changes to improve your quality of life.

    Deciding what treatment
    Your gynaecologist will discuss the treatment options with you and outline the risks and benefits of each. Treatment may not be necessary if your symptoms are mild and you have no fertility problem. One course of action is to keep an eye on symptoms and decide to have treatment if they get worse. Advice on diet, exercise and complementary therapies may help you manage your symptoms.

    Philosophy of care
    We understand that endometriosis and long term pelvic pain are chronic conditions and can be very difficult to live with. As well as physical symptoms such as extreme pain, infertility and heavy menstrual bleeding, it may also cause emotional, social and economic difficulties.

    All of our team is committed to treating you with kindness, respect and dignity.
    The team will ensure that you have all the information you need regarding treatment options for your condition. You will be involved in all decisions regarding your care, and together we will create a treatment plan that suits your circumstances.
    We will continue to support you once your treatment is completed. The specialist nurse is always available for you to contact if you need advice or someone to discuss your concern.